|
EAPG 45: BUNION PROCEDURES
|
Facility
|
OP
|
$4,487.98
|
|
|
Service Code
|
EAPG 0045
|
| Min. Negotiated Rate |
$1,994.66 |
| Max. Negotiated Rate |
$4,487.98 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,487.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,994.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,994.66
|
| Rate for Payer: CDPHP Essential Plan |
$4,487.98
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,393.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,994.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,994.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,487.98
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,994.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,994.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,288.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,288.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,994.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,094.39
|
|
|
EAPG 460: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
|
OP
|
$3,351.74
|
|
|
Service Code
|
EAPG 0460
|
| Min. Negotiated Rate |
$1,489.66 |
| Max. Negotiated Rate |
$3,351.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$3,351.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$1,489.66
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$1,489.66
|
| Rate for Payer: CDPHP Essential Plan |
$3,351.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,787.59
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,489.66
|
| Rate for Payer: EmblemHealth Medicaid |
$1,489.66
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$3,351.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,489.66
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,489.66
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$3,202.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$3,202.77
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1,489.66
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$1,564.14
|
|
|
EAPG 461: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
|
OP
|
$4,623.23
|
|
|
Service Code
|
EAPG 0461
|
| Min. Negotiated Rate |
$2,054.77 |
| Max. Negotiated Rate |
$4,623.23 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$4,623.23
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,054.77
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,054.77
|
| Rate for Payer: CDPHP Essential Plan |
$4,623.23
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,465.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,054.77
|
| Rate for Payer: EmblemHealth Medicaid |
$2,054.77
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$4,623.23
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,054.77
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,054.77
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$4,417.76
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$4,417.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,054.77
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,157.51
|
|
|
EAPG 462: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
|
OP
|
$7,344.72
|
|
|
Service Code
|
EAPG 0462
|
| Min. Negotiated Rate |
$3,264.32 |
| Max. Negotiated Rate |
$7,344.72 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$7,344.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,264.32
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,264.32
|
| Rate for Payer: CDPHP Essential Plan |
$7,344.72
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,917.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,264.32
|
| Rate for Payer: EmblemHealth Medicaid |
$3,264.32
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$7,344.72
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,264.32
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,264.32
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$7,018.29
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$7,018.29
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,264.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,427.54
|
|
|
EAPG 463: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
|
OP
|
$11,846.74
|
|
|
Service Code
|
EAPG 0463
|
| Min. Negotiated Rate |
$5,265.22 |
| Max. Negotiated Rate |
$11,846.74 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$11,846.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$5,265.22
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$5,265.22
|
| Rate for Payer: CDPHP Essential Plan |
$11,846.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$6,318.26
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5,265.22
|
| Rate for Payer: EmblemHealth Medicaid |
$5,265.22
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$11,846.74
|
| Rate for Payer: Hamaspik Choice Medicaid |
$5,265.22
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$5,265.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$11,320.22
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$11,320.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5,265.22
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$5,528.48
|
|
|
EAPG 464: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
|
Facility
|
OP
|
$18,182.20
|
|
|
Service Code
|
EAPG 0464
|
| Min. Negotiated Rate |
$8,080.98 |
| Max. Negotiated Rate |
$18,182.20 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$18,182.20
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$8,080.98
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$8,080.98
|
| Rate for Payer: CDPHP Essential Plan |
$18,182.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$9,697.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8,080.98
|
| Rate for Payer: EmblemHealth Medicaid |
$8,080.98
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$18,182.20
|
| Rate for Payer: Hamaspik Choice Medicaid |
$8,080.98
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$8,080.98
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$17,374.11
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$17,374.11
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8,080.98
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$8,485.03
|
|
|
EAPG 46: LEVEL I ARTHROPLASTY
|
Facility
|
OP
|
$6,068.25
|
|
|
Service Code
|
EAPG 0046
|
| Min. Negotiated Rate |
$2,697.00 |
| Max. Negotiated Rate |
$6,068.25 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,068.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$2,697.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$2,697.00
|
| Rate for Payer: CDPHP Essential Plan |
$6,068.25
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,236.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,697.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,697.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,068.25
|
| Rate for Payer: Hamaspik Choice Medicaid |
$2,697.00
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$2,697.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$5,798.55
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$5,798.55
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2,697.00
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$2,831.85
|
|
|
EAPG 470: OBSTETRICAL ULTRASOUND
|
Facility
|
OP
|
$254.38
|
|
|
Service Code
|
EAPG 0470
|
| Min. Negotiated Rate |
$113.06 |
| Max. Negotiated Rate |
$254.38 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$254.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$113.06
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$113.06
|
| Rate for Payer: CDPHP Essential Plan |
$254.38
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$135.67
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$113.06
|
| Rate for Payer: EmblemHealth Medicaid |
$113.06
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$254.38
|
| Rate for Payer: Hamaspik Choice Medicaid |
$113.06
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$113.06
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$243.08
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$243.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$113.06
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$118.71
|
|
|
EAPG 471: LEVEL I CONVENTIONAL RADIOLOGY
|
Facility
|
OP
|
$68.96
|
|
|
Service Code
|
EAPG 0471
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$68.96 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$68.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$30.65
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$30.65
|
| Rate for Payer: CDPHP Essential Plan |
$68.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.78
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$30.65
|
| Rate for Payer: EmblemHealth Medicaid |
$30.65
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$68.96
|
| Rate for Payer: Hamaspik Choice Medicaid |
$30.65
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$30.65
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$65.90
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$65.90
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.65
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$32.18
|
|
|
EAPG 472: ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$422.53
|
|
|
Service Code
|
EAPG 0472
|
| Min. Negotiated Rate |
$187.79 |
| Max. Negotiated Rate |
$422.53 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$422.53
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$187.79
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$187.79
|
| Rate for Payer: CDPHP Essential Plan |
$422.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$225.35
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$187.79
|
| Rate for Payer: EmblemHealth Medicaid |
$187.79
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$422.53
|
| Rate for Payer: Hamaspik Choice Medicaid |
$187.79
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$187.79
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$403.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$403.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$187.79
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$197.18
|
|
|
EAPG 473: CT GUIDANCE
|
Facility
|
OP
|
$389.12
|
|
|
Service Code
|
EAPG 0473
|
| Min. Negotiated Rate |
$172.94 |
| Max. Negotiated Rate |
$389.12 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$389.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$172.94
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$172.94
|
| Rate for Payer: CDPHP Essential Plan |
$389.12
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$207.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.94
|
| Rate for Payer: EmblemHealth Medicaid |
$172.94
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$389.12
|
| Rate for Payer: Hamaspik Choice Medicaid |
$172.94
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$172.94
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$371.82
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$371.82
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$172.94
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$181.59
|
|
|
EAPG 474: RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES
|
Facility
|
OP
|
$707.42
|
|
|
Service Code
|
EAPG 0474
|
| 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 475: MRI GUIDANCE
|
Facility
|
OP
|
$522.97
|
|
|
Service Code
|
EAPG 0475
|
| Min. Negotiated Rate |
$232.43 |
| Max. Negotiated Rate |
$522.97 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$522.97
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$232.43
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$232.43
|
| Rate for Payer: CDPHP Essential Plan |
$522.97
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$278.92
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$232.43
|
| Rate for Payer: EmblemHealth Medicaid |
$232.43
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$522.97
|
| Rate for Payer: Hamaspik Choice Medicaid |
$232.43
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$232.43
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$499.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$499.72
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$232.43
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$244.05
|
|
|
EAPG 476: LEVEL I RADIATION TREATMENT PREPARATION & PLANNING
|
Facility
|
OP
|
$932.51
|
|
|
Service Code
|
EAPG 0476
|
| Min. Negotiated Rate |
$414.45 |
| Max. Negotiated Rate |
$932.51 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$932.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$414.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$414.45
|
| Rate for Payer: CDPHP Essential Plan |
$932.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$497.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$414.45
|
| Rate for Payer: EmblemHealth Medicaid |
$414.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$932.51
|
| Rate for Payer: Hamaspik Choice Medicaid |
$414.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$414.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$891.07
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$891.07
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$414.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$435.17
|
|
|
EAPG 477: LEVEL II RADIATION TREATMENT PREPARATION & PLANNING
|
Facility
|
OP
|
$880.67
|
|
|
Service Code
|
EAPG 0477
|
| Min. Negotiated Rate |
$391.41 |
| Max. Negotiated Rate |
$880.67 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$880.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$391.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$391.41
|
| Rate for Payer: CDPHP Essential Plan |
$880.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$469.69
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$391.41
|
| Rate for Payer: EmblemHealth Medicaid |
$391.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$880.67
|
| Rate for Payer: Hamaspik Choice Medicaid |
$391.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$391.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$841.53
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$841.53
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$391.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$410.98
|
|
|
EAPG 478: LEVEL III RADIATION TREATMENT PREPARATION & PLANNING
|
Facility
|
OP
|
$335.70
|
|
|
Service Code
|
EAPG 0478
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$335.70 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$335.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$149.20
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$149.20
|
| Rate for Payer: CDPHP Essential Plan |
$335.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$179.04
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$149.20
|
| Rate for Payer: EmblemHealth Medicaid |
$149.20
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$335.70
|
| Rate for Payer: Hamaspik Choice Medicaid |
$149.20
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$149.20
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$320.78
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$320.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$149.20
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$156.66
|
|
|
EAPG 47: LEVEL II ARTHROPLASTY
|
Facility
|
OP
|
$6,971.51
|
|
|
Service Code
|
EAPG 0047
|
| Min. Negotiated Rate |
$3,098.45 |
| Max. Negotiated Rate |
$6,971.51 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$6,971.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$3,098.45
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$3,098.45
|
| Rate for Payer: CDPHP Essential Plan |
$6,971.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3,718.14
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3,098.45
|
| Rate for Payer: EmblemHealth Medicaid |
$3,098.45
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$6,971.51
|
| Rate for Payer: Hamaspik Choice Medicaid |
$3,098.45
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$3,098.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$6,661.67
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$6,661.67
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3,098.45
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$3,253.37
|
|
|
EAPG 483: RADIATION THERAPY MANAGEMENT
|
Facility
|
OP
|
$627.80
|
|
|
Service Code
|
EAPG 0483
|
| Min. Negotiated Rate |
$279.02 |
| Max. Negotiated Rate |
$627.80 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$279.02
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$279.02
|
| Rate for Payer: CDPHP Essential Plan |
$627.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$334.82
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$279.02
|
| Rate for Payer: EmblemHealth Medicaid |
$279.02
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$627.80
|
| Rate for Payer: Hamaspik Choice Medicaid |
$279.02
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$279.02
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$599.89
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$599.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$279.02
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$292.97
|
|
|
EAPG 485: CORNEAL TISSUE PROCESSING
|
Facility
|
OP
|
$1,544.02
|
|
|
Service Code
|
EAPG 0485
|
| Min. Negotiated Rate |
$686.23 |
| Max. Negotiated Rate |
$1,544.02 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,544.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$686.23
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$686.23
|
| Rate for Payer: CDPHP Essential Plan |
$1,544.02
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$823.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$686.23
|
| Rate for Payer: EmblemHealth Medicaid |
$686.23
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,544.02
|
| Rate for Payer: Hamaspik Choice Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$686.23
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,475.39
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,475.39
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$686.23
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$720.54
|
|
|
EAPG 486: LEVEL I BLOOD AND TISSUE TYPING TESTS
|
Facility
|
OP
|
$93.87
|
|
|
Service Code
|
EAPG 0486
|
| Min. Negotiated Rate |
$41.72 |
| Max. Negotiated Rate |
$93.87 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$93.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.72
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.72
|
| Rate for Payer: CDPHP Essential Plan |
$93.87
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$50.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.72
|
| Rate for Payer: EmblemHealth Medicaid |
$41.72
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$93.87
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.72
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.72
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$89.70
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$89.70
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.72
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.81
|
|
|
EAPG 488: MINOR DEVICE EVALUATION AND INTERROGATION
|
Facility
|
OP
|
$166.16
|
|
|
Service Code
|
EAPG 0488
|
| 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 48: HAND AND FOOT TENOTOMY
|
Facility
|
OP
|
$1,375.58
|
|
|
Service Code
|
EAPG 0048
|
| Min. Negotiated Rate |
$611.37 |
| Max. Negotiated Rate |
$1,375.58 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$1,375.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$611.37
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$611.37
|
| Rate for Payer: CDPHP Essential Plan |
$1,375.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$733.64
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$611.37
|
| Rate for Payer: EmblemHealth Medicaid |
$611.37
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$1,375.58
|
| Rate for Payer: Hamaspik Choice Medicaid |
$611.37
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$611.37
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$1,314.45
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$1,314.45
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$611.37
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$641.94
|
|
|
EAPG 493: LEVEL I ANCILLARY THERAPEUTIC SERVICES
|
Facility
|
OP
|
$50.42
|
|
|
Service Code
|
EAPG 0493
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$50.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$22.41
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$22.41
|
| Rate for Payer: CDPHP Essential Plan |
$50.42
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.89
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.41
|
| Rate for Payer: EmblemHealth Medicaid |
$22.41
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$50.42
|
| Rate for Payer: Hamaspik Choice Medicaid |
$22.41
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$22.41
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$48.18
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$48.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$22.41
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$23.53
|
|
|
EAPG 494: COMPLEX BLOOD COLLECTION SERVICES
|
Facility
|
OP
|
$63.76
|
|
|
Service Code
|
EAPG 0494
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$63.76 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$63.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$28.34
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$28.34
|
| Rate for Payer: CDPHP Essential Plan |
$63.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$28.34
|
| Rate for Payer: EmblemHealth Medicaid |
$28.34
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$63.76
|
| Rate for Payer: Hamaspik Choice Medicaid |
$28.34
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$28.34
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$60.93
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$60.93
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.34
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$29.76
|
|
|
EAPG 499: BLOOD PROCESSING, STORAGE AND RELATED SERVICES
|
Facility
|
OP
|
$92.63
|
|
|
Service Code
|
EAPG 0499
|
| Min. Negotiated Rate |
$41.17 |
| Max. Negotiated Rate |
$92.63 |
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$92.63
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$41.17
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$41.17
|
| Rate for Payer: CDPHP Essential Plan |
$92.63
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$49.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$41.17
|
| Rate for Payer: EmblemHealth Medicaid |
$41.17
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$92.63
|
| Rate for Payer: Hamaspik Choice Medicaid |
$41.17
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$41.17
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$88.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$88.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$41.17
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$43.23
|
|
