|
EAPG 167: LEVEL II URETHRAL PROCEDURES
|
Facility
OP
|
$5,051.36
|
|
|
Service Code
|
EAPG 0167
|
| Min. Negotiated Rate |
$2,245.05 |
| Max. Negotiated Rate |
$5,051.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,051.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,245.05
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,245.05
|
| Rate for Payer: CDPHP Essential Plan |
$5,051.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,694.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,245.05
|
| Rate for Payer: EmblemHealth Medicaid |
$2,245.05
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,051.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,245.05
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,245.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,826.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,826.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,245.05
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,357.30
|
|
|
EAPG 168: DIALYSIS PROCEDURES
|
Facility
OP
|
$499.18
|
|
|
Service Code
|
EAPG 0168
|
| Min. Negotiated Rate |
$221.86 |
| Max. Negotiated Rate |
$499.18 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$499.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$221.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$221.86
|
| Rate for Payer: CDPHP Essential Plan |
$499.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$266.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.86
|
| Rate for Payer: EmblemHealth Medicaid |
$221.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$499.18
|
| Rate for Payer: Hamaspik Choice Medicaid |
$221.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$221.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$477.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$477.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$221.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$232.95
|
|
|
EAPG 16: SIMPLE WOUND REPAIR AND TREATMENT
|
Facility
OP
|
$914.00
|
|
|
Service Code
|
EAPG 0016
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$914.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$406.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$406.22
|
| Rate for Payer: CDPHP Essential Plan |
$914.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$487.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$406.22
|
| Rate for Payer: EmblemHealth Medicaid |
$406.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$914.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$406.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$406.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$873.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$873.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$406.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$426.53
|
|
|
EAPG 170: LEVEL I KIDNEY AND URETERAL PROCEDURES
|
Facility
OP
|
$2,188.35
|
|
|
Service Code
|
EAPG 0170
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$2,188.35 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,188.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$972.60
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$972.60
|
| Rate for Payer: CDPHP Essential Plan |
$2,188.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,167.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$972.60
|
| Rate for Payer: EmblemHealth Medicaid |
$972.60
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,188.35
|
| Rate for Payer: Hamaspik Choice Medicaid |
$972.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$972.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,091.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,091.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$972.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,021.23
|
|
|
EAPG 171: LEVEL II KIDNEY AND URETERAL PROCEDURES
|
Facility
OP
|
$2,884.00
|
|
|
Service Code
|
EAPG 0171
|
| Min. Negotiated Rate |
$1,281.78 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,884.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,281.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,281.78
|
| Rate for Payer: CDPHP Essential Plan |
$2,884.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,538.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,281.78
|
| Rate for Payer: EmblemHealth Medicaid |
$1,281.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,884.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,281.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,281.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,755.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,755.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,281.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,345.87
|
|
|
EAPG 172: LEVEL III KIDNEY AND URETERAL PROCEDURES
|
Facility
OP
|
$3,911.58
|
|
|
Service Code
|
EAPG 0172
|
| Min. Negotiated Rate |
$1,738.48 |
| Max. Negotiated Rate |
$3,911.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,911.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,738.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,738.48
|
| Rate for Payer: CDPHP Essential Plan |
$3,911.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,086.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,738.48
|
| Rate for Payer: EmblemHealth Medicaid |
$1,738.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,911.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,738.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,738.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,737.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,737.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,738.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,825.40
|
|
|
EAPG 173: LEVEL I BLADDER AND URETERAL PROCEDURES
|
Facility
OP
|
$3,235.36
|
|
|
Service Code
|
EAPG 0173
|
| Min. Negotiated Rate |
$1,437.94 |
| Max. Negotiated Rate |
$3,235.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,235.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,437.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,437.94
|
| Rate for Payer: CDPHP Essential Plan |
$3,235.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,725.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.94
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,235.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,437.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,437.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,091.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,091.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,437.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,509.84
|
|
|
EAPG 174: LEVEL II BLADDER AND URETERAL PROCEDURES
|
Facility
OP
|
$3,883.05
|
|
|
Service Code
|
EAPG 0174
|
| Min. Negotiated Rate |
$1,725.80 |
| Max. Negotiated Rate |
$3,883.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,883.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,725.80
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,725.80
|
| Rate for Payer: CDPHP Essential Plan |
$3,883.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,725.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,725.80
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,883.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,725.80
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,725.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,710.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,710.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,725.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,812.09
|
|
|
EAPG 176: LEVEL I PROSTATE PROCEDURES
|
Facility
OP
|
$3,973.59
|
|
|
Service Code
|
EAPG 0176
|
| Min. Negotiated Rate |
$1,766.04 |
| Max. Negotiated Rate |
$3,973.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,973.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,766.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,766.04
|
| Rate for Payer: CDPHP Essential Plan |
$3,973.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,119.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,766.04
|
| Rate for Payer: EmblemHealth Medicaid |
$1,766.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,973.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,766.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,766.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,796.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,796.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,766.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,854.34
|
|
|
EAPG 177: MINOR DERMATOLOGY SERVICES
|
Facility
OP
|
$84.98
|
|
|
Service Code
|
EAPG 0177
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$84.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$84.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.77
|
| Rate for Payer: CDPHP Essential Plan |
$84.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.77
|
| Rate for Payer: EmblemHealth Medicaid |
$37.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$84.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$81.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$81.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.66
|
|
|
EAPG 178: ANTEPARTUM PROCEDURES
|
Facility
OP
|
$1,513.73
|
|
|
Service Code
|
EAPG 0178
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,513.73 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,513.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$672.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$672.77
|
| Rate for Payer: CDPHP Essential Plan |
$1,513.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$807.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$672.77
|
| Rate for Payer: EmblemHealth Medicaid |
$672.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,513.73
|
| Rate for Payer: Hamaspik Choice Medicaid |
$672.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$672.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,446.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,446.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$672.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$706.41
|
|
|
EAPG 179: ECTOPIC PREGNANCY PROCEDURES
|
Facility
OP
|
$3,215.59
|
|
|
Service Code
|
EAPG 0179
|
| Min. Negotiated Rate |
$1,429.15 |
| Max. Negotiated Rate |
$3,215.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,215.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,429.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,429.15
|
| Rate for Payer: CDPHP Essential Plan |
$3,215.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,714.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,429.15
|
| Rate for Payer: EmblemHealth Medicaid |
$1,429.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,215.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,429.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,429.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,072.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,072.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,429.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,500.61
|
|
|
EAPG 17: INTERMEDIATE WOUND REPAIR AND TREATMENT
|
Facility
OP
|
$1,391.60
|
|
|
Service Code
|
EAPG 0017
|
| Min. Negotiated Rate |
$618.49 |
| Max. Negotiated Rate |
$1,391.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,391.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$618.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$618.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,391.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$742.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$618.49
|
| Rate for Payer: EmblemHealth Medicaid |
$618.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,391.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$618.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$618.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,329.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,329.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$618.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$649.41
|
|
|
EAPG 180: TESTICULAR AND EPIDIDYMAL PROCEDURES
|
Facility
OP
|
$2,594.74
|
|
|
Service Code
|
EAPG 0180
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,594.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,594.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,153.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,153.22
|
| Rate for Payer: CDPHP Essential Plan |
$2,594.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,383.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,153.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,153.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,594.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,153.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,153.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,479.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,479.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,153.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,210.88
|
|
|
EAPG 182: INSERTION OF PENILE PROSTHESIS
|
Facility
OP
|
$10,552.10
|
|
|
Service Code
|
EAPG 0182
|
| Min. Negotiated Rate |
$4,689.82 |
| Max. Negotiated Rate |
$10,552.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$10,552.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$4,689.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$4,689.82
|
| Rate for Payer: CDPHP Essential Plan |
$10,552.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,627.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,689.82
|
| Rate for Payer: EmblemHealth Medicaid |
$4,689.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$10,552.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,689.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,689.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$10,083.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$10,083.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,689.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$4,924.31
|
|
|
EAPG 183: LEVEL I PENILE PROCEDURES
|
Facility
OP
|
$1,887.48
|
|
|
Service Code
|
EAPG 0183
|
| Min. Negotiated Rate |
$838.88 |
| Max. Negotiated Rate |
$1,887.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,887.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$838.88
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$838.88
|
| Rate for Payer: CDPHP Essential Plan |
$1,887.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,006.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$838.88
|
| Rate for Payer: EmblemHealth Medicaid |
$838.88
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,887.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$838.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$838.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,803.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,803.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$838.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$880.82
|
|
|
EAPG 184: LEVEL II PROSTATE PROCEDURES
|
Facility
OP
|
$5,375.02
|
|
|
Service Code
|
EAPG 0184
|
| Min. Negotiated Rate |
$2,388.90 |
| Max. Negotiated Rate |
$5,375.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,375.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,388.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,388.90
|
| Rate for Payer: CDPHP Essential Plan |
$5,375.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,866.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,388.90
|
| Rate for Payer: EmblemHealth Medicaid |
$2,388.90
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,375.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,388.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,388.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,136.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,136.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,388.90
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,508.34
|
|
|
EAPG 187: LEVEL II PENILE PROCEDURES
|
Facility
OP
|
$1,977.37
|
|
|
Service Code
|
EAPG 0187
|
| Min. Negotiated Rate |
$878.83 |
| Max. Negotiated Rate |
$1,977.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,977.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$878.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$878.83
|
| Rate for Payer: CDPHP Essential Plan |
$1,977.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,054.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$878.83
|
| Rate for Payer: EmblemHealth Medicaid |
$878.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,977.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$878.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$878.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,889.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,889.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$878.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$922.77
|
|
|
EAPG 188: LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES
|
Facility
OP
|
$2,584.82
|
|
|
Service Code
|
EAPG 0188
|
| Min. Negotiated Rate |
$1,148.81 |
| Max. Negotiated Rate |
$2,584.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,584.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,148.81
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,148.81
|
| Rate for Payer: CDPHP Essential Plan |
$2,584.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,378.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,148.81
|
| Rate for Payer: EmblemHealth Medicaid |
$1,148.81
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,584.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,148.81
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,148.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,469.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,469.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,148.81
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,206.25
|
|
|
EAPG 189: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES
|
Facility
OP
|
$2,914.38
|
|
|
Service Code
|
EAPG 0189
|
| Min. Negotiated Rate |
$1,295.28 |
| Max. Negotiated Rate |
$2,914.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,914.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,295.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,295.28
|
| Rate for Payer: CDPHP Essential Plan |
$2,914.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,554.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,295.28
|
| Rate for Payer: EmblemHealth Medicaid |
$1,295.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,914.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,295.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,295.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,784.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,784.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,295.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,360.04
|
|
|
EAPG 18: COMPLEX WOUND REPAIR AND TREATMENT
|
Facility
OP
|
$2,771.01
|
|
|
Service Code
|
EAPG 0018
|
| Min. Negotiated Rate |
$1,231.56 |
| Max. Negotiated Rate |
$2,771.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,771.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,231.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,231.56
|
| Rate for Payer: CDPHP Essential Plan |
$2,771.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,477.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,231.56
|
| Rate for Payer: EmblemHealth Medicaid |
$1,231.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,771.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,231.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,231.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,647.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,647.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,231.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,293.14
|
|
|
EAPG 191: LEVEL I FETAL PROCEDURES
|
Facility
OP
|
$474.23
|
|
|
Service Code
|
EAPG 0191
|
| Min. Negotiated Rate |
$210.77 |
| Max. Negotiated Rate |
$474.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$474.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$210.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$210.77
|
| Rate for Payer: CDPHP Essential Plan |
$474.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$210.77
|
| Rate for Payer: EmblemHealth Medicaid |
$210.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$474.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$210.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$210.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$453.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$453.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$210.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$221.31
|
|
|
EAPG 192: LEVEL II FETAL PROCEDURES
|
Facility
OP
|
$1,420.85
|
|
|
Service Code
|
EAPG 0192
|
| Min. Negotiated Rate |
$631.49 |
| Max. Negotiated Rate |
$1,420.85 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,420.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$631.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$631.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,420.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$757.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$631.49
|
| Rate for Payer: EmblemHealth Medicaid |
$631.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,420.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$631.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$631.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,357.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,357.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$631.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$663.06
|
|
|
EAPG 194: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES
|
Facility
OP
|
$1,516.66
|
|
|
Service Code
|
EAPG 0194
|
| Min. Negotiated Rate |
$674.07 |
| Max. Negotiated Rate |
$1,516.66 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,516.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$674.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$674.07
|
| Rate for Payer: CDPHP Essential Plan |
$1,516.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$808.88
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$674.07
|
| Rate for Payer: EmblemHealth Medicaid |
$674.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,516.66
|
| Rate for Payer: Hamaspik Choice Medicaid |
$674.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$674.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,449.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,449.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$674.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$707.77
|
|
|
EAPG 195: VAGINAL DELIVERY PROCEDURES
|
Facility
OP
|
$3,989.14
|
|
|
Service Code
|
EAPG 0195
|
| Min. Negotiated Rate |
$1,772.95 |
| Max. Negotiated Rate |
$3,989.14 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,989.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,772.95
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,772.95
|
| Rate for Payer: CDPHP Essential Plan |
$3,989.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,127.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,772.95
|
| Rate for Payer: EmblemHealth Medicaid |
$1,772.95
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,989.14
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,772.95
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,772.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,811.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,811.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,772.95
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,861.60
|
|
