Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HC MRI, FACE, NECK W/CONTRAST - MR ORBIT FACE NECK W IV CONTRAST

Facility

IP

$1,156.00

Service Code	CPT 70542 TC
Hospital Charge Code	6157054202
Hospital Revenue Code	615
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, FACE, NECK W/CONTRAST - MR ORBIT FACE NECK W IV CONTRAST

Facility

OP

$1,156.00

Service Code	CPT 70542 TC
Hospital Charge Code	6157054202
Hospital Revenue Code	615
Min. Negotiated Rate	$204.98
Max. Negotiated Rate	$935.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$204.98
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$204.98
Rate for Payer: Healthfirst Essential Plan	$864.16
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.07

HC MRI GUIDANCE TISSUE ABLATION - MR GUIDED RF ABLATION RENAL

Facility

OP

$526.00

Service Code	CPT 77022 TC
Hospital Charge Code	6107702203
Hospital Revenue Code	610
Min. Negotiated Rate	$184.10
Max. Negotiated Rate	$1,264.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$289.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$394.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$420.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$357.68
Rate for Payer: EmblemHealth Commercial	$263.00
Rate for Payer: Group Health Inc Commercial	$263.00
Rate for Payer: Group Health Inc Medicare	$184.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$263.00
Rate for Payer: Hamaspik Choice Inc Medicare	$263.00
Rate for Payer: Healthfirst Essential Plan	$1,264.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$561.84

HC MRI GUIDANCE TISSUE ABLATION - MR GUIDED RF ABLATION RENAL

Facility

IP

$526.00

Service Code	CPT 77022 TC
Hospital Charge Code	6107702203
Hospital Revenue Code	610
Min. Negotiated Rate	$263.00
Max. Negotiated Rate	$263.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$263.00

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

IP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372102
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

OP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372102
Hospital Revenue Code	614
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$742.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$150.14
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.14
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

IP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372104
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

OP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372103
Hospital Revenue Code	614
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$742.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$150.14
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.14
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

IP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372103
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI JNT OF LWR EXTRE W/O DYE

Facility

OP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372104
Hospital Revenue Code	614
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$742.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$150.14
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.14
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI JNT OF LWR EXTRE W/O DYE - MR LOWER EXT JOINT WO IV CONT

Facility

OP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372101
Hospital Revenue Code	614
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$742.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$387.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$528.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$733.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$617.72
Rate for Payer: EmblemHealth Commercial	$150.14
Rate for Payer: Group Health Inc Commercial	$352.50
Rate for Payer: Group Health Inc Medicare	$246.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50
Rate for Payer: Hamaspik Choice Inc Medicare	$352.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.14
Rate for Payer: Healthfirst Essential Plan	$742.54
Rate for Payer: United Healthcare Commercial	$274.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$330.02

HC MRI JNT OF LWR EXTRE W/O DYE - MR LOWER EXT JOINT WO IV CONT

Facility

IP

$705.00

Service Code	CPT 73721 TC
Hospital Charge Code	6147372101
Hospital Revenue Code	614
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.50

HC MRI, JOINT OF LEG. COMBO - MR ANKLE W AND WO IV CONTRAST

Facility

IP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372305
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, JOINT OF LEG. COMBO - MR ANKLE W AND WO IV CONTRAST

Facility

OP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372305
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$301.75
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$301.75
Rate for Payer: Healthfirst Essential Plan	$1,142.68
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.86

HC MRI, JOINT OF LEG. COMBO - MR HIP W AND WO IV CONTRAST

Facility

OP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372301
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$301.75
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$301.75
Rate for Payer: Healthfirst Essential Plan	$1,142.68
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.86

HC MRI, JOINT OF LEG. COMBO - MR HIP W AND WO IV CONTRAST

Facility

IP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372301
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, JOINT OF LEG. COMBO - MR KNEE W AND WO IV CONTRAST

Facility

IP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372303
Hospital Revenue Code	614
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC MRI, JOINT OF LEG. COMBO - MR KNEE W AND WO IV CONTRAST

Facility

OP

$1,156.00

Service Code	CPT 73723 TC
Hospital Charge Code	6147372303
Hospital Revenue Code	614
Min. Negotiated Rate	$259.35
Max. Negotiated Rate	$1,142.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,141.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$961.17
Rate for Payer: EmblemHealth Commercial	$301.75
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$301.75
Rate for Payer: Healthfirst Essential Plan	$1,142.68
Rate for Payer: United Healthcare Commercial	$426.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$507.86

HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM

Facility

OP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372207
Hospital Revenue Code	614
Min. Negotiated Rate	$252.50
Max. Negotiated Rate	$1,546.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,546.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$252.50
Rate for Payer: Group Health Inc Commercial	$1,031.00
Rate for Payer: Group Health Inc Medicare	$721.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$252.50
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI, JOINT OF LEG W/CONTRAST - MR ANKLE ARTHROGRAM

Facility

IP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372207
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM

Facility

OP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372202
Hospital Revenue Code	614
Min. Negotiated Rate	$252.50
Max. Negotiated Rate	$1,546.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,546.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$252.50
Rate for Payer: Group Health Inc Commercial	$1,031.00
Rate for Payer: Group Health Inc Medicare	$721.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$252.50
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI, JOINT OF LEG W/CONTRAST - MR HIP ARTHROGRAM

Facility

IP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372202
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, JOINT OF LEG W/CONTRAST - MR HIP W IV CONTRAST

Facility

OP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372205
Hospital Revenue Code	614
Min. Negotiated Rate	$252.50
Max. Negotiated Rate	$1,546.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,546.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$252.50
Rate for Payer: Group Health Inc Commercial	$1,031.00
Rate for Payer: Group Health Inc Medicare	$721.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$252.50
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

HC MRI, JOINT OF LEG W/CONTRAST - MR HIP W IV CONTRAST

Facility

IP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372205
Hospital Revenue Code	614
Min. Negotiated Rate	$1,031.00
Max. Negotiated Rate	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00

HC MRI, JOINT OF LEG W/CONTRAST - MR KNEE ARTHROGRAM

Facility

OP

$2,062.00

Service Code	CPT 73722 TC
Hospital Charge Code	6147372201
Hospital Revenue Code	614
Min. Negotiated Rate	$252.50
Max. Negotiated Rate	$1,546.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,134.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$259.35
Rate for Payer: Aetna Government	$259.35
Rate for Payer: Brighton Health Commercial	$1,546.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$787.13
Rate for Payer: EmblemHealth Commercial	$252.50
Rate for Payer: Group Health Inc Commercial	$1,031.00
Rate for Payer: Group Health Inc Medicare	$721.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,031.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,031.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$252.50
Rate for Payer: Healthfirst Essential Plan	$864.09
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$384.04

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