|
MRA NECK W/DYE
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
4230038
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$388.20 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,190.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: Cash Price |
$1,941.00
|
| Rate for Payer: CDPHP Medicare |
$957.56
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,811.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,070.40
|
| Rate for Payer: EmblemHealth Medicare |
$879.92
|
| Rate for Payer: EmblemHealth Select Care |
$1,682.20
|
| Rate for Payer: Fidelis Medicare |
$1,035.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,682.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,035.20
|
| Rate for Payer: Humana Medicare |
$1,035.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,190.48
|
| 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 |
$1,086.96
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$388.20
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,035.20
|
| Rate for Payer: WellCare Medicare |
$1,423.40
|
|
|
MRA NECK W/O DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
4230037
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,749.80 |
| Max. Negotiated Rate |
$1,749.80 |
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
|
|
MRA NECK W/O DYE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
4230037
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$403.80 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,238.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,076.80
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: CDPHP Medicare |
$996.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,884.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,153.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,153.60
|
| Rate for Payer: EmblemHealth Medicare |
$915.28
|
| Rate for Payer: EmblemHealth Select Care |
$1,749.80
|
| Rate for Payer: Fidelis Medicare |
$1,076.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,749.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,076.80
|
| Rate for Payer: Humana Medicare |
$1,076.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,238.32
|
| 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 |
$1,130.64
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$403.80
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,076.80
|
| Rate for Payer: WellCare Medicare |
$1,480.60
|
|
|
MRA NECK W/O DYE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 70547 26
|
| Hospital Charge Code |
5230037
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Galaxy Health Commercial |
$114.40
|
|
|
MRA NECK W/O DYE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 70547 26
|
| Hospital Charge Code |
5230037
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$140.80 |
| Rate for Payer: Aetna of NY Commercial |
$123.20
|
| Rate for Payer: Aetna of NY Medicare |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$70.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: CDPHP Medicare |
$65.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.80
|
| Rate for Payer: EmblemHealth Medicaid |
$140.80
|
| Rate for Payer: EmblemHealth Medicare |
$59.84
|
| Rate for Payer: Fidelis Medicare |
$70.40
|
| Rate for Payer: Galaxy Health Commercial |
$114.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$70.40
|
| Rate for Payer: Humana Medicare |
$70.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$123.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$80.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$132.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$99.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$73.92
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.40
|
| Rate for Payer: United Healthcare Medicare |
$70.40
|
| Rate for Payer: WellCare Medicare |
$96.80
|
|
|
MRA NECK W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 70549 26
|
| Hospital Charge Code |
5230039
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MRA NECK W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 70549 26
|
| Hospital Charge Code |
5230039
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MRA NECK W/O&W/DYE
|
Facility
|
OP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
4230039
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$496.95 |
| Max. Negotiated Rate |
$2,650.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,523.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,325.20
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: CDPHP Medicare |
$1,225.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,319.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,650.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicaid |
$2,650.40
|
| Rate for Payer: EmblemHealth Medicare |
$1,126.42
|
| Rate for Payer: EmblemHealth Select Care |
$2,153.45
|
| Rate for Payer: Fidelis Medicare |
$1,325.20
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,325.20
|
| Rate for Payer: Humana Medicare |
$1,325.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,523.98
|
| 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 |
$1,391.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$496.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,325.20
|
| Rate for Payer: WellCare Medicare |
$1,822.15
|
|
|
MRA NECK W/O&W/DYE
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
4230039
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,153.45 |
| Max. Negotiated Rate |
$2,153.45 |
| Rate for Payer: Cash Price |
$2,484.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,153.45
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230071
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230071
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230070
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MR ANGIO PELVIS W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72198 26
|
| Hospital Charge Code |
5230070
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
4230046
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$617.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$537.20
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: CDPHP Medicare |
$496.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$940.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,074.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,074.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,074.40
|
| Rate for Payer: EmblemHealth Medicare |
$456.62
|
| Rate for Payer: EmblemHealth Select Care |
$872.95
|
| Rate for Payer: Fidelis Medicare |
$537.20
|
| Rate for Payer: Galaxy Health Commercial |
$872.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$537.20
|
| Rate for Payer: Humana Medicare |
$537.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$617.78
|
| 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 |
$564.06
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$201.45
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$537.20
|
| Rate for Payer: WellCare Medicare |
$738.65
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
4230046
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$872.95 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Cash Price |
$1,007.25
|
| Rate for Payer: Galaxy Health Commercial |
$872.95
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230234
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230202
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230206
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.95 |
| Max. Negotiated Rate |
$170.95 |
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MRA SPINE W/O & W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230206
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
