|
MRA SPINE W/O & W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72159 26
|
| Hospital Charge Code |
5230234
|
|
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 |
5230202
|
|
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
|
$4,071.00
|
|
|
Service Code
|
HCPCS 72159
|
| Hospital Charge Code |
4230045
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$2,646.15 |
| Max. Negotiated Rate |
$2,646.15 |
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,646.15
|
|
|
MRA SPINE W/O&W/DYE
|
Facility
|
OP
|
$4,071.00
|
|
|
Service Code
|
HCPCS 72159
|
| Hospital Charge Code |
4230045
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$610.65 |
| Max. Negotiated Rate |
$3,256.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,872.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,628.40
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: Cash Price |
$3,053.25
|
| Rate for Payer: CDPHP Medicare |
$1,506.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,849.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,256.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,256.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,256.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,384.14
|
| Rate for Payer: EmblemHealth Select Care |
$2,646.15
|
| Rate for Payer: Fidelis Medicare |
$1,628.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,646.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,628.40
|
| Rate for Payer: Humana Medicare |
$1,628.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,872.66
|
| 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 |
$1,709.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$610.65
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,628.40
|
| Rate for Payer: WellCare Medicare |
$2,239.05
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230203
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230203
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.80
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: CDPHP Medicare |
$91.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$197.60
|
| Rate for Payer: EmblemHealth Medicaid |
$197.60
|
| Rate for Payer: EmblemHealth Medicare |
$83.98
|
| Rate for Payer: Fidelis Medicare |
$98.80
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.80
|
| Rate for Payer: Humana Medicare |
$98.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$98.80
|
| Rate for Payer: WellCare Medicare |
$135.85
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230205
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.80
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: CDPHP Medicare |
$91.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$197.60
|
| Rate for Payer: EmblemHealth Medicaid |
$197.60
|
| Rate for Payer: EmblemHealth Medicare |
$83.98
|
| Rate for Payer: Fidelis Medicare |
$98.80
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.80
|
| Rate for Payer: Humana Medicare |
$98.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$98.80
|
| Rate for Payer: WellCare Medicare |
$135.85
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230205
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230047
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.80
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: CDPHP Medicare |
$91.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$197.60
|
| Rate for Payer: EmblemHealth Medicaid |
$197.60
|
| Rate for Payer: EmblemHealth Medicare |
$83.98
|
| Rate for Payer: Fidelis Medicare |
$98.80
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.80
|
| Rate for Payer: Humana Medicare |
$98.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$98.80
|
| Rate for Payer: WellCare Medicare |
$135.85
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230201
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna of NY Commercial |
$172.90
|
| Rate for Payer: Aetna of NY Medicare |
$113.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$98.80
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: CDPHP Medicare |
$91.39
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$197.60
|
| Rate for Payer: EmblemHealth Medicaid |
$197.60
|
| Rate for Payer: EmblemHealth Medicare |
$83.98
|
| Rate for Payer: Fidelis Medicare |
$98.80
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$98.80
|
| Rate for Payer: Humana Medicare |
$98.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$172.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$113.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$185.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$103.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.05
|
| Rate for Payer: United Healthcare Medicare |
$98.80
|
| Rate for Payer: WellCare Medicare |
$135.85
|
|
|
MRA UPPER EXT W/O & W/ DYE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 73225 26
|
| Hospital Charge Code |
5230047
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Galaxy Health Commercial |
$160.55
|
|
|
MRA UPPER EXT W/O&W/DYE
|
Facility
|
OP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
4230047
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$358.35 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,098.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$955.60
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: CDPHP Medicare |
$883.93
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,672.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,911.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,911.20
|
| Rate for Payer: EmblemHealth Medicare |
$812.26
|
| Rate for Payer: EmblemHealth Select Care |
$1,552.85
|
| Rate for Payer: Fidelis Medicare |
$955.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$955.60
|
| Rate for Payer: Humana Medicare |
$955.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,098.94
|
| 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 |
$1,003.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$358.35
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$955.60
|
| Rate for Payer: WellCare Medicare |
$1,313.95
|
|
|
MRA UPPER EXT W/O&W/DYE
|
Facility
|
IP
|
$2,389.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
4230047
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,552.85 |
| Max. Negotiated Rate |
$1,552.85 |
| Rate for Payer: Cash Price |
$1,791.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,552.85
|
|
|
MRA W/DYE SPINAL CANAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8931
|
| Hospital Charge Code |
4230206
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
MRA W/DYE SPINAL CANAL
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8931
|
| Hospital Charge Code |
4230206
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: EmblemHealth Select Care |
$715.00
|
| Rate for Payer: Fidelis Medicare |
$440.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$440.00
|
| Rate for Payer: Humana Medicare |
$440.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| 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 |
$462.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$440.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
MRA W/DYE UPPER EXTREMITY
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
4230205
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$506.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$440.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: CDPHP Medicare |
$407.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$770.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$880.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$880.00
|
| Rate for Payer: EmblemHealth Medicaid |
$880.00
|
| Rate for Payer: EmblemHealth Medicare |
$374.00
|
| Rate for Payer: EmblemHealth Select Care |
$715.00
|
| Rate for Payer: Fidelis Medicare |
$440.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$440.00
|
| Rate for Payer: Humana Medicare |
$440.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$506.00
|
| 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 |
$462.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$440.00
|
| Rate for Payer: WellCare Medicare |
$605.00
|
|
|
MRA W/DYE UPPER EXTREMITY
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C8934
|
| Hospital Charge Code |
4230205
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$715.00 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Galaxy Health Commercial |
$715.00
|
|
|
MRA W/O DYE SPINAL CANAL
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C8932
|
| Hospital Charge Code |
4230234
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$857.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$745.60
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: CDPHP Medicare |
$689.68
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,304.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,491.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,491.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,491.20
|
| Rate for Payer: EmblemHealth Medicare |
$633.76
|
| Rate for Payer: EmblemHealth Select Care |
$1,211.60
|
| Rate for Payer: Fidelis Medicare |
$745.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,211.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$745.60
|
| Rate for Payer: Humana Medicare |
$745.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$857.44
|
| 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 |
$782.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$279.60
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$745.60
|
| Rate for Payer: WellCare Medicare |
$1,025.20
|
|
|
MRA W/O DYE SPINAL CANAL
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS C8932
|
| Hospital Charge Code |
4230234
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,211.60 |
| Max. Negotiated Rate |
$1,211.60 |
| Rate for Payer: Cash Price |
$1,398.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,211.60
|
|
|
MRA W/O DYE UPPER EXTR
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
4230203
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,177.80 |
| Max. Negotiated Rate |
$1,177.80 |
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,177.80
|
|
|
MRA W/O DYE UPPER EXTR
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C8935
|
| Hospital Charge Code |
4230203
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$833.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$724.80
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: CDPHP Medicare |
$670.44
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,268.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,449.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,449.60
|
| Rate for Payer: EmblemHealth Medicare |
$616.08
|
| Rate for Payer: EmblemHealth Select Care |
$1,177.80
|
| Rate for Payer: Fidelis Medicare |
$724.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,177.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$724.80
|
| Rate for Payer: Humana Medicare |
$724.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$833.52
|
| 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 |
$761.04
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$271.80
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$724.80
|
| Rate for Payer: WellCare Medicare |
$996.60
|
|
|
MRA W/O&W/DYE SPINAL CANAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS C8933
|
| Hospital Charge Code |
4230202
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,346.15 |
| Max. Negotiated Rate |
$1,346.15 |
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
|
|
MRA W/O&W/DYE SPINAL CANAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS C8933
|
| Hospital Charge Code |
4230202
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$310.65 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$952.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$828.40
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: Cash Price |
$1,553.25
|
| Rate for Payer: CDPHP Medicare |
$766.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,449.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,656.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,656.80
|
| Rate for Payer: EmblemHealth Medicare |
$704.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,346.15
|
| Rate for Payer: Fidelis Medicare |
$828.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,346.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$828.40
|
| Rate for Payer: Humana Medicare |
$828.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$952.66
|
| 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 |
$869.82
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$310.65
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$828.40
|
| Rate for Payer: WellCare Medicare |
$1,139.05
|
|
|
MRA W/O&W/DYE UPPER EXTR
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
4230201
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$1,413.10 |
| Max. Negotiated Rate |
$1,413.10 |
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.10
|
|
