|
EAPG 5: NAIL PROCEDURES
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
EAPG 0005
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$183.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$81.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$81.40
|
| Rate for Payer: CDPHP Essential Plan |
$183.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$97.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$81.40
|
| Rate for Payer: EmblemHealth Medicaid |
$81.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$183.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$81.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$81.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$175.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$175.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$81.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$85.47
|
|
|
EAPG 600: CARDIAC STRUCTURAL AND VALVULAR DIAGNOSES
|
Facility
|
OP
|
$316.06
|
|
|
Service Code
|
EAPG 0600
|
| Min. Negotiated Rate |
$140.47 |
| Max. Negotiated Rate |
$316.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$316.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$140.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$140.47
|
| Rate for Payer: CDPHP Essential Plan |
$316.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.47
|
| Rate for Payer: EmblemHealth Medicaid |
$140.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$316.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$140.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$140.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$302.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$302.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$140.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$147.49
|
|
|
EAPG 601: CARDIAC ARRHYTHMIA AND CONDUCTION DIAGNOSES
|
Facility
|
OP
|
$283.72
|
|
|
Service Code
|
EAPG 0601
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$283.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$283.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.10
|
| Rate for Payer: CDPHP Essential Plan |
$283.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.10
|
| Rate for Payer: EmblemHealth Medicaid |
$126.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$283.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.40
|
|
|
EAPG 602: ATRIAL FIBRILLATION
|
Facility
|
OP
|
$255.06
|
|
|
Service Code
|
EAPG 0602
|
| Min. Negotiated Rate |
$113.36 |
| Max. Negotiated Rate |
$255.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$255.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.36
|
| Rate for Payer: CDPHP Essential Plan |
$255.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.36
|
| Rate for Payer: EmblemHealth Medicaid |
$113.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$255.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$119.03
|
|
|
EAPG 604: CHEST PAIN
|
Facility
|
OP
|
$334.17
|
|
|
Service Code
|
EAPG 0604
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$334.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$148.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$148.52
|
| Rate for Payer: CDPHP Essential Plan |
$334.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.52
|
| Rate for Payer: EmblemHealth Medicaid |
$148.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$334.17
|
| Rate for Payer: Hamaspik Choice Medicaid |
$148.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$148.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$319.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$319.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$155.95
|
|
|
EAPG 605: SYNCOPE AND COLLAPSE
|
Facility
|
OP
|
$300.62
|
|
|
Service Code
|
EAPG 0605
|
| Min. Negotiated Rate |
$133.61 |
| Max. Negotiated Rate |
$300.62 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$300.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$133.61
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$133.61
|
| Rate for Payer: CDPHP Essential Plan |
$300.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$133.61
|
| Rate for Payer: EmblemHealth Medicaid |
$133.61
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$300.62
|
| Rate for Payer: Hamaspik Choice Medicaid |
$133.61
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$133.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$287.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$287.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$133.61
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$140.29
|
|
|
EAPG 607: CARDIOMYOPATHY DIAGNOSES
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
EAPG 0607
|
| Min. Negotiated Rate |
$117.50 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$264.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.50
|
| Rate for Payer: CDPHP Essential Plan |
$264.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$141.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.50
|
| Rate for Payer: EmblemHealth Medicaid |
$117.50
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$264.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.50
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.38
|
|
|
EAPG 608: ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
OP
|
$260.03
|
|
|
Service Code
|
EAPG 0608
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$260.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$260.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$115.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$115.57
|
| Rate for Payer: CDPHP Essential Plan |
$260.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$138.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$115.57
|
| Rate for Payer: EmblemHealth Medicaid |
$115.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$260.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$115.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$115.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$248.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$248.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$115.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$121.35
|
|
|
EAPG 60: PULMONARY FUNCTION TESTS
|
Facility
|
OP
|
$545.31
|
|
|
Service Code
|
EAPG 0060
|
| Min. Negotiated Rate |
$242.36 |
| Max. Negotiated Rate |
$545.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$545.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$242.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$242.36
|
| Rate for Payer: CDPHP Essential Plan |
$545.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$290.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$242.36
|
| Rate for Payer: EmblemHealth Medicaid |
$242.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$545.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$242.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$242.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$521.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$521.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$242.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$254.48
|
|
|
EAPG 610: CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA
|
Facility
|
OP
|
$350.42
|
|
|
Service Code
|
EAPG 0610
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$350.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$350.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$155.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$155.74
|
| Rate for Payer: CDPHP Essential Plan |
$350.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$186.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$155.74
|
| Rate for Payer: EmblemHealth Medicaid |
$155.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$350.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$155.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$155.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$334.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$334.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$155.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$163.53
|
|
|
EAPG 616: DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
OP
|
$268.54
|
|
|
Service Code
|
EAPG 0616
|
| Min. Negotiated Rate |
$119.35 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$268.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$119.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$119.35
|
| Rate for Payer: CDPHP Essential Plan |
$268.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$119.35
|
| Rate for Payer: EmblemHealth Medicaid |
$119.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$268.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$119.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$119.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$256.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$256.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$119.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$125.32
|
|
|
EAPG 617: GASTROINTESTINAL HEMORRHAGE DIAGNOSES
|
Facility
|
OP
|
$273.13
|
|
|
Service Code
|
EAPG 0617
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$273.13 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$273.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.39
|
| Rate for Payer: CDPHP Essential Plan |
$273.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.39
|
| Rate for Payer: EmblemHealth Medicaid |
$121.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$273.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$260.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$260.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.46
|
|
|
EAPG 618: INTESTINAL OBSTRUCTION DIAGNOSES
|
Facility
|
OP
|
$272.45
|
|
|
Service Code
|
EAPG 0618
|
| Min. Negotiated Rate |
$121.09 |
| Max. Negotiated Rate |
$272.45 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$272.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.09
|
| Rate for Payer: CDPHP Essential Plan |
$272.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.09
|
| Rate for Payer: EmblemHealth Medicaid |
$121.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$272.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$260.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$260.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.14
|
|
|
EAPG 619: GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES
|
Facility
|
OP
|
$271.46
|
|
|
Service Code
|
EAPG 0619
|
| Min. Negotiated Rate |
$120.65 |
| Max. Negotiated Rate |
$271.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.65
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.65
|
| Rate for Payer: CDPHP Essential Plan |
$271.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.65
|
| Rate for Payer: EmblemHealth Medicaid |
$120.65
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.65
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$259.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$259.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.65
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.68
|
|
|
EAPG 61: NEEDLE AND CATHETER BIOPSY, ASPIRATION, LAVAGE AND INTUBATION
|
Facility
|
OP
|
$1,203.03
|
|
|
Service Code
|
EAPG 0061
|
| Min. Negotiated Rate |
$534.68 |
| Max. Negotiated Rate |
$1,203.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,203.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$534.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$534.68
|
| Rate for Payer: CDPHP Essential Plan |
$1,203.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$641.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$534.68
|
| Rate for Payer: EmblemHealth Medicaid |
$534.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,203.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$534.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$534.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,149.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,149.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$534.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$561.41
|
|
|
EAPG 620: DIGESTIVE MALIGNANCY
|
Facility
|
OP
|
$229.54
|
|
|
Service Code
|
EAPG 0620
|
| Min. Negotiated Rate |
$102.02 |
| Max. Negotiated Rate |
$229.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$229.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$102.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$102.02
|
| Rate for Payer: CDPHP Essential Plan |
$229.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$102.02
|
| Rate for Payer: EmblemHealth Medicaid |
$102.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$229.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$102.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$102.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$219.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$219.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$107.12
|
|
|
EAPG 621: PEPTIC ULCER AND GASTRITIS
|
Facility
|
OP
|
$311.22
|
|
|
Service Code
|
EAPG 0621
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$311.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$138.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$138.32
|
| Rate for Payer: CDPHP Essential Plan |
$311.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$165.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$138.32
|
| Rate for Payer: EmblemHealth Medicaid |
$138.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$311.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$138.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$138.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$297.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$297.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$138.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$145.24
|
|
|
EAPG 623: ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES
|
Facility
|
OP
|
$247.10
|
|
|
Service Code
|
EAPG 0623
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$247.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$109.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$109.82
|
| Rate for Payer: CDPHP Essential Plan |
$247.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.82
|
| Rate for Payer: EmblemHealth Medicaid |
$109.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$247.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$109.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$109.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$236.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$236.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.31
|
|
|
EAPG 624: OTHER GASTROINTESTINAL SYSTEM DIAGNOSES
|
Facility
|
OP
|
$268.54
|
|
|
Service Code
|
EAPG 0624
|
| Min. Negotiated Rate |
$119.35 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$268.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$119.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$119.35
|
| Rate for Payer: CDPHP Essential Plan |
$268.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$119.35
|
| Rate for Payer: EmblemHealth Medicaid |
$119.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$268.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$119.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$119.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$256.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$256.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$119.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$125.32
|
|
|
EAPG 626: INFLAMMATORY BOWEL DISEASE
|
Facility
|
OP
|
$225.38
|
|
|
Service Code
|
EAPG 0626
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$225.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$225.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$100.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$100.17
|
| Rate for Payer: CDPHP Essential Plan |
$225.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.17
|
| Rate for Payer: EmblemHealth Medicaid |
$100.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$225.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$100.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$100.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$215.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$215.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$105.18
|
|
|
EAPG 627: NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING
|
Facility
|
OP
|
$274.18
|
|
|
Service Code
|
EAPG 0627
|
| Min. Negotiated Rate |
$121.86 |
| Max. Negotiated Rate |
$274.18 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$274.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.86
|
| Rate for Payer: CDPHP Essential Plan |
$274.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.86
|
| Rate for Payer: EmblemHealth Medicaid |
$121.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$274.18
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$262.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$262.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.95
|
|
|
EAPG 628: ABDOMINAL PAIN
|
Facility
|
OP
|
$282.67
|
|
|
Service Code
|
EAPG 0628
|
| Min. Negotiated Rate |
$125.63 |
| Max. Negotiated Rate |
$282.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$282.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.63
|
| Rate for Payer: CDPHP Essential Plan |
$282.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.63
|
| Rate for Payer: EmblemHealth Medicaid |
$125.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$282.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$270.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$270.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.91
|
|
|
EAPG 629: MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE
|
Facility
|
OP
|
$323.60
|
|
|
Service Code
|
EAPG 0629
|
| Min. Negotiated Rate |
$143.82 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$323.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$143.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$143.82
|
| Rate for Payer: CDPHP Essential Plan |
$323.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$143.82
|
| Rate for Payer: EmblemHealth Medicaid |
$143.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$323.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$143.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$143.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$309.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$309.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$143.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$151.01
|
|
|
EAPG 62: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY
|
Facility
|
OP
|
$761.42
|
|
|
Service Code
|
EAPG 0062
|
| Min. Negotiated Rate |
$338.41 |
| Max. Negotiated Rate |
$761.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$761.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$338.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$338.41
|
| Rate for Payer: CDPHP Essential Plan |
$761.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$406.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$338.41
|
| Rate for Payer: EmblemHealth Medicaid |
$338.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$761.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$338.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$338.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$727.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$727.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$338.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$355.33
|
|
|
EAPG 630: CONSTIPATION
|
Facility
|
OP
|
$310.36
|
|
|
Service Code
|
EAPG 0630
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$310.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$310.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$137.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$137.94
|
| Rate for Payer: CDPHP Essential Plan |
$310.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$165.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$137.94
|
| Rate for Payer: EmblemHealth Medicaid |
$137.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$310.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$137.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$137.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$296.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$296.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$137.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$144.84
|
|
