|
EAPG 85: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES
|
Facility
OP
|
$5,326.70
|
|
|
Service Code
|
EAPG 0085
|
| Min. Negotiated Rate |
$2,367.42 |
| Max. Negotiated Rate |
$5,326.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,326.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,367.42
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,367.42
|
| Rate for Payer: CDPHP Essential Plan |
$5,326.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,840.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,367.42
|
| Rate for Payer: EmblemHealth Medicaid |
$2,367.42
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,326.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,367.42
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,367.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,089.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,089.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,367.42
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,485.79
|
|
|
EAPG 860: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
|
Facility
OP
|
$329.40
|
|
|
Service Code
|
EAPG 0860
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$146.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$146.40
|
| Rate for Payer: CDPHP Essential Plan |
$329.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$175.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$146.40
|
| Rate for Payer: EmblemHealth Medicaid |
$146.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$329.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$146.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$146.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$314.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$314.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$146.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$153.72
|
|
|
EAPG 861: PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT
|
Facility
OP
|
$315.63
|
|
|
Service Code
|
EAPG 0861
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$315.63 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$315.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$140.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$140.28
|
| Rate for Payer: CDPHP Essential Plan |
$315.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$168.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$140.28
|
| Rate for Payer: EmblemHealth Medicaid |
$140.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$315.63
|
| Rate for Payer: Hamaspik Choice Medicaid |
$140.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$140.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$301.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$301.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$140.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$147.29
|
|
|
EAPG 867: ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES
|
Facility
OP
|
$257.69
|
|
|
Service Code
|
EAPG 0867
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$257.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$257.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$114.53
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$114.53
|
| Rate for Payer: CDPHP Essential Plan |
$257.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$137.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$114.53
|
| Rate for Payer: EmblemHealth Medicaid |
$114.53
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$257.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$114.53
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$114.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$246.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$246.24
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$114.53
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$120.26
|
|
|
EAPG 869: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES
|
Facility
OP
|
$270.70
|
|
|
Service Code
|
EAPG 0869
|
| Min. Negotiated Rate |
$120.31 |
| Max. Negotiated Rate |
$270.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$270.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.31
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.31
|
| Rate for Payer: CDPHP Essential Plan |
$270.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.31
|
| Rate for Payer: EmblemHealth Medicaid |
$120.31
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$270.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.31
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$258.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$258.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.31
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.33
|
|
|
EAPG 86: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT
|
Facility
OP
|
$12,679.36
|
|
|
Service Code
|
EAPG 0086
|
| Min. Negotiated Rate |
$5,635.27 |
| Max. Negotiated Rate |
$12,679.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$12,679.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$5,635.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$5,635.27
|
| Rate for Payer: CDPHP Essential Plan |
$12,679.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,762.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,635.27
|
| Rate for Payer: EmblemHealth Medicaid |
$5,635.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$12,679.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$5,635.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$5,635.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$12,115.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$12,115.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5,635.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$5,917.03
|
|
|
EAPG 870: REHABILITATION
|
Facility
OP
|
$226.62
|
|
|
Service Code
|
EAPG 0870
|
| Min. Negotiated Rate |
$100.72 |
| Max. Negotiated Rate |
$226.62 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$226.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$100.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$100.72
|
| Rate for Payer: CDPHP Essential Plan |
$226.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$120.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$100.72
|
| Rate for Payer: EmblemHealth Medicaid |
$100.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$226.62
|
| Rate for Payer: Hamaspik Choice Medicaid |
$100.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$100.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$216.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$216.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$100.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$105.76
|
|
|
EAPG 871: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0871
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 872: OTHER AFTERCARE AND CONVALESCENCE
|
Facility
OP
|
$249.57
|
|
|
Service Code
|
EAPG 0872
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$249.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.92
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.92
|
| Rate for Payer: CDPHP Essential Plan |
$249.57
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.92
|
| Rate for Payer: EmblemHealth Medicaid |
$110.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$249.57
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.92
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.92
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.47
|
|
|
EAPG 873: NEONATAL AFTERCARE
|
Facility
OP
|
$271.55
|
|
|
Service Code
|
EAPG 0873
|
| Min. Negotiated Rate |
$120.69 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$271.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$120.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$120.69
|
| Rate for Payer: CDPHP Essential Plan |
$271.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$144.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$120.69
|
| Rate for Payer: EmblemHealth Medicaid |
$120.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$271.55
|
| Rate for Payer: Hamaspik Choice Medicaid |
$120.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$120.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$259.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$259.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$120.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$126.72
|
|
|
EAPG 874: AFTERCARE FOR JOINT REPLACEMENT
|
Facility
OP
|
$239.47
|
|
|
Service Code
|
EAPG 0874
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$239.47 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$239.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.43
|
| Rate for Payer: CDPHP Essential Plan |
$239.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.43
|
| Rate for Payer: EmblemHealth Medicaid |
$106.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$239.47
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$228.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$228.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.75
|
|
|
EAPG 875: CONTRACEPTIVE MANAGEMENT
|
Facility
OP
|
$596.27
|
|
|
Service Code
|
EAPG 0875
|
| Min. Negotiated Rate |
$265.01 |
| Max. Negotiated Rate |
$596.27 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$596.27
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$265.01
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$265.01
|
| Rate for Payer: CDPHP Essential Plan |
$596.27
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$318.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$265.01
|
| Rate for Payer: EmblemHealth Medicaid |
$265.01
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$596.27
|
| Rate for Payer: Hamaspik Choice Medicaid |
$265.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$265.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$569.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$569.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$265.01
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$278.26
|
|
|
EAPG 876: ADULT PREVENTIVE MEDICINE
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0876
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 877: CHILD PREVENTIVE MEDICINE
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0877
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 878: GYNECOLOGIC PREVENTIVE MEDICINE
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0878
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 879: PREVENTIVE OR SCREENING ENCOUNTER
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0879
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 87: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES
|
Facility
OP
|
$4,529.86
|
|
|
Service Code
|
EAPG 0087
|
| Min. Negotiated Rate |
$2,013.27 |
| Max. Negotiated Rate |
$4,529.86 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,529.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,013.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,013.27
|
| Rate for Payer: CDPHP Essential Plan |
$4,529.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,415.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,013.27
|
| Rate for Payer: EmblemHealth Medicaid |
$2,013.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,529.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,013.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,013.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,328.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,328.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,013.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,113.93
|
|
|
EAPG 880: HIV INFECTION
|
Facility
OP
|
$293.38
|
|
|
Service Code
|
EAPG 0880
|
| Min. Negotiated Rate |
$130.39 |
| Max. Negotiated Rate |
$293.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$293.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.39
|
| Rate for Payer: CDPHP Essential Plan |
$293.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.39
|
| Rate for Payer: EmblemHealth Medicaid |
$130.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$293.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$280.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$280.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$136.91
|
|
|
EAPG 881: AIDS
|
Facility
OP
|
$334.19
|
|
|
Service Code
|
EAPG 0881
|
| Min. Negotiated Rate |
$148.53 |
| Max. Negotiated Rate |
$334.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$334.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$148.53
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$148.53
|
| Rate for Payer: CDPHP Essential Plan |
$334.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$178.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$148.53
|
| Rate for Payer: EmblemHealth Medicaid |
$148.53
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$334.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$148.53
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$148.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$319.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$319.34
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$148.53
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$155.96
|
|
|
EAPG 882: GENETIC COUNSELING
|
Facility
OP
|
$254.81
|
|
|
Service Code
|
EAPG 0882
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$254.81 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.81
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.25
|
| Rate for Payer: CDPHP Essential Plan |
$254.81
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.25
|
| Rate for Payer: EmblemHealth Medicaid |
$113.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.81
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.91
|
|
|
EAPG 883: ALTERATION IN CONSCIOUSNESS
|
Facility
OP
|
$302.56
|
|
|
Service Code
|
EAPG 0883
|
| Min. Negotiated Rate |
$134.47 |
| Max. Negotiated Rate |
$302.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$302.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$134.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$134.47
|
| Rate for Payer: CDPHP Essential Plan |
$302.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$134.47
|
| Rate for Payer: EmblemHealth Medicaid |
$134.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$302.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$134.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$134.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$289.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$289.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$134.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$141.19
|
|
|
EAPG 90: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES
|
Facility
OP
|
$2,090.43
|
|
|
Service Code
|
EAPG 0090
|
| Min. Negotiated Rate |
$929.08 |
| Max. Negotiated Rate |
$2,090.43 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,090.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$929.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$929.08
|
| Rate for Payer: CDPHP Essential Plan |
$2,090.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,114.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$929.08
|
| Rate for Payer: EmblemHealth Medicaid |
$929.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,090.43
|
| Rate for Payer: Hamaspik Choice Medicaid |
$929.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$929.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,997.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,997.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$929.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$975.53
|
|
|
EAPG 91: LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
OP
|
$5,100.26
|
|
|
Service Code
|
EAPG 0091
|
| Min. Negotiated Rate |
$2,266.78 |
| Max. Negotiated Rate |
$5,100.26 |
| Rate for Payer: Hamaspik Choice Medicaid |
$2,266.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,100.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,266.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,266.78
|
| Rate for Payer: CDPHP Essential Plan |
$5,100.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,720.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,266.78
|
| Rate for Payer: EmblemHealth Medicaid |
$2,266.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,100.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,266.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,873.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,873.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,266.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,380.12
|
|
|
EAPG 92: RESUSCITATION
|
Facility
OP
|
$1,144.01
|
|
|
Service Code
|
EAPG 0092
|
| Min. Negotiated Rate |
$508.45 |
| Max. Negotiated Rate |
$1,144.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,144.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$508.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$508.45
|
| Rate for Payer: CDPHP Essential Plan |
$1,144.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$610.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$508.45
|
| Rate for Payer: EmblemHealth Medicaid |
$508.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,144.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$508.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$508.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,093.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,093.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$508.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$533.87
|
|
|
EAPG 93: CARDIOVERSION
|
Facility
OP
|
$1,061.21
|
|
|
Service Code
|
EAPG 0093
|
| Min. Negotiated Rate |
$471.65 |
| Max. Negotiated Rate |
$1,061.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,061.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$471.65
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$471.65
|
| Rate for Payer: CDPHP Essential Plan |
$1,061.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$565.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$471.65
|
| Rate for Payer: EmblemHealth Medicaid |
$471.65
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,061.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$471.65
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$471.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,014.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,014.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$471.65
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$495.23
|
|
