|
EAPG 538: HEAD TRAUMA WITH LOC/COMA MORE THEN 1 HR
|
Facility
|
OP
|
$271.51
|
|
|
Service Code
|
EAPG 0538
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$271.51 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.67
|
| Rate for Payer: CDPHP Essential Plan |
$271.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.67
|
| Rate for Payer: EmblemHealth Medicaid |
$120.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.51
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$259.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$259.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.70
|
|
|
EAPG 539: INTRACRANIAL HEMORRHAGE
|
Facility
|
OP
|
$277.63
|
|
|
Service Code
|
EAPG 0539
|
| Min. Negotiated Rate |
$123.39 |
| Max. Negotiated Rate |
$277.63 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$277.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$123.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$123.39
|
| Rate for Payer: CDPHP Essential Plan |
$277.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$123.39
|
| Rate for Payer: EmblemHealth Medicaid |
$123.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$277.63
|
| Rate for Payer: Hamaspik Choice Medicaid |
$123.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$123.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$265.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$265.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$123.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$129.56
|
|
|
EAPG 53: SPINE INJECTIONS AND OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$1,105.90
|
|
|
Service Code
|
EAPG 0053
|
| Min. Negotiated Rate |
$491.51 |
| Max. Negotiated Rate |
$1,105.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,105.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$491.51
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$491.51
|
| Rate for Payer: CDPHP Essential Plan |
$1,105.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$589.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$491.51
|
| Rate for Payer: EmblemHealth Medicaid |
$491.51
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,105.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$491.51
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$491.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,056.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,056.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$491.51
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$516.09
|
|
|
EAPG 545: PERIPHERAL, CRANIAL, AND AUTONOMIC NERVE INJURIES
|
Facility
|
OP
|
$267.08
|
|
|
Service Code
|
EAPG 0545
|
| Min. Negotiated Rate |
$118.70 |
| Max. Negotiated Rate |
$267.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$267.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$118.70
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$118.70
|
| Rate for Payer: CDPHP Essential Plan |
$267.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.70
|
| Rate for Payer: EmblemHealth Medicaid |
$118.70
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$267.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$118.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$118.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$255.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$255.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$124.64
|
|
|
EAPG 548: PERIPHERAL AND OTHER VASCULAR RELATED INJURIES
|
Facility
|
OP
|
$284.24
|
|
|
Service Code
|
EAPG 0548
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$284.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$284.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.33
|
| Rate for Payer: CDPHP Essential Plan |
$284.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.33
|
| Rate for Payer: EmblemHealth Medicaid |
$126.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$284.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.65
|
|
|
EAPG 54: FIXATION DEVICE INSERTION OR REPLACEMENT PROCEDURES
|
Facility
|
OP
|
$3,418.54
|
|
|
Service Code
|
EAPG 0054
|
| Min. Negotiated Rate |
$1,519.35 |
| Max. Negotiated Rate |
$3,418.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,418.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,519.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,519.35
|
| Rate for Payer: CDPHP Essential Plan |
$3,418.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,823.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,519.35
|
| Rate for Payer: EmblemHealth Medicaid |
$1,519.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,418.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,519.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,519.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,266.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,266.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,519.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,595.32
|
|
|
EAPG 550: ACUTE MAJOR EYE INFECTIONS
|
Facility
|
OP
|
$238.48
|
|
|
Service Code
|
EAPG 0550
|
| Min. Negotiated Rate |
$105.99 |
| Max. Negotiated Rate |
$238.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$238.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$105.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$105.99
|
| Rate for Payer: CDPHP Essential Plan |
$238.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.99
|
| Rate for Payer: EmblemHealth Medicaid |
$105.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$238.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$105.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$105.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$227.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$227.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.29
|
|
|
EAPG 551: CATARACTS
|
Facility
|
OP
|
$249.86
|
|
|
Service Code
|
EAPG 0551
|
| Min. Negotiated Rate |
$111.05 |
| Max. Negotiated Rate |
$249.86 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$249.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.05
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.05
|
| Rate for Payer: CDPHP Essential Plan |
$249.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.05
|
| Rate for Payer: EmblemHealth Medicaid |
$111.05
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$249.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.05
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.05
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.60
|
|
|
EAPG 552: GLAUCOMA
|
Facility
|
OP
|
$247.23
|
|
|
Service Code
|
EAPG 0552
|
| Min. Negotiated Rate |
$109.88 |
| Max. Negotiated Rate |
$247.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$247.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$109.88
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$109.88
|
| Rate for Payer: CDPHP Essential Plan |
$247.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.88
|
| Rate for Payer: EmblemHealth Medicaid |
$109.88
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$247.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$109.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$109.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$236.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$236.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.37
|
|
|
EAPG 553: OTHER OPHTHALMIC SYSTEM DIAGNOSES
|
Facility
|
OP
|
$275.06
|
|
|
Service Code
|
EAPG 0553
|
| Min. Negotiated Rate |
$122.25 |
| Max. Negotiated Rate |
$275.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.25
|
| Rate for Payer: CDPHP Essential Plan |
$275.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.25
|
| Rate for Payer: EmblemHealth Medicaid |
$122.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$275.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$262.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$262.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.36
|
|
|
EAPG 555: CONJUNCTIVITIS
|
Facility
|
OP
|
$232.13
|
|
|
Service Code
|
EAPG 0555
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$232.13 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$232.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$103.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$103.17
|
| Rate for Payer: CDPHP Essential Plan |
$232.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$123.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$103.17
|
| Rate for Payer: EmblemHealth Medicaid |
$103.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$232.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$103.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$103.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$221.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$221.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$103.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$108.33
|
|
|
EAPG 556: OCULAR AND PERIOCULAR MALIGNANCY
|
Facility
|
OP
|
$275.42
|
|
|
Service Code
|
EAPG 0556
|
| Min. Negotiated Rate |
$122.41 |
| Max. Negotiated Rate |
$275.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$275.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.41
|
| Rate for Payer: CDPHP Essential Plan |
$275.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.41
|
| Rate for Payer: EmblemHealth Medicaid |
$122.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$275.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$263.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$263.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.53
|
|
|
EAPG 557: OTHER EYE INFECTION DIAGNOSES
|
Facility
|
OP
|
$275.06
|
|
|
Service Code
|
EAPG 0557
|
| Min. Negotiated Rate |
$122.25 |
| Max. Negotiated Rate |
$275.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.25
|
| Rate for Payer: CDPHP Essential Plan |
$275.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.25
|
| Rate for Payer: EmblemHealth Medicaid |
$122.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$275.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$262.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$262.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.36
|
|
|
EAPG 558: MALFUNCTION, REACTION, OR COMPLICATION OF OCULAR DEVICE OR PROCEDURE
|
Facility
|
OP
|
$308.12
|
|
|
Service Code
|
EAPG 0558
|
| Min. Negotiated Rate |
$136.94 |
| Max. Negotiated Rate |
$308.12 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$308.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$136.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$136.94
|
| Rate for Payer: CDPHP Essential Plan |
$308.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$164.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.94
|
| Rate for Payer: EmblemHealth Medicaid |
$136.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$308.12
|
| Rate for Payer: Hamaspik Choice Medicaid |
$136.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$136.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$294.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$294.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$136.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$143.79
|
|
|
EAPG 55: LEVEL II HIP AND FEMUR PROCEDURES
|
Facility
|
OP
|
$4,373.82
|
|
|
Service Code
|
EAPG 0055
|
| Min. Negotiated Rate |
$1,943.92 |
| Max. Negotiated Rate |
$4,373.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,373.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,943.92
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,943.92
|
| Rate for Payer: CDPHP Essential Plan |
$4,373.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,332.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,943.92
|
| Rate for Payer: EmblemHealth Medicaid |
$1,943.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,373.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,943.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,943.92
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,179.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,179.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,943.92
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,041.12
|
|
|
EAPG 560: EAR, NOSE, MOUTH, THROAT, CRANIAL AND FACIAL MALIGNANCIES
|
Facility
|
OP
|
$274.75
|
|
|
Service Code
|
EAPG 0560
|
| Min. Negotiated Rate |
$122.11 |
| Max. Negotiated Rate |
$274.75 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$274.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.11
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.11
|
| Rate for Payer: CDPHP Essential Plan |
$274.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.11
|
| Rate for Payer: EmblemHealth Medicaid |
$122.11
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$274.75
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.11
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$262.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$262.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.11
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.22
|
|
|
EAPG 561: VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
|
Facility
|
OP
|
$276.26
|
|
|
Service Code
|
EAPG 0561
|
| Min. Negotiated Rate |
$122.78 |
| Max. Negotiated Rate |
$276.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$276.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.78
|
| Rate for Payer: CDPHP Essential Plan |
$276.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$147.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.78
|
| Rate for Payer: EmblemHealth Medicaid |
$122.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$276.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$263.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$263.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.92
|
|
|
EAPG 562: INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA
|
Facility
|
OP
|
$235.01
|
|
|
Service Code
|
EAPG 0562
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$235.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$104.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$104.45
|
| Rate for Payer: CDPHP Essential Plan |
$235.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$125.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.45
|
| Rate for Payer: EmblemHealth Medicaid |
$104.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$235.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$104.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$104.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$224.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$224.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$104.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$109.67
|
|
|
EAPG 563: DENTAL AND ORAL DIAGNOSES AND INJURIES
|
Facility
|
OP
|
$227.27
|
|
|
Service Code
|
EAPG 0563
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$227.27 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$227.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$101.01
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$101.01
|
| Rate for Payer: CDPHP Essential Plan |
$227.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$121.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.01
|
| Rate for Payer: EmblemHealth Medicaid |
$101.01
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$227.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$101.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$101.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$217.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$217.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.01
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$106.06
|
|
|
EAPG 564: OTHER EAR, NOSE, MOUTH, THROAT AND CRANIOFACIAL DIAGNOSES
|
Facility
|
OP
|
$256.64
|
|
|
Service Code
|
EAPG 0564
|
| Min. Negotiated Rate |
$114.06 |
| Max. Negotiated Rate |
$256.64 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$256.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$114.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$114.06
|
| Rate for Payer: CDPHP Essential Plan |
$256.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.06
|
| Rate for Payer: EmblemHealth Medicaid |
$114.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$256.64
|
| Rate for Payer: Hamaspik Choice Medicaid |
$114.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$114.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$245.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$245.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$119.76
|
|
|
EAPG 566: MALFUNCTION, REACTION, OR COMPLICATION OF OTOLARYNGOLOGIC DEVICE OR PROCEDURE
|
Facility
|
OP
|
$279.27
|
|
|
Service Code
|
EAPG 0566
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$279.27 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$279.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.12
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.12
|
| Rate for Payer: CDPHP Essential Plan |
$279.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.12
|
| Rate for Payer: EmblemHealth Medicaid |
$124.12
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$279.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.12
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$266.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$266.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.12
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$130.33
|
|
|
EAPG 568: TRAUMATIC INJURIES
|
Facility
|
OP
|
$299.30
|
|
|
Service Code
|
EAPG 0568
|
| Min. Negotiated Rate |
$133.02 |
| Max. Negotiated Rate |
$299.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$299.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$133.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$133.02
|
| Rate for Payer: CDPHP Essential Plan |
$299.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$133.02
|
| Rate for Payer: EmblemHealth Medicaid |
$133.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$299.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$133.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$133.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$285.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$285.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$133.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$139.67
|
|
|
EAPG 56: SKIN AND CONNECTIVE TISSUE GRAFTING AND FLAP PROCEDURES
|
Facility
|
OP
|
$2,892.82
|
|
|
Service Code
|
EAPG 0056
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$2,892.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,892.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,285.70
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,285.70
|
| Rate for Payer: CDPHP Essential Plan |
$2,892.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,542.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,285.70
|
| Rate for Payer: EmblemHealth Medicaid |
$1,285.70
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,892.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,285.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,285.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,764.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,764.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,285.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,349.98
|
|
|
EAPG 570: CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
EAPG 0570
|
| Min. Negotiated Rate |
$156.89 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$353.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$156.89
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$156.89
|
| Rate for Payer: CDPHP Essential Plan |
$353.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$188.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.89
|
| Rate for Payer: EmblemHealth Medicaid |
$156.89
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$353.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$156.89
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$156.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$337.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$337.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$156.89
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$164.73
|
|
|
EAPG 571: RESPIRATORY MALIGNANCY
|
Facility
|
OP
|
$250.81
|
|
|
Service Code
|
EAPG 0571
|
| Min. Negotiated Rate |
$111.47 |
| Max. Negotiated Rate |
$250.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$250.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.47
|
| Rate for Payer: CDPHP Essential Plan |
$250.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.47
|
| Rate for Payer: EmblemHealth Medicaid |
$111.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$239.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$239.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$117.04
|
|
