|
EAPG 397: LEVEL II MICROBIOLOGY TESTS
|
Facility
OP
|
$87.01
|
|
|
Service Code
|
EAPG 0397
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$87.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$87.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$38.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$38.67
|
| Rate for Payer: CDPHP Essential Plan |
$87.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$46.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.67
|
| Rate for Payer: EmblemHealth Medicaid |
$38.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$87.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$38.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$38.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$83.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$83.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$40.60
|
|
|
EAPG 398: LEVEL I ENDOCRINOLOGY TESTS
|
Facility
OP
|
$57.35
|
|
|
Service Code
|
EAPG 0398
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$57.35 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$57.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$25.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$25.49
|
| Rate for Payer: CDPHP Essential Plan |
$57.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.49
|
| Rate for Payer: EmblemHealth Medicaid |
$25.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$57.35
|
| Rate for Payer: Hamaspik Choice Medicaid |
$25.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$25.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$54.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$54.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$26.76
|
|
|
EAPG 399: LEVEL II ENDOCRINOLOGY TESTS
|
Facility
OP
|
$80.75
|
|
|
Service Code
|
EAPG 0399
|
| Min. Negotiated Rate |
$35.89 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$80.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$35.89
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$35.89
|
| Rate for Payer: CDPHP Essential Plan |
$80.75
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$43.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$35.89
|
| Rate for Payer: EmblemHealth Medicaid |
$35.89
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$80.75
|
| Rate for Payer: Hamaspik Choice Medicaid |
$35.89
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$35.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$77.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$77.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.89
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$37.68
|
|
|
EAPG 39: CAST APPLICATION OR REPLACEMENT
|
Facility
OP
|
$578.32
|
|
|
Service Code
|
EAPG 0039
|
| Min. Negotiated Rate |
$257.03 |
| Max. Negotiated Rate |
$578.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$578.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$257.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$257.03
|
| Rate for Payer: CDPHP Essential Plan |
$578.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$308.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$257.03
|
| Rate for Payer: EmblemHealth Medicaid |
$257.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$578.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$257.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$257.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$552.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$552.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$257.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$269.88
|
|
|
EAPG 3: LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX
|
Facility
OP
|
$642.28
|
|
|
Service Code
|
EAPG 0003
|
| Min. Negotiated Rate |
$285.46 |
| Max. Negotiated Rate |
$642.28 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$642.28
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$285.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$285.46
|
| Rate for Payer: CDPHP Essential Plan |
$642.28
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$342.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$285.46
|
| Rate for Payer: EmblemHealth Medicaid |
$285.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$642.28
|
| Rate for Payer: Hamaspik Choice Medicaid |
$285.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$285.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$613.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$613.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$285.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$299.73
|
|
|
EAPG 4001: EMERGING TECHNOLOGY PROCEDURES
|
Facility
OP
|
$166.16
|
|
|
Service Code
|
EAPG 4001
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$166.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$166.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$73.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$73.85
|
| Rate for Payer: CDPHP Essential Plan |
$166.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.85
|
| Rate for Payer: EmblemHealth Medicaid |
$73.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$166.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$73.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$73.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$158.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$158.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$73.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$77.54
|
|
|
EAPG 400: LEVEL I CHEMISTRY TESTS
|
Facility
OP
|
$24.44
|
|
|
Service Code
|
EAPG 0400
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Hamaspik Choice Medicaid |
$10.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$24.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$10.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$10.86
|
| Rate for Payer: CDPHP Essential Plan |
$24.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.86
|
| Rate for Payer: EmblemHealth Medicaid |
$10.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$24.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$10.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$23.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$23.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.40
|
|
|
EAPG 401: LEVEL II CHEMISTRY TESTS
|
Facility
OP
|
$76.25
|
|
|
Service Code
|
EAPG 0401
|
| Min. Negotiated Rate |
$33.89 |
| Max. Negotiated Rate |
$76.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$76.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$33.89
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$33.89
|
| Rate for Payer: CDPHP Essential Plan |
$76.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.89
|
| Rate for Payer: EmblemHealth Medicaid |
$33.89
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$76.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$33.89
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$72.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$72.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.89
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$35.58
|
|
|
EAPG 402: BASIC CHEMISTRY TESTS
|
Facility
OP
|
$15.19
|
|
|
Service Code
|
EAPG 0402
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$6.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$6.75
|
| Rate for Payer: CDPHP Essential Plan |
$15.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$6.75
|
| Rate for Payer: EmblemHealth Medicaid |
$6.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$15.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$6.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$6.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$14.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$14.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$7.09
|
|
|
EAPG 403: ORGAN OR DISEASE ORIENTED PANELS
|
Facility
OP
|
$58.68
|
|
|
Service Code
|
EAPG 0403
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$58.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$58.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$26.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$26.08
|
| Rate for Payer: CDPHP Essential Plan |
$58.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$31.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.08
|
| Rate for Payer: EmblemHealth Medicaid |
$26.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$58.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$26.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$26.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$56.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$56.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$27.38
|
|
|
EAPG 404: TOXICOLOGY TESTS
|
Facility
OP
|
$42.98
|
|
|
Service Code
|
EAPG 0404
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$42.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$19.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$19.10
|
| Rate for Payer: CDPHP Essential Plan |
$42.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.10
|
| Rate for Payer: EmblemHealth Medicaid |
$19.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$42.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$19.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$19.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$41.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$41.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$19.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$20.06
|
|
|
EAPG 405: THERAPEUTIC DRUG MONITORING
|
Facility
OP
|
$38.54
|
|
|
Service Code
|
EAPG 0405
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$38.54 |
| Rate for Payer: Hamaspik Choice Medicaid |
$17.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$38.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$17.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$17.13
|
| Rate for Payer: CDPHP Essential Plan |
$38.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.13
|
| Rate for Payer: EmblemHealth Medicaid |
$17.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$38.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$17.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$36.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$36.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$17.99
|
|
|
EAPG 406: LEVEL I CLOTTING TESTS
|
Facility
OP
|
$30.22
|
|
|
Service Code
|
EAPG 0406
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$30.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13.43
|
| Rate for Payer: CDPHP Essential Plan |
$30.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.43
|
| Rate for Payer: EmblemHealth Medicaid |
$13.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$13.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$13.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.10
|
|
|
EAPG 407: LEVEL II CLOTTING TESTS
|
Facility
OP
|
$90.58
|
|
|
Service Code
|
EAPG 0407
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$90.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$90.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$40.26
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$40.26
|
| Rate for Payer: CDPHP Essential Plan |
$90.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$48.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.26
|
| Rate for Payer: EmblemHealth Medicaid |
$40.26
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$90.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$40.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$40.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$86.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$86.56
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$40.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$42.27
|
|
|
EAPG 408: LEVEL I HEMATOLOGY TESTS
|
Facility
OP
|
$25.13
|
|
|
Service Code
|
EAPG 0408
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$25.13 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$11.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$11.17
|
| Rate for Payer: CDPHP Essential Plan |
$25.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11.17
|
| Rate for Payer: EmblemHealth Medicaid |
$11.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$25.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$11.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$11.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$24.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$24.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.73
|
|
|
EAPG 409: LEVEL II HEMATOLOGY TESTS
|
Facility
OP
|
$61.27
|
|
|
Service Code
|
EAPG 0409
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$61.27 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$61.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$27.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$27.23
|
| Rate for Payer: CDPHP Essential Plan |
$61.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.23
|
| Rate for Payer: EmblemHealth Medicaid |
$27.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$61.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$27.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$27.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$58.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$58.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$28.59
|
|
|
EAPG 40: MINOR SPLINT AND STRAPPING APPLICATION
|
Facility
OP
|
$423.14
|
|
|
Service Code
|
EAPG 0040
|
| Min. Negotiated Rate |
$188.06 |
| Max. Negotiated Rate |
$423.14 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$423.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$188.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$188.06
|
| Rate for Payer: CDPHP Essential Plan |
$423.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$225.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$188.06
|
| Rate for Payer: EmblemHealth Medicaid |
$188.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$423.14
|
| Rate for Payer: Hamaspik Choice Medicaid |
$188.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$188.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$404.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$404.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$188.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$197.46
|
|
|
EAPG 410: URINALYSIS
|
Facility
OP
|
$23.94
|
|
|
Service Code
|
EAPG 0410
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$23.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$10.64
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$10.64
|
| Rate for Payer: CDPHP Essential Plan |
$23.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.77
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.64
|
| Rate for Payer: EmblemHealth Medicaid |
$10.64
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$23.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$10.64
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$10.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$22.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$22.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.64
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$11.17
|
|
|
EAPG 412: MINOR PULMONARY TESTS AND SERVICES
|
Facility
OP
|
$147.56
|
|
|
Service Code
|
EAPG 0412
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$147.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$147.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$65.58
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$65.58
|
| Rate for Payer: CDPHP Essential Plan |
$147.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.58
|
| Rate for Payer: EmblemHealth Medicaid |
$65.58
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$147.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$65.58
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$65.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$141.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$141.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$65.58
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$68.86
|
|
|
EAPG 413: CARDIOGRAM
|
Facility
OP
|
$83.70
|
|
|
Service Code
|
EAPG 0413
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.20
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.20
|
| Rate for Payer: CDPHP Essential Plan |
$83.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.20
|
| Rate for Payer: EmblemHealth Medicaid |
$37.20
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$83.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.20
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.06
|
|
|
EAPG 414: LEVEL I IMMUNIZATION
|
Facility
OP
|
$65.20
|
|
|
Service Code
|
EAPG 0414
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$65.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$28.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$28.98
|
| Rate for Payer: CDPHP Essential Plan |
$65.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.98
|
| Rate for Payer: EmblemHealth Medicaid |
$28.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$65.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$28.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$28.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$62.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$62.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$30.43
|
|
|
EAPG 415: LEVEL II IMMUNIZATION
|
Facility
OP
|
$135.22
|
|
|
Service Code
|
EAPG 0415
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$135.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$135.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$60.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$60.10
|
| Rate for Payer: CDPHP Essential Plan |
$135.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.10
|
| Rate for Payer: EmblemHealth Medicaid |
$60.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$135.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$60.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$60.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$129.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$129.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$63.10
|
|
|
EAPG 417: MINOR FEMALE REPRODUCTIVE PROCEDURES
|
Facility
OP
|
$294.03
|
|
|
Service Code
|
EAPG 0417
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.68
|
| Rate for Payer: CDPHP Essential Plan |
$294.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.68
|
| Rate for Payer: EmblemHealth Medicaid |
$130.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$294.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$280.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$280.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$137.21
|
|
|
EAPG 418: AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS
|
Facility
OP
|
$370.37
|
|
|
Service Code
|
EAPG 0418
|
| Min. Negotiated Rate |
$164.61 |
| Max. Negotiated Rate |
$370.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$370.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$164.61
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$164.61
|
| Rate for Payer: CDPHP Essential Plan |
$370.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.61
|
| Rate for Payer: EmblemHealth Medicaid |
$164.61
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$370.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$164.61
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$164.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$353.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$353.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$164.61
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$172.84
|
|
|
EAPG 419: MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
|
Facility
OP
|
$181.08
|
|
|
Service Code
|
EAPG 0419
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$181.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$181.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$80.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$80.48
|
| Rate for Payer: CDPHP Essential Plan |
$181.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.48
|
| Rate for Payer: EmblemHealth Medicaid |
$80.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$181.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$80.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$80.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$173.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$173.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$80.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$84.50
|
|
