|
MRA W/O&W/DYE UPPER EXTR
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C8936
|
| Hospital Charge Code |
4230201
|
|
Hospital Revenue Code
|
619
|
| Min. Negotiated Rate |
$326.10 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,000.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$869.60
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: Cash Price |
$1,630.50
|
| Rate for Payer: CDPHP Medicare |
$804.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,521.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,739.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,739.20
|
| Rate for Payer: EmblemHealth Medicare |
$739.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,413.10
|
| Rate for Payer: Fidelis Medicare |
$869.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,413.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$869.60
|
| Rate for Payer: Humana Medicare |
$869.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,000.04
|
| 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 |
$913.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$326.10
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$869.60
|
| Rate for Payer: WellCare Medicare |
$1,195.70
|
|
|
MRI ABDOMEN W/ DYE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 74182 26
|
| Hospital Charge Code |
5230027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
|
|
MRI ABDOMEN W/ DYE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 74182 26
|
| Hospital Charge Code |
5230027
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna of NY Commercial |
$176.40
|
| Rate for Payer: Aetna of NY Medicare |
$115.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: CDPHP Medicare |
$93.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$201.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$201.60
|
| Rate for Payer: EmblemHealth Medicaid |
$201.60
|
| Rate for Payer: EmblemHealth Medicare |
$85.68
|
| Rate for Payer: Fidelis Medicare |
$100.80
|
| Rate for Payer: Galaxy Health Commercial |
$163.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$100.80
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$176.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$115.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$189.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$141.88
|
| Rate for Payer: MVP Health Care of NY Medicare |
$105.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.80
|
| Rate for Payer: United Healthcare Medicare |
$100.80
|
| Rate for Payer: WellCare Medicare |
$138.60
|
|
|
MRI ABDOMEN W/DYE
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
4230027
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
MRI ABDOMEN W/DYE
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
4230027
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 74181 26
|
| Hospital Charge Code |
5230001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$138.45 |
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
4230001
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
4230001
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
|
MRI ABDOMEN W/O DYE
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 74181 26
|
| Hospital Charge Code |
5230001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$170.40 |
| Rate for Payer: Aetna of NY Commercial |
$149.10
|
| Rate for Payer: Aetna of NY Medicare |
$97.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$159.75
|
| Rate for Payer: CDPHP Medicare |
$78.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$170.40
|
| Rate for Payer: EmblemHealth Medicaid |
$170.40
|
| Rate for Payer: EmblemHealth Medicare |
$72.42
|
| Rate for Payer: Fidelis Medicare |
$85.20
|
| Rate for Payer: Galaxy Health Commercial |
$138.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.20
|
| Rate for Payer: Humana Medicare |
$85.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$159.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$119.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.95
|
| Rate for Payer: United Healthcare Medicare |
$85.20
|
| Rate for Payer: WellCare Medicare |
$117.15
|
|
|
MRI ABDOMEN W/O & W/ DYE
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 74183 26
|
| Hospital Charge Code |
5230002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna of NY Commercial |
$226.10
|
| Rate for Payer: Aetna of NY Medicare |
$148.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$129.20
|
| Rate for Payer: Cash Price |
$242.25
|
| Rate for Payer: CDPHP Medicare |
$119.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$258.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$258.40
|
| Rate for Payer: EmblemHealth Medicaid |
$258.40
|
| Rate for Payer: EmblemHealth Medicare |
$109.82
|
| Rate for Payer: Fidelis Medicare |
$129.20
|
| Rate for Payer: Galaxy Health Commercial |
$209.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$129.20
|
| Rate for Payer: Humana Medicare |
$129.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$226.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$148.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$242.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$181.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$135.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$48.45
|
| Rate for Payer: United Healthcare Medicare |
$129.20
|
| Rate for Payer: WellCare Medicare |
$177.65
|
|
|
MRI ABDOMEN W/O & W/ DYE
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 74183 26
|
| Hospital Charge Code |
5230002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$242.25
|
| Rate for Payer: Galaxy Health Commercial |
$209.95
|
|
|
MRI ABDOMEN W/O & W/DYE
|
Facility
|
IP
|
$4,096.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
4230002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,662.40 |
| Max. Negotiated Rate |
$2,662.40 |
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,662.40
|
|
|
MRI ABDOMEN W/O & W/DYE
|
Facility
|
OP
|
$4,096.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
4230002
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$614.40 |
| Max. Negotiated Rate |
$3,276.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,884.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,638.40
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: CDPHP Medicare |
$1,515.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,867.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,276.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicaid |
$3,276.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,392.64
|
| Rate for Payer: EmblemHealth Select Care |
$2,662.40
|
| Rate for Payer: Fidelis Medicare |
$1,638.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,662.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,638.40
|
| Rate for Payer: Humana Medicare |
$1,638.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,884.16
|
| 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 |
$1,720.32
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$614.40
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,638.40
|
| Rate for Payer: WellCare Medicare |
$2,252.80
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
4230044
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,069.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$929.60
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: CDPHP Medicare |
$859.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,626.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,859.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,859.20
|
| Rate for Payer: EmblemHealth Medicare |
$790.16
|
| Rate for Payer: EmblemHealth Select Care |
$1,510.60
|
| Rate for Payer: Fidelis Medicare |
$929.60
|
| Rate for Payer: Galaxy Health Commercial |
$1,510.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$929.60
|
| Rate for Payer: Humana Medicare |
$929.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,069.04
|
| 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 |
$976.08
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$348.60
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$929.60
|
| Rate for Payer: WellCare Medicare |
$1,278.20
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 71555
|
| Hospital Charge Code |
4230044
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,510.60 |
| Max. Negotiated Rate |
$1,510.60 |
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,510.60
|
|
|
MRI ANGIO CHEST W OR W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230074
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230074
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230208
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
|
|
MRI ANGIO CHEST W/ OR W/O DYE
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 71555 26
|
| Hospital Charge Code |
5230208
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$209.60 |
| Rate for Payer: Aetna of NY Commercial |
$183.40
|
| Rate for Payer: Aetna of NY Medicare |
$120.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.80
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: CDPHP Medicare |
$96.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$209.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$209.60
|
| Rate for Payer: EmblemHealth Medicaid |
$209.60
|
| Rate for Payer: EmblemHealth Medicare |
$89.08
|
| Rate for Payer: Fidelis Medicare |
$104.80
|
| Rate for Payer: Galaxy Health Commercial |
$170.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.80
|
| Rate for Payer: Humana Medicare |
$104.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$183.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$196.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$147.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare |
$104.80
|
| Rate for Payer: WellCare Medicare |
$144.10
|
|
|
MRI BRAIN STEAM W/O & W/ DYE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 70553 26
|
| Hospital Charge Code |
5230009
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$269.60 |
| Rate for Payer: Aetna of NY Commercial |
$235.90
|
| Rate for Payer: Aetna of NY Medicare |
$155.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$134.80
|
| Rate for Payer: Cash Price |
$252.75
|
| Rate for Payer: CDPHP Medicare |
$124.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$269.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$269.60
|
| Rate for Payer: EmblemHealth Medicaid |
$269.60
|
| Rate for Payer: EmblemHealth Medicare |
$114.58
|
| Rate for Payer: Fidelis Medicare |
$134.80
|
| Rate for Payer: Galaxy Health Commercial |
$219.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$134.80
|
| Rate for Payer: Humana Medicare |
$134.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$235.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$252.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$189.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.55
|
| Rate for Payer: United Healthcare Medicare |
$134.80
|
| Rate for Payer: WellCare Medicare |
$185.35
|
|
|
MRI BRAIN STEAM W/O & W/ DYE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 70553 26
|
| Hospital Charge Code |
5230009
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.05 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Cash Price |
$252.75
|
| Rate for Payer: Galaxy Health Commercial |
$219.05
|
|
