|
MRA HEAD W/O DYE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 70544 26
|
| Hospital Charge Code |
5230034
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$113.75 |
| Rate for Payer: Cash Price |
$131.25
|
| Rate for Payer: Galaxy Health Commercial |
$113.75
|
|
|
MRA HEAD W/O DYE
|
Facility
|
OP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
4230034
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,205.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,048.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: Cash Price |
$1,965.00
|
| Rate for Payer: CDPHP Medicare |
$969.40
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,834.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,096.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,096.00
|
| Rate for Payer: EmblemHealth Medicare |
$890.80
|
| Rate for Payer: EmblemHealth Select Care |
$1,703.00
|
| Rate for Payer: Fidelis Medicare |
$1,048.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,703.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,048.00
|
| Rate for Payer: Humana Medicare |
$1,048.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,205.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,100.40
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$393.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,048.00
|
| Rate for Payer: WellCare Medicare |
$1,441.00
|
|
|
MRA HEAD W/O & W/ DYE
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 70546 26
|
| Hospital Charge Code |
5230036
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Galaxy Health Commercial |
$140.40
|
|
|
MRA HEAD W/O & W/ DYE
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 70546 26
|
| Hospital Charge Code |
5230036
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna of NY Commercial |
$151.20
|
| Rate for Payer: Aetna of NY Medicare |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: CDPHP Medicare |
$79.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.80
|
| Rate for Payer: EmblemHealth Medicaid |
$172.80
|
| Rate for Payer: EmblemHealth Medicare |
$73.44
|
| Rate for Payer: Fidelis Medicare |
$86.40
|
| Rate for Payer: Galaxy Health Commercial |
$140.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.40
|
| Rate for Payer: Humana Medicare |
$86.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$151.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$99.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.61
|
| Rate for Payer: MVP Health Care of NY Medicare |
$90.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.40
|
| Rate for Payer: United Healthcare Medicare |
$86.40
|
| Rate for Payer: WellCare Medicare |
$118.80
|
|
|
MRA HEAD W/O&W/DYE
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
4230036
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$761.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$662.40
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: CDPHP Medicare |
$612.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,159.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,324.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,324.80
|
| Rate for Payer: EmblemHealth Medicare |
$563.04
|
| Rate for Payer: EmblemHealth Select Care |
$1,076.40
|
| Rate for Payer: Fidelis Medicare |
$662.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$662.40
|
| Rate for Payer: Humana Medicare |
$662.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$761.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$695.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$248.40
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$662.40
|
| Rate for Payer: WellCare Medicare |
$910.80
|
|
|
MRA HEAD W/O&W/DYE
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
4230036
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,076.40 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,076.40
|
|
|
MRA LEXTREM W CONT
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8912
|
| Hospital Charge Code |
4230072
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,850.55 |
| Max. Negotiated Rate |
$1,850.55 |
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
|
|
MRA LEXTREM W CONT
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS C8912
|
| Hospital Charge Code |
4230072
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,309.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,138.80
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: CDPHP Medicare |
$1,053.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,992.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,277.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicare |
$967.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,850.55
|
| Rate for Payer: Fidelis Medicare |
$1,138.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,138.80
|
| Rate for Payer: Humana Medicare |
$1,138.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,309.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,195.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$427.05
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,138.80
|
| Rate for Payer: WellCare Medicare |
$1,565.85
|
|
|
MRA LEXTREM WO CONTR
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
4230207
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$217.35 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$666.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$579.60
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: CDPHP Medicare |
$536.13
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,014.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,159.20
|
| Rate for Payer: EmblemHealth Medicare |
$492.66
|
| Rate for Payer: EmblemHealth Select Care |
$941.85
|
| Rate for Payer: Fidelis Medicare |
$579.60
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$579.60
|
| Rate for Payer: Humana Medicare |
$579.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$666.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$608.58
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$217.35
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$579.60
|
| Rate for Payer: WellCare Medicare |
$796.95
|
|
|
MRA LEXTREM WO CONTR
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS C8913
|
| Hospital Charge Code |
4230207
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$941.85 |
| Max. Negotiated Rate |
$941.85 |
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Galaxy Health Commercial |
$941.85
|
|
|
MRA LEXTREM W/WO CONTR
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
HCPCS C8914
|
| Hospital Charge Code |
4230068
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$597.90 |
| Max. Negotiated Rate |
$3,188.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,833.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,594.40
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: CDPHP Medicare |
$1,474.82
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,790.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,188.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,188.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,355.24
|
| Rate for Payer: EmblemHealth Select Care |
$2,590.90
|
| Rate for Payer: Fidelis Medicare |
$1,594.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,590.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,594.40
|
| Rate for Payer: Humana Medicare |
$1,594.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,833.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,674.12
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$597.90
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,594.40
|
| Rate for Payer: WellCare Medicare |
$2,192.30
|
|
|
MRA LEXTREM W/WO CONTR
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
HCPCS C8914
|
| Hospital Charge Code |
4230068
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,590.90 |
| Max. Negotiated Rate |
$2,590.90 |
| Rate for Payer: Cash Price |
$2,989.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,590.90
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna of NY Commercial |
$184.80
|
| Rate for Payer: Aetna of NY Medicare |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.60
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: CDPHP Medicare |
$97.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$211.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$211.20
|
| Rate for Payer: EmblemHealth Medicaid |
$211.20
|
| Rate for Payer: EmblemHealth Medicare |
$89.76
|
| Rate for Payer: Fidelis Medicare |
$105.60
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.60
|
| Rate for Payer: Humana Medicare |
$105.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WellCare Medicare |
$145.20
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230068
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna of NY Commercial |
$184.80
|
| Rate for Payer: Aetna of NY Medicare |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.60
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: CDPHP Medicare |
$97.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$211.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$211.20
|
| Rate for Payer: EmblemHealth Medicaid |
$211.20
|
| Rate for Payer: EmblemHealth Medicare |
$89.76
|
| Rate for Payer: Fidelis Medicare |
$105.60
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.60
|
| Rate for Payer: Humana Medicare |
$105.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WellCare Medicare |
$145.20
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230068
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$171.60 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
4230048
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,235.00 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,235.00
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230072
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$171.60 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$171.60 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230072
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna of NY Commercial |
$184.80
|
| Rate for Payer: Aetna of NY Medicare |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.60
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: CDPHP Medicare |
$97.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$211.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$211.20
|
| Rate for Payer: EmblemHealth Medicaid |
$211.20
|
| Rate for Payer: EmblemHealth Medicare |
$89.76
|
| Rate for Payer: Fidelis Medicare |
$105.60
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.60
|
| Rate for Payer: Humana Medicare |
$105.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WellCare Medicare |
$145.20
|
|
|
MRA LWR EXT W OR W/O DYE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
4230048
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$874.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$760.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: CDPHP Medicare |
$703.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,330.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$646.00
|
| Rate for Payer: EmblemHealth Select Care |
$1,235.00
|
| Rate for Payer: Fidelis Medicare |
$760.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,235.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$760.00
|
| Rate for Payer: Humana Medicare |
$760.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$874.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$798.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$285.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$760.00
|
| Rate for Payer: WellCare Medicare |
$1,045.00
|
|
|
MRA LWR EXT W/ OR W/O DYE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230207
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$171.60 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
|
|
MRA LWR EXT W/ OR W/O DYE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 73725 26
|
| Hospital Charge Code |
5230207
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna of NY Commercial |
$184.80
|
| Rate for Payer: Aetna of NY Medicare |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.60
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: CDPHP Medicare |
$97.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$211.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$211.20
|
| Rate for Payer: EmblemHealth Medicaid |
$211.20
|
| Rate for Payer: EmblemHealth Medicare |
$89.76
|
| Rate for Payer: Fidelis Medicare |
$105.60
|
| Rate for Payer: Galaxy Health Commercial |
$171.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.60
|
| Rate for Payer: Humana Medicare |
$105.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$121.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$198.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.60
|
| Rate for Payer: United Healthcare Medicare |
$105.60
|
| Rate for Payer: WellCare Medicare |
$145.20
|
|
|
MRA NECK W/ DYE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 70548 26
|
| Hospital Charge Code |
5230038
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.35 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Galaxy Health Commercial |
$142.35
|
|
|
MRA NECK W/ DYE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 70548 26
|
| Hospital Charge Code |
5230038
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$175.20 |
| Rate for Payer: Aetna of NY Commercial |
$153.30
|
| Rate for Payer: Aetna of NY Medicare |
$100.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$87.60
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: CDPHP Medicare |
$81.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$175.20
|
| Rate for Payer: EmblemHealth Medicaid |
$175.20
|
| Rate for Payer: EmblemHealth Medicare |
$74.46
|
| Rate for Payer: Fidelis Medicare |
$87.60
|
| Rate for Payer: Galaxy Health Commercial |
$142.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$87.60
|
| Rate for Payer: Humana Medicare |
$87.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$153.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$100.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$164.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$123.30
|
| Rate for Payer: MVP Health Care of NY Medicare |
$91.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.85
|
| Rate for Payer: United Healthcare Medicare |
$87.60
|
| Rate for Payer: WellCare Medicare |
$120.45
|
|
|
MRA NECK W/DYE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
4230038
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$1,682.20 |
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
|
