|
EAPG 155: LEVEL III BLOOD PRODUCT EXCHANGE SERVICES
|
Facility
|
OP
|
$4,078.69
|
|
|
Service Code
|
EAPG 0155
|
| 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 156: OCULAR IMAGING AND RELATED SERVICES
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
EAPG 0156
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$92.80
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$92.80
|
| Rate for Payer: CDPHP Essential Plan |
$208.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$111.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.80
|
| Rate for Payer: EmblemHealth Medicaid |
$92.80
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$208.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$92.80
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$92.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$199.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$199.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$92.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$97.44
|
|
|
EAPG 158: PATHOLOGY CONSULTATION AND INTERPRETATION
|
Facility
|
OP
|
$134.53
|
|
|
Service Code
|
EAPG 0158
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$134.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$134.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$59.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$59.79
|
| Rate for Payer: CDPHP Essential Plan |
$134.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$71.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$59.79
|
| Rate for Payer: EmblemHealth Medicaid |
$59.79
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$134.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$59.79
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$59.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$128.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$128.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.79
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$62.78
|
|
|
EAPG 159: MINOR UROLOGY SERVICES
|
Facility
|
OP
|
$781.04
|
|
|
Service Code
|
EAPG 0159
|
| Min. Negotiated Rate |
$347.13 |
| Max. Negotiated Rate |
$781.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$781.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$347.13
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$347.13
|
| Rate for Payer: CDPHP Essential Plan |
$781.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$416.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$347.13
|
| Rate for Payer: EmblemHealth Medicaid |
$347.13
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$781.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$347.13
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$347.13
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$746.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$746.33
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$347.13
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$364.49
|
|
|
EAPG 161: URINARY STUDIES AND PROCEDURES
|
Facility
|
OP
|
$848.34
|
|
|
Service Code
|
EAPG 0161
|
| Min. Negotiated Rate |
$377.04 |
| Max. Negotiated Rate |
$848.34 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$848.34
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$377.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$377.04
|
| Rate for Payer: CDPHP Essential Plan |
$848.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$452.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$377.04
|
| Rate for Payer: EmblemHealth Medicaid |
$377.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$848.34
|
| Rate for Payer: Hamaspik Choice Medicaid |
$377.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$377.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$810.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$810.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$377.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$395.89
|
|
|
EAPG 166: LEVEL I URETHRAL PROCEDURES
|
Facility
|
OP
|
$2,002.46
|
|
|
Service Code
|
EAPG 0166
|
| Min. Negotiated Rate |
$889.98 |
| Max. Negotiated Rate |
$2,002.46 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,002.46
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$889.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$889.98
|
| Rate for Payer: CDPHP Essential Plan |
$2,002.46
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,067.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$889.98
|
| Rate for Payer: EmblemHealth Medicaid |
$889.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,002.46
|
| Rate for Payer: Hamaspik Choice Medicaid |
$889.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$889.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,913.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,913.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$889.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$934.48
|
|
|
EAPG 167: LEVEL II URETHRAL PROCEDURES
|
Facility
|
OP
|
$5,051.36
|
|
|
Service Code
|
EAPG 0167
|
| Min. Negotiated Rate |
$2,245.05 |
| Max. Negotiated Rate |
$5,051.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,051.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,245.05
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,245.05
|
| Rate for Payer: CDPHP Essential Plan |
$5,051.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,694.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,245.05
|
| Rate for Payer: EmblemHealth Medicaid |
$2,245.05
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,051.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,245.05
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,245.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,826.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,826.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,245.05
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,357.30
|
|
|
EAPG 168: DIALYSIS PROCEDURES
|
Facility
|
OP
|
$499.18
|
|
|
Service Code
|
EAPG 0168
|
| Min. Negotiated Rate |
$221.86 |
| Max. Negotiated Rate |
$499.18 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$499.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$221.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$221.86
|
| Rate for Payer: CDPHP Essential Plan |
$499.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$266.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$221.86
|
| Rate for Payer: EmblemHealth Medicaid |
$221.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$499.18
|
| Rate for Payer: Hamaspik Choice Medicaid |
$221.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$221.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$477.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$477.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$221.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$232.95
|
|
|
EAPG 16: SIMPLE WOUND REPAIR AND TREATMENT
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
EAPG 0016
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$914.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$406.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$406.22
|
| Rate for Payer: CDPHP Essential Plan |
$914.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$487.46
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$406.22
|
| Rate for Payer: EmblemHealth Medicaid |
$406.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$914.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$406.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$406.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$873.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$873.37
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$406.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$426.53
|
|
|
EAPG 170: LEVEL I KIDNEY AND URETERAL PROCEDURES
|
Facility
|
OP
|
$2,188.35
|
|
|
Service Code
|
EAPG 0170
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$2,188.35 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,188.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$972.60
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$972.60
|
| Rate for Payer: CDPHP Essential Plan |
$2,188.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,167.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$972.60
|
| Rate for Payer: EmblemHealth Medicaid |
$972.60
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,188.35
|
| Rate for Payer: Hamaspik Choice Medicaid |
$972.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$972.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,091.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,091.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$972.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,021.23
|
|
|
EAPG 171: LEVEL II KIDNEY AND URETERAL PROCEDURES
|
Facility
|
OP
|
$2,884.00
|
|
|
Service Code
|
EAPG 0171
|
| Min. Negotiated Rate |
$1,281.78 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,884.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,281.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,281.78
|
| Rate for Payer: CDPHP Essential Plan |
$2,884.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,538.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,281.78
|
| Rate for Payer: EmblemHealth Medicaid |
$1,281.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,884.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,281.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,281.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,755.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,755.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,281.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,345.87
|
|
|
EAPG 172: LEVEL III KIDNEY AND URETERAL PROCEDURES
|
Facility
|
OP
|
$3,911.58
|
|
|
Service Code
|
EAPG 0172
|
| Min. Negotiated Rate |
$1,738.48 |
| Max. Negotiated Rate |
$3,911.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,911.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,738.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,738.48
|
| Rate for Payer: CDPHP Essential Plan |
$3,911.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,086.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,738.48
|
| Rate for Payer: EmblemHealth Medicaid |
$1,738.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,911.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,738.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,738.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,737.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,737.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,738.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,825.40
|
|
|
EAPG 173: LEVEL I BLADDER AND URETERAL PROCEDURES
|
Facility
|
OP
|
$3,235.36
|
|
|
Service Code
|
EAPG 0173
|
| Min. Negotiated Rate |
$1,437.94 |
| Max. Negotiated Rate |
$3,235.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,235.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,437.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,437.94
|
| Rate for Payer: CDPHP Essential Plan |
$3,235.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,725.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,437.94
|
| Rate for Payer: EmblemHealth Medicaid |
$1,437.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,235.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,437.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,437.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,091.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,091.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,437.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,509.84
|
|
|
EAPG 174: LEVEL II BLADDER AND URETERAL PROCEDURES
|
Facility
|
OP
|
$3,883.05
|
|
|
Service Code
|
EAPG 0174
|
| Min. Negotiated Rate |
$1,725.80 |
| Max. Negotiated Rate |
$3,883.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,883.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,725.80
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,725.80
|
| Rate for Payer: CDPHP Essential Plan |
$3,883.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,070.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,725.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,725.80
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,883.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,725.80
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,725.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,710.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,710.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,725.80
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,812.09
|
|
|
EAPG 176: LEVEL I PROSTATE PROCEDURES
|
Facility
|
OP
|
$3,973.59
|
|
|
Service Code
|
EAPG 0176
|
| Min. Negotiated Rate |
$1,766.04 |
| Max. Negotiated Rate |
$3,973.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,973.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,766.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,766.04
|
| Rate for Payer: CDPHP Essential Plan |
$3,973.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,119.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,766.04
|
| Rate for Payer: EmblemHealth Medicaid |
$1,766.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,973.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,766.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,766.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,796.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,796.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,766.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,854.34
|
|
|
EAPG 177: MINOR DERMATOLOGY SERVICES
|
Facility
|
OP
|
$84.98
|
|
|
Service Code
|
EAPG 0177
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$84.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$84.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.77
|
| Rate for Payer: CDPHP Essential Plan |
$84.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.77
|
| Rate for Payer: EmblemHealth Medicaid |
$37.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$84.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$81.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$81.21
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.66
|
|
|
EAPG 178: ANTEPARTUM PROCEDURES
|
Facility
|
OP
|
$1,513.73
|
|
|
Service Code
|
EAPG 0178
|
| Min. Negotiated Rate |
$672.77 |
| Max. Negotiated Rate |
$1,513.73 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,513.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$672.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$672.77
|
| Rate for Payer: CDPHP Essential Plan |
$1,513.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$807.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$672.77
|
| Rate for Payer: EmblemHealth Medicaid |
$672.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,513.73
|
| Rate for Payer: Hamaspik Choice Medicaid |
$672.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$672.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,446.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,446.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$672.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$706.41
|
|
|
EAPG 179: ECTOPIC PREGNANCY PROCEDURES
|
Facility
|
OP
|
$3,215.59
|
|
|
Service Code
|
EAPG 0179
|
| Min. Negotiated Rate |
$1,429.15 |
| Max. Negotiated Rate |
$3,215.59 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,215.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,429.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,429.15
|
| Rate for Payer: CDPHP Essential Plan |
$3,215.59
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,714.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,429.15
|
| Rate for Payer: EmblemHealth Medicaid |
$1,429.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,215.59
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,429.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,429.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,072.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,072.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,429.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,500.61
|
|
|
EAPG 17: INTERMEDIATE WOUND REPAIR AND TREATMENT
|
Facility
|
OP
|
$1,391.60
|
|
|
Service Code
|
EAPG 0017
|
| Min. Negotiated Rate |
$618.49 |
| Max. Negotiated Rate |
$1,391.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,391.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$618.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$618.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,391.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$742.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$618.49
|
| Rate for Payer: EmblemHealth Medicaid |
$618.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,391.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$618.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$618.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,329.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,329.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$618.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$649.41
|
|
|
EAPG 180: TESTICULAR AND EPIDIDYMAL PROCEDURES
|
Facility
|
OP
|
$2,594.74
|
|
|
Service Code
|
EAPG 0180
|
| Min. Negotiated Rate |
$1,153.22 |
| Max. Negotiated Rate |
$2,594.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,594.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,153.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,153.22
|
| Rate for Payer: CDPHP Essential Plan |
$2,594.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,383.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,153.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,153.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,594.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,153.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,153.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,479.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,479.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,153.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,210.88
|
|
|
EAPG 182: INSERTION OF PENILE PROSTHESIS
|
Facility
|
OP
|
$10,552.10
|
|
|
Service Code
|
EAPG 0182
|
| Min. Negotiated Rate |
$4,689.82 |
| Max. Negotiated Rate |
$10,552.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$10,552.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$4,689.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$4,689.82
|
| Rate for Payer: CDPHP Essential Plan |
$10,552.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,627.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,689.82
|
| Rate for Payer: EmblemHealth Medicaid |
$4,689.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$10,552.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,689.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,689.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$10,083.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$10,083.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,689.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$4,924.31
|
|
|
EAPG 183: LEVEL I PENILE PROCEDURES
|
Facility
|
OP
|
$1,887.48
|
|
|
Service Code
|
EAPG 0183
|
| Min. Negotiated Rate |
$838.88 |
| Max. Negotiated Rate |
$1,887.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,887.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$838.88
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$838.88
|
| Rate for Payer: CDPHP Essential Plan |
$1,887.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,006.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$838.88
|
| Rate for Payer: EmblemHealth Medicaid |
$838.88
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,887.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$838.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$838.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,803.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,803.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$838.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$880.82
|
|
|
EAPG 184: LEVEL II PROSTATE PROCEDURES
|
Facility
|
OP
|
$5,375.02
|
|
|
Service Code
|
EAPG 0184
|
| Min. Negotiated Rate |
$2,388.90 |
| Max. Negotiated Rate |
$5,375.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,375.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,388.90
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,388.90
|
| Rate for Payer: CDPHP Essential Plan |
$5,375.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,866.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,388.90
|
| Rate for Payer: EmblemHealth Medicaid |
$2,388.90
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,375.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,388.90
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,388.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,136.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,136.14
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,388.90
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,508.34
|
|
|
EAPG 187: LEVEL II PENILE PROCEDURES
|
Facility
|
OP
|
$1,977.37
|
|
|
Service Code
|
EAPG 0187
|
| Min. Negotiated Rate |
$878.83 |
| Max. Negotiated Rate |
$1,977.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,977.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$878.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$878.83
|
| Rate for Payer: CDPHP Essential Plan |
$1,977.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,054.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$878.83
|
| Rate for Payer: EmblemHealth Medicaid |
$878.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,977.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$878.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$878.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,889.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,889.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$878.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$922.77
|
|
|
EAPG 188: LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES
|
Facility
|
OP
|
$2,584.82
|
|
|
Service Code
|
EAPG 0188
|
| Min. Negotiated Rate |
$1,148.81 |
| Max. Negotiated Rate |
$2,584.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,584.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,148.81
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,148.81
|
| Rate for Payer: CDPHP Essential Plan |
$2,584.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,378.57
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,148.81
|
| Rate for Payer: EmblemHealth Medicaid |
$1,148.81
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,584.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,148.81
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,148.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,469.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,469.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,148.81
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,206.25
|
|
