|
EAPG 241: LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE
|
Facility
|
OP
|
$3,807.00
|
|
|
Service Code
|
EAPG 0241
|
| Min. Negotiated Rate |
$1,692.00 |
| Max. Negotiated Rate |
$3,807.00 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,807.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,692.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,692.00
|
| Rate for Payer: CDPHP Essential Plan |
$3,807.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,030.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,692.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,692.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,807.00
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,692.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,692.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,637.80
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,637.80
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,692.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,776.60
|
|
|
EAPG 243: CLASS I THERAPEUTIC RADIOPHARMACEUTICALS
|
Facility
|
OP
|
$34.38
|
|
|
Service Code
|
EAPG 0243
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$15.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$15.28
|
| Rate for Payer: CDPHP Essential Plan |
$34.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.28
|
| Rate for Payer: EmblemHealth Medicaid |
$15.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$34.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$15.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$15.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$32.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$32.85
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$16.04
|
|
|
EAPG 244: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS
|
Facility
|
OP
|
$797.08
|
|
|
Service Code
|
EAPG 0244
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$797.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$797.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$354.26
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$354.26
|
| Rate for Payer: CDPHP Essential Plan |
$797.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$425.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$354.26
|
| Rate for Payer: EmblemHealth Medicaid |
$354.26
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$797.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$354.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$354.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$761.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$761.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$354.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$371.97
|
|
|
EAPG 245: CLASS III THERAPEUTIC RADIOPHARMACEUTICALS
|
Facility
|
OP
|
$2,315.90
|
|
|
Service Code
|
EAPG 0245
|
| Min. Negotiated Rate |
$1,029.29 |
| Max. Negotiated Rate |
$2,315.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,315.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,029.29
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,029.29
|
| Rate for Payer: CDPHP Essential Plan |
$2,315.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,235.15
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,029.29
|
| Rate for Payer: EmblemHealth Medicaid |
$1,029.29
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,315.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,029.29
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,029.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,212.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,212.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,029.29
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,080.75
|
|
|
EAPG 247: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES
|
Facility
|
OP
|
$3,214.58
|
|
|
Service Code
|
EAPG 0247
|
| Min. Negotiated Rate |
$1,428.70 |
| Max. Negotiated Rate |
$3,214.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,214.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,428.70
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,428.70
|
| Rate for Payer: CDPHP Essential Plan |
$3,214.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,714.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,428.70
|
| Rate for Payer: EmblemHealth Medicaid |
$1,428.70
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,214.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,428.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,428.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,071.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,071.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,428.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,500.14
|
|
|
EAPG 248: LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES
|
Facility
|
OP
|
$5,875.29
|
|
|
Service Code
|
EAPG 0248
|
| Min. Negotiated Rate |
$2,611.24 |
| Max. Negotiated Rate |
$5,875.29 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,875.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,611.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,611.24
|
| Rate for Payer: CDPHP Essential Plan |
$5,875.29
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,133.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,611.24
|
| Rate for Payer: EmblemHealth Medicaid |
$2,611.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,875.29
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,611.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,611.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,614.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,614.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,611.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,741.80
|
|
|
EAPG 249: MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$267.23
|
|
|
Service Code
|
EAPG 0249
|
| Min. Negotiated Rate |
$118.77 |
| Max. Negotiated Rate |
$267.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$267.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$118.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$118.77
|
| Rate for Payer: CDPHP Essential Plan |
$267.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.52
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$118.77
|
| Rate for Payer: EmblemHealth Medicaid |
$118.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$267.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$118.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$118.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$255.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$255.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$118.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$124.71
|
|
|
EAPG 24: LEVEL II FOREARM AND WRIST PROCEDURES
|
Facility
|
OP
|
$4,518.22
|
|
|
Service Code
|
EAPG 0024
|
| Min. Negotiated Rate |
$2,008.10 |
| Max. Negotiated Rate |
$4,518.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,518.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,008.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,008.10
|
| Rate for Payer: CDPHP Essential Plan |
$4,518.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,409.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,008.10
|
| Rate for Payer: EmblemHealth Medicaid |
$2,008.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,518.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,008.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,008.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,317.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,317.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,008.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,108.50
|
|
|
EAPG 250: COCHLEAR DEVICE IMPLANTATION
|
Facility
|
OP
|
$61,243.47
|
|
|
Service Code
|
EAPG 0250
|
| Min. Negotiated Rate |
$27,219.32 |
| Max. Negotiated Rate |
$61,243.47 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$61,243.47
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$27,219.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$27,219.32
|
| Rate for Payer: CDPHP Essential Plan |
$61,243.47
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32,663.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27,219.32
|
| Rate for Payer: EmblemHealth Medicaid |
$27,219.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$61,243.47
|
| Rate for Payer: Hamaspik Choice Medicaid |
$27,219.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$27,219.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$58,521.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$58,521.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$27,219.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$28,580.29
|
|
|
EAPG 251: OTORHINOLARYNGOLOGIC FUNCTION TESTS
|
Facility
|
OP
|
$269.86
|
|
|
Service Code
|
EAPG 0251
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$269.86 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$269.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$119.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$119.94
|
| Rate for Payer: CDPHP Essential Plan |
$269.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$143.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$119.94
|
| Rate for Payer: EmblemHealth Medicaid |
$119.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$269.86
|
| Rate for Payer: Hamaspik Choice Medicaid |
$119.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$119.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$257.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$257.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$119.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$125.94
|
|
|
EAPG 252: LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$2,485.19
|
|
|
Service Code
|
EAPG 0252
|
| Min. Negotiated Rate |
$1,104.53 |
| Max. Negotiated Rate |
$2,485.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,485.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,104.53
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,104.53
|
| Rate for Payer: CDPHP Essential Plan |
$2,485.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,325.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,104.53
|
| Rate for Payer: EmblemHealth Medicaid |
$1,104.53
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,485.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,104.53
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,104.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,374.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,374.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,104.53
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,159.76
|
|
|
EAPG 253: LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$3,343.16
|
|
|
Service Code
|
EAPG 0253
|
| Min. Negotiated Rate |
$1,485.85 |
| Max. Negotiated Rate |
$3,343.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,343.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,485.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,485.85
|
| Rate for Payer: CDPHP Essential Plan |
$3,343.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,783.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,485.85
|
| Rate for Payer: EmblemHealth Medicaid |
$1,485.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,343.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,485.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,485.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,194.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,194.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,485.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,560.14
|
|
|
EAPG 254: LEVEL III EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$4,738.48
|
|
|
Service Code
|
EAPG 0254
|
| Min. Negotiated Rate |
$2,105.99 |
| Max. Negotiated Rate |
$4,738.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,738.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,105.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,105.99
|
| Rate for Payer: CDPHP Essential Plan |
$4,738.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,527.19
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,105.99
|
| Rate for Payer: EmblemHealth Medicaid |
$2,105.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,738.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,105.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,105.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,527.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,527.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,105.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,211.29
|
|
|
EAPG 255: LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$6,822.09
|
|
|
Service Code
|
EAPG 0255
|
| Min. Negotiated Rate |
$3,032.04 |
| Max. Negotiated Rate |
$6,822.09 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,822.09
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,032.04
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,032.04
|
| Rate for Payer: CDPHP Essential Plan |
$6,822.09
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,638.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,032.04
|
| Rate for Payer: EmblemHealth Medicaid |
$3,032.04
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,822.09
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,032.04
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,032.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,518.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,518.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,032.04
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,183.64
|
|
|
EAPG 256: TONSIL AND ADENOID PROCEDURES
|
Facility
|
OP
|
$2,878.38
|
|
|
Service Code
|
EAPG 0256
|
| Min. Negotiated Rate |
$1,279.28 |
| Max. Negotiated Rate |
$2,878.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,878.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,279.28
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,279.28
|
| Rate for Payer: CDPHP Essential Plan |
$2,878.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,535.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,279.28
|
| Rate for Payer: EmblemHealth Medicaid |
$1,279.28
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,878.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,279.28
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,279.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,750.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,750.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,279.28
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,343.24
|
|
|
EAPG 257: AUDIOMETRY
|
Facility
|
OP
|
$153.97
|
|
|
Service Code
|
EAPG 0257
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$153.97 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$153.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$68.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$68.43
|
| Rate for Payer: CDPHP Essential Plan |
$153.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$68.43
|
| Rate for Payer: EmblemHealth Medicaid |
$68.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$153.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$68.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$68.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$147.12
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$147.12
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$68.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$71.85
|
|
|
EAPG 258: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES
|
Facility
|
OP
|
$2,377.55
|
|
|
Service Code
|
EAPG 0258
|
| Min. Negotiated Rate |
$1,056.69 |
| Max. Negotiated Rate |
$2,377.55 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,377.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,056.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,056.69
|
| Rate for Payer: CDPHP Essential Plan |
$2,377.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,268.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,056.69
|
| Rate for Payer: EmblemHealth Medicaid |
$1,056.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,377.55
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,056.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,056.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,271.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,271.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,056.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,109.52
|
|
|
EAPG 259: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES
|
Facility
|
OP
|
$3,589.16
|
|
|
Service Code
|
EAPG 0259
|
| Min. Negotiated Rate |
$1,595.18 |
| Max. Negotiated Rate |
$3,589.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,589.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,595.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,595.18
|
| Rate for Payer: CDPHP Essential Plan |
$3,589.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,914.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,595.18
|
| Rate for Payer: EmblemHealth Medicaid |
$1,595.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,589.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,595.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,595.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,429.64
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,429.64
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,595.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,674.94
|
|
|
EAPG 25: SHOULDER AND UPPER ARM PROCEDURES
|
Facility
|
OP
|
$4,546.48
|
|
|
Service Code
|
EAPG 0025
|
| Min. Negotiated Rate |
$2,020.66 |
| Max. Negotiated Rate |
$4,546.48 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,546.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,020.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,020.66
|
| Rate for Payer: CDPHP Essential Plan |
$4,546.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,424.79
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,020.66
|
| Rate for Payer: EmblemHealth Medicaid |
$2,020.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,546.48
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,020.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,020.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,344.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,344.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,020.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,121.69
|
|
|
EAPG 261: ESRD CASE MANAGEMENT
|
Facility
|
OP
|
$38.90
|
|
|
Service Code
|
EAPG 0261
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$38.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$38.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$17.29
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$17.29
|
| Rate for Payer: CDPHP Essential Plan |
$38.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.75
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.29
|
| Rate for Payer: EmblemHealth Medicaid |
$17.29
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$38.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$17.29
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$17.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$37.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$37.17
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.29
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$18.15
|
|
|
EAPG 262: CLEFT LIP AND PALATE REPAIR
|
Facility
|
OP
|
$6,126.77
|
|
|
Service Code
|
EAPG 0262
|
| Min. Negotiated Rate |
$2,723.01 |
| Max. Negotiated Rate |
$6,126.77 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,126.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,723.01
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,723.01
|
| Rate for Payer: CDPHP Essential Plan |
$6,126.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,267.61
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,723.01
|
| Rate for Payer: EmblemHealth Medicaid |
$2,723.01
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,126.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,723.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,723.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,854.47
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,854.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,723.01
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,859.16
|
|
|
EAPG 263: THYROID AND PARATHYROID PROCEDURES
|
Facility
|
OP
|
$5,829.44
|
|
|
Service Code
|
EAPG 0263
|
| Min. Negotiated Rate |
$2,590.86 |
| Max. Negotiated Rate |
$5,829.44 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,829.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,590.86
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,590.86
|
| Rate for Payer: CDPHP Essential Plan |
$5,829.44
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,109.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,590.86
|
| Rate for Payer: EmblemHealth Medicaid |
$2,590.86
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,829.44
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,590.86
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,590.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,570.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,570.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,590.86
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,720.40
|
|
|
EAPG 265: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
OP
|
$5,266.01
|
|
|
Service Code
|
EAPG 0265
|
| Min. Negotiated Rate |
$2,340.45 |
| Max. Negotiated Rate |
$5,266.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,266.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,340.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,340.45
|
| Rate for Payer: CDPHP Essential Plan |
$5,266.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,808.54
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,340.45
|
| Rate for Payer: EmblemHealth Medicaid |
$2,340.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,266.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,340.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,340.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,031.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,031.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,340.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,457.47
|
|
|
EAPG 266: OPEN INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
OP
|
$5,017.54
|
|
|
Service Code
|
EAPG 0266
|
| Min. Negotiated Rate |
$2,230.02 |
| Max. Negotiated Rate |
$5,017.54 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,017.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,230.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,230.02
|
| Rate for Payer: CDPHP Essential Plan |
$5,017.54
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,676.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,230.02
|
| Rate for Payer: EmblemHealth Medicaid |
$2,230.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,017.54
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,230.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,230.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,794.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,794.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,230.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,341.52
|
|
|
EAPG 267: OTHER CRANIOTOMY PROCEDURES INCLUDING CRANIOPLASTY
|
Facility
|
OP
|
$5,391.58
|
|
|
Service Code
|
EAPG 0267
|
| Min. Negotiated Rate |
$2,396.26 |
| Max. Negotiated Rate |
$5,391.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,391.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,396.26
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,396.26
|
| Rate for Payer: CDPHP Essential Plan |
$5,391.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,875.51
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,396.26
|
| Rate for Payer: EmblemHealth Medicaid |
$2,396.26
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,391.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,396.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,396.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,151.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,151.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,396.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,516.07
|
|
