|
EAPG 268: CRANIAL AND SPINAL SHUNT PROCEDURES
|
Facility
|
OP
|
$7,072.36
|
|
|
Service Code
|
EAPG 0268
|
| Min. Negotiated Rate |
$3,143.27 |
| Max. Negotiated Rate |
$7,072.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,072.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,143.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,143.27
|
| Rate for Payer: CDPHP Essential Plan |
$7,072.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,771.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,143.27
|
| Rate for Payer: EmblemHealth Medicaid |
$3,143.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,072.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,143.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,143.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,758.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,758.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,143.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,300.43
|
|
|
EAPG 269: LEVEL II ANCLLARY THERAPEUTIC SERVICES
|
Facility
|
OP
|
$142.18
|
|
|
Service Code
|
EAPG 0269
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$142.18 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$142.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$63.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$63.19
|
| Rate for Payer: CDPHP Essential Plan |
$142.18
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$75.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.19
|
| Rate for Payer: EmblemHealth Medicaid |
$63.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$142.18
|
| Rate for Payer: Hamaspik Choice Medicaid |
$63.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$63.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$135.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$135.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$63.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$66.35
|
|
|
EAPG 26: LEVEL I KNEE AND LOWER LEG PROCEDURES
|
Facility
|
OP
|
$3,502.17
|
|
|
Service Code
|
EAPG 0026
|
| Min. Negotiated Rate |
$1,556.52 |
| Max. Negotiated Rate |
$3,502.17 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,502.17
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,556.52
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,556.52
|
| Rate for Payer: CDPHP Essential Plan |
$3,502.17
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,867.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,556.52
|
| Rate for Payer: EmblemHealth Medicaid |
$1,556.52
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,502.17
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,556.52
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,556.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,346.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,346.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,556.52
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,634.35
|
|
|
EAPG 270: OCCUPATIONAL THERAPY
|
Facility
|
OP
|
$264.78
|
|
|
Service Code
|
EAPG 0270
|
| Min. Negotiated Rate |
$117.68 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$264.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$117.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$117.68
|
| Rate for Payer: CDPHP Essential Plan |
$264.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$141.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$117.68
|
| Rate for Payer: EmblemHealth Medicaid |
$117.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$264.78
|
| Rate for Payer: Hamaspik Choice Medicaid |
$117.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$117.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$253.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$253.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$117.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$123.56
|
|
|
EAPG 271: PHYSICAL THERAPY
|
Facility
|
OP
|
$249.64
|
|
|
Service Code
|
EAPG 0271
|
| Min. Negotiated Rate |
$110.95 |
| Max. Negotiated Rate |
$249.64 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$249.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$110.95
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$110.95
|
| Rate for Payer: CDPHP Essential Plan |
$249.64
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$133.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$110.95
|
| Rate for Payer: EmblemHealth Medicaid |
$110.95
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$249.64
|
| Rate for Payer: Hamaspik Choice Medicaid |
$110.95
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$110.95
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$238.54
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$238.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$110.95
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$116.50
|
|
|
EAPG 272: SPEECH THERAPY AND EVALUATION
|
Facility
|
OP
|
$242.08
|
|
|
Service Code
|
EAPG 0272
|
| Min. Negotiated Rate |
$107.59 |
| Max. Negotiated Rate |
$242.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$242.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$107.59
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$107.59
|
| Rate for Payer: CDPHP Essential Plan |
$242.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$107.59
|
| Rate for Payer: EmblemHealth Medicaid |
$107.59
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$242.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$107.59
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$107.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$231.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$231.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$107.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.97
|
|
|
EAPG 276: PROCEDURES FOR REVISION OR REMOVAL OF NEUROSTIMULATOR DEVICES
|
Facility
|
OP
|
$3,854.68
|
|
|
Service Code
|
EAPG 0276
|
| Min. Negotiated Rate |
$1,713.19 |
| Max. Negotiated Rate |
$3,854.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,854.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,713.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,713.19
|
| Rate for Payer: CDPHP Essential Plan |
$3,854.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,055.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,713.19
|
| Rate for Payer: EmblemHealth Medicaid |
$1,713.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,854.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,713.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,713.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,683.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,683.36
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,713.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,798.85
|
|
|
EAPG 277: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES
|
Facility
|
OP
|
$636.68
|
|
|
Service Code
|
EAPG 0277
|
| Min. Negotiated Rate |
$282.97 |
| Max. Negotiated Rate |
$636.68 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$636.68
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$282.97
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$282.97
|
| Rate for Payer: CDPHP Essential Plan |
$636.68
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$339.56
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$282.97
|
| Rate for Payer: EmblemHealth Medicaid |
$282.97
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$636.68
|
| Rate for Payer: Hamaspik Choice Medicaid |
$282.97
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$282.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$608.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$608.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$282.97
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$297.12
|
|
|
EAPG 278: INJECTION(S) FOR RADIOLOGICAL IMAGING
|
Facility
|
OP
|
$925.16
|
|
|
Service Code
|
EAPG 0278
|
| Min. Negotiated Rate |
$411.18 |
| Max. Negotiated Rate |
$925.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$925.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$411.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$411.18
|
| Rate for Payer: CDPHP Essential Plan |
$925.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$493.42
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$411.18
|
| Rate for Payer: EmblemHealth Medicaid |
$411.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$925.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$411.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$411.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$884.04
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$884.04
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$411.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$431.74
|
|
|
EAPG 279: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES
|
Facility
|
OP
|
$707.42
|
|
|
Service Code
|
EAPG 0279
|
| Min. Negotiated Rate |
$314.41 |
| Max. Negotiated Rate |
$707.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$707.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$314.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$314.41
|
| Rate for Payer: CDPHP Essential Plan |
$707.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$377.29
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$314.41
|
| Rate for Payer: EmblemHealth Medicaid |
$314.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$707.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$314.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$314.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$675.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$675.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$314.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$330.13
|
|
|
EAPG 27: PELVIS, FEMUR AND UPPER LEG PROCEDURES
|
Facility
|
OP
|
$4,373.82
|
|
|
Service Code
|
EAPG 0027
|
| Min. Negotiated Rate |
$1,943.92 |
| Max. Negotiated Rate |
$4,373.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,373.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,943.92
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,943.92
|
| Rate for Payer: CDPHP Essential Plan |
$4,373.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,332.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,943.92
|
| Rate for Payer: EmblemHealth Medicaid |
$1,943.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,373.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,943.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,943.92
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,179.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,179.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,943.92
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,041.12
|
|
|
EAPG 280: LEVEL III VASCULAR RADIOLOGICAL PROCEDURES
|
Facility
|
OP
|
$1,847.56
|
|
|
Service Code
|
EAPG 0280
|
| Min. Negotiated Rate |
$821.14 |
| Max. Negotiated Rate |
$1,847.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,847.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$821.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$821.14
|
| Rate for Payer: CDPHP Essential Plan |
$1,847.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$985.37
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$821.14
|
| Rate for Payer: EmblemHealth Medicaid |
$821.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,847.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$821.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$821.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,765.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,765.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$821.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$862.20
|
|
|
EAPG 282: MAGNETIC RESONANCE ANGIOGRAPHY
|
Facility
|
OP
|
$1,108.96
|
|
|
Service Code
|
EAPG 0282
|
| Min. Negotiated Rate |
$492.87 |
| Max. Negotiated Rate |
$1,108.96 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,108.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$492.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$492.87
|
| Rate for Payer: CDPHP Essential Plan |
$1,108.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$591.44
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$492.87
|
| Rate for Payer: EmblemHealth Medicaid |
$492.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,108.96
|
| Rate for Payer: Hamaspik Choice Medicaid |
$492.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$492.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,059.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,059.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$492.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$517.51
|
|
|
EAPG 284: MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES
|
Facility
|
OP
|
$1,189.35
|
|
|
Service Code
|
EAPG 0284
|
| Min. Negotiated Rate |
$528.60 |
| Max. Negotiated Rate |
$1,189.35 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,189.35
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$528.60
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$528.60
|
| Rate for Payer: CDPHP Essential Plan |
$1,189.35
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$634.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$528.60
|
| Rate for Payer: EmblemHealth Medicaid |
$528.60
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,189.35
|
| Rate for Payer: Hamaspik Choice Medicaid |
$528.60
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$528.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,136.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,136.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$528.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$555.03
|
|
|
EAPG 286: MAMMOGRAPHY & OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$243.16
|
|
|
Service Code
|
EAPG 0286
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$243.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$243.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$108.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$108.07
|
| Rate for Payer: CDPHP Essential Plan |
$243.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$129.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$108.07
|
| Rate for Payer: EmblemHealth Medicaid |
$108.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$243.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$108.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$108.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$232.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$232.35
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$108.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$113.47
|
|
|
EAPG 288: LEVEL I DIAGNOSTIC ULTRASOUND
|
Facility
|
OP
|
$294.37
|
|
|
Service Code
|
EAPG 0288
|
| Min. Negotiated Rate |
$130.83 |
| Max. Negotiated Rate |
$294.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$294.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.83
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.83
|
| Rate for Payer: CDPHP Essential Plan |
$294.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$157.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.83
|
| Rate for Payer: EmblemHealth Medicaid |
$130.83
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$294.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.83
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$281.28
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$281.28
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.83
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$137.37
|
|
|
EAPG 289: LEVEL II DIAGNOSTIC ULTRASOUND
|
Facility
|
OP
|
$1,276.85
|
|
|
Service Code
|
EAPG 0289
|
| Min. Negotiated Rate |
$567.49 |
| Max. Negotiated Rate |
$1,276.85 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,276.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$567.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$567.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,276.85
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$680.99
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$567.49
|
| Rate for Payer: EmblemHealth Medicaid |
$567.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,276.85
|
| Rate for Payer: Hamaspik Choice Medicaid |
$567.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$567.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,220.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,220.10
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$567.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$595.86
|
|
|
EAPG 28: LEVEL I SPINE PROCEDURES
|
Facility
|
OP
|
$6,439.52
|
|
|
Service Code
|
EAPG 0028
|
| Min. Negotiated Rate |
$2,862.01 |
| Max. Negotiated Rate |
$6,439.52 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,439.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,862.01
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,862.01
|
| Rate for Payer: CDPHP Essential Plan |
$6,439.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,434.41
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,862.01
|
| Rate for Payer: EmblemHealth Medicaid |
$2,862.01
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,439.52
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,862.01
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,862.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,153.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,153.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,862.01
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,005.11
|
|
|
EAPG 290: PET SCANS
|
Facility
|
OP
|
$3,016.84
|
|
|
Service Code
|
EAPG 0290
|
| Min. Negotiated Rate |
$1,340.82 |
| Max. Negotiated Rate |
$3,016.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,016.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,340.82
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,340.82
|
| Rate for Payer: CDPHP Essential Plan |
$3,016.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,608.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,340.82
|
| Rate for Payer: EmblemHealth Medicaid |
$1,340.82
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,016.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,340.82
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,340.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,882.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,882.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,340.82
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,407.86
|
|
|
EAPG 291: BONE DENSITY AND RELATED PROCEDURES
|
Facility
|
OP
|
$326.72
|
|
|
Service Code
|
EAPG 0291
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$326.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$326.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$145.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$145.21
|
| Rate for Payer: CDPHP Essential Plan |
$326.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$174.25
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$145.21
|
| Rate for Payer: EmblemHealth Medicaid |
$145.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$326.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$145.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$145.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$312.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$312.20
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$145.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$152.47
|
|
|
EAPG 293: MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST
|
Facility
|
OP
|
$865.98
|
|
|
Service Code
|
EAPG 0293
|
| Min. Negotiated Rate |
$384.88 |
| Max. Negotiated Rate |
$865.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$865.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$384.88
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$384.88
|
| Rate for Payer: CDPHP Essential Plan |
$865.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$461.86
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$384.88
|
| Rate for Payer: EmblemHealth Medicaid |
$384.88
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$865.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$384.88
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$384.88
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$827.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$827.49
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$384.88
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$404.12
|
|
|
EAPG 295: MAGNETIC RESONANCE IMAGING WITH CONTRAST
|
Facility
|
OP
|
$1,306.10
|
|
|
Service Code
|
EAPG 0295
|
| Min. Negotiated Rate |
$580.49 |
| Max. Negotiated Rate |
$1,306.10 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,306.10
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$580.49
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$580.49
|
| Rate for Payer: CDPHP Essential Plan |
$1,306.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$696.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$580.49
|
| Rate for Payer: EmblemHealth Medicaid |
$580.49
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,306.10
|
| Rate for Payer: Hamaspik Choice Medicaid |
$580.49
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$580.49
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,248.05
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,248.05
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$580.49
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$609.51
|
|
|
EAPG 297: MAGNETOCEPHALOGRAPHY
|
Facility
|
OP
|
$1,175.08
|
|
|
Service Code
|
EAPG 0297
|
| Min. Negotiated Rate |
$522.26 |
| Max. Negotiated Rate |
$1,175.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,175.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$522.26
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$522.26
|
| Rate for Payer: CDPHP Essential Plan |
$1,175.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$626.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$522.26
|
| Rate for Payer: EmblemHealth Medicaid |
$522.26
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,175.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$522.26
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$522.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,122.86
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,122.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$522.26
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$548.37
|
|
|
EAPG 299: LEVEL I COMPUTED TOMOGRAPHY
|
Facility
|
OP
|
$591.73
|
|
|
Service Code
|
EAPG 0299
|
| Min. Negotiated Rate |
$262.99 |
| Max. Negotiated Rate |
$591.73 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$591.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$262.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$262.99
|
| Rate for Payer: CDPHP Essential Plan |
$591.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$262.99
|
| Rate for Payer: EmblemHealth Medicaid |
$262.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$591.73
|
| Rate for Payer: Hamaspik Choice Medicaid |
$262.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$262.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$565.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$565.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$262.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$276.14
|
|
|
EAPG 29: LEVEL II SPINE PROCEDURES
|
Facility
|
OP
|
$7,809.95
|
|
|
Service Code
|
EAPG 0029
|
| Min. Negotiated Rate |
$3,471.09 |
| Max. Negotiated Rate |
$7,809.95 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,809.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,471.09
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,471.09
|
| Rate for Payer: CDPHP Essential Plan |
$7,809.95
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4,165.31
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,471.09
|
| Rate for Payer: EmblemHealth Medicaid |
$3,471.09
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,809.95
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,471.09
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,471.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$7,462.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$7,462.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,471.09
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,644.64
|
|
