|
EAPG 412: MINOR PULMONARY TESTS AND SERVICES
|
Facility
|
OP
|
$147.56
|
|
|
Service Code
|
EAPG 0412
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$147.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$147.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$65.58
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$65.58
|
| Rate for Payer: CDPHP Essential Plan |
$147.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$78.70
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$65.58
|
| Rate for Payer: EmblemHealth Medicaid |
$65.58
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$147.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$65.58
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$65.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$141.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$141.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$65.58
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$68.86
|
|
|
EAPG 413: CARDIOGRAM
|
Facility
|
OP
|
$83.70
|
|
|
Service Code
|
EAPG 0413
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$37.20
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$37.20
|
| Rate for Payer: CDPHP Essential Plan |
$83.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.20
|
| Rate for Payer: EmblemHealth Medicaid |
$37.20
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$83.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$37.20
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$37.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$79.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$79.98
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$39.06
|
|
|
EAPG 414: LEVEL I IMMUNIZATION
|
Facility
|
OP
|
$65.20
|
|
|
Service Code
|
EAPG 0414
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$65.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$65.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$28.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$28.98
|
| Rate for Payer: CDPHP Essential Plan |
$65.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.98
|
| Rate for Payer: EmblemHealth Medicaid |
$28.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$65.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$28.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$28.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$62.31
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$62.31
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$30.43
|
|
|
EAPG 415: LEVEL II IMMUNIZATION
|
Facility
|
OP
|
$135.22
|
|
|
Service Code
|
EAPG 0415
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$135.22 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$135.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$60.10
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$60.10
|
| Rate for Payer: CDPHP Essential Plan |
$135.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$72.12
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.10
|
| Rate for Payer: EmblemHealth Medicaid |
$60.10
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$135.22
|
| Rate for Payer: Hamaspik Choice Medicaid |
$60.10
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$60.10
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$129.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$129.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$60.10
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$63.10
|
|
|
EAPG 417: MINOR FEMALE REPRODUCTIVE PROCEDURES
|
Facility
|
OP
|
$294.03
|
|
|
Service Code
|
EAPG 0417
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$130.68
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$130.68
|
| Rate for Payer: CDPHP Essential Plan |
$294.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$156.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$130.68
|
| Rate for Payer: EmblemHealth Medicaid |
$130.68
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$294.03
|
| Rate for Payer: Hamaspik Choice Medicaid |
$130.68
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$130.68
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$280.96
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$280.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$130.68
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$137.21
|
|
|
EAPG 418: AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS
|
Facility
|
OP
|
$370.37
|
|
|
Service Code
|
EAPG 0418
|
| Min. Negotiated Rate |
$164.61 |
| Max. Negotiated Rate |
$370.37 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$370.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$164.61
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$164.61
|
| Rate for Payer: CDPHP Essential Plan |
$370.37
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$197.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$164.61
|
| Rate for Payer: EmblemHealth Medicaid |
$164.61
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$370.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$164.61
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$164.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$353.91
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$353.91
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$164.61
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$172.84
|
|
|
EAPG 419: MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
|
Facility
|
OP
|
$181.08
|
|
|
Service Code
|
EAPG 0419
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$181.08 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$181.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$80.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$80.48
|
| Rate for Payer: CDPHP Essential Plan |
$181.08
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$96.58
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$80.48
|
| Rate for Payer: EmblemHealth Medicaid |
$80.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$181.08
|
| Rate for Payer: Hamaspik Choice Medicaid |
$80.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$80.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$173.03
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$173.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$80.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$84.50
|
|
|
EAPG 41: CLOSED TREATMENT FX AND DISLOCATION
|
Facility
|
OP
|
$1,003.16
|
|
|
Service Code
|
EAPG 0041
|
| Min. Negotiated Rate |
$445.85 |
| Max. Negotiated Rate |
$1,003.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,003.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$445.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$445.85
|
| Rate for Payer: CDPHP Essential Plan |
$1,003.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$535.02
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$445.85
|
| Rate for Payer: EmblemHealth Medicaid |
$445.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,003.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$445.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$445.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$958.58
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$958.58
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$445.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$468.14
|
|
|
EAPG 420: ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES
|
Facility
|
OP
|
$166.16
|
|
|
Service Code
|
EAPG 0420
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$166.16 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$166.16
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$73.85
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$73.85
|
| Rate for Payer: CDPHP Essential Plan |
$166.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$88.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$73.85
|
| Rate for Payer: EmblemHealth Medicaid |
$73.85
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$166.16
|
| Rate for Payer: Hamaspik Choice Medicaid |
$73.85
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$73.85
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$158.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$158.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$73.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$77.54
|
|
|
EAPG 421: TUBE REPLACEMENT, REVISION OR REMOVAL
|
Facility
|
OP
|
$715.97
|
|
|
Service Code
|
EAPG 0421
|
| Min. Negotiated Rate |
$318.21 |
| Max. Negotiated Rate |
$715.97 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$715.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$318.21
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$318.21
|
| Rate for Payer: CDPHP Essential Plan |
$715.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$381.85
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$318.21
|
| Rate for Payer: EmblemHealth Medicaid |
$318.21
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$715.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$318.21
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$318.21
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$684.15
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$684.15
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$318.21
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$334.12
|
|
|
EAPG 423: VASCULAR ACCESS BY NEEDLE OR CATHETER
|
Facility
|
OP
|
$379.69
|
|
|
Service Code
|
EAPG 0423
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$379.69 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$379.69
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$168.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$168.75
|
| Rate for Payer: CDPHP Essential Plan |
$379.69
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$202.50
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$168.75
|
| Rate for Payer: EmblemHealth Medicaid |
$168.75
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$379.69
|
| Rate for Payer: Hamaspik Choice Medicaid |
$168.75
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$168.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$362.81
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$362.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$168.75
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$177.19
|
|
|
EAPG 435: CLASS I PHARMACOTHERAPY
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
EAPG 0435
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$68.31
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$30.36
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$30.36
|
| Rate for Payer: CDPHP Essential Plan |
$68.31
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.43
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.36
|
| Rate for Payer: EmblemHealth Medicaid |
$30.36
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$68.31
|
| Rate for Payer: Hamaspik Choice Medicaid |
$30.36
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$30.36
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$65.27
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$65.27
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.36
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$31.88
|
|
|
EAPG 436: CLASS II PHARMACOTHERAPY
|
Facility
|
OP
|
$204.93
|
|
|
Service Code
|
EAPG 0436
|
| Min. Negotiated Rate |
$91.08 |
| Max. Negotiated Rate |
$204.93 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$204.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$91.08
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$91.08
|
| Rate for Payer: CDPHP Essential Plan |
$204.93
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$109.30
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$91.08
|
| Rate for Payer: EmblemHealth Medicaid |
$91.08
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$204.93
|
| Rate for Payer: Hamaspik Choice Medicaid |
$91.08
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$91.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$195.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$195.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$91.08
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$95.63
|
|
|
EAPG 437: CLASS III PHARMACOTHERAPY
|
Facility
|
OP
|
$368.01
|
|
|
Service Code
|
EAPG 0437
|
| Min. Negotiated Rate |
$163.56 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$368.01
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$163.56
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$163.56
|
| Rate for Payer: CDPHP Essential Plan |
$368.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$196.27
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$163.56
|
| Rate for Payer: EmblemHealth Medicaid |
$163.56
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$368.01
|
| Rate for Payer: Hamaspik Choice Medicaid |
$163.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$163.56
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$351.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$351.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$163.56
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$171.74
|
|
|
EAPG 438: CLASS IV PHARMACOTHERAPY
|
Facility
|
OP
|
$617.02
|
|
|
Service Code
|
EAPG 0438
|
| Min. Negotiated Rate |
$274.23 |
| Max. Negotiated Rate |
$617.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$617.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$274.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$274.23
|
| Rate for Payer: CDPHP Essential Plan |
$617.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$329.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$274.23
|
| Rate for Payer: EmblemHealth Medicaid |
$274.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$617.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$274.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$274.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$589.59
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$589.59
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$274.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$287.94
|
|
|
EAPG 439: CLASS V PHARMACOTHERAPY
|
Facility
|
OP
|
$998.26
|
|
|
Service Code
|
EAPG 0439
|
| Min. Negotiated Rate |
$443.67 |
| Max. Negotiated Rate |
$998.26 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$998.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$443.67
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$443.67
|
| Rate for Payer: CDPHP Essential Plan |
$998.26
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$532.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$443.67
|
| Rate for Payer: EmblemHealth Medicaid |
$443.67
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$998.26
|
| Rate for Payer: Hamaspik Choice Medicaid |
$443.67
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$443.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$953.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$953.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$443.67
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$465.85
|
|
|
EAPG 43: OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES
|
Facility
|
OP
|
$5,915.77
|
|
|
Service Code
|
EAPG 0043
|
| Min. Negotiated Rate |
$2,629.23 |
| Max. Negotiated Rate |
$5,915.77 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$5,915.77
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,629.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,629.23
|
| Rate for Payer: CDPHP Essential Plan |
$5,915.77
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,155.08
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,629.23
|
| Rate for Payer: EmblemHealth Medicaid |
$2,629.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$5,915.77
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,629.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,629.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,652.84
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,652.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,629.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,760.69
|
|
|
EAPG 440: CLASS VI PHARMACOTHERAPY
|
Facility
|
OP
|
$1,555.76
|
|
|
Service Code
|
EAPG 0440
|
| Min. Negotiated Rate |
$691.45 |
| Max. Negotiated Rate |
$1,555.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,555.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$691.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$691.45
|
| Rate for Payer: CDPHP Essential Plan |
$1,555.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$829.74
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$691.45
|
| Rate for Payer: EmblemHealth Medicaid |
$691.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,555.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$691.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$691.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,486.62
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,486.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$691.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$726.02
|
|
|
EAPG 444: CLASS VII PHARMACOTHERAPY
|
Facility
|
OP
|
$2,329.24
|
|
|
Service Code
|
EAPG 0444
|
| Min. Negotiated Rate |
$1,035.22 |
| Max. Negotiated Rate |
$2,329.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,329.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,035.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,035.22
|
| Rate for Payer: CDPHP Essential Plan |
$2,329.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,242.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,035.22
|
| Rate for Payer: EmblemHealth Medicaid |
$1,035.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,329.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,035.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,035.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,225.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,225.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,035.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,086.98
|
|
|
EAPG 448: EXPANDED HOURS ACCESS
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
EAPG 0448
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$27.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$12.33
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$12.33
|
| Rate for Payer: CDPHP Essential Plan |
$27.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$14.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.33
|
| Rate for Payer: EmblemHealth Medicaid |
$12.33
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$27.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$12.33
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$12.33
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$26.51
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$26.51
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$12.33
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$12.95
|
|
|
EAPG 44: BONE OR JOINT MANIPULATION UNDER ANESTHESIA
|
Facility
|
OP
|
$1,848.67
|
|
|
Service Code
|
EAPG 0044
|
| Min. Negotiated Rate |
$821.63 |
| Max. Negotiated Rate |
$1,848.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,848.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$821.63
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$821.63
|
| Rate for Payer: CDPHP Essential Plan |
$1,848.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$985.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$821.63
|
| Rate for Payer: EmblemHealth Medicaid |
$821.63
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,848.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$821.63
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$821.63
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,766.50
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,766.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$821.63
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$862.71
|
|
|
EAPG 450: OBSERVATION
|
Facility
|
OP
|
$57.15
|
|
|
Service Code
|
EAPG 0450
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$57.15 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$57.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$25.40
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$25.40
|
| Rate for Payer: CDPHP Essential Plan |
$57.15
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$30.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.40
|
| Rate for Payer: EmblemHealth Medicaid |
$25.40
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$57.15
|
| Rate for Payer: Hamaspik Choice Medicaid |
$25.40
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$25.40
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$54.61
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$54.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$25.40
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$26.67
|
|
|
EAPG 455: IMPLANTED TISSUE OF ANY TYPE
|
Facility
|
OP
|
$2,347.83
|
|
|
Service Code
|
EAPG 0455
|
| Min. Negotiated Rate |
$1,043.48 |
| Max. Negotiated Rate |
$2,347.83 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$2,347.83
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,043.48
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,043.48
|
| Rate for Payer: CDPHP Essential Plan |
$2,347.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,252.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,043.48
|
| Rate for Payer: EmblemHealth Medicaid |
$1,043.48
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$2,347.83
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,043.48
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,043.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$2,243.48
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$2,243.48
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,043.48
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,095.65
|
|
|
EAPG 458: ALLERGY THERAPY
|
Facility
|
OP
|
$65.56
|
|
|
Service Code
|
EAPG 0458
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$65.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$29.14
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$29.14
|
| Rate for Payer: CDPHP Essential Plan |
$65.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.97
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.14
|
| Rate for Payer: EmblemHealth Medicaid |
$29.14
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$65.56
|
| Rate for Payer: Hamaspik Choice Medicaid |
$29.14
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$29.14
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$62.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$62.65
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$29.14
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$30.60
|
|
|
EAPG 459: VACCINE ADMINISTRATION
|
Facility
|
OP
|
$30.24
|
|
|
Service Code
|
EAPG 0459
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$30.24 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$13.44
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$13.44
|
| Rate for Payer: CDPHP Essential Plan |
$30.24
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$16.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.44
|
| Rate for Payer: EmblemHealth Medicaid |
$13.44
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$30.24
|
| Rate for Payer: Hamaspik Choice Medicaid |
$13.44
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$13.44
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$28.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$28.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.44
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$14.11
|
|
