|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
|
Professional
|
Both
|
$103.85
|
|
|
Service Code
|
HCPCS 62367
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$61.63 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.54
|
| Rate for Payer: Healthfirst Commercial |
$27.39
|
| Rate for Payer: Healthfirst Essential Plan |
$61.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.02
|
| Rate for Payer: Healthfirst QHP |
$27.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.54
|
| Rate for Payer: SOMOS Essential |
$20.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.39
|
|
|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL
|
Professional
|
Both
|
$146.06
|
|
|
Service Code
|
HCPCS 62369
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$86.98 |
| Rate for Payer: Cash Price |
$39.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.00
|
| Rate for Payer: Healthfirst Commercial |
$38.66
|
| Rate for Payer: Healthfirst Essential Plan |
$86.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.73
|
| Rate for Payer: Healthfirst QHP |
$38.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.00
|
| Rate for Payer: SOMOS Essential |
$29.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.66
|
|
|
PR ELECTRICAL STIMULATION BONE HEALING INVASIVE
|
Professional
|
Both
|
$786.70
|
|
|
Service Code
|
HCPCS 20975
|
| Min. Negotiated Rate |
$150.21 |
| Max. Negotiated Rate |
$482.81 |
| Rate for Payer: Cash Price |
$212.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$214.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.94
|
| Rate for Payer: Healthfirst Commercial |
$214.58
|
| Rate for Payer: Healthfirst Essential Plan |
$482.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.85
|
| Rate for Payer: Healthfirst QHP |
$214.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.94
|
| Rate for Payer: SOMOS Essential |
$160.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.58
|
|
|
PR ELECTRICAL STIMULATION BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$229.11
|
|
|
Service Code
|
HCPCS 20974
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$139.30 |
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.43
|
| Rate for Payer: Healthfirst Commercial |
$61.91
|
| Rate for Payer: Healthfirst Essential Plan |
$139.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.81
|
| Rate for Payer: Healthfirst QHP |
$61.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.43
|
| Rate for Payer: SOMOS Essential |
$46.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.91
|
|
|
PR ELECTRICAL STIMULATION GUID W/CHEMODENERVATION
|
Professional
|
Both
|
$76.41
|
|
|
Service Code
|
HCPCS 95873 26
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Cash Price |
$20.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.55
|
| Rate for Payer: Healthfirst Commercial |
$20.74
|
| Rate for Payer: Healthfirst Essential Plan |
$46.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.70
|
| Rate for Payer: Healthfirst QHP |
$20.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.55
|
| Rate for Payer: SOMOS Essential |
$15.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.74
|
|
|
PR ELECTRICAL STIMULATION GUID W/CHEMODENERVATION
|
Professional
|
Both
|
$227.12
|
|
|
Service Code
|
HCPCS 95873 TC
|
| Min. Negotiated Rate |
$39.94 |
| Max. Negotiated Rate |
$128.38 |
| Rate for Payer: Cash Price |
$60.51
|
| 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
|
|
|
PR ELECTRICAL STIMULATION GUID W/CHEMODENERVATION
|
Professional
|
Both
|
$303.52
|
|
|
Service Code
|
HCPCS 95873
|
| Min. Negotiated Rate |
$54.46 |
| Max. Negotiated Rate |
$175.05 |
| Rate for Payer: Cash Price |
$81.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.35
|
| Rate for Payer: Healthfirst Commercial |
$77.80
|
| Rate for Payer: Healthfirst Essential Plan |
$175.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.91
|
| Rate for Payer: Healthfirst QHP |
$77.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.35
|
| Rate for Payer: SOMOS Essential |
$58.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.80
|
|
|
PR ELECTROCOCHLEOGRAPHY
|
Professional
|
Both
|
$472.57
|
|
|
Service Code
|
HCPCS 92584
|
| Min. Negotiated Rate |
$85.62 |
| Max. Negotiated Rate |
$275.22 |
| Rate for Payer: Cash Price |
$126.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.74
|
| Rate for Payer: Healthfirst Commercial |
$122.32
|
| Rate for Payer: Healthfirst Essential Plan |
$275.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.20
|
| Rate for Payer: Healthfirst QHP |
$122.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.74
|
| Rate for Payer: SOMOS Essential |
$91.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.32
|
|
|
PR ELECTROCONVULSIVE THERAPY
|
Professional
|
Both
|
$413.81
|
|
|
Service Code
|
HCPCS 90870
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$253.10 |
| Rate for Payer: Amida Care Medicaid |
$45.45
|
| Rate for Payer: Cash Price |
$113.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.37
|
| Rate for Payer: Healthfirst Commercial |
$112.49
|
| Rate for Payer: Healthfirst Essential Plan |
$253.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.87
|
| Rate for Payer: Healthfirst QHP |
$112.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.37
|
| Rate for Payer: SOMOS Essential |
$84.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.49
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$7,558.88
|
|
|
Service Code
|
HCPCS 95829
|
| Min. Negotiated Rate |
$1,040.84 |
| Max. Negotiated Rate |
$4,517.28 |
| Rate for Payer: Amida Care Medicaid |
$1,040.84
|
| Rate for Payer: Cash Price |
$2,069.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,007.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,806.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,806.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,907.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,007.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,907.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,007.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,007.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,505.76
|
| Rate for Payer: Healthfirst Commercial |
$2,007.68
|
| Rate for Payer: Healthfirst Essential Plan |
$4,517.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,907.30
|
| Rate for Payer: Healthfirst QHP |
$2,007.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,405.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,007.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,706.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,405.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,007.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,505.76
|
| Rate for Payer: SOMOS Essential |
$1,505.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,007.68
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$1,327.31
|
|
|
Service Code
|
HCPCS 95829 26
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$1,040.84 |
| Rate for Payer: Amida Care Medicaid |
$1,040.84
|
| Rate for Payer: Cash Price |
$360.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$355.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.78
|
| Rate for Payer: Healthfirst Commercial |
$355.71
|
| Rate for Payer: Healthfirst Essential Plan |
$800.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.92
|
| Rate for Payer: Healthfirst QHP |
$355.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.78
|
| Rate for Payer: SOMOS Essential |
$266.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.71
|
|
|
PR ELECTROCORTICOGRAM SURGERY SPX
|
Professional
|
Both
|
$6,231.58
|
|
|
Service Code
|
HCPCS 95829 TC
|
| Min. Negotiated Rate |
$1,040.84 |
| Max. Negotiated Rate |
$3,716.93 |
| Rate for Payer: Amida Care Medicaid |
$1,040.84
|
| Rate for Payer: Cash Price |
$1,708.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,651.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,486.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,486.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,651.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,651.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,651.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,238.98
|
| Rate for Payer: Healthfirst Commercial |
$1,651.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,716.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,569.37
|
| Rate for Payer: Healthfirst QHP |
$1,651.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,156.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,651.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,404.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,156.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,651.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,238.98
|
| Rate for Payer: SOMOS Essential |
$1,238.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,651.97
|
|
|
PR ELECTROEJACULATION
|
Professional
|
Both
|
$586.36
|
|
|
Service Code
|
HCPCS 55870
|
| Min. Negotiated Rate |
$111.87 |
| Max. Negotiated Rate |
$359.60 |
| Rate for Payer: Cash Price |
$161.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$159.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.86
|
| Rate for Payer: Healthfirst Commercial |
$159.82
|
| Rate for Payer: Healthfirst Essential Plan |
$359.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.83
|
| Rate for Payer: Healthfirst QHP |
$159.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.86
|
| Rate for Payer: SOMOS Essential |
$119.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.82
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$534.03
|
|
|
Service Code
|
HCPCS 95824
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$95.89 |
| Rate for Payer: Amida Care Medicaid |
$95.89
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$378.67
|
|
|
Service Code
|
HCPCS 95824 TC
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$95.89 |
| Rate for Payer: Amida Care Medicaid |
$95.89
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$155.37
|
|
|
Service Code
|
HCPCS 95824 26
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$95.89 |
| Rate for Payer: Amida Care Medicaid |
$95.89
|
| Rate for Payer: Cash Price |
$42.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.99
|
| Rate for Payer: Healthfirst Commercial |
$41.32
|
| Rate for Payer: Healthfirst Essential Plan |
$92.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.25
|
| Rate for Payer: Healthfirst QHP |
$41.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.99
|
| Rate for Payer: SOMOS Essential |
$30.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.32
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,251.50
|
|
|
Service Code
|
HCPCS 95812 TC
|
| Min. Negotiated Rate |
$187.04 |
| Max. Negotiated Rate |
$767.14 |
| Rate for Payer: Amida Care Medicaid |
$187.04
|
| Rate for Payer: Cash Price |
$348.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$340.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.71
|
| Rate for Payer: Healthfirst Commercial |
$340.95
|
| Rate for Payer: Healthfirst Essential Plan |
$767.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.90
|
| Rate for Payer: Healthfirst QHP |
$340.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$255.71
|
| Rate for Payer: SOMOS Essential |
$255.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.95
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$222.39
|
|
|
Service Code
|
HCPCS 95812 26
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$187.04 |
| Rate for Payer: Amida Care Medicaid |
$187.04
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.48
|
| Rate for Payer: Healthfirst Commercial |
$60.64
|
| Rate for Payer: Healthfirst Essential Plan |
$136.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.61
|
| Rate for Payer: Healthfirst QHP |
$60.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.48
|
| Rate for Payer: SOMOS Essential |
$45.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.64
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$1,473.89
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$187.04 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: Amida Care Medicaid |
$187.04
|
| Rate for Payer: Cash Price |
$410.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.19
|
| Rate for Payer: Healthfirst Commercial |
$401.58
|
| Rate for Payer: Healthfirst Essential Plan |
$903.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.50
|
| Rate for Payer: Healthfirst QHP |
$401.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.19
|
| Rate for Payer: SOMOS Essential |
$301.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.58
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$223.83
|
|
|
Service Code
|
HCPCS 95822 26
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$190.41 |
| Rate for Payer: Amida Care Medicaid |
$190.41
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.48
|
| Rate for Payer: Healthfirst Commercial |
$60.64
|
| Rate for Payer: Healthfirst Essential Plan |
$136.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.61
|
| Rate for Payer: Healthfirst QHP |
$60.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.48
|
| Rate for Payer: SOMOS Essential |
$45.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.64
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,553.37
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Min. Negotiated Rate |
$190.41 |
| Max. Negotiated Rate |
$949.66 |
| Rate for Payer: Amida Care Medicaid |
$190.41
|
| Rate for Payer: Cash Price |
$422.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$379.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.55
|
| Rate for Payer: Healthfirst Commercial |
$422.07
|
| Rate for Payer: Healthfirst Essential Plan |
$949.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.97
|
| Rate for Payer: Healthfirst QHP |
$422.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$358.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.55
|
| Rate for Payer: SOMOS Essential |
$316.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.07
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$1,777.23
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$190.41 |
| Max. Negotiated Rate |
$1,086.10 |
| Rate for Payer: Amida Care Medicaid |
$190.41
|
| Rate for Payer: Cash Price |
$484.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$482.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$434.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$458.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$482.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$458.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.03
|
| Rate for Payer: Healthfirst Commercial |
$482.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,086.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$458.57
|
| Rate for Payer: Healthfirst QHP |
$482.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$482.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$482.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.03
|
| Rate for Payer: SOMOS Essential |
$362.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$482.71
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,675.56
|
|
|
Service Code
|
HCPCS 95819 TC
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Amida Care Medicaid |
$174.02
|
| Rate for Payer: Cash Price |
$472.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$415.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$415.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$438.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$438.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.42
|
| Rate for Payer: Healthfirst Commercial |
$461.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,039.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$438.80
|
| Rate for Payer: Healthfirst QHP |
$461.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$392.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.42
|
| Rate for Payer: SOMOS Essential |
$346.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.89
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$222.39
|
|
|
Service Code
|
HCPCS 95819 26
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$174.02 |
| Rate for Payer: Amida Care Medicaid |
$174.02
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.48
|
| Rate for Payer: Healthfirst Commercial |
$60.64
|
| Rate for Payer: Healthfirst Essential Plan |
$136.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.61
|
| Rate for Payer: Healthfirst QHP |
$60.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.48
|
| Rate for Payer: SOMOS Essential |
$45.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.64
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$1,897.98
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$1,175.69 |
| Rate for Payer: Amida Care Medicaid |
$174.02
|
| Rate for Payer: Cash Price |
$534.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$522.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$470.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$470.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$496.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$522.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$496.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$522.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$522.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$391.90
|
| Rate for Payer: Healthfirst Commercial |
$522.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,175.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$496.40
|
| Rate for Payer: Healthfirst QHP |
$522.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$365.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$522.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$444.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$365.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$522.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$391.90
|
| Rate for Payer: SOMOS Essential |
$391.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$522.53
|
|
