|
EAPG 572: BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
OP
|
$226.69
|
|
|
Service Code
|
EAPG 0572
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$226.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$226.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$100.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$100.75
|
| Rate for Payer: CDPHP Essential Plan |
$226.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.75
|
| Rate for Payer: EmblemHealth Medicaid |
$100.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$226.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$100.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$100.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$216.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$216.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$105.79
|
|
|
EAPG 574: CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
OP
|
$242.48
|
|
|
Service Code
|
EAPG 0574
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$242.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$242.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$107.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$107.77
|
| Rate for Payer: CDPHP Essential Plan |
$242.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.77
|
| Rate for Payer: EmblemHealth Medicaid |
$107.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$242.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$107.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.16
|
|
|
EAPG 575: ASTHMA
|
Facility
|
OP
|
$327.69
|
|
|
Service Code
|
EAPG 0575
|
| Min. Negotiated Rate |
$145.64 |
| Max. Negotiated Rate |
$327.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$327.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$145.64
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$145.64
|
| Rate for Payer: CDPHP Essential Plan |
$327.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$145.64
|
| Rate for Payer: EmblemHealth Medicaid |
$145.64
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$327.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$145.64
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$145.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$313.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$313.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$145.64
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$152.92
|
|
|
EAPG 576: OTHER RESPIRATORY SYSTEM DIAGNOSES
|
Facility
|
OP
|
$282.53
|
|
|
Service Code
|
EAPG 0576
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$282.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$282.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.57
|
| Rate for Payer: CDPHP Essential Plan |
$282.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.57
|
| Rate for Payer: EmblemHealth Medicaid |
$125.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$282.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$269.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$269.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.85
|
|
|
EAPG 579: STATUS ASTHMATICUS
|
Facility
|
OP
|
$266.42
|
|
|
Service Code
|
EAPG 0579
|
| Min. Negotiated Rate |
$118.41 |
| Max. Negotiated Rate |
$266.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$266.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$118.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$118.41
|
| Rate for Payer: CDPHP Essential Plan |
$266.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.41
|
| Rate for Payer: EmblemHealth Medicaid |
$118.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$266.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$118.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$118.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$254.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$254.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$124.33
|
|
|
EAPG 57: LEVEL III SPINE PROCEDURES
|
Facility
|
OP
|
$7,809.95
|
|
|
Service Code
|
EAPG 0057
|
| Min. Negotiated Rate |
$3,471.09 |
| Max. Negotiated Rate |
$7,809.95 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,809.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,471.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,471.09
|
| Rate for Payer: CDPHP Essential Plan |
$7,809.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,165.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,471.09
|
| Rate for Payer: EmblemHealth Medicaid |
$3,471.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,809.95
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,471.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,471.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$7,462.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$7,462.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,471.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,644.64
|
|
|
EAPG 580: MAJOR CHEST AND RESPIRATORY TRAUMA
|
Facility
|
OP
|
$309.76
|
|
|
Service Code
|
EAPG 0580
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$309.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$309.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$137.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$137.67
|
| Rate for Payer: CDPHP Essential Plan |
$309.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$165.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$137.67
|
| Rate for Payer: EmblemHealth Medicaid |
$137.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$309.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$137.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$137.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$295.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$295.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$137.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$144.55
|
|
|
EAPG 581: PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA
|
Facility
|
OP
|
$318.76
|
|
|
Service Code
|
EAPG 0581
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$318.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$318.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$141.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$141.67
|
| Rate for Payer: CDPHP Essential Plan |
$318.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$141.67
|
| Rate for Payer: EmblemHealth Medicaid |
$141.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$318.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$141.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$141.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$304.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$304.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$148.75
|
|
|
EAPG 582: INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES
|
Facility
|
OP
|
$340.06
|
|
|
Service Code
|
EAPG 0582
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$340.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$340.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$151.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$151.14
|
| Rate for Payer: CDPHP Essential Plan |
$340.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$181.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$151.14
|
| Rate for Payer: EmblemHealth Medicaid |
$151.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$340.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$151.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$151.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$324.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$324.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$151.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$158.70
|
|
|
EAPG 583: MALFUNCTION, REACTION, OR COMPLICATION OF PULMONARY DEVICE OR PROCEDURE
|
Facility
|
OP
|
$303.21
|
|
|
Service Code
|
EAPG 0583
|
| Min. Negotiated Rate |
$134.76 |
| Max. Negotiated Rate |
$303.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$303.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$134.76
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$134.76
|
| Rate for Payer: CDPHP Essential Plan |
$303.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.76
|
| Rate for Payer: EmblemHealth Medicaid |
$134.76
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$303.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$134.76
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$134.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$289.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$289.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$134.76
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$141.50
|
|
|
EAPG 584: ACUTE BRONCHITIS
|
Facility
|
OP
|
$302.78
|
|
|
Service Code
|
EAPG 0584
|
| Min. Negotiated Rate |
$134.57 |
| Max. Negotiated Rate |
$302.78 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$302.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$134.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$134.57
|
| Rate for Payer: CDPHP Essential Plan |
$302.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.57
|
| Rate for Payer: EmblemHealth Medicaid |
$134.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$302.78
|
| Rate for Payer: Hamaspik Choice Medicaid |
$134.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$134.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$289.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$289.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$134.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$141.30
|
|
|
EAPG 585: AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES
|
Facility
|
OP
|
$312.75
|
|
|
Service Code
|
EAPG 0585
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$312.75 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$312.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$139.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$139.00
|
| Rate for Payer: CDPHP Essential Plan |
$312.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$166.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.00
|
| Rate for Payer: EmblemHealth Medicaid |
$139.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$312.75
|
| Rate for Payer: Hamaspik Choice Medicaid |
$139.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$139.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$298.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$298.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$139.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$145.95
|
|
|
EAPG 586: PULMONARY EMBOLISM
|
Facility
|
OP
|
$294.77
|
|
|
Service Code
|
EAPG 0586
|
| Min. Negotiated Rate |
$131.01 |
| Max. Negotiated Rate |
$294.77 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$294.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$131.01
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$131.01
|
| Rate for Payer: CDPHP Essential Plan |
$294.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$157.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.01
|
| Rate for Payer: EmblemHealth Medicaid |
$131.01
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$294.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$131.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$131.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$281.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$281.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$131.01
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$137.56
|
|
|
EAPG 587: RESPIRATORY FAILURE
|
Facility
|
OP
|
$282.56
|
|
|
Service Code
|
EAPG 0587
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$282.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$282.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.58
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.58
|
| Rate for Payer: CDPHP Essential Plan |
$282.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.58
|
| Rate for Payer: EmblemHealth Medicaid |
$125.58
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$282.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.58
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$270.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$270.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.58
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.86
|
|
|
EAPG 589: MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC
|
Facility
|
OP
|
$299.23
|
|
|
Service Code
|
EAPG 0589
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$299.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$299.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$132.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$132.99
|
| Rate for Payer: CDPHP Essential Plan |
$299.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$159.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.99
|
| Rate for Payer: EmblemHealth Medicaid |
$132.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$299.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$132.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$132.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$285.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$285.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$139.64
|
|
|
EAPG 58: LEVEL II SHOULDER AND UPPER ARM PROCEDURES
|
Facility
|
OP
|
$4,546.48
|
|
|
Service Code
|
EAPG 0058
|
| Min. Negotiated Rate |
$2,020.66 |
| Max. Negotiated Rate |
$4,546.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,546.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,020.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,020.66
|
| Rate for Payer: CDPHP Essential Plan |
$4,546.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,424.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,020.66
|
| Rate for Payer: EmblemHealth Medicaid |
$2,020.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,546.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,020.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,020.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,344.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,344.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,020.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,121.69
|
|
|
EAPG 591: ACUTE MYOCARDIAL INFARCTION
|
Facility
|
OP
|
$538.92
|
|
|
Service Code
|
EAPG 0591
|
| Min. Negotiated Rate |
$239.52 |
| Max. Negotiated Rate |
$538.92 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$538.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$239.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$239.52
|
| Rate for Payer: CDPHP Essential Plan |
$538.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$287.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$239.52
|
| Rate for Payer: EmblemHealth Medicaid |
$239.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$538.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$239.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$239.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$514.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$514.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$239.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$251.50
|
|
|
EAPG 592: OTHER CARDIOVASCULAR SYSTEM DIAGNOSES
|
Facility
|
OP
|
$260.01
|
|
|
Service Code
|
EAPG 0592
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$260.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$260.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$115.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$115.56
|
| Rate for Payer: CDPHP Essential Plan |
$260.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$138.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$115.56
|
| Rate for Payer: EmblemHealth Medicaid |
$115.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$260.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$115.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$115.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$248.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$248.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$115.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$121.34
|
|
|
EAPG 594: HEART FAILURE
|
Facility
|
OP
|
$275.83
|
|
|
Service Code
|
EAPG 0594
|
| Min. Negotiated Rate |
$122.59 |
| Max. Negotiated Rate |
$275.83 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$275.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.59
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.59
|
| Rate for Payer: CDPHP Essential Plan |
$275.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$147.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.59
|
| Rate for Payer: EmblemHealth Medicaid |
$122.59
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$275.83
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.59
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$263.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$263.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.72
|
|
|
EAPG 595: CARDIAC ARREST OR OTHER CAUSES OF MORTALITY
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
EAPG 0595
|
| Min. Negotiated Rate |
$264.89 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$596.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$264.89
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$264.89
|
| Rate for Payer: CDPHP Essential Plan |
$596.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$317.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$264.89
|
| Rate for Payer: EmblemHealth Medicaid |
$264.89
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$596.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$264.89
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$264.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$569.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$569.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$264.89
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$278.13
|
|
|
EAPG 596: PERIPHERAL AND OTHER VASCULAR DIAGNOSES
|
Facility
|
OP
|
$276.52
|
|
|
Service Code
|
EAPG 0596
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$276.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.90
|
| Rate for Payer: CDPHP Essential Plan |
$276.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$147.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.90
|
| Rate for Payer: EmblemHealth Medicaid |
$122.90
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$276.52
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$264.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$264.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.90
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$129.04
|
|
|
EAPG 597: PHLEBITIS
|
Facility
|
OP
|
$240.05
|
|
|
Service Code
|
EAPG 0597
|
| Min. Negotiated Rate |
$106.69 |
| Max. Negotiated Rate |
$240.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$240.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.69
|
| Rate for Payer: CDPHP Essential Plan |
$240.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.69
|
| Rate for Payer: EmblemHealth Medicaid |
$106.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$240.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$229.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$229.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.02
|
|
|
EAPG 598: ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
OP
|
$252.83
|
|
|
Service Code
|
EAPG 0598
|
| 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 599: HYPERTENSION
|
Facility
|
OP
|
$237.24
|
|
|
Service Code
|
EAPG 0599
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$237.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$237.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$105.44
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$105.44
|
| Rate for Payer: CDPHP Essential Plan |
$237.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.44
|
| Rate for Payer: EmblemHealth Medicaid |
$105.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$237.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$105.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$105.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$226.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$226.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$110.71
|
|
|
EAPG 59: ARTERIOVENOUS FISTULA CREATION OR REVISION FOR HEMODIALYSIS
|
Facility
|
OP
|
$5,065.38
|
|
|
Service Code
|
EAPG 0059
|
| Min. Negotiated Rate |
$2,251.28 |
| Max. Negotiated Rate |
$5,065.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,065.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,251.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,251.28
|
| Rate for Payer: CDPHP Essential Plan |
$5,065.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,701.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,251.28
|
| Rate for Payer: EmblemHealth Medicaid |
$2,251.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,065.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,251.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,251.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,840.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,840.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,251.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,363.84
|
|
