|
DVT BOOT FOR FLOWTRON 17"
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
4471951
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
|
|
DVT BOOT FOR FLOWTRON 17"
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
4471951
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$35.00
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$37.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$35.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
DVT BOOT FOR FLOWTRON 23"
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
4471952
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
|
|
DVT BOOT FOR FLOWTRON 23"
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
4471952
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$58.76 |
| Rate for Payer: Aetna of NY Commercial |
$51.10
|
| Rate for Payer: Aetna of NY Medicare |
$33.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$27.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$36.50
|
| Rate for Payer: Cash Price |
$54.75
|
| Rate for Payer: CDPHP Commercial |
$58.76
|
| Rate for Payer: CDPHP Medicare |
$27.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$58.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$58.40
|
| Rate for Payer: EmblemHealth Medicaid |
$58.40
|
| Rate for Payer: EmblemHealth Medicare |
$24.82
|
| Rate for Payer: EmblemHealth Select Care |
$52.56
|
| Rate for Payer: Fidelis Medicare |
$27.82
|
| Rate for Payer: Galaxy Health Commercial |
$47.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$27.01
|
| Rate for Payer: Humana Medicare |
$27.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$51.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$33.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$41.10
|
| Rate for Payer: MVP Health Care of NY Medicare |
$28.36
|
| Rate for Payer: United Healthcare Medicare |
$27.01
|
| Rate for Payer: WellCare Medicare |
$40.15
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
4150311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$189.00
|
| Rate for Payer: Aetna of NY Medicare |
$144.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$236.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$116.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$157.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: CDPHP Commercial |
$253.58
|
| Rate for Payer: CDPHP Medicare |
$116.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$220.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$252.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$252.00
|
| Rate for Payer: EmblemHealth Medicaid |
$252.00
|
| Rate for Payer: EmblemHealth Medicare |
$107.10
|
| Rate for Payer: EmblemHealth Select Care |
$204.75
|
| Rate for Payer: Fidelis Medicare |
$120.05
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$116.55
|
| Rate for Payer: Humana Medicare |
$116.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$189.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$144.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$236.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$177.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$122.38
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.00
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$116.55
|
| Rate for Payer: WellCare Medicare |
$173.25
|
|
|
DXA BONE DENSITY AXIAL 1+ SITES
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
4150311
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Galaxy Health Commercial |
$204.75
|
|
|
DXA BONE DENSITY/PERIPHERAL 1+ SITES
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 77081
|
| Hospital Charge Code |
4150312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
|
|
DXA BONE DENSITY/PERIPHERAL 1+ SITES
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 77081
|
| Hospital Charge Code |
4150312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna of NY Commercial |
$156.00
|
| Rate for Payer: Aetna of NY Medicare |
$119.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$96.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$130.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: CDPHP Commercial |
$209.30
|
| Rate for Payer: CDPHP Medicare |
$96.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$208.00
|
| Rate for Payer: EmblemHealth Medicaid |
$208.00
|
| Rate for Payer: EmblemHealth Medicare |
$88.40
|
| Rate for Payer: EmblemHealth Select Care |
$169.00
|
| Rate for Payer: Fidelis Medicare |
$99.09
|
| Rate for Payer: Galaxy Health Commercial |
$169.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$96.20
|
| Rate for Payer: Humana Medicare |
$96.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$156.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$119.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$146.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$101.01
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$390.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$52.52
|
| Rate for Payer: United Healthcare Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicare |
$96.20
|
| Rate for Payer: WellCare Medicare |
$143.00
|
|
|
EAPG 103: LEVEL II VARICOSE VEIN AND RELATED PROCEDURES
|
Facility
|
OP
|
$4,783.43
|
|
|
Service Code
|
EAPG 0103
|
| Min. Negotiated Rate |
$2,125.97 |
| Max. Negotiated Rate |
$4,783.43 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,783.43
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,125.97
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,125.97
|
| Rate for Payer: CDPHP Essential Plan |
$4,783.43
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,551.16
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,125.97
|
| Rate for Payer: EmblemHealth Medicaid |
$2,125.97
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,783.43
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,125.97
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,125.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,570.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,570.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,125.97
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,232.27
|
|
|
EAPG 106: MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES
|
Facility
|
OP
|
$5,100.26
|
|
|
Service Code
|
EAPG 0106
|
| Min. Negotiated Rate |
$2,266.78 |
| Max. Negotiated Rate |
$5,100.26 |
| 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: Hamaspik Choice Medicaid |
$2,266.78
|
| 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 107: CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES
|
Facility
|
OP
|
$5,379.05
|
|
|
Service Code
|
EAPG 0107
|
| Min. Negotiated Rate |
$2,390.69 |
| Max. Negotiated Rate |
$5,379.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,379.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,390.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,390.69
|
| Rate for Payer: CDPHP Essential Plan |
$5,379.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,868.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,390.69
|
| Rate for Payer: EmblemHealth Medicaid |
$2,390.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,379.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,390.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,390.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,139.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,139.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,390.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,510.22
|
|
|
EAPG 108: OTHER INTRA-ABDOMINAL AND INTRAPERITONEAL SURGICAL PROCEDURES
|
Facility
|
OP
|
$4,149.76
|
|
|
Service Code
|
EAPG 0108
|
| Min. Negotiated Rate |
$1,844.34 |
| Max. Negotiated Rate |
$4,149.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,149.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,844.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,844.34
|
| Rate for Payer: CDPHP Essential Plan |
$4,149.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,213.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,844.34
|
| Rate for Payer: EmblemHealth Medicaid |
$1,844.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,149.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,844.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,844.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,965.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,965.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,844.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,936.56
|
|
|
EAPG 109: ANCILLARY DRUG ADMINISTRATION
|
Facility
|
OP
|
$75.46
|
|
|
Service Code
|
EAPG 0109
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$75.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$33.54
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$33.54
|
| Rate for Payer: CDPHP Essential Plan |
$75.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.54
|
| Rate for Payer: EmblemHealth Medicaid |
$33.54
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$75.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$33.54
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$72.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$72.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.54
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$35.22
|
|
|
EAPG 10: LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
|
OP
|
$2,467.40
|
|
|
Service Code
|
EAPG 0010
|
| Min. Negotiated Rate |
$1,096.62 |
| Max. Negotiated Rate |
$2,467.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,467.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,096.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,096.62
|
| Rate for Payer: CDPHP Essential Plan |
$2,467.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,315.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,096.62
|
| Rate for Payer: EmblemHealth Medicaid |
$1,096.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,467.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,096.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,096.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,357.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,357.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,096.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,151.45
|
|
|
EAPG 110: PHARMACOTHERAPY BY EXTENDED INFUSION
|
Facility
|
OP
|
$1,427.85
|
|
|
Service Code
|
EAPG 0110
|
| Min. Negotiated Rate |
$634.60 |
| Max. Negotiated Rate |
$1,427.85 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,427.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$634.60
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$634.60
|
| Rate for Payer: CDPHP Essential Plan |
$1,427.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$761.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$634.60
|
| Rate for Payer: EmblemHealth Medicaid |
$634.60
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,427.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$634.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$634.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,364.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,364.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$634.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$666.33
|
|
|
EAPG 111: PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION
|
Facility
|
OP
|
$534.76
|
|
|
Service Code
|
EAPG 0111
|
| Min. Negotiated Rate |
$237.67 |
| Max. Negotiated Rate |
$534.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$534.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$237.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$237.67
|
| Rate for Payer: CDPHP Essential Plan |
$534.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$285.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$237.67
|
| Rate for Payer: EmblemHealth Medicaid |
$237.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$534.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$237.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$237.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$510.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$510.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$237.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$249.55
|
|
|
EAPG 113: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE
|
Facility
|
OP
|
$1,082.30
|
|
|
Service Code
|
EAPG 0113
|
| Min. Negotiated Rate |
$481.02 |
| Max. Negotiated Rate |
$1,082.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,082.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$481.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$481.02
|
| Rate for Payer: CDPHP Essential Plan |
$1,082.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$577.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$481.02
|
| Rate for Payer: EmblemHealth Medicaid |
$481.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,082.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$481.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$481.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,034.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,034.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$481.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$505.07
|
|
|
EAPG 114: LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE
|
Facility
|
OP
|
$4,078.69
|
|
|
Service Code
|
EAPG 0114
|
| Min. Negotiated Rate |
$1,812.75 |
| Max. Negotiated Rate |
$4,078.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,078.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,812.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,812.75
|
| Rate for Payer: CDPHP Essential Plan |
$4,078.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,175.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,812.75
|
| Rate for Payer: EmblemHealth Medicaid |
$1,812.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,078.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,812.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,812.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,897.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,897.41
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,812.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,903.39
|
|
|
EAPG 115: DEEP LYMPH STRUCTURE PROCEDURES
|
Facility
|
OP
|
$2,867.42
|
|
|
Service Code
|
EAPG 0115
|
| Min. Negotiated Rate |
$1,274.41 |
| Max. Negotiated Rate |
$2,867.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,867.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,274.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,274.41
|
| Rate for Payer: CDPHP Essential Plan |
$2,867.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,529.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,274.41
|
| Rate for Payer: EmblemHealth Medicaid |
$1,274.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,867.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,274.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,274.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,739.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,739.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,274.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,338.13
|
|
|
EAPG 116: ALLERGY TESTS
|
Facility
|
OP
|
$504.56
|
|
|
Service Code
|
EAPG 0116
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$504.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$504.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$224.25
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$224.25
|
| Rate for Payer: CDPHP Essential Plan |
$504.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$269.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$224.25
|
| Rate for Payer: EmblemHealth Medicaid |
$224.25
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$504.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$224.25
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$224.25
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$482.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$482.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$224.25
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$235.46
|
|
|
EAPG 11: LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
|
OP
|
$4,136.65
|
|
|
Service Code
|
EAPG 0011
|
| Min. Negotiated Rate |
$1,838.51 |
| Max. Negotiated Rate |
$4,136.65 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,136.65
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,838.51
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,838.51
|
| Rate for Payer: CDPHP Essential Plan |
$4,136.65
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,206.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,838.51
|
| Rate for Payer: EmblemHealth Medicaid |
$1,838.51
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,136.65
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,838.51
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,838.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,952.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,952.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,838.51
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,930.44
|
|
|
EAPG 121: LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES
|
Facility
|
OP
|
$5,474.25
|
|
|
Service Code
|
EAPG 0121
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$5,474.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,474.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,433.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,433.00
|
| Rate for Payer: CDPHP Essential Plan |
$5,474.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,919.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,433.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,433.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,474.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,433.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,433.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,230.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,230.95
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,433.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,554.65
|
|
|
EAPG 122: PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES
|
Facility
|
OP
|
$3,091.70
|
|
|
Service Code
|
EAPG 0122
|
| Min. Negotiated Rate |
$1,374.09 |
| Max. Negotiated Rate |
$3,091.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,091.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,374.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,374.09
|
| Rate for Payer: CDPHP Essential Plan |
$3,091.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,648.91
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,374.09
|
| Rate for Payer: EmblemHealth Medicaid |
$1,374.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,091.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,374.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,374.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,954.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,954.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,374.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,442.79
|
|
|
EAPG 123: PERIPHERAL VASCULAR BYPASS PROCEDURES
|
Facility
|
OP
|
$4,686.73
|
|
|
Service Code
|
EAPG 0123
|
| Min. Negotiated Rate |
$2,082.99 |
| Max. Negotiated Rate |
$4,686.73 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,686.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,082.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,082.99
|
| Rate for Payer: CDPHP Essential Plan |
$4,686.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,499.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,082.99
|
| Rate for Payer: EmblemHealth Medicaid |
$2,082.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,686.73
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,082.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,082.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,478.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,478.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,082.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,187.14
|
|
|
EAPG 124: BONE MARROW BIOPSIES
|
Facility
|
OP
|
$1,010.56
|
|
|
Service Code
|
EAPG 0124
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$1,010.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,010.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$449.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$449.14
|
| Rate for Payer: CDPHP Essential Plan |
$1,010.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$538.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$449.14
|
| Rate for Payer: EmblemHealth Medicaid |
$449.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,010.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$449.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$449.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$965.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$965.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$449.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$471.60
|
|
