|
EAPG 41: CLOSED TREATMENT FX AND DISLOCATION
|
Facility
OP
|
$1,003.16
|
|
|
Service Code
|
EAPG 0041
|
| Min. Negotiated Rate |
$445.85 |
| Max. Negotiated Rate |
$1,003.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,003.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$445.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$445.85
|
| Rate for Payer: CDPHP Essential Plan |
$1,003.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$535.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$445.85
|
| Rate for Payer: EmblemHealth Medicaid |
$445.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,003.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$445.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$445.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$958.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$958.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$445.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$468.14
|
|
|
EAPG 420: ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES
|
Facility
OP
|
$166.16
|
|
|
Service Code
|
EAPG 0420
|
| 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 421: TUBE REPLACEMENT, REVISION OR REMOVAL
|
Facility
OP
|
$715.97
|
|
|
Service Code
|
EAPG 0421
|
| Min. Negotiated Rate |
$318.21 |
| Max. Negotiated Rate |
$715.97 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$715.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$318.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$318.21
|
| Rate for Payer: CDPHP Essential Plan |
$715.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$381.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$318.21
|
| Rate for Payer: EmblemHealth Medicaid |
$318.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$715.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$318.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$318.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$684.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$684.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$318.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$334.12
|
|
|
EAPG 423: VASCULAR ACCESS BY NEEDLE OR CATHETER
|
Facility
OP
|
$379.69
|
|
|
Service Code
|
EAPG 0423
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$379.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$168.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$168.75
|
| Rate for Payer: CDPHP Essential Plan |
$379.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$202.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.75
|
| Rate for Payer: EmblemHealth Medicaid |
$168.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$379.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$168.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$168.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$362.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$362.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$168.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$177.19
|
|
|
EAPG 435: CLASS I PHARMACOTHERAPY
|
Facility
OP
|
$68.31
|
|
|
Service Code
|
EAPG 0435
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$30.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$30.36
|
| Rate for Payer: CDPHP Essential Plan |
$68.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.36
|
| Rate for Payer: EmblemHealth Medicaid |
$30.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$68.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$30.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$30.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$65.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$65.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$31.88
|
|
|
EAPG 436: CLASS II PHARMACOTHERAPY
|
Facility
OP
|
$204.93
|
|
|
Service Code
|
EAPG 0436
|
| Min. Negotiated Rate |
$91.08 |
| Max. Negotiated Rate |
$204.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$204.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$91.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$91.08
|
| Rate for Payer: CDPHP Essential Plan |
$204.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$91.08
|
| Rate for Payer: EmblemHealth Medicaid |
$91.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$204.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$91.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$91.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$195.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$195.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$91.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$95.63
|
|
|
EAPG 437: CLASS III PHARMACOTHERAPY
|
Facility
OP
|
$368.01
|
|
|
Service Code
|
EAPG 0437
|
| Min. Negotiated Rate |
$163.56 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$163.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$163.56
|
| Rate for Payer: CDPHP Essential Plan |
$368.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$196.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.56
|
| Rate for Payer: EmblemHealth Medicaid |
$163.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$368.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$163.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$163.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$351.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$351.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$163.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$171.74
|
|
|
EAPG 438: CLASS IV PHARMACOTHERAPY
|
Facility
OP
|
$617.02
|
|
|
Service Code
|
EAPG 0438
|
| Min. Negotiated Rate |
$274.23 |
| Max. Negotiated Rate |
$617.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$617.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$274.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$274.23
|
| Rate for Payer: CDPHP Essential Plan |
$617.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$329.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$274.23
|
| Rate for Payer: EmblemHealth Medicaid |
$274.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$617.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$274.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$274.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$589.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$589.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$274.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$287.94
|
|
|
EAPG 439: CLASS V PHARMACOTHERAPY
|
Facility
OP
|
$998.26
|
|
|
Service Code
|
EAPG 0439
|
| Min. Negotiated Rate |
$443.67 |
| Max. Negotiated Rate |
$998.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$998.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$443.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$443.67
|
| Rate for Payer: CDPHP Essential Plan |
$998.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$532.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$443.67
|
| Rate for Payer: EmblemHealth Medicaid |
$443.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$998.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$443.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$443.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$953.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$953.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$443.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$465.85
|
|
|
EAPG 43: OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES
|
Facility
OP
|
$5,915.77
|
|
|
Service Code
|
EAPG 0043
|
| Min. Negotiated Rate |
$2,629.23 |
| Max. Negotiated Rate |
$5,915.77 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,915.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,629.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,629.23
|
| Rate for Payer: CDPHP Essential Plan |
$5,915.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,155.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,629.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2,629.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,915.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,629.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,629.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,652.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,652.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,629.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,760.69
|
|
|
EAPG 440: CLASS VI PHARMACOTHERAPY
|
Facility
OP
|
$1,555.76
|
|
|
Service Code
|
EAPG 0440
|
| Min. Negotiated Rate |
$691.45 |
| Max. Negotiated Rate |
$1,555.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,555.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$691.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$691.45
|
| Rate for Payer: CDPHP Essential Plan |
$1,555.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$829.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$691.45
|
| Rate for Payer: EmblemHealth Medicaid |
$691.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,555.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$691.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$691.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,486.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,486.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$691.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$726.02
|
|
|
EAPG 444: CLASS VII PHARMACOTHERAPY
|
Facility
OP
|
$2,329.24
|
|
|
Service Code
|
EAPG 0444
|
| Min. Negotiated Rate |
$1,035.22 |
| Max. Negotiated Rate |
$2,329.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,329.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,035.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,035.22
|
| Rate for Payer: CDPHP Essential Plan |
$2,329.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,242.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,035.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,035.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,329.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,035.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,035.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,225.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,225.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,035.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,086.98
|
|
|
EAPG 448: EXPANDED HOURS ACCESS
|
Facility
OP
|
$27.74
|
|
|
Service Code
|
EAPG 0448
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$27.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$12.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$12.33
|
| Rate for Payer: CDPHP Essential Plan |
$27.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.33
|
| Rate for Payer: EmblemHealth Medicaid |
$12.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$27.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$26.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$26.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$12.95
|
|
|
EAPG 44: BONE OR JOINT MANIPULATION UNDER ANESTHESIA
|
Facility
OP
|
$1,848.67
|
|
|
Service Code
|
EAPG 0044
|
| Min. Negotiated Rate |
$821.63 |
| Max. Negotiated Rate |
$1,848.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,848.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$821.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$821.63
|
| Rate for Payer: CDPHP Essential Plan |
$1,848.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$985.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$821.63
|
| Rate for Payer: EmblemHealth Medicaid |
$821.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,848.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$821.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$821.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,766.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,766.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$821.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$862.71
|
|
|
EAPG 450: OBSERVATION
|
Facility
OP
|
$57.15
|
|
|
Service Code
|
EAPG 0450
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$57.15 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$25.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$25.40
|
| Rate for Payer: CDPHP Essential Plan |
$57.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.40
|
| Rate for Payer: EmblemHealth Medicaid |
$25.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$57.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$25.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$25.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$54.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$54.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$26.67
|
|
|
EAPG 455: IMPLANTED TISSUE OF ANY TYPE
|
Facility
OP
|
$2,347.83
|
|
|
Service Code
|
EAPG 0455
|
| Min. Negotiated Rate |
$1,043.48 |
| Max. Negotiated Rate |
$2,347.83 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,347.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,043.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,043.48
|
| Rate for Payer: CDPHP Essential Plan |
$2,347.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,252.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,043.48
|
| Rate for Payer: EmblemHealth Medicaid |
$1,043.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,347.83
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,043.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,043.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,243.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,243.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,043.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,095.65
|
|
|
EAPG 458: ALLERGY THERAPY
|
Facility
OP
|
$65.56
|
|
|
Service Code
|
EAPG 0458
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$65.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$29.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$29.14
|
| Rate for Payer: CDPHP Essential Plan |
$65.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.14
|
| Rate for Payer: EmblemHealth Medicaid |
$29.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$65.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$29.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$29.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$62.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$62.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$30.60
|
|
|
EAPG 459: VACCINE ADMINISTRATION
|
Facility
OP
|
$30.24
|
|
|
Service Code
|
EAPG 0459
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.44
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13.44
|
| Rate for Payer: CDPHP Essential Plan |
$30.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.44
|
| Rate for Payer: EmblemHealth Medicaid |
$13.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$13.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$13.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.11
|
|
|
EAPG 45: BUNION PROCEDURES
|
Facility
OP
|
$4,487.98
|
|
|
Service Code
|
EAPG 0045
|
| Min. Negotiated Rate |
$1,994.66 |
| Max. Negotiated Rate |
$4,487.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,487.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,994.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,994.66
|
| Rate for Payer: CDPHP Essential Plan |
$4,487.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,393.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,994.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,994.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,487.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,994.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,994.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,288.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,288.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,994.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,094.39
|
|
|
EAPG 460: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
OP
|
$3,351.74
|
|
|
Service Code
|
EAPG 0460
|
| Min. Negotiated Rate |
$1,489.66 |
| Max. Negotiated Rate |
$3,351.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,351.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,489.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,489.66
|
| Rate for Payer: CDPHP Essential Plan |
$3,351.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,787.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,351.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,489.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,489.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,202.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,202.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,489.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,564.14
|
|
|
EAPG 461: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
OP
|
$4,623.23
|
|
|
Service Code
|
EAPG 0461
|
| Min. Negotiated Rate |
$2,054.77 |
| Max. Negotiated Rate |
$4,623.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,623.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,054.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,054.77
|
| Rate for Payer: CDPHP Essential Plan |
$4,623.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,465.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,054.77
|
| Rate for Payer: EmblemHealth Medicaid |
$2,054.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,623.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,054.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,054.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,417.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,417.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,054.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,157.51
|
|
|
EAPG 462: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
OP
|
$7,344.72
|
|
|
Service Code
|
EAPG 0462
|
| Min. Negotiated Rate |
$3,264.32 |
| Max. Negotiated Rate |
$7,344.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,344.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,264.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,264.32
|
| Rate for Payer: CDPHP Essential Plan |
$7,344.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,917.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,264.32
|
| Rate for Payer: EmblemHealth Medicaid |
$3,264.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,344.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,264.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,264.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$7,018.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$7,018.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,264.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,427.54
|
|
|
EAPG 463: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
OP
|
$11,846.74
|
|
|
Service Code
|
EAPG 0463
|
| Min. Negotiated Rate |
$5,265.22 |
| Max. Negotiated Rate |
$11,846.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$11,846.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$5,265.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$5,265.22
|
| Rate for Payer: CDPHP Essential Plan |
$11,846.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,318.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,265.22
|
| Rate for Payer: EmblemHealth Medicaid |
$5,265.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$11,846.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$5,265.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$5,265.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$11,320.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$11,320.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5,265.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$5,528.48
|
|
|
EAPG 464: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
OP
|
$18,182.20
|
|
|
Service Code
|
EAPG 0464
|
| Min. Negotiated Rate |
$8,080.98 |
| Max. Negotiated Rate |
$18,182.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$18,182.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$8,080.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$8,080.98
|
| Rate for Payer: CDPHP Essential Plan |
$18,182.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,697.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,080.98
|
| Rate for Payer: EmblemHealth Medicaid |
$8,080.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$18,182.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$8,080.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$8,080.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$17,374.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$17,374.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8,080.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$8,485.03
|
|
|
EAPG 46: LEVEL I ARTHROPLASTY
|
Facility
OP
|
$6,068.25
|
|
|
Service Code
|
EAPG 0046
|
| Min. Negotiated Rate |
$2,697.00 |
| Max. Negotiated Rate |
$6,068.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,068.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,697.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,697.00
|
| Rate for Payer: CDPHP Essential Plan |
$6,068.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,236.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,697.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,697.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,068.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,697.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,697.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,798.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,798.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,697.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,831.85
|
|
