|
MRI CERVICAL SPINE W/O & W/ DYE
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 72156 26
|
| Hospital Charge Code |
5230011
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Galaxy Health Commercial |
$219.70
|
|
|
MRI CERVICAL SPINE W/O & W/DYE
|
Facility
|
IP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
4230011
|
|
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/O & W/DYE
|
Facility
|
OP
|
$3,779.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
4230011
|
|
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 CHEST W/ DYE
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 71551 26
|
| Hospital Charge Code |
5230028
|
|
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 CHEST W/ DYE
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 71551 26
|
| Hospital Charge Code |
5230028
|
|
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 CHEST W/DYE
|
Facility
|
IP
|
$3,106.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
4230028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,018.90 |
| Max. Negotiated Rate |
$2,018.90 |
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,018.90
|
|
|
MRI CHEST W/DYE
|
Facility
|
OP
|
$3,106.00
|
|
|
Service Code
|
HCPCS 71551
|
| Hospital Charge Code |
4230028
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$465.90 |
| Max. Negotiated Rate |
$2,484.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,428.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,242.40
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: Cash Price |
$2,329.50
|
| Rate for Payer: CDPHP Medicare |
$1,149.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,174.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,484.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,484.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,484.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,056.04
|
| Rate for Payer: EmblemHealth Select Care |
$2,018.90
|
| Rate for Payer: Fidelis Medicare |
$1,242.40
|
| Rate for Payer: Galaxy Health Commercial |
$2,018.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,242.40
|
| Rate for Payer: Humana Medicare |
$1,242.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,428.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,334.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$964.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,304.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$465.90
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,242.40
|
| Rate for Payer: WellCare Medicare |
$1,708.30
|
|
|
MRI CHEST W/O DYE
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 71550 26
|
| Hospital Charge Code |
5230003
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$139.10 |
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Galaxy Health Commercial |
$139.10
|
|
|
MRI CHEST W/O DYE
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
4230003
|
|
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 CHEST W/O DYE
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
4230003
|
|
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 CHEST W/O DYE
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 71550 26
|
| Hospital Charge Code |
5230003
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$171.20 |
| Rate for Payer: Aetna of NY Commercial |
$149.80
|
| Rate for Payer: Aetna of NY Medicare |
$98.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$85.60
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: CDPHP Medicare |
$79.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$171.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$171.20
|
| Rate for Payer: EmblemHealth Medicaid |
$171.20
|
| Rate for Payer: EmblemHealth Medicare |
$72.76
|
| Rate for Payer: Fidelis Medicare |
$85.60
|
| Rate for Payer: Galaxy Health Commercial |
$139.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$85.60
|
| Rate for Payer: Humana Medicare |
$85.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$149.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$160.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$120.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$89.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.10
|
| Rate for Payer: United Healthcare Medicare |
$85.60
|
| Rate for Payer: WellCare Medicare |
$117.70
|
|
|
MRI CHEST W/O & W/ DYE
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 71552 26
|
| Hospital Charge Code |
5230004
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Aetna of NY Commercial |
$233.10
|
| Rate for Payer: Aetna of NY Medicare |
$153.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: CDPHP Medicare |
$123.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$266.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$266.40
|
| Rate for Payer: EmblemHealth Medicaid |
$266.40
|
| Rate for Payer: EmblemHealth Medicare |
$113.22
|
| Rate for Payer: Fidelis Medicare |
$133.20
|
| Rate for Payer: Galaxy Health Commercial |
$216.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$133.20
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$233.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$153.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$249.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$187.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$139.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$49.95
|
| Rate for Payer: United Healthcare Medicare |
$133.20
|
| Rate for Payer: WellCare Medicare |
$183.15
|
|
|
MRI CHEST W/O & W/ DYE
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 71552 26
|
| Hospital Charge Code |
5230004
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Galaxy Health Commercial |
$216.45
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
4230004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,860.00 |
| Max. Negotiated Rate |
$2,860.00 |
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
|
|
MRI CHEST W/O & W/DYE
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
4230004
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$2,024.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,760.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: Cash Price |
$3,300.00
|
| Rate for Payer: CDPHP Medicare |
$1,628.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3,080.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,520.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,520.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,496.00
|
| Rate for Payer: EmblemHealth Select Care |
$2,860.00
|
| Rate for Payer: Fidelis Medicare |
$1,760.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,860.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,760.00
|
| Rate for Payer: Humana Medicare |
$1,760.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$2,024.00
|
| 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 |
$1,848.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$660.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,760.00
|
| Rate for Payer: WellCare Medicare |
$2,420.00
|
|
|
MRI LOWER EXT, ANY JOINT W/ DYE
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 73722 26
|
| Hospital Charge Code |
5230017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Galaxy Health Commercial |
$154.70
|
|
|
MRI LOWER EXT, ANY JOINT W/ DYE
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 73722 26
|
| Hospital Charge Code |
5230020
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna of NY Commercial |
$166.60
|
| Rate for Payer: Aetna of NY Medicare |
$109.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$95.20
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: CDPHP Medicare |
$88.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$190.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$190.40
|
| Rate for Payer: EmblemHealth Medicaid |
$190.40
|
| Rate for Payer: EmblemHealth Medicare |
$80.92
|
| Rate for Payer: Fidelis Medicare |
$95.20
|
| Rate for Payer: Galaxy Health Commercial |
$154.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$95.20
|
| Rate for Payer: Humana Medicare |
$95.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$166.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$109.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$133.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.70
|
| Rate for Payer: United Healthcare Medicare |
$95.20
|
| Rate for Payer: WellCare Medicare |
$130.90
|
|
|
MRI LOWER EXT, ANY JOINT W/ DYE
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 73722 26
|
| Hospital Charge Code |
5230017
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna of NY Commercial |
$166.60
|
| Rate for Payer: Aetna of NY Medicare |
$109.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$95.20
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: CDPHP Medicare |
$88.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$190.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$190.40
|
| Rate for Payer: EmblemHealth Medicaid |
$190.40
|
| Rate for Payer: EmblemHealth Medicare |
$80.92
|
| Rate for Payer: Fidelis Medicare |
$95.20
|
| Rate for Payer: Galaxy Health Commercial |
$154.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$95.20
|
| Rate for Payer: Humana Medicare |
$95.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$166.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$109.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$178.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$133.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.70
|
| Rate for Payer: United Healthcare Medicare |
$95.20
|
| Rate for Payer: WellCare Medicare |
$130.90
|
|
|
MRI LOWER EXT, ANY JOINT W/ DYE
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 73722 26
|
| Hospital Charge Code |
5230020
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Galaxy Health Commercial |
$154.70
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
|
OP
|
$2,403.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$360.45 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,105.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$961.20
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: CDPHP Medicare |
$889.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,682.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,922.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,922.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,922.40
|
| Rate for Payer: EmblemHealth Medicare |
$817.02
|
| Rate for Payer: EmblemHealth Select Care |
$1,561.95
|
| Rate for Payer: Fidelis Medicare |
$961.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,561.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$961.20
|
| Rate for Payer: Humana Medicare |
$961.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,105.38
|
| 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 |
$1,009.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$360.45
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$961.20
|
| Rate for Payer: WellCare Medicare |
$1,321.65
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
|
OP
|
$2,403.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$360.45 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,105.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$961.20
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: CDPHP Medicare |
$889.11
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,682.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,922.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,922.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,922.40
|
| Rate for Payer: EmblemHealth Medicare |
$817.02
|
| Rate for Payer: EmblemHealth Select Care |
$1,561.95
|
| Rate for Payer: Fidelis Medicare |
$961.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,561.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$961.20
|
| Rate for Payer: Humana Medicare |
$961.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,105.38
|
| 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 |
$1,009.26
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$360.45
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$961.20
|
| Rate for Payer: WellCare Medicare |
$1,321.65
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
|
IP
|
$2,403.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230017
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,561.95 |
| Max. Negotiated Rate |
$1,561.95 |
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,561.95
|
|
|
MRI LOWER EXT; ANY JOINT W/DYE
|
Facility
|
IP
|
$2,403.00
|
|
|
Service Code
|
HCPCS 73722
|
| Hospital Charge Code |
4230020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,561.95 |
| Max. Negotiated Rate |
$1,561.95 |
| Rate for Payer: Cash Price |
$1,802.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,561.95
|
|
|
MRI LOWER EXT, ANY JOINT W/O DYE
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 73721 26
|
| Hospital Charge Code |
5230016
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: Aetna of NY Commercial |
$139.30
|
| Rate for Payer: Aetna of NY Medicare |
$91.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.60
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: CDPHP Medicare |
$73.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.20
|
| Rate for Payer: EmblemHealth Medicaid |
$159.20
|
| Rate for Payer: EmblemHealth Medicare |
$67.66
|
| Rate for Payer: Fidelis Medicare |
$79.60
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.60
|
| Rate for Payer: Humana Medicare |
$79.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$139.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.54
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.04
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.85
|
| Rate for Payer: United Healthcare Medicare |
$79.60
|
| Rate for Payer: WellCare Medicare |
$109.45
|
|
|
MRI LOWER EXT, ANY JOINT W/O DYE
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 73721 26
|
| Hospital Charge Code |
5230016
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$129.35 |
| Max. Negotiated Rate |
$129.35 |
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Galaxy Health Commercial |
$129.35
|
|
