|
EAPG 19: MOHS MICROGRAPHIC SURGERY
|
Facility
OP
|
$2,467.40
|
|
|
Service Code
|
EAPG 0019
|
| Min. Negotiated Rate |
$1,096.62 |
| Max. Negotiated Rate |
$2,467.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,467.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,096.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,096.62
|
| Rate for Payer: CDPHP Essential Plan |
$2,467.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,315.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,096.62
|
| Rate for Payer: EmblemHealth Medicaid |
$1,096.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,467.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,096.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,096.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,357.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,357.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,096.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,151.45
|
|
|
EAPG 2008: INCIDENTAL INTRAOPERATIVE PROCEDURES
|
Facility
OP
|
$3,387.53
|
|
|
Service Code
|
EAPG 2008
|
| Min. Negotiated Rate |
$1,505.57 |
| Max. Negotiated Rate |
$3,387.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,387.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,505.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,505.57
|
| Rate for Payer: CDPHP Essential Plan |
$3,387.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,806.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,505.57
|
| Rate for Payer: EmblemHealth Medicaid |
$1,505.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,387.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,505.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,505.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,236.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,236.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,505.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,580.85
|
|
|
EAPG 2010: INCIDENTAL SKIN SUBSTITUTES
|
Facility
OP
|
$2,361.20
|
|
|
Service Code
|
EAPG 2010
|
| Min. Negotiated Rate |
$1,049.42 |
| Max. Negotiated Rate |
$2,361.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,361.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,049.42
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,049.42
|
| Rate for Payer: CDPHP Essential Plan |
$2,361.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,259.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,049.42
|
| Rate for Payer: EmblemHealth Medicaid |
$1,049.42
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,361.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,049.42
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,049.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,256.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,256.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,049.42
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,101.89
|
|
|
EAPG 2016: LEVEL II ALLERGY TESTS
|
Facility
OP
|
$504.58
|
|
|
Service Code
|
EAPG 2016
|
| Min. Negotiated Rate |
$224.26 |
| Max. Negotiated Rate |
$504.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$504.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$224.26
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$224.26
|
| Rate for Payer: CDPHP Essential Plan |
$504.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$269.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$224.26
|
| Rate for Payer: EmblemHealth Medicaid |
$224.26
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$504.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$224.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$224.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$482.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$482.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$235.47
|
|
|
EAPG 2020: NONINVASIVE VENTILATION SUPPORT
|
Facility
OP
|
$375.44
|
|
|
Service Code
|
EAPG 2020
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$375.44 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$375.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$166.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$166.86
|
| Rate for Payer: CDPHP Essential Plan |
$375.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$166.86
|
| Rate for Payer: EmblemHealth Medicaid |
$166.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$375.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$166.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$166.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$358.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$358.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$166.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$175.20
|
|
|
EAPG 2030: MINOR MUSCULOSKELETAL PROCEDURES
|
Facility
OP
|
$943.42
|
|
|
Service Code
|
EAPG 2030
|
| Min. Negotiated Rate |
$419.30 |
| Max. Negotiated Rate |
$943.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$943.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$419.30
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$419.30
|
| Rate for Payer: CDPHP Essential Plan |
$943.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$503.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$419.30
|
| Rate for Payer: EmblemHealth Medicaid |
$419.30
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$943.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$419.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$419.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$901.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$901.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$419.30
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$440.26
|
|
|
EAPG 2043: LEVEL III BLOOD AND TISSUE TYPING TESTS
|
Facility
OP
|
$93.87
|
|
|
Service Code
|
EAPG 2043
|
| Min. Negotiated Rate |
$41.72 |
| Max. Negotiated Rate |
$93.87 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.72
|
| Rate for Payer: CDPHP Essential Plan |
$93.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.72
|
| Rate for Payer: EmblemHealth Medicaid |
$41.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$93.87
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$89.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$89.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.81
|
|
|
EAPG 204: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES
|
Facility
OP
|
$2,395.46
|
|
|
Service Code
|
EAPG 0204
|
| Min. Negotiated Rate |
$1,064.65 |
| Max. Negotiated Rate |
$2,395.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,395.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,064.65
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,064.65
|
| Rate for Payer: CDPHP Essential Plan |
$2,395.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,277.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,064.65
|
| Rate for Payer: EmblemHealth Medicaid |
$1,064.65
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,395.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,064.65
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,064.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,289.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,289.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,064.65
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,117.88
|
|
|
EAPG 205: OBSTETRICAL PROCEDURES
|
Facility
OP
|
$2,056.68
|
|
|
Service Code
|
EAPG 0205
|
| Min. Negotiated Rate |
$914.08 |
| Max. Negotiated Rate |
$2,056.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,056.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$914.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$914.08
|
| Rate for Payer: CDPHP Essential Plan |
$2,056.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,096.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$914.08
|
| Rate for Payer: EmblemHealth Medicaid |
$914.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,056.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$914.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$914.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,965.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,965.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$914.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$959.78
|
|
|
EAPG 2061: LEVEL I BLOOD PRODUCTS
|
Facility
OP
|
$1,082.32
|
|
|
Service Code
|
EAPG 2061
|
| Min. Negotiated Rate |
$481.03 |
| Max. Negotiated Rate |
$1,082.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,082.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$481.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$481.03
|
| Rate for Payer: CDPHP Essential Plan |
$1,082.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$577.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$481.03
|
| Rate for Payer: EmblemHealth Medicaid |
$481.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,082.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$481.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$481.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,034.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,034.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$481.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$505.08
|
|
|
EAPG 2062: LEVEL II BLOOD PRODUCTS
|
Facility
OP
|
$1,332.00
|
|
|
Service Code
|
EAPG 2062
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$592.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$592.00
|
| Rate for Payer: CDPHP Essential Plan |
$1,332.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$710.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$592.00
|
| Rate for Payer: EmblemHealth Medicaid |
$592.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,332.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$592.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$592.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,272.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,272.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$592.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$621.60
|
|
|
EAPG 206: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES
|
Facility
OP
|
$4,098.92
|
|
|
Service Code
|
EAPG 0206
|
| Min. Negotiated Rate |
$1,821.74 |
| Max. Negotiated Rate |
$4,098.92 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,098.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,821.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,821.74
|
| Rate for Payer: CDPHP Essential Plan |
$4,098.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,186.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,821.74
|
| Rate for Payer: EmblemHealth Medicaid |
$1,821.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,098.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,821.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,821.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,916.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,916.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,821.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,912.83
|
|
|
EAPG 207: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES
|
Facility
OP
|
$2,786.98
|
|
|
Service Code
|
EAPG 0207
|
| Min. Negotiated Rate |
$1,238.66 |
| Max. Negotiated Rate |
$2,786.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,786.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,238.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,238.66
|
| Rate for Payer: CDPHP Essential Plan |
$2,786.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,486.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,238.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,238.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,786.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,238.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,238.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,663.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,663.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,238.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,300.59
|
|
|
EAPG 208: LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES
|
Facility
OP
|
$3,443.69
|
|
|
Service Code
|
EAPG 0208
|
| Min. Negotiated Rate |
$1,530.53 |
| Max. Negotiated Rate |
$3,443.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,443.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,530.53
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,530.53
|
| Rate for Payer: CDPHP Essential Plan |
$3,443.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,836.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,530.53
|
| Rate for Payer: EmblemHealth Medicaid |
$1,530.53
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,443.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,530.53
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,530.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,290.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,290.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,530.53
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,607.06
|
|
|
EAPG 209: OTHER GYNECOLOGICAL PROCEDURES
|
Facility
OP
|
$1,125.07
|
|
|
Service Code
|
EAPG 0209
|
| Min. Negotiated Rate |
$500.03 |
| Max. Negotiated Rate |
$1,125.07 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,125.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$500.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$500.03
|
| Rate for Payer: CDPHP Essential Plan |
$1,125.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$600.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$500.03
|
| Rate for Payer: EmblemHealth Medicaid |
$500.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,125.07
|
| Rate for Payer: Hamaspik Choice Medicaid |
$500.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$500.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,075.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,075.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$500.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$525.03
|
|
|
EAPG 20: LEVEL I BREAST PROCEDURES
|
Facility
OP
|
$3,134.56
|
|
|
Service Code
|
EAPG 0020
|
| Min. Negotiated Rate |
$1,393.14 |
| Max. Negotiated Rate |
$3,134.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,134.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,393.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,393.14
|
| Rate for Payer: CDPHP Essential Plan |
$3,134.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,671.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,393.14
|
| Rate for Payer: EmblemHealth Medicaid |
$1,393.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,134.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,393.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,393.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,995.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,995.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,393.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,462.80
|
|
|
EAPG 210: EXTENDED EEG STUDIES
|
Facility
OP
|
$643.16
|
|
|
Service Code
|
EAPG 0210
|
| Min. Negotiated Rate |
$285.85 |
| Max. Negotiated Rate |
$643.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$643.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$285.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$285.85
|
| Rate for Payer: CDPHP Essential Plan |
$643.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$343.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$285.85
|
| Rate for Payer: EmblemHealth Medicaid |
$285.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$643.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$285.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$285.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$614.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$614.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$285.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$300.14
|
|
|
EAPG 211: ELECTROENCEPHALOGRAM
|
Facility
OP
|
$355.21
|
|
|
Service Code
|
EAPG 0211
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$355.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$355.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$157.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$157.87
|
| Rate for Payer: CDPHP Essential Plan |
$355.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$189.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$157.87
|
| Rate for Payer: EmblemHealth Medicaid |
$157.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$355.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$157.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$157.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$339.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$339.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$157.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$165.76
|
|
|
EAPG 212: ELECTROCONVULSIVE THERAPY
|
Facility
OP
|
$767.45
|
|
|
Service Code
|
EAPG 0212
|
| Min. Negotiated Rate |
$341.09 |
| Max. Negotiated Rate |
$767.45 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$767.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$341.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$341.09
|
| Rate for Payer: CDPHP Essential Plan |
$767.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$409.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$341.09
|
| Rate for Payer: EmblemHealth Medicaid |
$341.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$767.45
|
| Rate for Payer: Hamaspik Choice Medicaid |
$341.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$341.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$733.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$733.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$341.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$358.14
|
|
|
EAPG 213: NERVE AND MUSCLE TESTS
|
Facility
OP
|
$273.42
|
|
|
Service Code
|
EAPG 0213
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.52
|
| Rate for Payer: CDPHP Essential Plan |
$273.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.52
|
| Rate for Payer: EmblemHealth Medicaid |
$121.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$273.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.60
|
|
|
EAPG 214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
OP
|
$924.16
|
|
|
Service Code
|
EAPG 0214
|
| Min. Negotiated Rate |
$410.74 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$924.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$410.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$410.74
|
| Rate for Payer: CDPHP Essential Plan |
$924.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$410.74
|
| Rate for Payer: EmblemHealth Medicaid |
$410.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$924.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$410.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$410.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$883.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$883.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$410.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$431.28
|
|
|
EAPG 217: LEVEL I NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
OP
|
$2,648.05
|
|
|
Service Code
|
EAPG 0217
|
| Min. Negotiated Rate |
$1,176.91 |
| Max. Negotiated Rate |
$2,648.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,648.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,176.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,176.91
|
| Rate for Payer: CDPHP Essential Plan |
$2,648.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,412.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,176.91
|
| Rate for Payer: EmblemHealth Medicaid |
$1,176.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,648.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,176.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,176.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,530.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,530.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,176.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,235.76
|
|
|
EAPG 218: LEVEL II NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
OP
|
$7,032.31
|
|
|
Service Code
|
EAPG 0218
|
| Min. Negotiated Rate |
$3,125.47 |
| Max. Negotiated Rate |
$7,032.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,032.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,125.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,125.47
|
| Rate for Payer: CDPHP Essential Plan |
$7,032.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,750.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,125.47
|
| Rate for Payer: EmblemHealth Medicaid |
$3,125.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,032.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,125.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,125.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,719.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,719.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,125.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,281.74
|
|
|
EAPG 21: LEVEL II BREAST PROCEDURES
|
Facility
OP
|
$4,426.29
|
|
|
Service Code
|
EAPG 0021
|
| Min. Negotiated Rate |
$1,967.24 |
| Max. Negotiated Rate |
$4,426.29 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,426.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,967.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,967.24
|
| Rate for Payer: CDPHP Essential Plan |
$4,426.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,360.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,967.24
|
| Rate for Payer: EmblemHealth Medicaid |
$1,967.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,426.29
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,967.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,967.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,229.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,229.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,967.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,065.60
|
|
|
EAPG 220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
OP
|
$1,110.13
|
|
|
Service Code
|
EAPG 0220
|
| Min. Negotiated Rate |
$493.39 |
| Max. Negotiated Rate |
$1,110.13 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,110.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$493.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$493.39
|
| Rate for Payer: CDPHP Essential Plan |
$1,110.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$592.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$493.39
|
| Rate for Payer: EmblemHealth Medicaid |
$493.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,110.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$493.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$493.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,060.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,060.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$493.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$518.06
|
|
