|
MRI LOWER EXT; ANY JOINT W/O DYE
|
Facility
|
IP
|
$2,278.00
|
|
|
Service Code
|
HCPCS 73721 TC
|
| Hospital Charge Code |
4230016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,480.70 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,480.70
|
|
|
MRI LOWER EXT; ANY JOINT W/O DYE
|
Facility
|
OP
|
$2,278.00
|
|
|
Service Code
|
HCPCS 73721 TC
|
| Hospital Charge Code |
4230016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$341.70 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,047.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$911.20
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: Cash Price |
$1,708.50
|
| Rate for Payer: CDPHP Medicare |
$842.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,594.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,822.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,822.40
|
| Rate for Payer: EmblemHealth Medicare |
$774.52
|
| Rate for Payer: EmblemHealth Select Care |
$1,480.70
|
| Rate for Payer: Fidelis Medicare |
$911.20
|
| Rate for Payer: Galaxy Health Commercial |
$1,480.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$911.20
|
| Rate for Payer: Humana Medicare |
$911.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,047.88
|
| 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 |
$956.76
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$341.70
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$911.20
|
| Rate for Payer: WellCare Medicare |
$1,252.90
|
|
|
MRI LOWER EXT, ANY JOINT W/O & W/ DYE
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 73723 26
|
| Hospital Charge Code |
5230018
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.05 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Cash Price |
$237.75
|
| Rate for Payer: Galaxy Health Commercial |
$206.05
|
|
|
MRI LOWER EXT, ANY JOINT W/O & W/ DYE
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 73723 26
|
| Hospital Charge Code |
5230018
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$253.60 |
| Rate for Payer: Aetna of NY Commercial |
$221.90
|
| Rate for Payer: Aetna of NY Medicare |
$145.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.80
|
| Rate for Payer: Cash Price |
$237.75
|
| Rate for Payer: CDPHP Medicare |
$117.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$253.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$253.60
|
| Rate for Payer: EmblemHealth Medicaid |
$253.60
|
| Rate for Payer: EmblemHealth Medicare |
$107.78
|
| Rate for Payer: Fidelis Medicare |
$126.80
|
| Rate for Payer: Galaxy Health Commercial |
$206.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.80
|
| Rate for Payer: Humana Medicare |
$126.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$221.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$145.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$178.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.55
|
| Rate for Payer: United Healthcare Medicare |
$126.80
|
| Rate for Payer: WellCare Medicare |
$174.35
|
|
|
MRI LOWER EXT; ANY JOINT W/O&W/DYE
|
Facility
|
IP
|
$3,882.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4230018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,523.30 |
| Max. Negotiated Rate |
$2,523.30 |
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Galaxy Health Commercial |
$2,523.30
|
|
|
MRI LOWER EXT; ANY JOINT W/O&W/DYE
|
Facility
|
OP
|
$3,882.00
|
|
|
Service Code
|
HCPCS 73723
|
| Hospital Charge Code |
4230018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$582.30 |
| Max. Negotiated Rate |
$3,105.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,785.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,552.80
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: CDPHP Medicare |
$1,436.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,717.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,105.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicaid |
$3,105.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,319.88
|
| Rate for Payer: EmblemHealth Select Care |
$2,523.30
|
| Rate for Payer: Fidelis Medicare |
$1,552.80
|
| Rate for Payer: Galaxy Health Commercial |
$2,523.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,552.80
|
| Rate for Payer: Humana Medicare |
$1,552.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,785.72
|
| 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 |
$1,630.44
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$582.30
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,552.80
|
| Rate for Payer: WellCare Medicare |
$2,135.10
|
|
|
MRI LOWER EXT, NON JOINT W/ DYE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 73719 26
|
| Hospital Charge Code |
5230069
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: Aetna of NY Commercial |
$165.90
|
| Rate for Payer: Aetna of NY Medicare |
$109.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$94.80
|
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: CDPHP Medicare |
$87.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$189.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$189.60
|
| Rate for Payer: EmblemHealth Medicaid |
$189.60
|
| Rate for Payer: EmblemHealth Medicare |
$80.58
|
| Rate for Payer: Fidelis Medicare |
$94.80
|
| Rate for Payer: Galaxy Health Commercial |
$154.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$94.80
|
| Rate for Payer: Humana Medicare |
$94.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$165.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$109.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$177.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$133.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$99.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.55
|
| Rate for Payer: United Healthcare Medicare |
$94.80
|
| Rate for Payer: WellCare Medicare |
$130.35
|
|
|
MRI LOWER EXT, NON JOINT W/ DYE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 73719 26
|
| Hospital Charge Code |
5230069
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$154.05 |
| Rate for Payer: Cash Price |
$177.75
|
| Rate for Payer: Galaxy Health Commercial |
$154.05
|
|
|
MRI LOWER EXT; NON JOINT W DYE
|
Facility
|
OP
|
$2,847.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
4230069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,309.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,138.80
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: CDPHP Medicare |
$1,053.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,992.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,277.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,277.60
|
| Rate for Payer: EmblemHealth Medicare |
$967.98
|
| Rate for Payer: EmblemHealth Select Care |
$1,850.55
|
| Rate for Payer: Fidelis Medicare |
$1,138.80
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,138.80
|
| Rate for Payer: Humana Medicare |
$1,138.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,309.62
|
| 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 |
$1,195.74
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$427.05
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,138.80
|
| Rate for Payer: WellCare Medicare |
$1,565.85
|
|
|
MRI LOWER EXT; NON JOINT W DYE
|
Facility
|
IP
|
$2,847.00
|
|
|
Service Code
|
HCPCS 73719
|
| Hospital Charge Code |
4230069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,850.55 |
| Max. Negotiated Rate |
$1,850.55 |
| Rate for Payer: Cash Price |
$2,135.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,850.55
|
|
|
MRI LOWER EXT, NON JOINT W/O DYE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 73718 26
|
| Hospital Charge Code |
5230019
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna of NY Commercial |
$138.60
|
| Rate for Payer: Aetna of NY Medicare |
$91.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: CDPHP Medicare |
$73.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$158.40
|
| Rate for Payer: EmblemHealth Medicaid |
$158.40
|
| Rate for Payer: EmblemHealth Medicare |
$67.32
|
| Rate for Payer: Fidelis Medicare |
$79.20
|
| Rate for Payer: Galaxy Health Commercial |
$128.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.20
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$138.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$91.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$148.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$111.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.70
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
| Rate for Payer: WellCare Medicare |
$108.90
|
|
|
MRI LOWER EXT, NON JOINT W/O DYE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 73718 26
|
| Hospital Charge Code |
5230019
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Galaxy Health Commercial |
$128.70
|
|
|
MRI LOWER EXT; NON JOINT W/O DYE
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
4230019
|
|
Hospital Revenue Code
|
610
|
| 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 LOWER EXT; NON JOINT W/O DYE
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS 73718
|
| Hospital Charge Code |
4230019
|
|
Hospital Revenue Code
|
610
|
| 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 LOWER EXT, NON JOINT W/O & W/ DYE
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 73720 26
|
| Hospital Charge Code |
5230033
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.05 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Cash Price |
$237.75
|
| Rate for Payer: Galaxy Health Commercial |
$206.05
|
|
|
MRI LOWER EXT, NON JOINT W/O & W/ DYE
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 73720 26
|
| Hospital Charge Code |
5230033
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$253.60 |
| Rate for Payer: Aetna of NY Commercial |
$221.90
|
| Rate for Payer: Aetna of NY Medicare |
$145.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$126.80
|
| Rate for Payer: Cash Price |
$237.75
|
| Rate for Payer: CDPHP Medicare |
$117.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$253.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$253.60
|
| Rate for Payer: EmblemHealth Medicaid |
$253.60
|
| Rate for Payer: EmblemHealth Medicare |
$107.78
|
| Rate for Payer: Fidelis Medicare |
$126.80
|
| Rate for Payer: Galaxy Health Commercial |
$206.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$126.80
|
| Rate for Payer: Humana Medicare |
$126.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$221.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$145.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$237.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$178.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$133.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.55
|
| Rate for Payer: United Healthcare Medicare |
$126.80
|
| Rate for Payer: WellCare Medicare |
$174.35
|
|
|
MRI LOWER EXT; NON JOINT W/O&W/DYE
|
Facility
|
OP
|
$4,005.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
4230033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$600.75 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,842.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,602.00
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: CDPHP Medicare |
$1,481.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,803.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$3,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$1,361.70
|
| Rate for Payer: EmblemHealth Select Care |
$2,603.25
|
| Rate for Payer: Fidelis Medicare |
$1,602.00
|
| Rate for Payer: Galaxy Health Commercial |
$2,603.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,602.00
|
| Rate for Payer: Humana Medicare |
$1,602.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,842.30
|
| 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 |
$1,682.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$600.75
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,602.00
|
| Rate for Payer: WellCare Medicare |
$2,202.75
|
|
|
MRI LOWER EXT; NON JOINT W/O&W/DYE
|
Facility
|
IP
|
$4,005.00
|
|
|
Service Code
|
HCPCS 73720
|
| Hospital Charge Code |
4230033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,603.25 |
| Max. Negotiated Rate |
$2,603.25 |
| Rate for Payer: Cash Price |
$3,003.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,603.25
|
|
|
MRI LUMBAR SPINE W/ DYE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 72149 26
|
| Hospital Charge Code |
5230032
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$210.40 |
| Rate for Payer: Aetna of NY Commercial |
$184.10
|
| Rate for Payer: Aetna of NY Medicare |
$120.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$105.20
|
| Rate for Payer: Cash Price |
$197.25
|
| Rate for Payer: CDPHP Medicare |
$97.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$210.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.40
|
| Rate for Payer: EmblemHealth Medicaid |
$210.40
|
| Rate for Payer: EmblemHealth Medicare |
$89.42
|
| Rate for Payer: Fidelis Medicare |
$105.20
|
| Rate for Payer: Galaxy Health Commercial |
$170.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$105.20
|
| Rate for Payer: Humana Medicare |
$105.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$184.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$120.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$197.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$148.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$110.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$39.45
|
| Rate for Payer: United Healthcare Medicare |
$105.20
|
| Rate for Payer: WellCare Medicare |
$144.65
|
|
|
MRI LUMBAR SPINE W/ DYE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 72149 26
|
| Hospital Charge Code |
5230032
|
|
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
|
|
|
MRI LUMBAR SPINE W/DYE
|
Facility
|
OP
|
$2,951.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
4230032
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$442.65 |
| Max. Negotiated Rate |
$2,360.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,357.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,180.40
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: CDPHP Medicare |
$1,091.87
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,065.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,360.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,360.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,360.80
|
| Rate for Payer: EmblemHealth Medicare |
$1,003.34
|
| Rate for Payer: EmblemHealth Select Care |
$1,918.15
|
| Rate for Payer: Fidelis Medicare |
$1,180.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,918.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,180.40
|
| Rate for Payer: Humana Medicare |
$1,180.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,357.46
|
| 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 |
$1,239.42
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$442.65
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,180.40
|
| Rate for Payer: WellCare Medicare |
$1,623.05
|
|
|
MRI LUMBAR SPINE W/DYE
|
Facility
|
IP
|
$2,951.00
|
|
|
Service Code
|
HCPCS 72149
|
| Hospital Charge Code |
4230032
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,918.15 |
| Max. Negotiated Rate |
$1,918.15 |
| Rate for Payer: Cash Price |
$2,213.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,918.15
|
|
|
MRI LUMBAR SPINE W/O DYE
|
Facility
|
IP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72148 TC
|
| Hospital Charge Code |
4230014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,547.65 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
|
|
MRI LUMBAR SPINE W/O DYE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 72148 26
|
| Hospital Charge Code |
5230014
|
|
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 LUMBAR SPINE W/O DYE
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72148 TC
|
| Hospital Charge Code |
4230014
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$357.15 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$952.40
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: CDPHP Medicare |
$880.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,666.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,904.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicare |
$809.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,547.65
|
| Rate for Payer: Fidelis Medicare |
$952.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$952.40
|
| Rate for Payer: Humana Medicare |
$952.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,095.26
|
| 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 |
$1,000.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$357.15
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$952.40
|
| Rate for Payer: WellCare Medicare |
$1,309.55
|
|
