|
EAPG 331: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE
|
Facility
|
OP
|
$681.88
|
|
|
Service Code
|
EAPG 0331
|
| Min. Negotiated Rate |
$303.06 |
| Max. Negotiated Rate |
$681.88 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$681.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$303.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$303.06
|
| Rate for Payer: CDPHP Essential Plan |
$681.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$363.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$303.06
|
| Rate for Payer: EmblemHealth Medicaid |
$303.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$681.88
|
| Rate for Payer: Hamaspik Choice Medicaid |
$303.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$303.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$651.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$651.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$303.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$318.21
|
|
|
EAPG 332: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE
|
Facility
|
OP
|
$1,488.15
|
|
|
Service Code
|
EAPG 0332
|
| Min. Negotiated Rate |
$661.40 |
| Max. Negotiated Rate |
$1,488.15 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,488.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$661.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$661.40
|
| Rate for Payer: CDPHP Essential Plan |
$1,488.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$793.68
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$661.40
|
| Rate for Payer: EmblemHealth Medicaid |
$661.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,488.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$661.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$661.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,422.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,422.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$661.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$694.47
|
|
|
EAPG 333: BEHAVIORAL HEALTH RESIDENTIAL TREATMENT
|
Facility
|
OP
|
$240.73
|
|
|
Service Code
|
EAPG 0333
|
| Min. Negotiated Rate |
$106.99 |
| Max. Negotiated Rate |
$240.73 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$240.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.99
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.99
|
| Rate for Payer: CDPHP Essential Plan |
$240.73
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$128.39
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.99
|
| Rate for Payer: EmblemHealth Medicaid |
$106.99
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$240.73
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.99
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$230.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$230.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.99
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$112.34
|
|
|
EAPG 334: LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY
|
Facility
|
OP
|
$1,656.16
|
|
|
Service Code
|
EAPG 0334
|
| Min. Negotiated Rate |
$736.07 |
| Max. Negotiated Rate |
$1,656.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,656.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$736.07
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$736.07
|
| Rate for Payer: CDPHP Essential Plan |
$1,656.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$883.28
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$736.07
|
| Rate for Payer: EmblemHealth Medicaid |
$736.07
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,656.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$736.07
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$736.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,582.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,582.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$736.07
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$772.87
|
|
|
EAPG 335: LEVEL I BRACHYTHERAPY SOURCES
|
Facility
|
OP
|
$1,967.02
|
|
|
Service Code
|
EAPG 0335
|
| Min. Negotiated Rate |
$874.23 |
| Max. Negotiated Rate |
$1,967.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,967.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$874.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$874.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,967.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,049.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$874.23
|
| Rate for Payer: EmblemHealth Medicaid |
$874.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,967.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$874.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$874.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,879.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,879.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$874.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$917.94
|
|
|
EAPG 336: LEVEL II BRACHYTHERAPY SOURCES
|
Facility
|
OP
|
$2,753.82
|
|
|
Service Code
|
EAPG 0336
|
| Min. Negotiated Rate |
$1,223.92 |
| Max. Negotiated Rate |
$2,753.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,753.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,223.92
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,223.92
|
| Rate for Payer: CDPHP Essential Plan |
$2,753.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,468.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,223.92
|
| Rate for Payer: EmblemHealth Medicaid |
$1,223.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,753.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,223.92
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,223.92
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,631.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,631.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,223.92
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,285.12
|
|
|
EAPG 337: LEVEL III BRACHYTHERAPY SOURCES
|
Facility
|
OP
|
$28,704.06
|
|
|
Service Code
|
EAPG 0337
|
| Min. Negotiated Rate |
$12,757.36 |
| Max. Negotiated Rate |
$28,704.06 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$28,704.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$12,757.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$12,757.36
|
| Rate for Payer: CDPHP Essential Plan |
$28,704.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15,308.83
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12,757.36
|
| Rate for Payer: EmblemHealth Medicaid |
$12,757.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$28,704.06
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12,757.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12,757.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$27,428.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$27,428.32
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12,757.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$13,395.23
|
|
|
EAPG 338: LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY
|
Facility
|
OP
|
$2,546.71
|
|
|
Service Code
|
EAPG 0338
|
| Min. Negotiated Rate |
$1,131.87 |
| Max. Negotiated Rate |
$2,546.71 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,546.71
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,131.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,131.87
|
| Rate for Payer: CDPHP Essential Plan |
$2,546.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,358.24
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,131.87
|
| Rate for Payer: EmblemHealth Medicaid |
$1,131.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,546.71
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,131.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,131.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,433.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,433.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,131.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,188.46
|
|
|
EAPG 339: LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY
|
Facility
|
OP
|
$3,632.26
|
|
|
Service Code
|
EAPG 0339
|
| Min. Negotiated Rate |
$1,614.34 |
| Max. Negotiated Rate |
$3,632.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,632.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,614.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,614.34
|
| Rate for Payer: CDPHP Essential Plan |
$3,632.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,937.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,614.34
|
| Rate for Payer: EmblemHealth Medicaid |
$1,614.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,632.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,614.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,614.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,470.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,470.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,614.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,695.06
|
|
|
EAPG 33: LEVEL I HAND PROCEDURES
|
Facility
|
OP
|
$2,525.22
|
|
|
Service Code
|
EAPG 0033
|
| Min. Negotiated Rate |
$1,122.32 |
| Max. Negotiated Rate |
$2,525.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,525.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,122.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,122.32
|
| Rate for Payer: CDPHP Essential Plan |
$2,525.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,346.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,122.32
|
| Rate for Payer: EmblemHealth Medicaid |
$1,122.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,525.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,122.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,122.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,412.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,412.99
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,122.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,178.44
|
|
|
EAPG 340: THERAPEUTIC NUCLEAR MEDICINE
|
Facility
|
OP
|
$776.30
|
|
|
Service Code
|
EAPG 0340
|
| Min. Negotiated Rate |
$345.02 |
| Max. Negotiated Rate |
$776.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$776.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$345.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$345.02
|
| Rate for Payer: CDPHP Essential Plan |
$776.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$414.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$345.02
|
| Rate for Payer: EmblemHealth Medicaid |
$345.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$776.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$345.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$345.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$741.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$741.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$345.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$362.27
|
|
|
EAPG 343: LEVEL I RADIATION THERAPY
|
Facility
|
OP
|
$695.79
|
|
|
Service Code
|
EAPG 0343
|
| Min. Negotiated Rate |
$309.24 |
| Max. Negotiated Rate |
$695.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$695.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$309.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$309.24
|
| Rate for Payer: CDPHP Essential Plan |
$695.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$371.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$309.24
|
| Rate for Payer: EmblemHealth Medicaid |
$309.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$695.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$309.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$309.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$664.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$664.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$309.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$324.70
|
|
|
EAPG 346: RADIOSURGERY
|
Facility
|
OP
|
$9,541.69
|
|
|
Service Code
|
EAPG 0346
|
| Min. Negotiated Rate |
$4,240.75 |
| Max. Negotiated Rate |
$9,541.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$9,541.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$4,240.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$4,240.75
|
| Rate for Payer: CDPHP Essential Plan |
$9,541.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5,088.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4,240.75
|
| Rate for Payer: EmblemHealth Medicaid |
$4,240.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$9,541.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$4,240.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$4,240.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$9,117.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$9,117.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4,240.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$4,452.79
|
|
|
EAPG 347: LEVEL II RADIATION THERAPY
|
Facility
|
OP
|
$320.24
|
|
|
Service Code
|
EAPG 0347
|
| Min. Negotiated Rate |
$142.33 |
| Max. Negotiated Rate |
$320.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$320.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$142.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$142.33
|
| Rate for Payer: CDPHP Essential Plan |
$320.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$170.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.33
|
| Rate for Payer: EmblemHealth Medicaid |
$142.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$320.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$142.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$142.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$306.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$306.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$142.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$149.45
|
|
|
EAPG 348: LEVEL III RADIATION THERAPY
|
Facility
|
OP
|
$1,539.52
|
|
|
Service Code
|
EAPG 0348
|
| Min. Negotiated Rate |
$684.23 |
| Max. Negotiated Rate |
$1,539.52 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,539.52
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$684.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$684.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,539.52
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$821.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$684.23
|
| Rate for Payer: EmblemHealth Medicaid |
$684.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,539.52
|
| Rate for Payer: Hamaspik Choice Medicaid |
$684.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$684.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,471.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,471.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$684.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$718.44
|
|
|
EAPG 34: LEVEL II HAND PROCEDURES
|
Facility
|
OP
|
$4,176.72
|
|
|
Service Code
|
EAPG 0034
|
| Min. Negotiated Rate |
$1,856.32 |
| Max. Negotiated Rate |
$4,176.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,176.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,856.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,856.32
|
| Rate for Payer: CDPHP Essential Plan |
$4,176.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,227.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,856.32
|
| Rate for Payer: EmblemHealth Medicaid |
$1,856.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,176.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,856.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,856.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,991.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,991.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,856.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,949.14
|
|
|
EAPG 350: LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES
|
Facility
|
OP
|
$169.63
|
|
|
Service Code
|
EAPG 0350
|
| Min. Negotiated Rate |
$75.39 |
| Max. Negotiated Rate |
$169.63 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$169.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$75.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$75.39
|
| Rate for Payer: CDPHP Essential Plan |
$169.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.47
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.39
|
| Rate for Payer: EmblemHealth Medicaid |
$75.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$169.63
|
| Rate for Payer: Hamaspik Choice Medicaid |
$75.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$75.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$162.09
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$162.09
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$79.16
|
|
|
EAPG 351: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES
|
Facility
|
OP
|
$478.04
|
|
|
Service Code
|
EAPG 0351
|
| Min. Negotiated Rate |
$212.46 |
| Max. Negotiated Rate |
$478.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$478.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$212.46
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$212.46
|
| Rate for Payer: CDPHP Essential Plan |
$478.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$254.95
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$212.46
|
| Rate for Payer: EmblemHealth Medicaid |
$212.46
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$478.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$212.46
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$212.46
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$456.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$456.79
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$212.46
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$223.08
|
|
|
EAPG 352: LEVEL I PERIODONTICS
|
Facility
|
OP
|
$297.40
|
|
|
Service Code
|
EAPG 0352
|
| Min. Negotiated Rate |
$132.18 |
| Max. Negotiated Rate |
$297.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$297.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$132.18
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$132.18
|
| Rate for Payer: CDPHP Essential Plan |
$297.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$158.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$132.18
|
| Rate for Payer: EmblemHealth Medicaid |
$132.18
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$297.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$132.18
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$132.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$284.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$284.19
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$132.18
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$138.79
|
|
|
EAPG 353: LEVEL I PROSTHODONTICS, FIXED
|
Facility
|
OP
|
$166.36
|
|
|
Service Code
|
EAPG 0353
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$166.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$73.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$73.94
|
| Rate for Payer: CDPHP Essential Plan |
$166.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.73
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.94
|
| Rate for Payer: EmblemHealth Medicaid |
$73.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$166.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$73.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$73.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$158.97
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$158.97
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$73.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$77.64
|
|
|
EAPG 354: LEVEL II PROSTHODONTICS, FIXED
|
Facility
|
OP
|
$622.40
|
|
|
Service Code
|
EAPG 0354
|
| Min. Negotiated Rate |
$276.62 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$622.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$276.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$276.62
|
| Rate for Payer: CDPHP Essential Plan |
$622.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$331.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$276.62
|
| Rate for Payer: EmblemHealth Medicaid |
$276.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$622.40
|
| Rate for Payer: Hamaspik Choice Medicaid |
$276.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$276.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$594.73
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$594.73
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$276.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$290.45
|
|
|
EAPG 355: LEVEL III PROSTHODONTICS, FIXED
|
Facility
|
OP
|
$769.93
|
|
|
Service Code
|
EAPG 0355
|
| Min. Negotiated Rate |
$342.19 |
| Max. Negotiated Rate |
$769.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$769.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$342.19
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$342.19
|
| Rate for Payer: CDPHP Essential Plan |
$769.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$410.63
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$342.19
|
| Rate for Payer: EmblemHealth Medicaid |
$342.19
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$769.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$342.19
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$342.19
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$735.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$735.71
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$342.19
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$359.30
|
|
|
EAPG 356: LEVEL I PROSTHODONTICS, REMOVABLE
|
Facility
|
OP
|
$337.21
|
|
|
Service Code
|
EAPG 0356
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$337.21 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$337.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$149.87
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$149.87
|
| Rate for Payer: CDPHP Essential Plan |
$337.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.87
|
| Rate for Payer: EmblemHealth Medicaid |
$149.87
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$337.21
|
| Rate for Payer: Hamaspik Choice Medicaid |
$149.87
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$149.87
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$322.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$322.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$149.87
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$157.36
|
|
|
EAPG 357: LEVEL II PROSTHODONTICS, REMOVABLE
|
Facility
|
OP
|
$645.19
|
|
|
Service Code
|
EAPG 0357
|
| Min. Negotiated Rate |
$286.75 |
| Max. Negotiated Rate |
$645.19 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$645.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$286.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$286.75
|
| Rate for Payer: CDPHP Essential Plan |
$645.19
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$344.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$286.75
|
| Rate for Payer: EmblemHealth Medicaid |
$286.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$645.19
|
| Rate for Payer: Hamaspik Choice Medicaid |
$286.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$286.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$616.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$616.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$286.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$301.09
|
|
|
EAPG 358: LEVEL III PROSTHODONTICS, REMOVABLE
|
Facility
|
OP
|
$496.60
|
|
|
Service Code
|
EAPG 0358
|
| Min. Negotiated Rate |
$220.71 |
| Max. Negotiated Rate |
$496.60 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$496.60
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$220.71
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$220.71
|
| Rate for Payer: CDPHP Essential Plan |
$496.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$264.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$220.71
|
| Rate for Payer: EmblemHealth Medicaid |
$220.71
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$496.60
|
| Rate for Payer: Hamaspik Choice Medicaid |
$220.71
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$220.71
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$474.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$474.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$220.71
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$231.75
|
|
