|
EAPG 714: DIABETES WITH RENAL MANIFESTATIONS
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
EAPG 0714
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$97.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$97.78
|
| Rate for Payer: CDPHP Essential Plan |
$220.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.78
|
| Rate for Payer: EmblemHealth Medicaid |
$97.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$220.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$97.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$97.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$210.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$210.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$97.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$102.67
|
|
|
EAPG 715: DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS
|
Facility
|
OP
|
$248.40
|
|
|
Service Code
|
EAPG 0715
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.40
|
| Rate for Payer: CDPHP Essential Plan |
$248.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$248.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$237.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$237.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.92
|
|
|
EAPG 71: LEVEL II LOWER AIRWAY ENDOSCOPY
|
Facility
|
OP
|
$2,572.16
|
|
|
Service Code
|
EAPG 0071
|
| Min. Negotiated Rate |
$1,143.18 |
| Max. Negotiated Rate |
$2,572.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,572.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,143.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,143.18
|
| Rate for Payer: CDPHP Essential Plan |
$2,572.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,371.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,143.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,143.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,572.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,143.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,143.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,457.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,457.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,143.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,200.34
|
|
|
EAPG 720: RENAL FAILURE
|
Facility
|
OP
|
$244.26
|
|
|
Service Code
|
EAPG 0720
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$244.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$244.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.56
|
| Rate for Payer: CDPHP Essential Plan |
$244.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$130.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.56
|
| Rate for Payer: EmblemHealth Medicaid |
$108.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$244.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$233.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$233.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.99
|
|
|
EAPG 721: KIDNEY AND URINARY TRACT MALIGNANCY
|
Facility
|
OP
|
$274.12
|
|
|
Service Code
|
EAPG 0721
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$274.12 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.83
|
| Rate for Payer: CDPHP Essential Plan |
$274.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.83
|
| Rate for Payer: EmblemHealth Medicaid |
$121.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$274.12
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.92
|
|
|
EAPG 722: NEPHRITIS AND NEPHROSIS
|
Facility
|
OP
|
$271.01
|
|
|
Service Code
|
EAPG 0722
|
| Min. Negotiated Rate |
$120.45 |
| Max. Negotiated Rate |
$271.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.45
|
| Rate for Payer: CDPHP Essential Plan |
$271.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.45
|
| Rate for Payer: EmblemHealth Medicaid |
$120.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$258.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$258.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.47
|
|
|
EAPG 723: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
OP
|
$292.16
|
|
|
Service Code
|
EAPG 0723
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$292.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$292.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.85
|
| Rate for Payer: CDPHP Essential Plan |
$292.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.85
|
| Rate for Payer: EmblemHealth Medicaid |
$129.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$292.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$279.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$279.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.34
|
|
|
EAPG 724: URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
OP
|
$279.36
|
|
|
Service Code
|
EAPG 0724
|
| Min. Negotiated Rate |
$124.16 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.16
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.16
|
| Rate for Payer: CDPHP Essential Plan |
$279.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$148.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.16
|
| Rate for Payer: EmblemHealth Medicaid |
$124.16
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$279.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.16
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$266.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$266.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.16
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$130.37
|
|
|
EAPG 725: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
EAPG 0725
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$420.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$186.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$186.69
|
| Rate for Payer: CDPHP Essential Plan |
$420.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$224.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$186.69
|
| Rate for Payer: EmblemHealth Medicaid |
$186.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$420.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$186.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$186.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$401.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$401.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$186.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$196.02
|
|
|
EAPG 726: OTHER KIDNEY AND URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS
|
Facility
|
OP
|
$267.28
|
|
|
Service Code
|
EAPG 0726
|
| Min. Negotiated Rate |
$118.79 |
| Max. Negotiated Rate |
$267.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$267.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$118.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$118.79
|
| Rate for Payer: CDPHP Essential Plan |
$267.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.79
|
| Rate for Payer: EmblemHealth Medicaid |
$118.79
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$267.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$118.79
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$118.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$255.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$255.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.79
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$124.73
|
|
|
EAPG 727: ACUTE LOWER URINARY TRACT INFECTIONS
|
Facility
|
OP
|
$283.79
|
|
|
Service Code
|
EAPG 0727
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$283.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$283.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$126.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$126.13
|
| Rate for Payer: CDPHP Essential Plan |
$283.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$151.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$126.13
|
| Rate for Payer: EmblemHealth Medicaid |
$126.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$283.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$126.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$126.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$271.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$271.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$126.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$132.44
|
|
|
EAPG 729: ACUTE KIDNEY INJURY
|
Facility
|
OP
|
$244.26
|
|
|
Service Code
|
EAPG 0729
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$244.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$244.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.56
|
| Rate for Payer: CDPHP Essential Plan |
$244.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$130.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.56
|
| Rate for Payer: EmblemHealth Medicaid |
$108.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$244.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$233.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$233.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.99
|
|
|
EAPG 72: TRACHEOSTOMY AND RELATED TRACHEAL PROCEDURES
|
Facility
|
OP
|
$3,981.74
|
|
|
Service Code
|
EAPG 0072
|
| Min. Negotiated Rate |
$1,769.66 |
| Max. Negotiated Rate |
$3,981.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,981.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,769.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,769.66
|
| Rate for Payer: CDPHP Essential Plan |
$3,981.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,123.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,769.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,769.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,981.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,769.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,769.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,804.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,804.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,769.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,858.14
|
|
|
EAPG 73: DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR
|
Facility
|
OP
|
$4,635.38
|
|
|
Service Code
|
EAPG 0073
|
| Min. Negotiated Rate |
$2,060.17 |
| Max. Negotiated Rate |
$4,635.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,635.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,060.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,060.17
|
| Rate for Payer: CDPHP Essential Plan |
$4,635.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,472.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,060.17
|
| Rate for Payer: EmblemHealth Medicaid |
$2,060.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,635.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,060.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,060.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,429.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,429.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,060.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,163.18
|
|
|
EAPG 740: MALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
OP
|
$253.28
|
|
|
Service Code
|
EAPG 0740
|
| Min. Negotiated Rate |
$112.57 |
| Max. Negotiated Rate |
$253.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$253.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$112.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$112.57
|
| Rate for Payer: CDPHP Essential Plan |
$253.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$112.57
|
| Rate for Payer: EmblemHealth Medicaid |
$112.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$253.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$112.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$112.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$242.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$242.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$112.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.20
|
|
|
EAPG 741: OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES
|
Facility
|
OP
|
$261.88
|
|
|
Service Code
|
EAPG 0741
|
| Min. Negotiated Rate |
$116.39 |
| Max. Negotiated Rate |
$261.88 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$261.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$116.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$116.39
|
| Rate for Payer: CDPHP Essential Plan |
$261.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.39
|
| Rate for Payer: EmblemHealth Medicaid |
$116.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$261.88
|
| Rate for Payer: Hamaspik Choice Medicaid |
$116.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$116.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$250.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$250.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$122.21
|
|
|
EAPG 743: PROSTATITIS
|
Facility
|
OP
|
$238.36
|
|
|
Service Code
|
EAPG 0743
|
| Min. Negotiated Rate |
$105.94 |
| Max. Negotiated Rate |
$238.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$105.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$105.94
|
| Rate for Payer: CDPHP Essential Plan |
$238.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.94
|
| Rate for Payer: EmblemHealth Medicaid |
$105.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$238.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$105.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$105.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$227.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$227.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.24
|
|
|
EAPG 744: MALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
OP
|
$277.40
|
|
|
Service Code
|
EAPG 0744
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$277.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$123.29
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$123.29
|
| Rate for Payer: CDPHP Essential Plan |
$277.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$147.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$123.29
|
| Rate for Payer: EmblemHealth Medicaid |
$123.29
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$277.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$123.29
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$123.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$265.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$265.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$123.29
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$129.45
|
|
|
EAPG 74: REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT
|
Facility
|
OP
|
$5,243.67
|
|
|
Service Code
|
EAPG 0074
|
| Min. Negotiated Rate |
$2,330.52 |
| Max. Negotiated Rate |
$5,243.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,243.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,330.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,330.52
|
| Rate for Payer: CDPHP Essential Plan |
$5,243.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,796.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,330.52
|
| Rate for Payer: EmblemHealth Medicaid |
$2,330.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,243.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,330.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,330.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,010.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,010.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,330.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,447.05
|
|
|
EAPG 750: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
OP
|
$240.55
|
|
|
Service Code
|
EAPG 0750
|
| Min. Negotiated Rate |
$106.91 |
| Max. Negotiated Rate |
$240.55 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$240.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.91
|
| Rate for Payer: CDPHP Essential Plan |
$240.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.91
|
| Rate for Payer: EmblemHealth Medicaid |
$106.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$240.55
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$229.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$229.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.26
|
|
|
EAPG 751: FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
OP
|
$264.26
|
|
|
Service Code
|
EAPG 0751
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$264.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$264.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.45
|
| Rate for Payer: CDPHP Essential Plan |
$264.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.45
|
| Rate for Payer: EmblemHealth Medicaid |
$117.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$264.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$252.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$252.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.32
|
|
|
EAPG 752: OTHER FEMALE REPRODUCTIVE SYSTEM AND MENSTRUAL DIAGNOSES
|
Facility
|
OP
|
$236.92
|
|
|
Service Code
|
EAPG 0752
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$236.92 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$236.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$105.30
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$105.30
|
| Rate for Payer: CDPHP Essential Plan |
$236.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$126.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$105.30
|
| Rate for Payer: EmblemHealth Medicaid |
$105.30
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$236.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$105.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$105.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$226.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$226.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$105.30
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$110.56
|
|
|
EAPG 75: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES
|
Facility
|
OP
|
$465.16
|
|
|
Service Code
|
EAPG 0075
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$465.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$465.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$206.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$206.74
|
| Rate for Payer: CDPHP Essential Plan |
$465.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$248.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$206.74
|
| Rate for Payer: EmblemHealth Medicaid |
$206.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$465.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$206.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$206.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$444.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$444.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$206.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$217.08
|
|
|
EAPG 760: LABOR AND DELIVERY RELATED DIAGNOSES
|
Facility
|
OP
|
$231.41
|
|
|
Service Code
|
EAPG 0760
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$231.41 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$102.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$102.85
|
| Rate for Payer: CDPHP Essential Plan |
$231.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$123.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$102.85
|
| Rate for Payer: EmblemHealth Medicaid |
$102.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$231.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$102.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$102.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$221.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$221.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$102.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$107.99
|
|
|
EAPG 761: POSTPARTUM AND POST ABORTION DIAGNOSES
|
Facility
|
OP
|
$263.59
|
|
|
Service Code
|
EAPG 0761
|
| Min. Negotiated Rate |
$117.15 |
| Max. Negotiated Rate |
$263.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$263.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.15
|
| Rate for Payer: CDPHP Essential Plan |
$263.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$140.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.15
|
| Rate for Payer: EmblemHealth Medicaid |
$117.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$263.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$251.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$251.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.01
|
|
