|
MRI BRAIN STEM W/ DYE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 70552 26
|
| Hospital Charge Code |
5230029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Galaxy Health Commercial |
$169.65
|
|
|
MRI BRAIN STEM W/ DYE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 70552 26
|
| Hospital Charge Code |
5230029
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.15 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna of NY Commercial |
$182.70
|
| Rate for Payer: Aetna of NY Medicare |
$120.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$104.40
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: CDPHP Medicare |
$96.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.80
|
| Rate for Payer: EmblemHealth Medicaid |
$208.80
|
| Rate for Payer: EmblemHealth Medicare |
$88.74
|
| Rate for Payer: Fidelis Medicare |
$104.40
|
| Rate for Payer: Galaxy Health Commercial |
$169.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$104.40
|
| Rate for Payer: Humana Medicare |
$104.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$182.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$109.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$104.40
|
| Rate for Payer: WellCare Medicare |
$143.55
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
4230029
|
|
Hospital Revenue Code
|
611
|
| 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
|
|
|
MRI BRAIN STEM W/DYE
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 70552
|
| Hospital Charge Code |
4230029
|
|
Hospital Revenue Code
|
611
|
| 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
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Hospital Charge Code |
4230008
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$364.95 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,119.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$973.20
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: CDPHP Medicare |
$900.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,703.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,946.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,946.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,946.40
|
| Rate for Payer: EmblemHealth Medicare |
$827.22
|
| Rate for Payer: EmblemHealth Select Care |
$1,581.45
|
| Rate for Payer: Fidelis Medicare |
$973.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,581.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$973.20
|
| Rate for Payer: Humana Medicare |
$973.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,119.18
|
| 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 |
$1,021.86
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$364.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$973.20
|
| Rate for Payer: WellCare Medicare |
$1,338.15
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 70551 26
|
| Hospital Charge Code |
5230008
|
|
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
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 70551 26
|
| Hospital Charge Code |
5230008
|
|
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
|
|
|
MRI BRAIN STEM W/O DYE
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Hospital Charge Code |
4230008
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,581.45 |
| Max. Negotiated Rate |
$1,581.45 |
| Rate for Payer: Cash Price |
$1,824.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,581.45
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
4230009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$566.85 |
| Max. Negotiated Rate |
$3,023.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,511.60
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,645.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: EmblemHealth Select Care |
$2,456.35
|
| Rate for Payer: Fidelis Medicare |
$1,511.60
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,511.60
|
| Rate for Payer: Humana Medicare |
$1,511.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,587.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$566.85
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,511.60
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI BRAIN STEM W/O & W/DYE
|
Facility
|
IP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 70553
|
| Hospital Charge Code |
4230009
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,456.35 |
| Max. Negotiated Rate |
$2,456.35 |
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
|
|
MRI, BREAST, W/O CONTRAST, BILAT
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 77047 26
|
| Hospital Charge Code |
5230212
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Galaxy Health Commercial |
$152.10
|
|
|
MRI, BREAST, W/O CONTRAST, BILAT
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 77047 26
|
| Hospital Charge Code |
5230212
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna of NY Commercial |
$163.80
|
| Rate for Payer: Aetna of NY Medicare |
$107.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: CDPHP Medicare |
$86.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$187.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$187.20
|
| Rate for Payer: EmblemHealth Medicaid |
$187.20
|
| Rate for Payer: EmblemHealth Medicare |
$79.56
|
| Rate for Payer: Fidelis Medicare |
$93.60
|
| Rate for Payer: Galaxy Health Commercial |
$152.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$93.60
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$163.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$107.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$131.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$98.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.10
|
| Rate for Payer: United Healthcare Medicare |
$93.60
|
| Rate for Payer: WellCare Medicare |
$128.70
|
|
|
MRI, BREAST, W/O CONTRAST; BILAT
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
4230212
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
MRI, BREAST, W/O CONTRAST; BILAT
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 77047
|
| Hospital Charge Code |
4230212
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| 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 |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
MRI, BREAST, W/O CONTRAST; UNI
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 77046
|
| Hospital Charge Code |
4230211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: CDPHP Medicare |
$270.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$511.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$584.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$584.80
|
| Rate for Payer: EmblemHealth Medicaid |
$584.80
|
| Rate for Payer: EmblemHealth Medicare |
$248.54
|
| Rate for Payer: EmblemHealth Select Care |
$475.15
|
| Rate for Payer: Fidelis Medicare |
$292.40
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$292.40
|
| Rate for Payer: Humana Medicare |
$292.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$336.26
|
| 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 |
$307.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.65
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$292.40
|
| Rate for Payer: WellCare Medicare |
$402.05
|
|
|
MRI, BREAST, W/O CONTRAST; UNI
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 77046
|
| Hospital Charge Code |
4230211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$548.25
|
| Rate for Payer: Galaxy Health Commercial |
$475.15
|
|
|
MRI CERVICAL SPINE W/ DYE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 72142 26
|
| Hospital Charge Code |
5230030
|
|
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
|
|
|
MRI CERVICAL SPINE W/ DYE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 72142 26
|
| Hospital Charge Code |
5230030
|
|
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
|
|
|
MRI CERVICAL SPINE W/DYE
|
Facility
|
IP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
4230030
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,456.35 |
| Max. Negotiated Rate |
$2,456.35 |
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
|
|
MRI CERVICAL SPINE W/DYE
|
Facility
|
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72142
|
| Hospital Charge Code |
4230030
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$566.85 |
| Max. Negotiated Rate |
$3,023.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,738.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,511.60
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: Cash Price |
$2,834.25
|
| Rate for Payer: CDPHP Medicare |
$1,398.23
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,645.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,023.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3,023.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,284.86
|
| Rate for Payer: EmblemHealth Select Care |
$2,456.35
|
| Rate for Payer: Fidelis Medicare |
$1,511.60
|
| Rate for Payer: Galaxy Health Commercial |
$2,456.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,511.60
|
| Rate for Payer: Humana Medicare |
$1,511.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,738.34
|
| 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 |
$1,587.18
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$566.85
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,511.60
|
| Rate for Payer: WellCare Medicare |
$2,078.45
|
|
|
MRI CERVICAL SPINE W/O DYE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Hospital Charge Code |
4230010
|
|
Hospital Revenue Code
|
612
|
| 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
|
|
|
MRI CERVICAL SPINE W/O DYE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 72141 26
|
| Hospital Charge Code |
5230010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: Galaxy Health Commercial |
$141.05
|
|
|
MRI CERVICAL SPINE W/O DYE
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Hospital Charge Code |
4230010
|
|
Hospital Revenue Code
|
612
|
| 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
|
|
|
MRI CERVICAL SPINE W/O DYE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 72141 26
|
| Hospital Charge Code |
5230010
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$173.60 |
| Rate for Payer: Aetna of NY Commercial |
$151.90
|
| Rate for Payer: Aetna of NY Medicare |
$99.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$86.80
|
| Rate for Payer: Cash Price |
$162.75
|
| Rate for Payer: CDPHP Medicare |
$80.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$173.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$173.60
|
| Rate for Payer: EmblemHealth Medicaid |
$173.60
|
| Rate for Payer: EmblemHealth Medicare |
$73.78
|
| Rate for Payer: Fidelis Medicare |
$86.80
|
| Rate for Payer: Galaxy Health Commercial |
$141.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$86.80
|
| Rate for Payer: Humana Medicare |
$86.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$151.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$99.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$162.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$122.17
|
| Rate for Payer: MVP Health Care of NY Medicare |
$91.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.55
|
| Rate for Payer: United Healthcare Medicare |
$86.80
|
| Rate for Payer: WellCare Medicare |
$119.35
|
|
|
MRI CERVICAL SPINE W/O & W/ DYE
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 72156 26
|
| Hospital Charge Code |
5230011
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$270.40 |
| Rate for Payer: Aetna of NY Commercial |
$236.60
|
| Rate for Payer: Aetna of NY Medicare |
$155.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.20
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: CDPHP Medicare |
$125.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$270.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$270.40
|
| Rate for Payer: EmblemHealth Medicaid |
$270.40
|
| Rate for Payer: EmblemHealth Medicare |
$114.92
|
| Rate for Payer: Fidelis Medicare |
$135.20
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.20
|
| Rate for Payer: Humana Medicare |
$135.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$236.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$155.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$253.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$190.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$141.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$50.70
|
| Rate for Payer: United Healthcare Medicare |
$135.20
|
| Rate for Payer: WellCare Medicare |
$185.90
|
|
