|
EAPG 673: CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS
|
Facility
OP
|
$243.63
|
|
|
Service Code
|
EAPG 0673
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$243.63 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.28
|
| Rate for Payer: CDPHP Essential Plan |
$243.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.28
|
| Rate for Payer: EmblemHealth Medicaid |
$108.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$243.63
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$232.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$232.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.69
|
|
|
EAPG 674: OPEN WOUNDS, PUNCTURES AND OTHER OPEN TRAUMATIC INJURIES
|
Facility
OP
|
$353.23
|
|
|
Service Code
|
EAPG 0674
|
| Min. Negotiated Rate |
$156.99 |
| Max. Negotiated Rate |
$353.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$353.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$156.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$156.99
|
| Rate for Payer: CDPHP Essential Plan |
$353.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$188.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$156.99
|
| Rate for Payer: EmblemHealth Medicaid |
$156.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$353.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$156.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$156.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$337.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$337.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$156.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$164.84
|
|
|
EAPG 675: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST DIAGNOSES
|
Facility
OP
|
$239.36
|
|
|
Service Code
|
EAPG 0675
|
| Min. Negotiated Rate |
$106.38 |
| Max. Negotiated Rate |
$239.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$239.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.38
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.38
|
| Rate for Payer: CDPHP Essential Plan |
$239.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.38
|
| Rate for Payer: EmblemHealth Medicaid |
$106.38
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$239.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.38
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$228.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$228.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.38
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.70
|
|
|
EAPG 676: PRESSURE ULCERS
|
Facility
OP
|
$291.22
|
|
|
Service Code
|
EAPG 0676
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$291.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$291.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.43
|
| Rate for Payer: CDPHP Essential Plan |
$291.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.43
|
| Rate for Payer: EmblemHealth Medicaid |
$129.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$291.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$278.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$278.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$135.90
|
|
|
EAPG 67: VENTILATION ASSISTANCE AND MANAGEMENT
|
Facility
OP
|
$375.41
|
|
|
Service Code
|
EAPG 0067
|
| Min. Negotiated Rate |
$166.85 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$375.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$166.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$166.85
|
| Rate for Payer: CDPHP Essential Plan |
$375.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$200.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$166.85
|
| Rate for Payer: EmblemHealth Medicaid |
$166.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$375.41
|
| Rate for Payer: Hamaspik Choice Medicaid |
$166.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$166.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$358.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$358.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$166.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$175.19
|
|
|
EAPG 68: THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES
|
Facility
OP
|
$1,203.01
|
|
|
Service Code
|
EAPG 0068
|
| Min. Negotiated Rate |
$534.67 |
| Max. Negotiated Rate |
$1,203.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,203.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$534.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$534.67
|
| Rate for Payer: CDPHP Essential Plan |
$1,203.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$641.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$534.67
|
| Rate for Payer: EmblemHealth Medicaid |
$534.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,203.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$534.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$534.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,149.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,149.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$534.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$561.40
|
|
|
EAPG 690: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES
|
Facility
OP
|
$262.26
|
|
|
Service Code
|
EAPG 0690
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$262.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$116.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$116.56
|
| Rate for Payer: CDPHP Essential Plan |
$262.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$139.87
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$116.56
|
| Rate for Payer: EmblemHealth Medicaid |
$116.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$262.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$116.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$116.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$250.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$250.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$116.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$122.39
|
|
|
EAPG 691: INBORN ERRORS OF METABOLISM
|
Facility
OP
|
$223.16
|
|
|
Service Code
|
EAPG 0691
|
| Min. Negotiated Rate |
$99.18 |
| Max. Negotiated Rate |
$223.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$223.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$99.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$99.18
|
| Rate for Payer: CDPHP Essential Plan |
$223.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$119.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$99.18
|
| Rate for Payer: EmblemHealth Medicaid |
$99.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$223.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$99.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$99.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$213.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$213.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$99.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$104.14
|
|
|
EAPG 692: OTHER ENDOCRINE SYSTEM DIAGNOSES
|
Facility
OP
|
$251.71
|
|
|
Service Code
|
EAPG 0692
|
| Min. Negotiated Rate |
$111.87 |
| Max. Negotiated Rate |
$251.71 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$251.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.87
|
| Rate for Payer: CDPHP Essential Plan |
$251.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$134.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.87
|
| Rate for Payer: EmblemHealth Medicaid |
$111.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$251.71
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$240.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$240.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$117.46
|
|
|
EAPG 694: ELECTROLYTE DISORDERS
|
Facility
OP
|
$268.47
|
|
|
Service Code
|
EAPG 0694
|
| Min. Negotiated Rate |
$119.32 |
| Max. Negotiated Rate |
$268.47 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$268.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$119.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$119.32
|
| Rate for Payer: CDPHP Essential Plan |
$268.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$119.32
|
| Rate for Payer: EmblemHealth Medicaid |
$119.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$268.47
|
| Rate for Payer: Hamaspik Choice Medicaid |
$119.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$119.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$256.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$256.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$119.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$125.29
|
|
|
EAPG 695: OBESITY
|
Facility
OP
|
$245.54
|
|
|
Service Code
|
EAPG 0695
|
| Min. Negotiated Rate |
$109.13 |
| Max. Negotiated Rate |
$245.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$245.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$109.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$109.13
|
| Rate for Payer: CDPHP Essential Plan |
$245.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$130.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$109.13
|
| Rate for Payer: EmblemHealth Medicaid |
$109.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$245.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$109.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$109.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$234.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$234.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$109.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$114.59
|
|
|
EAPG 696: THYROID AND PARATHYROID DIAGNOSES
|
Facility
OP
|
$250.27
|
|
|
Service Code
|
EAPG 0696
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$250.27 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$250.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$111.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$111.23
|
| Rate for Payer: CDPHP Essential Plan |
$250.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$111.23
|
| Rate for Payer: EmblemHealth Medicaid |
$111.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$111.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$111.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$239.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$239.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$111.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.79
|
|
|
EAPG 69: LEVEL I THORACIC AND CHEST PROCEDURES
|
Facility
OP
|
$3,583.53
|
|
|
Service Code
|
EAPG 0069
|
| Min. Negotiated Rate |
$1,592.68 |
| Max. Negotiated Rate |
$3,583.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,583.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,592.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,592.68
|
| Rate for Payer: CDPHP Essential Plan |
$3,583.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,911.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,592.68
|
| Rate for Payer: EmblemHealth Medicaid |
$1,592.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,583.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,592.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,592.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,424.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,424.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,592.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,672.31
|
|
|
EAPG 70: LEVEL II THORACIC AND CHEST PROCEDURES
|
Facility
OP
|
$4,650.70
|
|
|
Service Code
|
EAPG 0070
|
| Min. Negotiated Rate |
$2,066.98 |
| Max. Negotiated Rate |
$4,650.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,650.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,066.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,066.98
|
| Rate for Payer: CDPHP Essential Plan |
$4,650.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,480.38
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,066.98
|
| Rate for Payer: EmblemHealth Medicaid |
$2,066.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,650.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,066.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,066.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,444.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,444.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,066.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,170.33
|
|
|
EAPG 710: DIABETES WITH OPHTHALMIC MANIFESTATIONS
|
Facility
OP
|
$274.50
|
|
|
Service Code
|
EAPG 0710
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$122.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$122.00
|
| Rate for Payer: CDPHP Essential Plan |
$274.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$122.00
|
| Rate for Payer: EmblemHealth Medicaid |
$122.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$274.50
|
| Rate for Payer: Hamaspik Choice Medicaid |
$122.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$122.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$262.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$262.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$122.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$128.10
|
|
|
EAPG 711: DIABETES WITH OTHER MANIFESTATIONS & COMPLICATIONS
|
Facility
OP
|
$248.40
|
|
|
Service Code
|
EAPG 0711
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.40
|
| Rate for Payer: CDPHP Essential Plan |
$248.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$248.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$237.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$237.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.92
|
|
|
EAPG 712: DIABETES WITH NEUROLOGIC MANIFESTATIONS
|
Facility
OP
|
$271.04
|
|
|
Service Code
|
EAPG 0712
|
| Min. Negotiated Rate |
$120.46 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.46
|
| Rate for Payer: CDPHP Essential Plan |
$271.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.55
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.46
|
| Rate for Payer: EmblemHealth Medicaid |
$120.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$258.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$258.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.48
|
|
|
EAPG 713: DIABETES WITHOUT COMPLICATIONS
|
Facility
OP
|
$235.80
|
|
|
Service Code
|
EAPG 0713
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$235.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$104.80
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$104.80
|
| Rate for Payer: CDPHP Essential Plan |
$235.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$125.76
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$104.80
|
| Rate for Payer: EmblemHealth Medicaid |
$104.80
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$235.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$104.80
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$104.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$225.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$225.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$104.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$110.04
|
|
|
EAPG 714: DIABETES WITH RENAL MANIFESTATIONS
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
EAPG 0714
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$97.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$97.78
|
| Rate for Payer: CDPHP Essential Plan |
$220.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$117.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$97.78
|
| Rate for Payer: EmblemHealth Medicaid |
$97.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$220.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$97.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$97.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$210.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$210.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$97.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$102.67
|
|
|
EAPG 715: DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS
|
Facility
OP
|
$248.40
|
|
|
Service Code
|
EAPG 0715
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.40
|
| Rate for Payer: CDPHP Essential Plan |
$248.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$132.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.40
|
| Rate for Payer: EmblemHealth Medicaid |
$110.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$248.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$237.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$237.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$115.92
|
|
|
EAPG 71: LEVEL II LOWER AIRWAY ENDOSCOPY
|
Facility
OP
|
$2,572.16
|
|
|
Service Code
|
EAPG 0071
|
| Min. Negotiated Rate |
$1,143.18 |
| Max. Negotiated Rate |
$2,572.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,572.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,143.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,143.18
|
| Rate for Payer: CDPHP Essential Plan |
$2,572.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,371.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,143.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,143.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,572.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,143.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,143.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,457.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,457.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,143.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,200.34
|
|
|
EAPG 720: RENAL FAILURE
|
Facility
OP
|
$244.26
|
|
|
Service Code
|
EAPG 0720
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$244.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$244.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.56
|
| Rate for Payer: CDPHP Essential Plan |
$244.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$130.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.56
|
| Rate for Payer: EmblemHealth Medicaid |
$108.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$244.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$233.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$233.40
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.99
|
|
|
EAPG 721: KIDNEY AND URINARY TRACT MALIGNANCY
|
Facility
OP
|
$274.12
|
|
|
Service Code
|
EAPG 0721
|
| Min. Negotiated Rate |
$121.83 |
| Max. Negotiated Rate |
$274.12 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$274.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.83
|
| Rate for Payer: CDPHP Essential Plan |
$274.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.83
|
| Rate for Payer: EmblemHealth Medicaid |
$121.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$274.12
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.92
|
|
|
EAPG 722: NEPHRITIS AND NEPHROSIS
|
Facility
OP
|
$271.01
|
|
|
Service Code
|
EAPG 0722
|
| Min. Negotiated Rate |
$120.45 |
| Max. Negotiated Rate |
$271.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.45
|
| Rate for Payer: CDPHP Essential Plan |
$271.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.45
|
| Rate for Payer: EmblemHealth Medicaid |
$120.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$258.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$258.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.47
|
|
|
EAPG 723: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
OP
|
$292.16
|
|
|
Service Code
|
EAPG 0723
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$292.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$292.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$129.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$129.85
|
| Rate for Payer: CDPHP Essential Plan |
$292.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$155.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$129.85
|
| Rate for Payer: EmblemHealth Medicaid |
$129.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$292.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$129.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$129.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$279.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$279.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.34
|
|
