|
EAPG 365: LEVEL II ENDODONTICS
|
Facility
OP
|
$411.05
|
|
|
Service Code
|
EAPG 0365
|
| Min. Negotiated Rate |
$182.69 |
| Max. Negotiated Rate |
$411.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$411.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$182.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$182.69
|
| Rate for Payer: CDPHP Essential Plan |
$411.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$219.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$182.69
|
| Rate for Payer: EmblemHealth Medicaid |
$182.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$411.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$182.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$182.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$392.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$392.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$182.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$191.82
|
|
|
EAPG 366: LEVEL III ENDODONTICS
|
Facility
OP
|
$414.07
|
|
|
Service Code
|
EAPG 0366
|
| Min. Negotiated Rate |
$184.03 |
| Max. Negotiated Rate |
$414.07 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$414.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$184.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$184.03
|
| Rate for Payer: CDPHP Essential Plan |
$414.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$220.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.03
|
| Rate for Payer: EmblemHealth Medicaid |
$184.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$414.07
|
| Rate for Payer: Hamaspik Choice Medicaid |
$184.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$184.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$395.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$395.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$184.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$193.23
|
|
|
EAPG 367: LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
OP
|
$273.94
|
|
|
Service Code
|
EAPG 0367
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$273.94 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$273.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.75
|
| Rate for Payer: CDPHP Essential Plan |
$273.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.75
|
| Rate for Payer: EmblemHealth Medicaid |
$121.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$273.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.84
|
|
|
EAPG 368: LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0368
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 369: LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0369
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 36: LEVEL II FOOT PROCEDURES
|
Facility
OP
|
$4,162.14
|
|
|
Service Code
|
EAPG 0036
|
| Min. Negotiated Rate |
$1,849.84 |
| Max. Negotiated Rate |
$4,162.14 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,162.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,849.84
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,849.84
|
| Rate for Payer: CDPHP Essential Plan |
$4,162.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,219.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,849.84
|
| Rate for Payer: EmblemHealth Medicaid |
$1,849.84
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,162.14
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,849.84
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,849.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,977.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,977.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,849.84
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,942.33
|
|
|
EAPG 370: LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0370
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 372: SEALANT
|
Facility
OP
|
$74.99
|
|
|
Service Code
|
EAPG 0372
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$74.99 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$33.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$33.33
|
| Rate for Payer: CDPHP Essential Plan |
$74.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.33
|
| Rate for Payer: EmblemHealth Medicaid |
$33.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$74.99
|
| Rate for Payer: Hamaspik Choice Medicaid |
$33.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$71.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$71.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$35.00
|
|
|
EAPG 373: LEVEL I DENTAL FILM
|
Facility
OP
|
$48.92
|
|
|
Service Code
|
EAPG 0373
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$21.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$21.74
|
| Rate for Payer: CDPHP Essential Plan |
$48.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.74
|
| Rate for Payer: EmblemHealth Medicaid |
$21.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$48.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$21.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$21.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$46.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$46.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$22.83
|
|
|
EAPG 374: LEVEL II DENTAL FILM
|
Facility
OP
|
$169.36
|
|
|
Service Code
|
EAPG 0374
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$169.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$169.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$75.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$75.27
|
| Rate for Payer: CDPHP Essential Plan |
$169.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.27
|
| Rate for Payer: EmblemHealth Medicaid |
$75.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$169.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$75.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$75.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$161.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$161.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$79.03
|
|
|
EAPG 375: DENTAL ANESTHESIA
|
Facility
OP
|
$2,066.26
|
|
|
Service Code
|
EAPG 0375
|
| Min. Negotiated Rate |
$918.34 |
| Max. Negotiated Rate |
$2,066.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,066.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$918.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$918.34
|
| Rate for Payer: CDPHP Essential Plan |
$2,066.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,102.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$918.34
|
| Rate for Payer: EmblemHealth Medicaid |
$918.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,066.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$918.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$918.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,974.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,974.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$918.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$964.26
|
|
|
EAPG 376: DIAGNOSTIC DENTAL PROCEDURES
|
Facility
OP
|
$85.30
|
|
|
Service Code
|
EAPG 0376
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$85.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.91
|
| Rate for Payer: CDPHP Essential Plan |
$85.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.91
|
| Rate for Payer: EmblemHealth Medicaid |
$37.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$85.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$81.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$81.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.81
|
|
|
EAPG 377: PREVENTIVE DENTAL PROCEDURES
|
Facility
OP
|
$119.32
|
|
|
Service Code
|
EAPG 0377
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$119.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$119.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$53.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$53.03
|
| Rate for Payer: CDPHP Essential Plan |
$119.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.03
|
| Rate for Payer: EmblemHealth Medicaid |
$53.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$119.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$53.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$53.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$114.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$114.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$55.68
|
|
|
EAPG 37: LEVEL I ARTHROSCOPY
|
Facility
OP
|
$3,638.74
|
|
|
Service Code
|
EAPG 0037
|
| Min. Negotiated Rate |
$1,617.22 |
| Max. Negotiated Rate |
$3,638.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,638.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,617.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,617.22
|
| Rate for Payer: CDPHP Essential Plan |
$3,638.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,940.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,617.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,617.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,638.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,617.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,617.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,477.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,477.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,617.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,698.08
|
|
|
EAPG 384: LEVEL III CHEMISTRY TESTS
|
Facility
OP
|
$107.37
|
|
|
Service Code
|
EAPG 0384
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.72
|
| Rate for Payer: CDPHP Essential Plan |
$107.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.72
|
| Rate for Payer: EmblemHealth Medicaid |
$47.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$107.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$47.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$47.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$102.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
|
|
EAPG 388: LEVEL III MICROBIOLOGY TESTS
|
Facility
OP
|
$121.84
|
|
|
Service Code
|
EAPG 0388
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$54.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$54.15
|
| Rate for Payer: CDPHP Essential Plan |
$121.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.15
|
| Rate for Payer: EmblemHealth Medicaid |
$54.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$121.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$54.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$54.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$116.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$116.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$56.86
|
|
|
EAPG 389: LEVEL II CONVENTIONAL RADIOLOGY
|
Facility
OP
|
$509.38
|
|
|
Service Code
|
EAPG 0389
|
| Min. Negotiated Rate |
$226.39 |
| Max. Negotiated Rate |
$509.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$509.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$226.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$226.39
|
| Rate for Payer: CDPHP Essential Plan |
$509.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$271.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$226.39
|
| Rate for Payer: EmblemHealth Medicaid |
$226.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$509.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$226.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$226.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$486.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$486.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$226.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$237.71
|
|
|
EAPG 38: LEVEL II ARTHROSCOPY
|
Facility
OP
|
$6,915.04
|
|
|
Service Code
|
EAPG 0038
|
| Min. Negotiated Rate |
$3,073.35 |
| Max. Negotiated Rate |
$6,915.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,915.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,073.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,073.35
|
| Rate for Payer: CDPHP Essential Plan |
$6,915.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,688.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,073.35
|
| Rate for Payer: EmblemHealth Medicaid |
$3,073.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,915.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,073.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,073.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,607.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,607.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,073.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,227.02
|
|
|
EAPG 390: LEVEL I PATHOLOGY TESTS
|
Facility
OP
|
$84.51
|
|
|
Service Code
|
EAPG 0390
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$84.51 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$84.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.56
|
| Rate for Payer: CDPHP Essential Plan |
$84.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.56
|
| Rate for Payer: EmblemHealth Medicaid |
$37.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$84.51
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$80.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$80.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.44
|
|
|
EAPG 391: LEVEL II PATHOLOGY TESTS
|
Facility
OP
|
$157.25
|
|
|
Service Code
|
EAPG 0391
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$69.89
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$69.89
|
| Rate for Payer: CDPHP Essential Plan |
$157.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$69.89
|
| Rate for Payer: EmblemHealth Medicaid |
$69.89
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$157.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$69.89
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$69.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$150.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$150.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$69.89
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$73.38
|
|
|
EAPG 392: PAP SMEARS
|
Facility
OP
|
$65.72
|
|
|
Service Code
|
EAPG 0392
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$65.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$29.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$29.21
|
| Rate for Payer: CDPHP Essential Plan |
$65.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$35.05
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.21
|
| Rate for Payer: EmblemHealth Medicaid |
$29.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$65.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$29.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$29.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$62.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$62.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$30.67
|
|
|
EAPG 393: LEVEL II BLOOD AND TISSUE TYPING TESTS
|
Facility
OP
|
$93.35
|
|
|
Service Code
|
EAPG 0393
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$93.35 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$93.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.49
|
| Rate for Payer: CDPHP Essential Plan |
$93.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.49
|
| Rate for Payer: EmblemHealth Medicaid |
$41.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$93.35
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$89.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$89.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.56
|
|
|
EAPG 394: LEVEL I IMMUNOLOGY TESTS
|
Facility
OP
|
$23.76
|
|
|
Service Code
|
EAPG 0394
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$23.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$10.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$10.56
|
| Rate for Payer: CDPHP Essential Plan |
$23.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.56
|
| Rate for Payer: EmblemHealth Medicaid |
$10.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$23.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$10.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$10.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$22.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$22.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.09
|
|
|
EAPG 395: LEVEL II IMMUNOLOGY TESTS
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
EAPG 0395
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$85.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.78
|
| Rate for Payer: CDPHP Essential Plan |
$85.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.78
|
| Rate for Payer: EmblemHealth Medicaid |
$37.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$81.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$81.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.67
|
|
|
EAPG 396: LEVEL I MICROBIOLOGY TESTS
|
Facility
OP
|
$21.98
|
|
|
Service Code
|
EAPG 0396
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$21.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$9.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$9.77
|
| Rate for Payer: CDPHP Essential Plan |
$21.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$9.77
|
| Rate for Payer: EmblemHealth Medicaid |
$9.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$21.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$9.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$9.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$21.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$21.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$9.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$10.26
|
|
