|
EAPG 337: LEVEL III BRACHYTHERAPY SOURCES
|
Facility
OP
|
$28,704.06
|
|
|
Service Code
|
EAPG 0337
|
| Min. Negotiated Rate |
$12,757.36 |
| Max. Negotiated Rate |
$28,704.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$28,704.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$12,757.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$12,757.36
|
| Rate for Payer: CDPHP Essential Plan |
$28,704.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,308.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,757.36
|
| Rate for Payer: EmblemHealth Medicaid |
$12,757.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$28,704.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12,757.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12,757.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$27,428.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$27,428.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12,757.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$13,395.23
|
|
|
EAPG 338: LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY
|
Facility
OP
|
$2,546.71
|
|
|
Service Code
|
EAPG 0338
|
| Min. Negotiated Rate |
$1,131.87 |
| Max. Negotiated Rate |
$2,546.71 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,546.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,131.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,131.87
|
| Rate for Payer: CDPHP Essential Plan |
$2,546.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,358.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,131.87
|
| Rate for Payer: EmblemHealth Medicaid |
$1,131.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,546.71
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,131.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,131.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,433.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,433.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,131.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,188.46
|
|
|
EAPG 339: LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY
|
Facility
OP
|
$3,632.26
|
|
|
Service Code
|
EAPG 0339
|
| Min. Negotiated Rate |
$1,614.34 |
| Max. Negotiated Rate |
$3,632.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,632.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,614.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,614.34
|
| Rate for Payer: CDPHP Essential Plan |
$3,632.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,937.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,614.34
|
| Rate for Payer: EmblemHealth Medicaid |
$1,614.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,632.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,614.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,614.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,470.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,470.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,614.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,695.06
|
|
|
EAPG 33: LEVEL I HAND PROCEDURES
|
Facility
OP
|
$2,525.22
|
|
|
Service Code
|
EAPG 0033
|
| Min. Negotiated Rate |
$1,122.32 |
| Max. Negotiated Rate |
$2,525.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,525.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,122.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,122.32
|
| Rate for Payer: CDPHP Essential Plan |
$2,525.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,346.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,122.32
|
| Rate for Payer: EmblemHealth Medicaid |
$1,122.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,525.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,122.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,122.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,412.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,412.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,122.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,178.44
|
|
|
EAPG 340: THERAPEUTIC NUCLEAR MEDICINE
|
Facility
OP
|
$776.30
|
|
|
Service Code
|
EAPG 0340
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$776.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$776.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$345.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$345.02
|
| Rate for Payer: CDPHP Essential Plan |
$776.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$414.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$345.02
|
| Rate for Payer: EmblemHealth Medicaid |
$345.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$776.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$345.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$345.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$741.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$741.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$345.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$362.27
|
|
|
EAPG 343: LEVEL I RADIATION THERAPY
|
Facility
OP
|
$695.79
|
|
|
Service Code
|
EAPG 0343
|
| Min. Negotiated Rate |
$309.24 |
| Max. Negotiated Rate |
$695.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$695.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$309.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$309.24
|
| Rate for Payer: CDPHP Essential Plan |
$695.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$371.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$309.24
|
| Rate for Payer: EmblemHealth Medicaid |
$309.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$695.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$309.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$309.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$664.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$664.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$309.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$324.70
|
|
|
EAPG 346: RADIOSURGERY
|
Facility
OP
|
$9,541.69
|
|
|
Service Code
|
EAPG 0346
|
| Min. Negotiated Rate |
$4,240.75 |
| Max. Negotiated Rate |
$9,541.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$9,541.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$4,240.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$4,240.75
|
| Rate for Payer: CDPHP Essential Plan |
$9,541.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,088.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,240.75
|
| Rate for Payer: EmblemHealth Medicaid |
$4,240.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$9,541.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,240.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,240.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$9,117.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$9,117.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,240.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$4,452.79
|
|
|
EAPG 347: LEVEL II RADIATION THERAPY
|
Facility
OP
|
$320.24
|
|
|
Service Code
|
EAPG 0347
|
| Min. Negotiated Rate |
$142.33 |
| Max. Negotiated Rate |
$320.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$320.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$142.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$142.33
|
| Rate for Payer: CDPHP Essential Plan |
$320.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.33
|
| Rate for Payer: EmblemHealth Medicaid |
$142.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$320.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$142.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$142.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$306.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$306.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$142.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$149.45
|
|
|
EAPG 348: LEVEL III RADIATION THERAPY
|
Facility
OP
|
$1,539.52
|
|
|
Service Code
|
EAPG 0348
|
| Min. Negotiated Rate |
$684.23 |
| Max. Negotiated Rate |
$1,539.52 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,539.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$684.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$684.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,539.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$821.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$684.23
|
| Rate for Payer: EmblemHealth Medicaid |
$684.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,539.52
|
| Rate for Payer: Hamaspik Choice Medicaid |
$684.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$684.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,471.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,471.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$684.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$718.44
|
|
|
EAPG 34: LEVEL II HAND PROCEDURES
|
Facility
OP
|
$4,176.72
|
|
|
Service Code
|
EAPG 0034
|
| Min. Negotiated Rate |
$1,856.32 |
| Max. Negotiated Rate |
$4,176.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,176.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,856.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,856.32
|
| Rate for Payer: CDPHP Essential Plan |
$4,176.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,227.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,856.32
|
| Rate for Payer: EmblemHealth Medicaid |
$1,856.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,176.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,856.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,856.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,991.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,991.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,856.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,949.14
|
|
|
EAPG 351: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES
|
Facility
OP
|
$478.04
|
|
|
Service Code
|
EAPG 0351
|
| Min. Negotiated Rate |
$212.46 |
| Max. Negotiated Rate |
$478.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$478.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$212.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$212.46
|
| Rate for Payer: CDPHP Essential Plan |
$478.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.46
|
| Rate for Payer: EmblemHealth Medicaid |
$212.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$478.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$212.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$212.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$456.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$456.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$212.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$223.08
|
|
|
EAPG 352: LEVEL I PERIODONTICS
|
Facility
OP
|
$297.40
|
|
|
Service Code
|
EAPG 0352
|
| Min. Negotiated Rate |
$132.18 |
| Max. Negotiated Rate |
$297.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$297.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$132.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$132.18
|
| Rate for Payer: CDPHP Essential Plan |
$297.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.18
|
| Rate for Payer: EmblemHealth Medicaid |
$132.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$297.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$132.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$132.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$284.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$284.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$138.79
|
|
|
EAPG 353: LEVEL I PROSTHODONTICS, FIXED
|
Facility
OP
|
$166.36
|
|
|
Service Code
|
EAPG 0353
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$166.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$73.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$73.94
|
| Rate for Payer: CDPHP Essential Plan |
$166.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.94
|
| Rate for Payer: EmblemHealth Medicaid |
$73.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$166.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$73.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$73.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$158.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$158.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$73.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$77.64
|
|
|
EAPG 354: LEVEL II PROSTHODONTICS, FIXED
|
Facility
OP
|
$622.40
|
|
|
Service Code
|
EAPG 0354
|
| Min. Negotiated Rate |
$276.62 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$622.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$276.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$276.62
|
| Rate for Payer: CDPHP Essential Plan |
$622.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$331.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.62
|
| Rate for Payer: EmblemHealth Medicaid |
$276.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$622.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$276.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$276.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$594.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$594.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$276.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$290.45
|
|
|
EAPG 355: LEVEL III PROSTHODONTICS, FIXED
|
Facility
OP
|
$769.93
|
|
|
Service Code
|
EAPG 0355
|
| Min. Negotiated Rate |
$342.19 |
| Max. Negotiated Rate |
$769.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$769.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$342.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$342.19
|
| Rate for Payer: CDPHP Essential Plan |
$769.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$410.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$342.19
|
| Rate for Payer: EmblemHealth Medicaid |
$342.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$769.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$342.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$342.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$735.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$735.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$342.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$359.30
|
|
|
EAPG 356: LEVEL I PROSTHODONTICS, REMOVABLE
|
Facility
OP
|
$337.21
|
|
|
Service Code
|
EAPG 0356
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$337.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$337.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$149.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$149.87
|
| Rate for Payer: CDPHP Essential Plan |
$337.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.87
|
| Rate for Payer: EmblemHealth Medicaid |
$149.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$337.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$149.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$149.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$322.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$322.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$149.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$157.36
|
|
|
EAPG 357: LEVEL II PROSTHODONTICS, REMOVABLE
|
Facility
OP
|
$645.19
|
|
|
Service Code
|
EAPG 0357
|
| Min. Negotiated Rate |
$286.75 |
| Max. Negotiated Rate |
$645.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$645.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$286.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$286.75
|
| Rate for Payer: CDPHP Essential Plan |
$645.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$344.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$286.75
|
| Rate for Payer: EmblemHealth Medicaid |
$286.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$645.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$286.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$286.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$616.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$616.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$286.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$301.09
|
|
|
EAPG 358: LEVEL III PROSTHODONTICS, REMOVABLE
|
Facility
OP
|
$496.60
|
|
|
Service Code
|
EAPG 0358
|
| Min. Negotiated Rate |
$220.71 |
| Max. Negotiated Rate |
$496.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$496.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$220.71
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$220.71
|
| Rate for Payer: CDPHP Essential Plan |
$496.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$264.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$220.71
|
| Rate for Payer: EmblemHealth Medicaid |
$220.71
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$496.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$220.71
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$220.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$474.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$474.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$220.71
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$231.75
|
|
|
EAPG 359: LEVEL I MAXILLOFACIAL PROSTHETICS
|
Facility
OP
|
$93.67
|
|
|
Service Code
|
EAPG 0359
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$93.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$93.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.63
|
| Rate for Payer: CDPHP Essential Plan |
$93.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.63
|
| Rate for Payer: EmblemHealth Medicaid |
$41.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$93.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$89.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$89.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.71
|
|
|
EAPG 35: LEVEL I FOOT PROCEDURES
|
Facility
OP
|
$3,252.82
|
|
|
Service Code
|
EAPG 0035
|
| Min. Negotiated Rate |
$1,445.70 |
| Max. Negotiated Rate |
$3,252.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,252.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,445.70
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,445.70
|
| Rate for Payer: CDPHP Essential Plan |
$3,252.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,734.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,445.70
|
| Rate for Payer: EmblemHealth Medicaid |
$1,445.70
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,252.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,445.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,445.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,108.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,108.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,445.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,517.98
|
|
|
EAPG 360: LEVEL II MAXILLOFACIAL PROSTHETICS
|
Facility
OP
|
$489.24
|
|
|
Service Code
|
EAPG 0360
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$489.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$217.44
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$217.44
|
| Rate for Payer: CDPHP Essential Plan |
$489.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$260.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.44
|
| Rate for Payer: EmblemHealth Medicaid |
$217.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$489.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$217.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$217.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$467.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$467.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$217.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$228.31
|
|
|
EAPG 361: LEVEL I DENTAL RESTORATIONS
|
Facility
OP
|
$239.90
|
|
|
Service Code
|
EAPG 0361
|
| Min. Negotiated Rate |
$106.62 |
| Max. Negotiated Rate |
$239.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$239.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.62
|
| Rate for Payer: CDPHP Essential Plan |
$239.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.62
|
| Rate for Payer: EmblemHealth Medicaid |
$106.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$239.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$229.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$229.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.95
|
|
|
EAPG 362: LEVEL II DENTAL RESTORATIONS
|
Facility
OP
|
$359.96
|
|
|
Service Code
|
EAPG 0362
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$359.96 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$359.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$159.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$159.98
|
| Rate for Payer: CDPHP Essential Plan |
$359.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$191.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.98
|
| Rate for Payer: EmblemHealth Medicaid |
$159.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$359.96
|
| Rate for Payer: Hamaspik Choice Medicaid |
$159.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$159.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$343.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$343.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$159.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$167.98
|
|
|
EAPG 363: LEVEL III DENTAL RESTORATIONS
|
Facility
OP
|
$858.38
|
|
|
Service Code
|
EAPG 0363
|
| Min. Negotiated Rate |
$381.50 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$858.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$381.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$381.50
|
| Rate for Payer: CDPHP Essential Plan |
$858.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$381.50
|
| Rate for Payer: EmblemHealth Medicaid |
$381.50
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$858.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$381.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$381.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$820.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$820.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$381.50
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$400.58
|
|
|
EAPG 364: LEVEL I ENDODONTICS
|
Facility
OP
|
$228.58
|
|
|
Service Code
|
EAPG 0364
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$228.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$228.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$101.59
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$101.59
|
| Rate for Payer: CDPHP Essential Plan |
$228.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$121.91
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.59
|
| Rate for Payer: EmblemHealth Medicaid |
$101.59
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$228.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$101.59
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$101.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$218.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$218.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$106.67
|
|
