|
EAPG 631: HERNIA
|
Facility
|
OP
|
$242.14
|
|
|
Service Code
|
EAPG 0631
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$242.14 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$242.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$107.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$107.62
|
| Rate for Payer: CDPHP Essential Plan |
$242.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.62
|
| Rate for Payer: EmblemHealth Medicaid |
$107.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$242.14
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$107.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.00
|
|
|
EAPG 632: IRRITABLE BOWEL SYNDROME
|
Facility
|
OP
|
$208.66
|
|
|
Service Code
|
EAPG 0632
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$208.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$92.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$92.74
|
| Rate for Payer: CDPHP Essential Plan |
$208.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$111.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.74
|
| Rate for Payer: EmblemHealth Medicaid |
$92.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$208.66
|
| Rate for Payer: Hamaspik Choice Medicaid |
$92.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$199.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$199.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$97.38
|
|
|
EAPG 633: ALCOHOLIC LIVER DISEASE
|
Facility
|
OP
|
$255.87
|
|
|
Service Code
|
EAPG 0633
|
| Min. Negotiated Rate |
$113.72 |
| Max. Negotiated Rate |
$255.87 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$255.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.72
|
| Rate for Payer: CDPHP Essential Plan |
$255.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.72
|
| Rate for Payer: EmblemHealth Medicaid |
$113.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$255.87
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$244.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$244.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$119.41
|
|
|
EAPG 634: MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS
|
Facility
|
OP
|
$272.48
|
|
|
Service Code
|
EAPG 0634
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$272.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.10
|
| Rate for Payer: CDPHP Essential Plan |
$272.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.10
|
| Rate for Payer: EmblemHealth Medicaid |
$121.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$272.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$260.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$260.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.16
|
|
|
EAPG 635: PANCREAS DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
OP
|
$250.02
|
|
|
Service Code
|
EAPG 0635
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$250.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.12
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.12
|
| Rate for Payer: CDPHP Essential Plan |
$250.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.12
|
| Rate for Payer: EmblemHealth Medicaid |
$111.12
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.12
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.12
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.68
|
|
|
EAPG 636: HEPATITIS WITHOUT COMA
|
Facility
|
OP
|
$288.86
|
|
|
Service Code
|
EAPG 0636
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$288.86 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$288.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$128.38
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$128.38
|
| Rate for Payer: CDPHP Essential Plan |
$288.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$128.38
|
| Rate for Payer: EmblemHealth Medicaid |
$128.38
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$288.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$128.38
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$128.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$276.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$276.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$128.38
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$134.80
|
|
|
EAPG 637: GALLBLADDER AND BILIARY TRACT DIAGNOSES
|
Facility
|
OP
|
$234.16
|
|
|
Service Code
|
EAPG 0637
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$234.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$104.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$104.07
|
| Rate for Payer: CDPHP Essential Plan |
$234.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$124.88
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.07
|
| Rate for Payer: EmblemHealth Medicaid |
$104.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$234.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$104.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$104.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$223.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$223.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$104.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$109.27
|
|
|
EAPG 638: CHOLECYSTITIS
|
Facility
|
OP
|
$229.48
|
|
|
Service Code
|
EAPG 0638
|
| Min. Negotiated Rate |
$101.99 |
| Max. Negotiated Rate |
$229.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$229.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$101.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$101.99
|
| Rate for Payer: CDPHP Essential Plan |
$229.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$122.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.99
|
| Rate for Payer: EmblemHealth Medicaid |
$101.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$229.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$101.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$101.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$219.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$219.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$107.09
|
|
|
EAPG 639: OTHER HEPATOBILIARY SYSTEM DIAGNOSES
|
Facility
|
OP
|
$263.81
|
|
|
Service Code
|
EAPG 0639
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$263.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$263.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.25
|
| Rate for Payer: CDPHP Essential Plan |
$263.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.25
|
| Rate for Payer: EmblemHealth Medicaid |
$117.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$263.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.11
|
|
|
EAPG 63: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY
|
Facility
|
OP
|
$3,363.10
|
|
|
Service Code
|
EAPG 0063
|
| Min. Negotiated Rate |
$1,494.71 |
| Max. Negotiated Rate |
$3,363.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,363.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,494.71
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,494.71
|
| Rate for Payer: CDPHP Essential Plan |
$3,363.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,793.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,494.71
|
| Rate for Payer: EmblemHealth Medicaid |
$1,494.71
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,363.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,494.71
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,494.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,213.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,213.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,494.71
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,569.45
|
|
|
EAPG 641: OTHER MAJOR LIVER DIAGNOSES
|
Facility
|
OP
|
$254.48
|
|
|
Service Code
|
EAPG 0641
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$254.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.10
|
| Rate for Payer: CDPHP Essential Plan |
$254.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.10
|
| Rate for Payer: EmblemHealth Medicaid |
$113.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.76
|
|
|
EAPG 642: GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
OP
|
$292.32
|
|
|
Service Code
|
EAPG 0642
|
| Min. Negotiated Rate |
$129.92 |
| Max. Negotiated Rate |
$292.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$292.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.92
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.92
|
| Rate for Payer: CDPHP Essential Plan |
$292.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.92
|
| Rate for Payer: EmblemHealth Medicaid |
$129.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$292.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.92
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$279.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$279.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.92
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.42
|
|
|
EAPG 647: FRACTURES, DISLOCATIONS, SPRAINS, OTHER INJURIES OF THE SHOULDER AND UPPER ARM
|
Facility
|
OP
|
$338.60
|
|
|
Service Code
|
EAPG 0647
|
| Min. Negotiated Rate |
$150.49 |
| Max. Negotiated Rate |
$338.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$338.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$150.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$150.49
|
| Rate for Payer: CDPHP Essential Plan |
$338.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$180.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.49
|
| Rate for Payer: EmblemHealth Medicaid |
$150.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$338.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$150.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$150.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$323.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$323.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$158.01
|
|
|
EAPG 648: FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE
|
Facility
|
OP
|
$283.28
|
|
|
Service Code
|
EAPG 0648
|
| Min. Negotiated Rate |
$125.90 |
| Max. Negotiated Rate |
$283.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$283.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.90
|
| Rate for Payer: CDPHP Essential Plan |
$283.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.90
|
| Rate for Payer: EmblemHealth Medicaid |
$125.90
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$283.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$270.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$270.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.90
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.20
|
|
|
EAPG 649: OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY
|
Facility
|
OP
|
$314.84
|
|
|
Service Code
|
EAPG 0649
|
| Min. Negotiated Rate |
$139.93 |
| Max. Negotiated Rate |
$314.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$314.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$139.93
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$139.93
|
| Rate for Payer: CDPHP Essential Plan |
$314.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$167.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$139.93
|
| Rate for Payer: EmblemHealth Medicaid |
$139.93
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$314.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$139.93
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$139.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$300.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$300.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$139.93
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$146.93
|
|
|
EAPG 64: LEVEL I LOWER AIRWAY ENDOSCOPY
|
Facility
|
OP
|
$2,338.31
|
|
|
Service Code
|
EAPG 0064
|
| Min. Negotiated Rate |
$1,039.25 |
| Max. Negotiated Rate |
$2,338.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,338.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,039.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,039.25
|
| Rate for Payer: CDPHP Essential Plan |
$2,338.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,247.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,039.25
|
| Rate for Payer: EmblemHealth Medicaid |
$1,039.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,338.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,039.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,039.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,234.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,234.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,039.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,091.21
|
|
|
EAPG 650: FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR
|
Facility
|
OP
|
$416.32
|
|
|
Service Code
|
EAPG 0650
|
| Min. Negotiated Rate |
$185.03 |
| Max. Negotiated Rate |
$416.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$416.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$185.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$185.03
|
| Rate for Payer: CDPHP Essential Plan |
$416.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$222.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$185.03
|
| Rate for Payer: EmblemHealth Medicaid |
$185.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$416.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$185.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$185.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$397.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$397.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$185.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$194.28
|
|
|
EAPG 651: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP
|
Facility
|
OP
|
$382.10
|
|
|
Service Code
|
EAPG 0651
|
| Min. Negotiated Rate |
$169.82 |
| Max. Negotiated Rate |
$382.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$382.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$169.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$169.82
|
| Rate for Payer: CDPHP Essential Plan |
$382.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$203.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$169.82
|
| Rate for Payer: EmblemHealth Medicaid |
$169.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$382.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$169.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$169.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$365.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$365.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$169.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$178.31
|
|
|
EAPG 652: OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE
|
Facility
|
OP
|
$382.84
|
|
|
Service Code
|
EAPG 0652
|
| Min. Negotiated Rate |
$170.15 |
| Max. Negotiated Rate |
$382.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$382.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$170.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$170.15
|
| Rate for Payer: CDPHP Essential Plan |
$382.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$204.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$170.15
|
| Rate for Payer: EmblemHealth Medicaid |
$170.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$382.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$170.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$170.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$365.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$365.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$170.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$178.66
|
|
|
EAPG 653: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY
|
Facility
|
OP
|
$311.90
|
|
|
Service Code
|
EAPG 0653
|
| Min. Negotiated Rate |
$138.62 |
| Max. Negotiated Rate |
$311.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$311.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$138.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$138.62
|
| Rate for Payer: CDPHP Essential Plan |
$311.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$166.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$138.62
|
| Rate for Payer: EmblemHealth Medicaid |
$138.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$311.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$138.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$138.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$298.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$298.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$138.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$145.55
|
|
|
EAPG 654: OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
OP
|
$301.50
|
|
|
Service Code
|
EAPG 0654
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$301.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$134.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$134.00
|
| Rate for Payer: CDPHP Essential Plan |
$301.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.00
|
| Rate for Payer: EmblemHealth Medicaid |
$134.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$301.50
|
| Rate for Payer: Hamaspik Choice Medicaid |
$134.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$134.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$288.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$288.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$134.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$140.70
|
|
|
EAPG 655: CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
OP
|
$251.78
|
|
|
Service Code
|
EAPG 0655
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$251.78 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$251.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.90
|
| Rate for Payer: CDPHP Essential Plan |
$251.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$134.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.90
|
| Rate for Payer: EmblemHealth Medicaid |
$111.90
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$251.78
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$240.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$240.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.90
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$117.50
|
|
|
EAPG 656: FRACTURES, DISLOCATIONS & OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST
|
Facility
|
OP
|
$295.54
|
|
|
Service Code
|
EAPG 0656
|
| Min. Negotiated Rate |
$131.35 |
| Max. Negotiated Rate |
$295.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$295.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$131.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$131.35
|
| Rate for Payer: CDPHP Essential Plan |
$295.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$157.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.35
|
| Rate for Payer: EmblemHealth Medicaid |
$131.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$295.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$131.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$131.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$282.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$282.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$131.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$137.92
|
|
|
EAPG 657: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK
|
Facility
|
OP
|
$290.59
|
|
|
Service Code
|
EAPG 0657
|
| Min. Negotiated Rate |
$129.15 |
| Max. Negotiated Rate |
$290.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$290.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.15
|
| Rate for Payer: CDPHP Essential Plan |
$290.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.15
|
| Rate for Payer: EmblemHealth Medicaid |
$129.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$290.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$277.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$277.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$135.61
|
|
|
EAPG 658: SCIATICA
|
Facility
|
OP
|
$307.22
|
|
|
Service Code
|
EAPG 0658
|
| Min. Negotiated Rate |
$136.54 |
| Max. Negotiated Rate |
$307.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$307.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$136.54
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$136.54
|
| Rate for Payer: CDPHP Essential Plan |
$307.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$163.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.54
|
| Rate for Payer: EmblemHealth Medicaid |
$136.54
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$307.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$136.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$136.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$293.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$293.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$136.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$143.37
|
|
