|
EAPG 359: LEVEL I MAXILLOFACIAL PROSTHETICS
|
Facility
|
OP
|
$93.67
|
|
|
Service Code
|
EAPG 0359
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$93.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$93.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.63
|
| Rate for Payer: CDPHP Essential Plan |
$93.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.63
|
| Rate for Payer: EmblemHealth Medicaid |
$41.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$93.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$89.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$89.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.71
|
|
|
EAPG 35: LEVEL I FOOT PROCEDURES
|
Facility
|
OP
|
$3,252.82
|
|
|
Service Code
|
EAPG 0035
|
| Min. Negotiated Rate |
$1,445.70 |
| Max. Negotiated Rate |
$3,252.82 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,252.82
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,445.70
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,445.70
|
| Rate for Payer: CDPHP Essential Plan |
$3,252.82
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,734.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,445.70
|
| Rate for Payer: EmblemHealth Medicaid |
$1,445.70
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,252.82
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,445.70
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,445.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,108.26
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,108.26
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,445.70
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,517.98
|
|
|
EAPG 360: LEVEL II MAXILLOFACIAL PROSTHETICS
|
Facility
|
OP
|
$489.24
|
|
|
Service Code
|
EAPG 0360
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$489.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$217.44
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$217.44
|
| Rate for Payer: CDPHP Essential Plan |
$489.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$260.93
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$217.44
|
| Rate for Payer: EmblemHealth Medicaid |
$217.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$489.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$217.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$217.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$467.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$467.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$217.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$228.31
|
|
|
EAPG 361: LEVEL I DENTAL RESTORATIONS
|
Facility
|
OP
|
$239.90
|
|
|
Service Code
|
EAPG 0361
|
| Min. Negotiated Rate |
$106.62 |
| Max. Negotiated Rate |
$239.90 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$239.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$106.62
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$106.62
|
| Rate for Payer: CDPHP Essential Plan |
$239.90
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$106.62
|
| Rate for Payer: EmblemHealth Medicaid |
$106.62
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$239.90
|
| Rate for Payer: Hamaspik Choice Medicaid |
$106.62
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$106.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$229.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$229.23
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$106.62
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$111.95
|
|
|
EAPG 362: LEVEL II DENTAL RESTORATIONS
|
Facility
|
OP
|
$359.96
|
|
|
Service Code
|
EAPG 0362
|
| Min. Negotiated Rate |
$159.98 |
| Max. Negotiated Rate |
$359.96 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$359.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$159.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$159.98
|
| Rate for Payer: CDPHP Essential Plan |
$359.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$191.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$159.98
|
| Rate for Payer: EmblemHealth Medicaid |
$159.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$359.96
|
| Rate for Payer: Hamaspik Choice Medicaid |
$159.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$159.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$343.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$343.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$159.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$167.98
|
|
|
EAPG 363: LEVEL III DENTAL RESTORATIONS
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
EAPG 0363
|
| Min. Negotiated Rate |
$381.50 |
| Max. Negotiated Rate |
$858.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$858.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$381.50
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$381.50
|
| Rate for Payer: CDPHP Essential Plan |
$858.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$457.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$381.50
|
| Rate for Payer: EmblemHealth Medicaid |
$381.50
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$858.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$381.50
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$381.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$820.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$820.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$381.50
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$400.58
|
|
|
EAPG 364: LEVEL I ENDODONTICS
|
Facility
|
OP
|
$228.58
|
|
|
Service Code
|
EAPG 0364
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$228.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$228.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$101.59
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$101.59
|
| Rate for Payer: CDPHP Essential Plan |
$228.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$121.91
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$101.59
|
| Rate for Payer: EmblemHealth Medicaid |
$101.59
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$228.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$101.59
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$101.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$218.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$218.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$101.59
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$106.67
|
|
|
EAPG 365: LEVEL II ENDODONTICS
|
Facility
|
OP
|
$411.05
|
|
|
Service Code
|
EAPG 0365
|
| Min. Negotiated Rate |
$182.69 |
| Max. Negotiated Rate |
$411.05 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$411.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$182.69
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$182.69
|
| Rate for Payer: CDPHP Essential Plan |
$411.05
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$219.23
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$182.69
|
| Rate for Payer: EmblemHealth Medicaid |
$182.69
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$411.05
|
| Rate for Payer: Hamaspik Choice Medicaid |
$182.69
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$182.69
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$392.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$392.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$182.69
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$191.82
|
|
|
EAPG 366: LEVEL III ENDODONTICS
|
Facility
|
OP
|
$414.07
|
|
|
Service Code
|
EAPG 0366
|
| Min. Negotiated Rate |
$184.03 |
| Max. Negotiated Rate |
$414.07 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$414.07
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$184.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$184.03
|
| Rate for Payer: CDPHP Essential Plan |
$414.07
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$220.84
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$184.03
|
| Rate for Payer: EmblemHealth Medicaid |
$184.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$414.07
|
| Rate for Payer: Hamaspik Choice Medicaid |
$184.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$184.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$395.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$395.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$184.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$193.23
|
|
|
EAPG 367: LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
|
OP
|
$273.94
|
|
|
Service Code
|
EAPG 0367
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$273.94 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$273.94
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$121.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$121.75
|
| Rate for Payer: CDPHP Essential Plan |
$273.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$146.10
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$121.75
|
| Rate for Payer: EmblemHealth Medicaid |
$121.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$273.94
|
| Rate for Payer: Hamaspik Choice Medicaid |
$121.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$121.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$261.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$261.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$121.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$127.84
|
|
|
EAPG 368: LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
|
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0368
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 369: LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
|
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0369
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 36: LEVEL II FOOT PROCEDURES
|
Facility
|
OP
|
$4,162.14
|
|
|
Service Code
|
EAPG 0036
|
| Min. Negotiated Rate |
$1,849.84 |
| Max. Negotiated Rate |
$4,162.14 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,162.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,849.84
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,849.84
|
| Rate for Payer: CDPHP Essential Plan |
$4,162.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,219.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,849.84
|
| Rate for Payer: EmblemHealth Medicaid |
$1,849.84
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,162.14
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,849.84
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,849.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,977.16
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,977.16
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,849.84
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,942.33
|
|
|
EAPG 370: LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES
|
Facility
|
OP
|
$758.79
|
|
|
Service Code
|
EAPG 0370
|
| Min. Negotiated Rate |
$337.24 |
| Max. Negotiated Rate |
$758.79 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$758.79
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$337.24
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$337.24
|
| Rate for Payer: CDPHP Essential Plan |
$758.79
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$404.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$337.24
|
| Rate for Payer: EmblemHealth Medicaid |
$337.24
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$758.79
|
| Rate for Payer: Hamaspik Choice Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$337.24
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$725.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$725.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$337.24
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$354.10
|
|
|
EAPG 372: SEALANT
|
Facility
|
OP
|
$74.99
|
|
|
Service Code
|
EAPG 0372
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$74.99 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$74.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$33.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$33.33
|
| Rate for Payer: CDPHP Essential Plan |
$74.99
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$33.33
|
| Rate for Payer: EmblemHealth Medicaid |
$33.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$74.99
|
| Rate for Payer: Hamaspik Choice Medicaid |
$33.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$33.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$71.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$71.66
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$33.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$35.00
|
|
|
EAPG 373: LEVEL I DENTAL FILM
|
Facility
|
OP
|
$48.92
|
|
|
Service Code
|
EAPG 0373
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$48.92 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$21.74
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$21.74
|
| Rate for Payer: CDPHP Essential Plan |
$48.92
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.09
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.74
|
| Rate for Payer: EmblemHealth Medicaid |
$21.74
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$48.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$21.74
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$21.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$46.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$46.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.74
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$22.83
|
|
|
EAPG 374: LEVEL II DENTAL FILM
|
Facility
|
OP
|
$169.36
|
|
|
Service Code
|
EAPG 0374
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$169.36 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$169.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$75.27
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$75.27
|
| Rate for Payer: CDPHP Essential Plan |
$169.36
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$90.32
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$75.27
|
| Rate for Payer: EmblemHealth Medicaid |
$75.27
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$169.36
|
| Rate for Payer: Hamaspik Choice Medicaid |
$75.27
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$75.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$161.83
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$161.83
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$75.27
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$79.03
|
|
|
EAPG 375: DENTAL ANESTHESIA
|
Facility
|
OP
|
$2,066.26
|
|
|
Service Code
|
EAPG 0375
|
| Min. Negotiated Rate |
$918.34 |
| Max. Negotiated Rate |
$2,066.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,066.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$918.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$918.34
|
| Rate for Payer: CDPHP Essential Plan |
$2,066.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,102.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$918.34
|
| Rate for Payer: EmblemHealth Medicaid |
$918.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,066.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$918.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$918.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,974.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,974.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$918.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$964.26
|
|
|
EAPG 376: DIAGNOSTIC DENTAL PROCEDURES
|
Facility
|
OP
|
$85.30
|
|
|
Service Code
|
EAPG 0376
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$85.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.91
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.91
|
| Rate for Payer: CDPHP Essential Plan |
$85.30
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$45.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.91
|
| Rate for Payer: EmblemHealth Medicaid |
$37.91
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$85.30
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.91
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$81.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$81.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.91
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.81
|
|
|
EAPG 377: PREVENTIVE DENTAL PROCEDURES
|
Facility
|
OP
|
$119.32
|
|
|
Service Code
|
EAPG 0377
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$119.32 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$119.32
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$53.03
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$53.03
|
| Rate for Payer: CDPHP Essential Plan |
$119.32
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$53.03
|
| Rate for Payer: EmblemHealth Medicaid |
$53.03
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$119.32
|
| Rate for Payer: Hamaspik Choice Medicaid |
$53.03
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$53.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$114.01
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$114.01
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$53.03
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$55.68
|
|
|
EAPG 37: LEVEL I ARTHROSCOPY
|
Facility
|
OP
|
$3,638.74
|
|
|
Service Code
|
EAPG 0037
|
| Min. Negotiated Rate |
$1,617.22 |
| Max. Negotiated Rate |
$3,638.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,638.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,617.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,617.22
|
| Rate for Payer: CDPHP Essential Plan |
$3,638.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,940.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,617.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,617.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,638.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,617.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,617.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,477.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,477.02
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,617.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,698.08
|
|
|
EAPG 384: LEVEL III CHEMISTRY TESTS
|
Facility
|
OP
|
$107.37
|
|
|
Service Code
|
EAPG 0384
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$107.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$107.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$47.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$47.72
|
| Rate for Payer: CDPHP Essential Plan |
$107.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$57.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$47.72
|
| Rate for Payer: EmblemHealth Medicaid |
$47.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$107.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$47.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$47.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$102.60
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$102.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$47.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$50.11
|
|
|
EAPG 388: LEVEL III MICROBIOLOGY TESTS
|
Facility
|
OP
|
$121.84
|
|
|
Service Code
|
EAPG 0388
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$121.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$54.15
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$54.15
|
| Rate for Payer: CDPHP Essential Plan |
$121.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$64.98
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$54.15
|
| Rate for Payer: EmblemHealth Medicaid |
$54.15
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$121.84
|
| Rate for Payer: Hamaspik Choice Medicaid |
$54.15
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$54.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$116.42
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$116.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$54.15
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$56.86
|
|
|
EAPG 389: LEVEL II CONVENTIONAL RADIOLOGY
|
Facility
|
OP
|
$509.38
|
|
|
Service Code
|
EAPG 0389
|
| Min. Negotiated Rate |
$226.39 |
| Max. Negotiated Rate |
$509.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$509.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$226.39
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$226.39
|
| Rate for Payer: CDPHP Essential Plan |
$509.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$271.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$226.39
|
| Rate for Payer: EmblemHealth Medicaid |
$226.39
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$509.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$226.39
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$226.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$486.74
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$486.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$226.39
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$237.71
|
|
|
EAPG 38: LEVEL II ARTHROSCOPY
|
Facility
|
OP
|
$6,915.04
|
|
|
Service Code
|
EAPG 0038
|
| Min. Negotiated Rate |
$3,073.35 |
| Max. Negotiated Rate |
$6,915.04 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,915.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,073.35
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,073.35
|
| Rate for Payer: CDPHP Essential Plan |
$6,915.04
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,688.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,073.35
|
| Rate for Payer: EmblemHealth Medicaid |
$3,073.35
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,915.04
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,073.35
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,073.35
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,607.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,607.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,073.35
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,227.02
|
|
