|
EAPG 49: LEVEL I JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES
|
Facility
|
OP
|
$584.91
|
|
|
Service Code
|
EAPG 0049
|
| Min. Negotiated Rate |
$259.96 |
| Max. Negotiated Rate |
$584.91 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$584.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$259.96
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$259.96
|
| Rate for Payer: CDPHP Essential Plan |
$584.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$311.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$259.96
|
| Rate for Payer: EmblemHealth Medicaid |
$259.96
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$584.91
|
| Rate for Payer: Hamaspik Choice Medicaid |
$259.96
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$259.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$558.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$558.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$259.96
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$272.96
|
|
|
EAPG 4: LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX
|
Facility
|
OP
|
$1,215.68
|
|
|
Service Code
|
EAPG 0004
|
| Min. Negotiated Rate |
$540.30 |
| Max. Negotiated Rate |
$1,215.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,215.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$540.30
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$540.30
|
| Rate for Payer: CDPHP Essential Plan |
$1,215.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$648.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$540.30
|
| Rate for Payer: EmblemHealth Medicaid |
$540.30
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,215.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$540.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$540.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,161.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,161.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$540.30
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$567.32
|
|
|
EAPG 50: LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES
|
Facility
|
OP
|
$1,061.46
|
|
|
Service Code
|
EAPG 0050
|
| Min. Negotiated Rate |
$471.76 |
| Max. Negotiated Rate |
$1,061.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,061.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$471.76
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$471.76
|
| Rate for Payer: CDPHP Essential Plan |
$1,061.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$566.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$471.76
|
| Rate for Payer: EmblemHealth Medicaid |
$471.76
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,061.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$471.76
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$471.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,014.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,014.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$471.76
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$495.35
|
|
|
EAPG 510: MAJOR SIGNS, SYMPTOMS AND FINDINGS
|
Facility
|
OP
|
$296.30
|
|
|
Service Code
|
EAPG 0510
|
| Min. Negotiated Rate |
$131.69 |
| Max. Negotiated Rate |
$296.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$296.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$131.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$131.69
|
| Rate for Payer: CDPHP Essential Plan |
$296.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.69
|
| Rate for Payer: EmblemHealth Medicaid |
$131.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$296.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$131.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$131.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$283.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$283.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$131.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$138.27
|
|
|
EAPG 518: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
OP
|
$285.03
|
|
|
Service Code
|
EAPG 0518
|
| Min. Negotiated Rate |
$126.68 |
| Max. Negotiated Rate |
$285.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$285.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.68
|
| Rate for Payer: CDPHP Essential Plan |
$285.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.68
|
| Rate for Payer: EmblemHealth Medicaid |
$126.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$285.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$272.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$272.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$133.01
|
|
|
EAPG 519: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
OP
|
$283.77
|
|
|
Service Code
|
EAPG 0519
|
| Min. Negotiated Rate |
$126.12 |
| Max. Negotiated Rate |
$283.77 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$283.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.12
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.12
|
| Rate for Payer: CDPHP Essential Plan |
$283.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.12
|
| Rate for Payer: EmblemHealth Medicaid |
$126.12
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$283.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.12
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.12
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.43
|
|
|
EAPG 51: MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES
|
Facility
|
OP
|
$2,142.25
|
|
|
Service Code
|
EAPG 0051
|
| Min. Negotiated Rate |
$952.11 |
| Max. Negotiated Rate |
$2,142.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,142.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$952.11
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$952.11
|
| Rate for Payer: CDPHP Essential Plan |
$2,142.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,142.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$952.11
|
| Rate for Payer: EmblemHealth Medicaid |
$952.11
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,142.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$952.11
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$952.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,047.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,047.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$952.11
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$999.72
|
|
|
EAPG 520: SPINAL DIAGNOSES AND INJURIES
|
Facility
|
OP
|
$284.42
|
|
|
Service Code
|
EAPG 0520
|
| Min. Negotiated Rate |
$126.41 |
| Max. Negotiated Rate |
$284.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$284.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.41
|
| Rate for Payer: CDPHP Essential Plan |
$284.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.41
|
| Rate for Payer: EmblemHealth Medicaid |
$126.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$284.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.73
|
|
|
EAPG 521: NERVOUS SYSTEM MALIGNANCY
|
Facility
|
OP
|
$264.28
|
|
|
Service Code
|
EAPG 0521
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$264.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$264.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.46
|
| Rate for Payer: CDPHP Essential Plan |
$264.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.46
|
| Rate for Payer: EmblemHealth Medicaid |
$117.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$264.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.33
|
|
|
EAPG 522: DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS
|
Facility
|
OP
|
$264.26
|
|
|
Service Code
|
EAPG 0522
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$264.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$264.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.45
|
| Rate for Payer: CDPHP Essential Plan |
$264.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.45
|
| Rate for Payer: EmblemHealth Medicaid |
$117.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$264.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.32
|
|
|
EAPG 523: MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES
|
Facility
|
OP
|
$243.81
|
|
|
Service Code
|
EAPG 0523
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$243.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$243.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.36
|
| Rate for Payer: CDPHP Essential Plan |
$243.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$130.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.36
|
| Rate for Payer: EmblemHealth Medicaid |
$108.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$243.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$232.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$232.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.78
|
|
|
EAPG 524: OTHER CENTRAL NERVOUS SYSTEM DIAGNOSES
|
Facility
|
OP
|
$248.78
|
|
|
Service Code
|
EAPG 0524
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$248.78 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$248.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.57
|
| Rate for Payer: CDPHP Essential Plan |
$248.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.57
|
| Rate for Payer: EmblemHealth Medicaid |
$110.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$248.78
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$237.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$237.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.10
|
|
|
EAPG 526: TRANSIENT ISCHEMIA
|
Facility
|
OP
|
$243.38
|
|
|
Service Code
|
EAPG 0526
|
| Min. Negotiated Rate |
$108.17 |
| Max. Negotiated Rate |
$243.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$243.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.17
|
| Rate for Payer: CDPHP Essential Plan |
$243.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.17
|
| Rate for Payer: EmblemHealth Medicaid |
$108.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$243.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$232.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$232.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.58
|
|
|
EAPG 527: PERIPHERAL AND CRANIAL NERVE DIAGNOSES
|
Facility
|
OP
|
$252.83
|
|
|
Service Code
|
EAPG 0527
|
| Min. Negotiated Rate |
$112.37 |
| Max. Negotiated Rate |
$252.83 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$252.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$112.37
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$112.37
|
| Rate for Payer: CDPHP Essential Plan |
$252.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$134.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.37
|
| Rate for Payer: EmblemHealth Medicaid |
$112.37
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$252.83
|
| Rate for Payer: Hamaspik Choice Medicaid |
$112.37
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$241.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$241.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$112.37
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$117.99
|
|
|
EAPG 528: NONTRAUMATIC STUPOR & COMA
|
Facility
|
OP
|
$306.29
|
|
|
Service Code
|
EAPG 0528
|
| Min. Negotiated Rate |
$136.13 |
| Max. Negotiated Rate |
$306.29 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$306.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$136.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$136.13
|
| Rate for Payer: CDPHP Essential Plan |
$306.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.13
|
| Rate for Payer: EmblemHealth Medicaid |
$136.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$306.29
|
| Rate for Payer: Hamaspik Choice Medicaid |
$136.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$136.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$292.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$292.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$136.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$142.94
|
|
|
EAPG 529: SEIZURE
|
Facility
|
OP
|
$285.28
|
|
|
Service Code
|
EAPG 0529
|
| Min. Negotiated Rate |
$126.79 |
| Max. Negotiated Rate |
$285.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$285.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.79
|
| Rate for Payer: CDPHP Essential Plan |
$285.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.79
|
| Rate for Payer: EmblemHealth Medicaid |
$126.79
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$285.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.79
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$272.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$272.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.79
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$133.13
|
|
|
EAPG 52: LEVEL II KNEE AND LOWER LEG PROCEDURES
|
Facility
|
OP
|
$3,991.79
|
|
|
Service Code
|
EAPG 0052
|
| Min. Negotiated Rate |
$1,774.13 |
| Max. Negotiated Rate |
$3,991.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,991.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,774.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,774.13
|
| Rate for Payer: CDPHP Essential Plan |
$3,991.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,128.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,774.13
|
| Rate for Payer: EmblemHealth Medicaid |
$1,774.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,991.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,774.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,774.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,814.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,814.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,774.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,862.84
|
|
|
EAPG 530: HEADACHES OTHER THAN MIGRAINE
|
Facility
|
OP
|
$283.90
|
|
|
Service Code
|
EAPG 0530
|
| Min. Negotiated Rate |
$126.18 |
| Max. Negotiated Rate |
$283.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$283.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.18
|
| Rate for Payer: CDPHP Essential Plan |
$283.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.18
|
| Rate for Payer: EmblemHealth Medicaid |
$126.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$283.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.49
|
|
|
EAPG 531: MIGRAINE
|
Facility
|
OP
|
$292.93
|
|
|
Service Code
|
EAPG 0531
|
| Min. Negotiated Rate |
$130.19 |
| Max. Negotiated Rate |
$292.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$292.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.19
|
| Rate for Payer: CDPHP Essential Plan |
$292.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.19
|
| Rate for Payer: EmblemHealth Medicaid |
$130.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$292.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$279.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$279.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.70
|
|
|
EAPG 532: HEAD TRAUMA
|
Facility
|
OP
|
$271.48
|
|
|
Service Code
|
EAPG 0532
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$271.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.66
|
| Rate for Payer: CDPHP Essential Plan |
$271.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.66
|
| Rate for Payer: EmblemHealth Medicaid |
$120.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$259.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$259.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.69
|
|
|
EAPG 533: AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
|
Facility
|
OP
|
$250.67
|
|
|
Service Code
|
EAPG 0533
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$250.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$250.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.41
|
| Rate for Payer: CDPHP Essential Plan |
$250.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.41
|
| Rate for Payer: EmblemHealth Medicaid |
$111.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$239.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$239.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.98
|
|
|
EAPG 534: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION W/O INFARC
|
Facility
|
OP
|
$249.66
|
|
|
Service Code
|
EAPG 0534
|
| Min. Negotiated Rate |
$110.96 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$249.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.96
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.96
|
| Rate for Payer: CDPHP Essential Plan |
$249.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.96
|
| Rate for Payer: EmblemHealth Medicaid |
$110.96
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$249.66
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.96
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.96
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.51
|
|
|
EAPG 535: CVA AND PRECEREBRAL OCCLUSION W INFARCT
|
Facility
|
OP
|
$249.12
|
|
|
Service Code
|
EAPG 0535
|
| Min. Negotiated Rate |
$110.72 |
| Max. Negotiated Rate |
$249.12 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$249.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.72
|
| Rate for Payer: CDPHP Essential Plan |
$249.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.72
|
| Rate for Payer: EmblemHealth Medicaid |
$110.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$249.12
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.26
|
|
|
EAPG 536: CEREBRAL PALSY
|
Facility
|
OP
|
$300.67
|
|
|
Service Code
|
EAPG 0536
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$300.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$300.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$133.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$133.63
|
| Rate for Payer: CDPHP Essential Plan |
$300.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$133.63
|
| Rate for Payer: EmblemHealth Medicaid |
$133.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$300.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$133.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$133.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$287.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$287.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$133.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$140.31
|
|
|
EAPG 537: MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC
|
Facility
|
OP
|
$257.40
|
|
|
Service Code
|
EAPG 0537
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$257.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$114.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$114.40
|
| Rate for Payer: CDPHP Essential Plan |
$257.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$137.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.40
|
| Rate for Payer: EmblemHealth Medicaid |
$114.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$257.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$114.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$114.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$245.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$245.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$120.12
|
|
