|
EAPG 134: LEVEL I UPPER GI ENDOSCOPY
|
Facility
OP
|
$1,607.31
|
|
|
Service Code
|
EAPG 0134
|
| Min. Negotiated Rate |
$714.36 |
| Max. Negotiated Rate |
$1,607.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,607.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$714.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$714.36
|
| Rate for Payer: CDPHP Essential Plan |
$1,607.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$857.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$714.36
|
| Rate for Payer: EmblemHealth Medicaid |
$714.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,607.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$714.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$714.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,535.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,535.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$714.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$750.08
|
|
|
EAPG 135: LEVEL II UPPER GI ENDOSCOPY
|
Facility
OP
|
$1,838.38
|
|
|
Service Code
|
EAPG 0135
|
| Min. Negotiated Rate |
$817.06 |
| Max. Negotiated Rate |
$1,838.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,838.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$817.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$817.06
|
| Rate for Payer: CDPHP Essential Plan |
$1,838.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$980.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$817.06
|
| Rate for Payer: EmblemHealth Medicaid |
$817.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,838.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$817.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$817.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,756.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,756.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$817.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$857.91
|
|
|
EAPG 136: LEVEL I LOWER GI ENDOSCOPY
|
Facility
OP
|
$1,544.02
|
|
|
Service Code
|
EAPG 0136
|
| Min. Negotiated Rate |
$686.23 |
| Max. Negotiated Rate |
$1,544.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,544.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$686.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$686.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,544.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$823.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$686.23
|
| Rate for Payer: EmblemHealth Medicaid |
$686.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,544.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,475.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,475.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$686.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$720.54
|
|
|
EAPG 137: LEVEL II LOWER GI ENDOSCOPY
|
Facility
OP
|
$1,749.31
|
|
|
Service Code
|
EAPG 0137
|
| Min. Negotiated Rate |
$777.47 |
| Max. Negotiated Rate |
$1,749.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,749.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$777.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$777.47
|
| Rate for Payer: CDPHP Essential Plan |
$1,749.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$932.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$777.47
|
| Rate for Payer: EmblemHealth Medicaid |
$777.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,749.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$777.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$777.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,671.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,671.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$777.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$816.34
|
|
|
EAPG 138: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES
|
Facility
OP
|
$2,597.22
|
|
|
Service Code
|
EAPG 0138
|
| Min. Negotiated Rate |
$1,154.32 |
| Max. Negotiated Rate |
$2,597.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,597.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,154.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,154.32
|
| Rate for Payer: CDPHP Essential Plan |
$2,597.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,385.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,154.32
|
| Rate for Payer: EmblemHealth Medicaid |
$1,154.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,597.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,154.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,154.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,481.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,481.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,154.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,212.04
|
|
|
EAPG 139: HERNIA REPAIRS
|
Facility
OP
|
$4,075.20
|
|
|
Service Code
|
EAPG 0139
|
| Min. Negotiated Rate |
$1,811.20 |
| Max. Negotiated Rate |
$4,075.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,075.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,811.20
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,811.20
|
| Rate for Payer: CDPHP Essential Plan |
$4,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,173.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,811.20
|
| Rate for Payer: EmblemHealth Medicaid |
$1,811.20
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,075.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,811.20
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,811.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,894.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,894.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,811.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,901.76
|
|
|
EAPG 141: LEVEL I ANAL AND RECTAL PROCEDURES
|
Facility
OP
|
$2,175.01
|
|
|
Service Code
|
EAPG 0141
|
| Min. Negotiated Rate |
$966.67 |
| Max. Negotiated Rate |
$2,175.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,175.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$966.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$966.67
|
| Rate for Payer: CDPHP Essential Plan |
$2,175.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,160.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$966.67
|
| Rate for Payer: EmblemHealth Medicaid |
$966.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,175.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$966.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$966.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,078.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,078.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$966.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,015.00
|
|
|
EAPG 142: LEVEL II ANAL AND RECTAL PROCEDURES
|
Facility
OP
|
$3,061.24
|
|
|
Service Code
|
EAPG 0142
|
| Min. Negotiated Rate |
$1,360.55 |
| Max. Negotiated Rate |
$3,061.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,061.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,360.55
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,360.55
|
| Rate for Payer: CDPHP Essential Plan |
$3,061.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,632.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,360.55
|
| Rate for Payer: EmblemHealth Medicaid |
$1,360.55
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,061.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,360.55
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,360.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,925.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,925.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,360.55
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,428.58
|
|
|
EAPG 143: LEVEL I GASTROINTESTINAL PROCEDURES
|
Facility
OP
|
$2,403.20
|
|
|
Service Code
|
EAPG 0143
|
| Min. Negotiated Rate |
$1,068.09 |
| Max. Negotiated Rate |
$2,403.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,403.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,068.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,068.09
|
| Rate for Payer: CDPHP Essential Plan |
$2,403.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,281.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,068.09
|
| Rate for Payer: EmblemHealth Medicaid |
$1,068.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,403.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,068.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,068.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,296.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,296.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,068.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,121.49
|
|
|
EAPG 144: LEVEL II GASTROINTESTINAL PROCEDURES
|
Facility
OP
|
$4,823.35
|
|
|
Service Code
|
EAPG 0144
|
| Min. Negotiated Rate |
$2,143.71 |
| Max. Negotiated Rate |
$4,823.35 |
| Rate for Payer: Hamaspik Choice Medicaid |
$2,143.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,823.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,143.71
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,143.71
|
| Rate for Payer: CDPHP Essential Plan |
$4,823.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,572.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,143.71
|
| Rate for Payer: EmblemHealth Medicaid |
$2,143.71
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,823.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,143.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,608.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,608.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,143.71
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,250.90
|
|
|
EAPG 145: LEVEL I LAPAROSCOPY
|
Facility
OP
|
$3,708.74
|
|
|
Service Code
|
EAPG 0145
|
| Min. Negotiated Rate |
$1,648.33 |
| Max. Negotiated Rate |
$3,708.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,708.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,648.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,648.33
|
| Rate for Payer: CDPHP Essential Plan |
$3,708.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,978.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,648.33
|
| Rate for Payer: EmblemHealth Medicaid |
$1,648.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,708.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,648.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,648.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,543.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,543.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,648.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,730.75
|
|
|
EAPG 146: LEVEL II LAPAROSCOPY
|
Facility
OP
|
$5,026.34
|
|
|
Service Code
|
EAPG 0146
|
| Min. Negotiated Rate |
$2,233.93 |
| Max. Negotiated Rate |
$5,026.34 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,026.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,233.93
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,233.93
|
| Rate for Payer: CDPHP Essential Plan |
$5,026.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,680.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,233.93
|
| Rate for Payer: EmblemHealth Medicaid |
$2,233.93
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,026.34
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,233.93
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,233.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,802.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,802.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,233.93
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,345.63
|
|
|
EAPG 148: LEVEL III LAPAROSCOPY
|
Facility
OP
|
$6,437.20
|
|
|
Service Code
|
EAPG 0148
|
| Min. Negotiated Rate |
$2,860.98 |
| Max. Negotiated Rate |
$6,437.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,437.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,860.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,860.98
|
| Rate for Payer: CDPHP Essential Plan |
$6,437.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,433.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,860.98
|
| Rate for Payer: EmblemHealth Medicaid |
$2,860.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,437.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,860.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,860.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,151.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,151.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,860.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,004.03
|
|
|
EAPG 149: SCREENING COLORECTAL SERVICES
|
Facility
OP
|
$1,544.02
|
|
|
Service Code
|
EAPG 0149
|
| Min. Negotiated Rate |
$686.23 |
| Max. Negotiated Rate |
$1,544.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,544.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$686.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$686.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,544.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$823.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$686.23
|
| Rate for Payer: EmblemHealth Medicaid |
$686.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,544.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,475.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,475.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$686.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$720.54
|
|
|
EAPG 150: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES
|
Facility
OP
|
$1,203.01
|
|
|
Service Code
|
EAPG 0150
|
| Min. Negotiated Rate |
$534.67 |
| Max. Negotiated Rate |
$1,203.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,203.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$534.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$534.67
|
| Rate for Payer: CDPHP Essential Plan |
$1,203.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$641.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$534.67
|
| Rate for Payer: EmblemHealth Medicaid |
$534.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,203.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$534.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$534.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,149.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,149.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$534.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$561.40
|
|
|
EAPG 151: LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES
|
Facility
OP
|
$2,887.22
|
|
|
Service Code
|
EAPG 0151
|
| Min. Negotiated Rate |
$1,283.21 |
| Max. Negotiated Rate |
$2,887.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,887.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,283.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,283.21
|
| Rate for Payer: CDPHP Essential Plan |
$2,887.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,539.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,283.21
|
| Rate for Payer: EmblemHealth Medicaid |
$1,283.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,887.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,283.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,283.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,758.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,758.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,283.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,347.37
|
|
|
EAPG 152: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES
|
Facility
OP
|
$4,581.34
|
|
|
Service Code
|
EAPG 0152
|
| Min. Negotiated Rate |
$2,036.15 |
| Max. Negotiated Rate |
$4,581.34 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,581.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,036.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,036.15
|
| Rate for Payer: CDPHP Essential Plan |
$4,581.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,443.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,036.15
|
| Rate for Payer: EmblemHealth Medicaid |
$2,036.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,581.34
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,036.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,036.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,377.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,377.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,036.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,137.96
|
|
|
EAPG 153: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES
|
Facility
OP
|
$2,856.94
|
|
|
Service Code
|
EAPG 0153
|
| Min. Negotiated Rate |
$1,269.75 |
| Max. Negotiated Rate |
$2,856.94 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,856.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,269.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,269.75
|
| Rate for Payer: CDPHP Essential Plan |
$2,856.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,523.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,269.75
|
| Rate for Payer: EmblemHealth Medicaid |
$1,269.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,856.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,269.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,269.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,729.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,729.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,269.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,333.24
|
|
|
EAPG 154: LEVEL III UPPER GI ENDOSCOPY
|
Facility
OP
|
$1,949.60
|
|
|
Service Code
|
EAPG 0154
|
| Min. Negotiated Rate |
$866.49 |
| Max. Negotiated Rate |
$1,949.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,949.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$866.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$866.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,949.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,039.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$866.49
|
| Rate for Payer: EmblemHealth Medicaid |
$866.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,949.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$866.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$866.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,862.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,862.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$866.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$909.81
|
|
|
EAPG 155: LEVEL III BLOOD PRODUCT EXCHANGE SERVICES
|
Facility
OP
|
$4,078.69
|
|
|
Service Code
|
EAPG 0155
|
| Min. Negotiated Rate |
$1,812.75 |
| Max. Negotiated Rate |
$4,078.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,078.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,812.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,812.75
|
| Rate for Payer: CDPHP Essential Plan |
$4,078.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,175.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,812.75
|
| Rate for Payer: EmblemHealth Medicaid |
$1,812.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,078.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,812.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,812.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,897.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,897.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,812.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,903.39
|
|
|
EAPG 156: OCULAR IMAGING AND RELATED SERVICES
|
Facility
OP
|
$208.80
|
|
|
Service Code
|
EAPG 0156
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$92.80
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$92.80
|
| Rate for Payer: CDPHP Essential Plan |
$208.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$111.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.80
|
| Rate for Payer: EmblemHealth Medicaid |
$92.80
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$208.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$92.80
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$199.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$199.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$97.44
|
|
|
EAPG 158: PATHOLOGY CONSULTATION AND INTERPRETATION
|
Facility
OP
|
$134.53
|
|
|
Service Code
|
EAPG 0158
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$134.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$134.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$59.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$59.79
|
| Rate for Payer: CDPHP Essential Plan |
$134.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$59.79
|
| Rate for Payer: EmblemHealth Medicaid |
$59.79
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$134.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$59.79
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$59.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$128.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$128.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.79
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$62.78
|
|
|
EAPG 159: MINOR UROLOGY SERVICES
|
Facility
OP
|
$781.04
|
|
|
Service Code
|
EAPG 0159
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$781.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$781.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$347.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$347.13
|
| Rate for Payer: CDPHP Essential Plan |
$781.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$416.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$347.13
|
| Rate for Payer: EmblemHealth Medicaid |
$347.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$781.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$347.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$347.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$746.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$746.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$347.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$364.49
|
|
|
EAPG 161: URINARY STUDIES AND PROCEDURES
|
Facility
OP
|
$848.34
|
|
|
Service Code
|
EAPG 0161
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$848.34 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$848.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$377.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$377.04
|
| Rate for Payer: CDPHP Essential Plan |
$848.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$452.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$377.04
|
| Rate for Payer: EmblemHealth Medicaid |
$377.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$848.34
|
| Rate for Payer: Hamaspik Choice Medicaid |
$377.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$377.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$810.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$810.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$377.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$395.89
|
|
|
EAPG 166: LEVEL I URETHRAL PROCEDURES
|
Facility
OP
|
$2,002.46
|
|
|
Service Code
|
EAPG 0166
|
| Min. Negotiated Rate |
$889.98 |
| Max. Negotiated Rate |
$2,002.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,002.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$889.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$889.98
|
| Rate for Payer: CDPHP Essential Plan |
$2,002.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,067.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$889.98
|
| Rate for Payer: EmblemHealth Medicaid |
$889.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,002.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$889.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$889.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,913.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,913.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$889.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$934.48
|
|
