|
PREDNISONE 5 MG PO TABS
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6068712201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6068712201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
7095405810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6068712211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6068712211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0603533721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054982825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0054982825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
0603533721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
|
PREDNISONE 5 MG PO TABS
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
7095405810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
|
|
PR ED SVC CKD GRP PER SESSION
|
Professional
|
Both
|
$108.08
|
|
|
Service Code
|
HCPCS G0421
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.59
|
| Rate for Payer: Healthfirst Commercial |
$28.78
|
| Rate for Payer: Healthfirst Essential Plan |
$64.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.34
|
| Rate for Payer: Healthfirst QHP |
$28.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.59
|
| Rate for Payer: SOMOS Essential |
$21.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.78
|
|
|
PR ED SVC CKD IND PER SESSION
|
Professional
|
Both
|
$440.69
|
|
|
Service Code
|
HCPCS G0420
|
| Min. Negotiated Rate |
$83.65 |
| Max. Negotiated Rate |
$268.88 |
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.62
|
| Rate for Payer: Healthfirst Commercial |
$119.50
|
| Rate for Payer: Healthfirst Essential Plan |
$268.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.53
|
| Rate for Payer: Healthfirst QHP |
$119.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.62
|
| Rate for Payer: SOMOS Essential |
$89.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.50
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$828.73
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$508.07 |
| Rate for Payer: Amida Care Medicaid |
$114.71
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.36
|
| Rate for Payer: Healthfirst Commercial |
$225.81
|
| Rate for Payer: Healthfirst Essential Plan |
$508.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.52
|
| Rate for Payer: Healthfirst QHP |
$225.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.36
|
| Rate for Payer: SOMOS Essential |
$169.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.81
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$1,011.89
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$619.76 |
| Rate for Payer: Amida Care Medicaid |
$139.57
|
| Rate for Payer: Cash Price |
$279.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$275.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$247.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$261.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$275.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$261.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$206.59
|
| Rate for Payer: Healthfirst Commercial |
$275.45
|
| Rate for Payer: Healthfirst Essential Plan |
$619.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$261.68
|
| Rate for Payer: Healthfirst QHP |
$275.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$192.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$275.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$234.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$192.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$275.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$206.59
|
| Rate for Payer: SOMOS Essential |
$206.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$275.45
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$1,012.69
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$142.23 |
| Max. Negotiated Rate |
$625.39 |
| Rate for Payer: Amida Care Medicaid |
$142.23
|
| Rate for Payer: Cash Price |
$278.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.46
|
| Rate for Payer: Healthfirst Commercial |
$277.95
|
| Rate for Payer: Healthfirst Essential Plan |
$625.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.05
|
| Rate for Payer: Healthfirst QHP |
$277.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.46
|
| Rate for Payer: SOMOS Essential |
$208.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.95
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$1,277.26
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$177.90 |
| Max. Negotiated Rate |
$785.97 |
| Rate for Payer: Amida Care Medicaid |
$177.90
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$349.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$349.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$349.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$349.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.99
|
| Rate for Payer: Healthfirst Commercial |
$349.32
|
| Rate for Payer: Healthfirst Essential Plan |
$785.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.85
|
| Rate for Payer: Healthfirst QHP |
$349.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$349.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$349.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.99
|
| Rate for Payer: SOMOS Essential |
$261.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.32
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$1,157.94
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$194.19 |
| Max. Negotiated Rate |
$717.30 |
| Rate for Payer: Amida Care Medicaid |
$194.19
|
| Rate for Payer: Cash Price |
$321.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.10
|
| Rate for Payer: Healthfirst Commercial |
$318.80
|
| Rate for Payer: Healthfirst Essential Plan |
$717.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.86
|
| Rate for Payer: Healthfirst QHP |
$318.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.10
|
| Rate for Payer: SOMOS Essential |
$239.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.80
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$1,625.58
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$224.83 |
| Max. Negotiated Rate |
$998.48 |
| Rate for Payer: Amida Care Medicaid |
$224.83
|
| Rate for Payer: Cash Price |
$449.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$443.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$399.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$399.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$421.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$421.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.83
|
| Rate for Payer: Healthfirst Commercial |
$443.77
|
| Rate for Payer: Healthfirst Essential Plan |
$998.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$421.58
|
| Rate for Payer: Healthfirst QHP |
$443.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$377.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.83
|
| Rate for Payer: SOMOS Essential |
$332.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.77
|
|
|
PR EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS
|
Professional
|
Both
|
$746.03
|
|
|
Service Code
|
HCPCS 95700
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Amida Care Medicaid |
$252.50
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$338.31
|
|
|
Service Code
|
HCPCS 95813 26
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$229.42 |
| Rate for Payer: Amida Care Medicaid |
$229.42
|
| Rate for Payer: Cash Price |
$93.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.77
|
| Rate for Payer: Healthfirst Commercial |
$91.69
|
| Rate for Payer: Healthfirst Essential Plan |
$206.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.11
|
| Rate for Payer: Healthfirst QHP |
$91.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.77
|
| Rate for Payer: SOMOS Essential |
$68.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.69
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$229.42 |
| Max. Negotiated Rate |
$1,149.84 |
| Rate for Payer: Amida Care Medicaid |
$229.42
|
| Rate for Payer: Cash Price |
$518.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$459.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$459.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.28
|
| Rate for Payer: Healthfirst Commercial |
$511.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,149.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.49
|
| Rate for Payer: Healthfirst QHP |
$511.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.28
|
| Rate for Payer: SOMOS Essential |
$383.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.04
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$1,488.69
|
|
|
Service Code
|
HCPCS 95813 TC
|
| Min. Negotiated Rate |
$229.42 |
| Max. Negotiated Rate |
$943.54 |
| Rate for Payer: Amida Care Medicaid |
$229.42
|
| Rate for Payer: Cash Price |
$424.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.51
|
| Rate for Payer: Healthfirst Commercial |
$419.35
|
| Rate for Payer: Healthfirst Essential Plan |
$943.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.38
|
| Rate for Payer: Healthfirst QHP |
$419.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.51
|
| Rate for Payer: SOMOS Essential |
$314.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.35
|
|
|
PR EEG NONINTRACRANIAL SURGERY
|
Professional
|
Both
|
$605.05
|
|
|
Service Code
|
HCPCS 95955 TC
|
| Min. Negotiated Rate |
$105.59 |
| Max. Negotiated Rate |
$339.39 |
| Rate for Payer: Amida Care Medicaid |
$111.20
|
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.13
|
| Rate for Payer: Healthfirst Commercial |
$150.84
|
| Rate for Payer: Healthfirst Essential Plan |
$339.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.30
|
| Rate for Payer: Healthfirst QHP |
$150.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.13
|
| Rate for Payer: SOMOS Essential |
$113.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.84
|
|
|
PR EEG NONINTRACRANIAL SURGERY
|
Professional
|
Both
|
$814.38
|
|
|
Service Code
|
HCPCS 95955
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$467.77 |
| Rate for Payer: Amida Care Medicaid |
$111.20
|
| Rate for Payer: Cash Price |
$221.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.93
|
| Rate for Payer: Healthfirst Commercial |
$207.90
|
| Rate for Payer: Healthfirst Essential Plan |
$467.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.50
|
| Rate for Payer: Healthfirst QHP |
$207.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.93
|
| Rate for Payer: SOMOS Essential |
$155.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.90
|
|
|
PR EEG NONINTRACRANIAL SURGERY
|
Professional
|
Both
|
$209.34
|
|
|
Service Code
|
HCPCS 95955 26
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$128.38 |
| Rate for Payer: Amida Care Medicaid |
$111.20
|
| Rate for Payer: Cash Price |
$57.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.80
|
| Rate for Payer: Healthfirst Commercial |
$57.06
|
| Rate for Payer: Healthfirst Essential Plan |
$128.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.21
|
| Rate for Payer: Healthfirst QHP |
$57.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.80
|
| Rate for Payer: SOMOS Essential |
$42.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.06
|
|
