|
MRI UPPER EXT, ANY JOINT W/O DYE
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 73221 26
|
| Hospital Charge Code |
5230021
|
|
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
|
|
|
MRI UPPER EXT; ANY JOINT W/O DYE
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Hospital Charge Code |
4230021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$2,328.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,030.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$896.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: CDPHP Medicare |
$828.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,568.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,792.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,792.00
|
| Rate for Payer: EmblemHealth Medicare |
$761.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,456.00
|
| Rate for Payer: Fidelis Medicare |
$896.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,456.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$896.00
|
| Rate for Payer: Humana Medicare |
$896.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,030.40
|
| 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 |
$940.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$336.00
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$896.00
|
| Rate for Payer: WellCare Medicare |
$1,232.00
|
|
|
MRI UPPER EXT; ANY JOINT W/O DYE
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Hospital Charge Code |
4230021
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,456.00 |
| Max. Negotiated Rate |
$1,456.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,456.00
|
|
|
MRI UPPER EXT, ANY JOINT W/O & W/ DYE
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 73223 26
|
| Hospital Charge Code |
5230023
|
|
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 UPPER EXT, ANY JOINT W/O & W/ DYE
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 73223 26
|
| Hospital Charge Code |
5230023
|
|
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 UPPER EXT; ANY JOINT W/O & W/DYE
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
4230023
|
|
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 UPPER EXT; ANY JOINT W/O & W/DYE
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73223
|
| Hospital Charge Code |
4230023
|
|
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 UPPER EXT, NON JOINT W/ DYE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 73219 26
|
| Hospital Charge Code |
5230025
|
|
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 UPPER EXT, NON JOINT W/ DYE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 73219 26
|
| Hospital Charge Code |
5230025
|
|
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 UPPER EXT; NON JOINT W/ DYE
|
Facility
|
IP
|
$3,209.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
4230025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,085.85 |
| Max. Negotiated Rate |
$2,085.85 |
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Galaxy Health Commercial |
$2,085.85
|
|
|
MRI UPPER EXT; NON JOINT W/ DYE
|
Facility
|
OP
|
$3,209.00
|
|
|
Service Code
|
HCPCS 73219
|
| Hospital Charge Code |
4230025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$481.35 |
| Max. Negotiated Rate |
$2,567.20 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,476.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,283.60
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: Cash Price |
$2,406.75
|
| Rate for Payer: CDPHP Medicare |
$1,187.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,246.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,567.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,567.20
|
| Rate for Payer: EmblemHealth Medicare |
$1,091.06
|
| Rate for Payer: EmblemHealth Select Care |
$2,085.85
|
| Rate for Payer: Fidelis Medicare |
$1,283.60
|
| Rate for Payer: Galaxy Health Commercial |
$2,085.85
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,283.60
|
| Rate for Payer: Humana Medicare |
$1,283.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,476.14
|
| 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 |
$1,347.78
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$481.35
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,283.60
|
| Rate for Payer: WellCare Medicare |
$1,764.95
|
|
|
MRI UPPER EXT, NON JOINT W/O DYE
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 73218 26
|
| Hospital Charge Code |
5230024
|
|
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
|
|
|
MRI UPPER EXT, NON JOINT W/O DYE
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 73218 26
|
| Hospital Charge Code |
5230024
|
|
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 UPPER EXT; NON JOINT W/O DYE
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
4230024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$514.05 |
| Max. Negotiated Rate |
$2,741.60 |
| Rate for Payer: Aetna of NY Commercial |
$1,750.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,576.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,370.80
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: CDPHP Medicare |
$1,267.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,398.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,741.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicaid |
$2,741.60
|
| Rate for Payer: EmblemHealth Medicare |
$1,165.18
|
| Rate for Payer: EmblemHealth Select Care |
$2,227.55
|
| Rate for Payer: Fidelis Medicare |
$1,370.80
|
| Rate for Payer: Galaxy Health Commercial |
$2,227.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,370.80
|
| Rate for Payer: Humana Medicare |
$1,370.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,750.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,576.42
|
| 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 |
$1,439.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$2,328.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$514.05
|
| Rate for Payer: United Healthcare Commercial |
$2,328.00
|
| Rate for Payer: United Healthcare Medicare |
$1,370.80
|
| Rate for Payer: WellCare Medicare |
$1,884.85
|
|
|
MRI UPPER EXT; NON JOINT W/O DYE
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
HCPCS 73218
|
| Hospital Charge Code |
4230024
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,227.55 |
| Max. Negotiated Rate |
$2,227.55 |
| Rate for Payer: Cash Price |
$2,570.25
|
| Rate for Payer: Galaxy Health Commercial |
$2,227.55
|
|
|
MRI UPPER EXT, NON JOINT W/O & W/ DYE
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 73220 26
|
| Hospital Charge Code |
5230026
|
|
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 UPPER EXT, NON JOINT W/O & W/ DYE
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 73220 26
|
| Hospital Charge Code |
5230026
|
|
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 UPPER EXT; NON JOINT W/O & W/DYE
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
4230026
|
|
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 UPPER EXT; NON JOINT W/O & W/DYE
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 73220
|
| Hospital Charge Code |
4230026
|
|
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
|
|
|
MUGA, MULTI W WM & EF
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 78473 26
|
| Hospital Charge Code |
5210098
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$168.80 |
| Rate for Payer: Aetna of NY Commercial |
$147.70
|
| Rate for Payer: Aetna of NY Medicare |
$97.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$84.40
|
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: CDPHP Medicare |
$78.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.80
|
| Rate for Payer: EmblemHealth Medicaid |
$168.80
|
| Rate for Payer: EmblemHealth Medicare |
$71.74
|
| Rate for Payer: Fidelis Medicare |
$84.40
|
| Rate for Payer: Galaxy Health Commercial |
$137.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$84.40
|
| Rate for Payer: Humana Medicare |
$84.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$147.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$97.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$158.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$118.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$88.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$31.65
|
| Rate for Payer: United Healthcare Medicare |
$84.40
|
| Rate for Payer: WellCare Medicare |
$116.05
|
|
|
MUGA, MULTI W WM & EF
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 78473 26
|
| Hospital Charge Code |
5210098
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$137.15 |
| Max. Negotiated Rate |
$137.15 |
| Rate for Payer: Cash Price |
$158.25
|
| Rate for Payer: Galaxy Health Commercial |
$137.15
|
|
|
MUGA; MULTI W WM & EF
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78473
|
| Hospital Charge Code |
4210098
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.25 |
| Max. Negotiated Rate |
$796.25 |
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
|
|
MUGA; MULTI W WM & EF
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 78473
|
| Hospital Charge Code |
4210098
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna of NY Commercial |
$857.50
|
| Rate for Payer: Aetna of NY Medicare |
$563.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$490.00
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: CDPHP Medicare |
$453.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$857.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$980.00
|
| Rate for Payer: EmblemHealth Medicaid |
$980.00
|
| Rate for Payer: EmblemHealth Medicare |
$416.50
|
| Rate for Payer: EmblemHealth Select Care |
$796.25
|
| Rate for Payer: Fidelis Medicare |
$490.00
|
| Rate for Payer: Galaxy Health Commercial |
$796.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$490.00
|
| Rate for Payer: Humana Medicare |
$490.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$857.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$563.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$918.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$689.67
|
| Rate for Payer: MVP Health Care of NY Medicare |
$514.50
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$1,545.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$183.75
|
| Rate for Payer: United Healthcare Commercial |
$1,545.00
|
| Rate for Payer: United Healthcare Medicare |
$490.00
|
| Rate for Payer: WellCare Medicare |
$673.75
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 78496 26
|
| Hospital Charge Code |
5210082
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of NY Commercial |
$49.00
|
| Rate for Payer: Aetna of NY Medicare |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: CDPHP Medicare |
$25.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.00
|
| Rate for Payer: EmblemHealth Medicaid |
$56.00
|
| Rate for Payer: EmblemHealth Medicare |
$23.80
|
| Rate for Payer: Fidelis Medicare |
$28.00
|
| Rate for Payer: Galaxy Health Commercial |
$45.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.00
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.41
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.50
|
| Rate for Payer: United Healthcare Medicare |
$28.00
|
| Rate for Payer: WellCare Medicare |
$38.50
|
|
|
MUGA SGL W RV EF BY 1ST PASS
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 78496 26
|
| Hospital Charge Code |
5210082
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Galaxy Health Commercial |
$45.50
|
|
