|
EAPG 213: NERVE AND MUSCLE TESTS
|
Facility
|
OP
|
$273.42
|
|
|
Service Code
|
EAPG 0213
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$273.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.52
|
| Rate for Payer: CDPHP Essential Plan |
$273.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$145.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.52
|
| Rate for Payer: EmblemHealth Medicaid |
$121.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$273.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.60
|
|
|
EAPG 214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
|
OP
|
$924.16
|
|
|
Service Code
|
EAPG 0214
|
| Min. Negotiated Rate |
$410.74 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$924.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$410.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$410.74
|
| Rate for Payer: CDPHP Essential Plan |
$924.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$492.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$410.74
|
| Rate for Payer: EmblemHealth Medicaid |
$410.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$924.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$410.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$410.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$883.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$883.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$410.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$431.28
|
|
|
EAPG 217: LEVEL I NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
|
OP
|
$2,648.05
|
|
|
Service Code
|
EAPG 0217
|
| Min. Negotiated Rate |
$1,176.91 |
| Max. Negotiated Rate |
$2,648.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,648.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,176.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,176.91
|
| Rate for Payer: CDPHP Essential Plan |
$2,648.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,412.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,176.91
|
| Rate for Payer: EmblemHealth Medicaid |
$1,176.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,648.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,176.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,176.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,530.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,530.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,176.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,235.76
|
|
|
EAPG 218: LEVEL II NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
|
OP
|
$7,032.31
|
|
|
Service Code
|
EAPG 0218
|
| Min. Negotiated Rate |
$3,125.47 |
| Max. Negotiated Rate |
$7,032.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,032.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,125.47
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,125.47
|
| Rate for Payer: CDPHP Essential Plan |
$7,032.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,750.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,125.47
|
| Rate for Payer: EmblemHealth Medicaid |
$3,125.47
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,032.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,125.47
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,125.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,719.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,719.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,125.47
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,281.74
|
|
|
EAPG 21: LEVEL II BREAST PROCEDURES
|
Facility
|
OP
|
$4,426.29
|
|
|
Service Code
|
EAPG 0021
|
| Min. Negotiated Rate |
$1,967.24 |
| Max. Negotiated Rate |
$4,426.29 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,426.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,967.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,967.24
|
| Rate for Payer: CDPHP Essential Plan |
$4,426.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,360.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,967.24
|
| Rate for Payer: EmblemHealth Medicaid |
$1,967.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,426.29
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,967.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,967.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,229.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,229.57
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,967.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,065.60
|
|
|
EAPG 220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
|
OP
|
$1,110.13
|
|
|
Service Code
|
EAPG 0220
|
| Min. Negotiated Rate |
$493.39 |
| Max. Negotiated Rate |
$1,110.13 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,110.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$493.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$493.39
|
| Rate for Payer: CDPHP Essential Plan |
$1,110.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$592.07
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$493.39
|
| Rate for Payer: EmblemHealth Medicaid |
$493.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,110.13
|
| Rate for Payer: Hamaspik Choice Medicaid |
$493.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$493.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,060.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,060.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$493.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$518.06
|
|
|
EAPG 222: SLEEP STUDIES ATTENDED
|
Facility
|
OP
|
$1,710.94
|
|
|
Service Code
|
EAPG 0222
|
| Min. Negotiated Rate |
$760.42 |
| Max. Negotiated Rate |
$1,710.94 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,710.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$760.42
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$760.42
|
| Rate for Payer: CDPHP Essential Plan |
$1,710.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$912.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$760.42
|
| Rate for Payer: EmblemHealth Medicaid |
$760.42
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,710.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$760.42
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$760.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,634.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,634.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$760.42
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$798.44
|
|
|
EAPG 223: LEVEL III NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
|
OP
|
$28,149.55
|
|
|
Service Code
|
EAPG 0223
|
| Min. Negotiated Rate |
$12,510.91 |
| Max. Negotiated Rate |
$28,149.55 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$28,149.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$12,510.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$12,510.91
|
| Rate for Payer: CDPHP Essential Plan |
$28,149.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,013.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,510.91
|
| Rate for Payer: EmblemHealth Medicaid |
$12,510.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$28,149.55
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12,510.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12,510.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$26,898.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$26,898.46
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12,510.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$13,136.46
|
|
|
EAPG 224: LEVEL IV NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
|
OP
|
$37,496.25
|
|
|
Service Code
|
EAPG 0224
|
| Min. Negotiated Rate |
$16,665.00 |
| Max. Negotiated Rate |
$37,496.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$37,496.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$16,665.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$16,665.00
|
| Rate for Payer: CDPHP Essential Plan |
$37,496.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19,998.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$16,665.00
|
| Rate for Payer: EmblemHealth Medicaid |
$16,665.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$37,496.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$16,665.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$16,665.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$35,829.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$35,829.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$16,665.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$17,498.25
|
|
|
EAPG 226: SLEEP STUDIES UNATTENDED
|
Facility
|
OP
|
$964.17
|
|
|
Service Code
|
EAPG 0226
|
| Min. Negotiated Rate |
$428.52 |
| Max. Negotiated Rate |
$964.17 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$964.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$428.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$428.52
|
| Rate for Payer: CDPHP Essential Plan |
$964.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$514.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$428.52
|
| Rate for Payer: EmblemHealth Medicaid |
$428.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$964.17
|
| Rate for Payer: Hamaspik Choice Medicaid |
$428.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$428.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$921.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$921.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$428.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$449.95
|
|
|
EAPG 227: LEVEL I CRANIOFACIAL BONE PROCEDURES
|
Facility
|
OP
|
$5,075.91
|
|
|
Service Code
|
EAPG 0227
|
| Min. Negotiated Rate |
$2,255.96 |
| Max. Negotiated Rate |
$5,075.91 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,075.91
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,255.96
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,255.96
|
| Rate for Payer: CDPHP Essential Plan |
$5,075.91
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,707.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,255.96
|
| Rate for Payer: EmblemHealth Medicaid |
$2,255.96
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,075.91
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,255.96
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,255.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,850.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,850.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,255.96
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,368.76
|
|
|
EAPG 228: LEVEL II CRANIOFACIAL BONE PROCEDURES
|
Facility
|
OP
|
$6,387.82
|
|
|
Service Code
|
EAPG 0228
|
| Min. Negotiated Rate |
$2,839.03 |
| Max. Negotiated Rate |
$6,387.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,387.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,839.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,839.03
|
| Rate for Payer: CDPHP Essential Plan |
$6,387.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,406.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,839.03
|
| Rate for Payer: EmblemHealth Medicaid |
$2,839.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,387.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,839.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,839.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,103.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,103.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,839.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,980.98
|
|
|
EAPG 229: MINOR AUDIOMETRIC TESTS AND SCREENING SERVICES
|
Facility
|
OP
|
$161.24
|
|
|
Service Code
|
EAPG 0229
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$161.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$161.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$71.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$71.66
|
| Rate for Payer: CDPHP Essential Plan |
$161.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$85.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$71.66
|
| Rate for Payer: EmblemHealth Medicaid |
$71.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$161.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$71.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$71.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$154.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$154.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$71.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$75.24
|
|
|
EAPG 22: LEVEL III BREAST PROCEDURES
|
Facility
|
OP
|
$6,339.40
|
|
|
Service Code
|
EAPG 0022
|
| Min. Negotiated Rate |
$2,817.51 |
| Max. Negotiated Rate |
$6,339.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,339.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,817.51
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,817.51
|
| Rate for Payer: CDPHP Essential Plan |
$6,339.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,381.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,817.51
|
| Rate for Payer: EmblemHealth Medicaid |
$2,817.51
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,339.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,817.51
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,817.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,057.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,057.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,817.51
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,958.39
|
|
|
EAPG 230: OPHTHALMOLOGICAL TESTS AND PROCEDURES
|
Facility
|
OP
|
$391.48
|
|
|
Service Code
|
EAPG 0230
|
| Min. Negotiated Rate |
$173.99 |
| Max. Negotiated Rate |
$391.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$391.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$173.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$173.99
|
| Rate for Payer: CDPHP Essential Plan |
$391.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$208.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$173.99
|
| Rate for Payer: EmblemHealth Medicaid |
$173.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$391.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$173.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$173.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$374.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$374.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$173.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$182.69
|
|
|
EAPG 232: LASER EYE PROCEDURES
|
Facility
|
OP
|
$1,079.03
|
|
|
Service Code
|
EAPG 0232
|
| Min. Negotiated Rate |
$479.57 |
| Max. Negotiated Rate |
$1,079.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,079.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$479.57
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$479.57
|
| Rate for Payer: CDPHP Essential Plan |
$1,079.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$575.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$479.57
|
| Rate for Payer: EmblemHealth Medicaid |
$479.57
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,079.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$479.57
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$479.57
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,031.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,031.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$479.57
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$503.55
|
|
|
EAPG 233: CATARACT PROCEDURES
|
Facility
|
OP
|
$4,066.85
|
|
|
Service Code
|
EAPG 0233
|
| Min. Negotiated Rate |
$1,807.49 |
| Max. Negotiated Rate |
$4,066.85 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,066.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,807.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,807.49
|
| Rate for Payer: CDPHP Essential Plan |
$4,066.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,168.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,807.49
|
| Rate for Payer: EmblemHealth Medicaid |
$1,807.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,066.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,807.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,807.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,886.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,886.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,807.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,897.86
|
|
|
EAPG 234: LEVEL I ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$3,265.78
|
|
|
Service Code
|
EAPG 0234
|
| Min. Negotiated Rate |
$1,451.46 |
| Max. Negotiated Rate |
$3,265.78 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,265.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,451.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,451.46
|
| Rate for Payer: CDPHP Essential Plan |
$3,265.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,741.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,451.46
|
| Rate for Payer: EmblemHealth Medicaid |
$1,451.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,265.78
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,451.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,451.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,120.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,120.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,451.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,524.03
|
|
|
EAPG 235: LEVEL II ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$4,376.32
|
|
|
Service Code
|
EAPG 0235
|
| Min. Negotiated Rate |
$1,945.03 |
| Max. Negotiated Rate |
$4,376.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,376.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,945.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,945.03
|
| Rate for Payer: CDPHP Essential Plan |
$4,376.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,334.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,945.03
|
| Rate for Payer: EmblemHealth Medicaid |
$1,945.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,376.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,945.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,945.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,181.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,181.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,945.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,042.28
|
|
|
EAPG 236: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$6,306.62
|
|
|
Service Code
|
EAPG 0236
|
| Min. Negotiated Rate |
$2,802.94 |
| Max. Negotiated Rate |
$6,306.62 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,306.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,802.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,802.94
|
| Rate for Payer: CDPHP Essential Plan |
$6,306.62
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,363.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,802.94
|
| Rate for Payer: EmblemHealth Medicaid |
$2,802.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,306.62
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,802.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,802.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,026.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,026.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,802.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,943.09
|
|
|
EAPG 237: LEVEL I POSTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$1,159.42
|
|
|
Service Code
|
EAPG 0237
|
| Min. Negotiated Rate |
$515.30 |
| Max. Negotiated Rate |
$1,159.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,159.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$515.30
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$515.30
|
| Rate for Payer: CDPHP Essential Plan |
$1,159.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$618.36
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$515.30
|
| Rate for Payer: EmblemHealth Medicaid |
$515.30
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,159.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$515.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$515.30
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,107.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,107.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$515.30
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$541.06
|
|
|
EAPG 238: LEVEL II POSTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$5,541.84
|
|
|
Service Code
|
EAPG 0238
|
| Min. Negotiated Rate |
$2,463.04 |
| Max. Negotiated Rate |
$5,541.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,541.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,463.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,463.04
|
| Rate for Payer: CDPHP Essential Plan |
$5,541.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,955.65
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,463.04
|
| Rate for Payer: EmblemHealth Medicaid |
$2,463.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,541.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,463.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,463.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,295.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,295.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,463.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,586.19
|
|
|
EAPG 239: STRABISMUS AND MUSCLE EYE PROCEDURES
|
Facility
|
OP
|
$3,468.80
|
|
|
Service Code
|
EAPG 0239
|
| Min. Negotiated Rate |
$1,541.69 |
| Max. Negotiated Rate |
$3,468.80 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,468.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,541.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,541.69
|
| Rate for Payer: CDPHP Essential Plan |
$3,468.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,850.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,541.69
|
| Rate for Payer: EmblemHealth Medicaid |
$1,541.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,468.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,541.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,541.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,314.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,314.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,541.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,618.77
|
|
|
EAPG 23: LEVEL I FOREARM AND WRIST PROCEDURES
|
Facility
|
OP
|
$3,964.66
|
|
|
Service Code
|
EAPG 0023
|
| Min. Negotiated Rate |
$1,762.07 |
| Max. Negotiated Rate |
$3,964.66 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,964.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,762.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,762.07
|
| Rate for Payer: CDPHP Essential Plan |
$3,964.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,114.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,762.07
|
| Rate for Payer: EmblemHealth Medicaid |
$1,762.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,964.66
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,762.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,762.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,788.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,788.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,762.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,850.17
|
|
|
EAPG 240: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE
|
Facility
|
OP
|
$1,527.26
|
|
|
Service Code
|
EAPG 0240
|
| Min. Negotiated Rate |
$678.78 |
| Max. Negotiated Rate |
$1,527.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,527.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$678.78
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$678.78
|
| Rate for Payer: CDPHP Essential Plan |
$1,527.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$814.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$678.78
|
| Rate for Payer: EmblemHealth Medicaid |
$678.78
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,527.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$678.78
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$678.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,459.38
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,459.38
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$678.78
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$712.72
|
|
