|
EAPG 762: PRETERM LABOR DIAGNOSES
|
Facility
|
OP
|
$338.67
|
|
|
Service Code
|
EAPG 0762
|
| Min. Negotiated Rate |
$150.52 |
| Max. Negotiated Rate |
$338.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$338.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$150.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$150.52
|
| Rate for Payer: CDPHP Essential Plan |
$338.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$180.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.52
|
| Rate for Payer: EmblemHealth Medicaid |
$150.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$338.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$150.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$150.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$323.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$323.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$150.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$158.05
|
|
|
EAPG 763: ABORTION RELATED DIAGNOSES
|
Facility
|
OP
|
$270.16
|
|
|
Service Code
|
EAPG 0763
|
| Min. Negotiated Rate |
$120.07 |
| Max. Negotiated Rate |
$270.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$270.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.07
|
| Rate for Payer: CDPHP Essential Plan |
$270.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.07
|
| Rate for Payer: EmblemHealth Medicaid |
$120.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$270.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$258.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$258.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.07
|
|
|
EAPG 764: FALSE LABOR
|
Facility
|
OP
|
$400.59
|
|
|
Service Code
|
EAPG 0764
|
| Min. Negotiated Rate |
$178.04 |
| Max. Negotiated Rate |
$400.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$400.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$178.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$178.04
|
| Rate for Payer: CDPHP Essential Plan |
$400.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$213.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$178.04
|
| Rate for Payer: EmblemHealth Medicaid |
$178.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$400.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$178.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$178.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$382.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$382.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$178.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$186.94
|
|
|
EAPG 765: OTHER ANTEPARTUM DIAGNOSES
|
Facility
|
OP
|
$280.42
|
|
|
Service Code
|
EAPG 0765
|
| Min. Negotiated Rate |
$124.63 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$280.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.63
|
| Rate for Payer: CDPHP Essential Plan |
$280.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.63
|
| Rate for Payer: EmblemHealth Medicaid |
$124.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$280.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$267.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$267.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$130.86
|
|
|
EAPG 766: ROUTINE PRENATAL CARE
|
Facility
|
OP
|
$269.10
|
|
|
Service Code
|
EAPG 0766
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$269.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$119.60
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$119.60
|
| Rate for Payer: CDPHP Essential Plan |
$269.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$119.60
|
| Rate for Payer: EmblemHealth Medicaid |
$119.60
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$269.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$119.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$119.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$257.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$257.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$119.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$125.58
|
|
|
EAPG 767: COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY
|
Facility
|
OP
|
$279.47
|
|
|
Service Code
|
EAPG 0767
|
| Min. Negotiated Rate |
$124.21 |
| Max. Negotiated Rate |
$279.47 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$279.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.21
|
| Rate for Payer: CDPHP Essential Plan |
$279.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.21
|
| Rate for Payer: EmblemHealth Medicaid |
$124.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$279.47
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$267.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$267.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$130.42
|
|
|
EAPG 768: ANTEPARTUM ENCOUNTERS FOR NON-ROUTINE AND ABNORMAL FINDINGS
|
Facility
|
OP
|
$280.44
|
|
|
Service Code
|
EAPG 0768
|
| Min. Negotiated Rate |
$124.64 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$280.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.64
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.64
|
| Rate for Payer: CDPHP Essential Plan |
$280.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.64
|
| Rate for Payer: EmblemHealth Medicaid |
$124.64
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$280.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.64
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$267.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$267.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.64
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$130.87
|
|
|
EAPG 76: REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$1,638.61
|
|
|
Service Code
|
EAPG 0076
|
| Min. Negotiated Rate |
$728.27 |
| Max. Negotiated Rate |
$1,638.61 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,638.61
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$728.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$728.27
|
| Rate for Payer: CDPHP Essential Plan |
$1,638.61
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$873.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$728.27
|
| Rate for Payer: EmblemHealth Medicaid |
$728.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,638.61
|
| Rate for Payer: Hamaspik Choice Medicaid |
$728.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$728.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,565.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,565.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$728.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$764.68
|
|
|
EAPG 770: NORMAL NEONATE
|
Facility
|
OP
|
$226.48
|
|
|
Service Code
|
EAPG 0770
|
| Min. Negotiated Rate |
$100.66 |
| Max. Negotiated Rate |
$226.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$226.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$100.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$100.66
|
| Rate for Payer: CDPHP Essential Plan |
$226.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.66
|
| Rate for Payer: EmblemHealth Medicaid |
$100.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$226.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$100.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$100.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$216.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$216.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$105.69
|
|
|
EAPG 771: NEONATAL DIAGNOSES
|
Facility
|
OP
|
$282.69
|
|
|
Service Code
|
EAPG 0771
|
| Min. Negotiated Rate |
$125.64 |
| Max. Negotiated Rate |
$282.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$282.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.64
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.64
|
| Rate for Payer: CDPHP Essential Plan |
$282.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.64
|
| Rate for Payer: EmblemHealth Medicaid |
$125.64
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$282.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.64
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$270.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$270.13
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.64
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.92
|
|
|
EAPG 777: SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
OP
|
$334.33
|
|
|
Service Code
|
EAPG 0777
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$334.33 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$334.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$148.59
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$148.59
|
| Rate for Payer: CDPHP Essential Plan |
$334.33
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.59
|
| Rate for Payer: EmblemHealth Medicaid |
$148.59
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$334.33
|
| Rate for Payer: Hamaspik Choice Medicaid |
$148.59
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$148.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$319.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$319.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$156.02
|
|
|
EAPG 77: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES
|
Facility
|
OP
|
$4,416.88
|
|
|
Service Code
|
EAPG 0077
|
| Min. Negotiated Rate |
$1,963.06 |
| Max. Negotiated Rate |
$4,416.88 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,416.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,963.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,963.06
|
| Rate for Payer: CDPHP Essential Plan |
$4,416.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,355.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,963.06
|
| Rate for Payer: EmblemHealth Medicaid |
$1,963.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,416.88
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,963.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,963.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,220.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,220.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,963.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,061.21
|
|
|
EAPG 780: OTHER HEMATOLOGICAL DIAGNOSES
|
Facility
|
OP
|
$290.34
|
|
|
Service Code
|
EAPG 0780
|
| Min. Negotiated Rate |
$129.04 |
| Max. Negotiated Rate |
$290.34 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$290.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.04
|
| Rate for Payer: CDPHP Essential Plan |
$290.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$154.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.04
|
| Rate for Payer: EmblemHealth Medicaid |
$129.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$290.34
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$277.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$277.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$135.49
|
|
|
EAPG 781: COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES
|
Facility
|
OP
|
$247.79
|
|
|
Service Code
|
EAPG 0781
|
| Min. Negotiated Rate |
$110.13 |
| Max. Negotiated Rate |
$247.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$247.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.13
|
| Rate for Payer: CDPHP Essential Plan |
$247.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.13
|
| Rate for Payer: EmblemHealth Medicaid |
$110.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$247.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$236.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$236.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.64
|
|
|
EAPG 783: SICKLE CELL ANEMIA CRISIS
|
Facility
|
OP
|
$636.59
|
|
|
Service Code
|
EAPG 0783
|
| Min. Negotiated Rate |
$282.93 |
| Max. Negotiated Rate |
$636.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$636.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$282.93
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$282.93
|
| Rate for Payer: CDPHP Essential Plan |
$636.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$339.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$282.93
|
| Rate for Payer: EmblemHealth Medicaid |
$282.93
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$636.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$282.93
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$282.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$608.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$608.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.93
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$297.08
|
|
|
EAPG 785: ANEMIA, BLOOD AND BLOOD-FORMING ORGAN DISORDERS
|
Facility
|
OP
|
$240.37
|
|
|
Service Code
|
EAPG 0785
|
| Min. Negotiated Rate |
$106.83 |
| Max. Negotiated Rate |
$240.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$240.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.83
|
| Rate for Payer: CDPHP Essential Plan |
$240.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.83
|
| Rate for Payer: EmblemHealth Medicaid |
$106.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$240.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$229.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$229.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.17
|
|
|
EAPG 787: AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS
|
Facility
|
OP
|
$318.89
|
|
|
Service Code
|
EAPG 0787
|
| Min. Negotiated Rate |
$141.73 |
| Max. Negotiated Rate |
$318.89 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$318.89
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$141.73
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$141.73
|
| Rate for Payer: CDPHP Essential Plan |
$318.89
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$141.73
|
| Rate for Payer: EmblemHealth Medicaid |
$141.73
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$318.89
|
| Rate for Payer: Hamaspik Choice Medicaid |
$141.73
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$141.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$304.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$304.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.73
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$148.82
|
|
|
EAPG 78: LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
|
OP
|
$5,100.26
|
|
|
Service Code
|
EAPG 0078
|
| Min. Negotiated Rate |
$2,266.78 |
| Max. Negotiated Rate |
$5,100.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,100.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,266.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,266.78
|
| Rate for Payer: CDPHP Essential Plan |
$5,100.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,720.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,266.78
|
| Rate for Payer: EmblemHealth Medicaid |
$2,266.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,100.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,266.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,266.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,873.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,873.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,266.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,380.12
|
|
|
EAPG 79: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES
|
Facility
|
OP
|
$5,326.67
|
|
|
Service Code
|
EAPG 0079
|
| Min. Negotiated Rate |
$2,367.41 |
| Max. Negotiated Rate |
$5,326.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,326.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,367.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,367.41
|
| Rate for Payer: CDPHP Essential Plan |
$5,326.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,840.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,367.41
|
| Rate for Payer: EmblemHealth Medicaid |
$2,367.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,326.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,367.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,367.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,089.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,089.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,367.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,485.78
|
|
|
EAPG 800: ACUTE LEUKEMIA
|
Facility
|
OP
|
$373.82
|
|
|
Service Code
|
EAPG 0800
|
| Min. Negotiated Rate |
$166.14 |
| Max. Negotiated Rate |
$373.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$373.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$166.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$166.14
|
| Rate for Payer: CDPHP Essential Plan |
$373.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$199.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$166.14
|
| Rate for Payer: EmblemHealth Medicaid |
$166.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$373.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$166.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$166.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$357.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$357.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$166.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$174.45
|
|
|
EAPG 801: LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA
|
Facility
|
OP
|
$280.76
|
|
|
Service Code
|
EAPG 0801
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$280.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$280.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$124.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$124.78
|
| Rate for Payer: CDPHP Essential Plan |
$280.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$149.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$124.78
|
| Rate for Payer: EmblemHealth Medicaid |
$124.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$280.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$124.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$124.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$268.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$268.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$124.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.02
|
|
|
EAPG 802: RADIOTHERAPY
|
Facility
|
OP
|
$220.93
|
|
|
Service Code
|
EAPG 0802
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$220.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$220.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$98.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$98.19
|
| Rate for Payer: CDPHP Essential Plan |
$220.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$98.19
|
| Rate for Payer: EmblemHealth Medicaid |
$98.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$220.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$98.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$98.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$211.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$211.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$98.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$103.10
|
|
|
EAPG 803: CHEMOTHERAPY
|
Facility
|
OP
|
$319.41
|
|
|
Service Code
|
EAPG 0803
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$319.41 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$319.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$141.96
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$141.96
|
| Rate for Payer: CDPHP Essential Plan |
$319.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.35
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$141.96
|
| Rate for Payer: EmblemHealth Medicaid |
$141.96
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$319.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$141.96
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$141.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$305.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$305.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$141.96
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$149.06
|
|
|
EAPG 804: LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
OP
|
$281.74
|
|
|
Service Code
|
EAPG 0804
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$281.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$125.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$125.22
|
| Rate for Payer: CDPHP Essential Plan |
$281.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$125.22
|
| Rate for Payer: EmblemHealth Medicaid |
$125.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$281.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$125.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$125.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$269.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$269.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$125.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$131.48
|
|
|
EAPG 805: SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
OP
|
$337.41
|
|
|
Service Code
|
EAPG 0805
|
| Min. Negotiated Rate |
$149.96 |
| Max. Negotiated Rate |
$337.41 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$337.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$149.96
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$149.96
|
| Rate for Payer: CDPHP Essential Plan |
$337.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.96
|
| Rate for Payer: EmblemHealth Medicaid |
$149.96
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$337.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$149.96
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$149.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$322.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$322.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$149.96
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$157.46
|
|
