Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: CARDIOMYOPATHY DIAGNOSES

Facility

$277.89

Service Code	EAPG 607
Min. Negotiated Rate	$126.66
Max. Negotiated Rate	$277.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$155.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$129.25
Rate for Payer: EmblemHealth Medicaid	$129.25
Rate for Payer: Galaxy Health Workers Comp	$126.66
Rate for Payer: Hamaspik Choice Medicaid	$129.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$135.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$277.89
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$277.89
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$129.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$135.71

EAPG 3.18: CARDIOVERSION

Facility

$1,115.45

Service Code	EAPG 93
Min. Negotiated Rate	$508.42
Max. Negotiated Rate	$1,115.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$622.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$518.81
Rate for Payer: EmblemHealth Medicaid	$518.81
Rate for Payer: Galaxy Health Workers Comp	$508.42
Rate for Payer: Hamaspik Choice Medicaid	$518.81
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$544.75
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,115.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,115.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$518.81
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$544.75

EAPG 3.18: CAST APPLICATION OR REPLACEMENT

Facility

$607.87

Service Code	EAPG 39
Min. Negotiated Rate	$277.06
Max. Negotiated Rate	$607.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$339.26
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$282.72
Rate for Payer: EmblemHealth Medicaid	$282.72
Rate for Payer: Galaxy Health Workers Comp	$277.06
Rate for Payer: Hamaspik Choice Medicaid	$282.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$296.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$607.87
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$607.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$282.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$296.86

EAPG 3.18: CATARACT PROCEDURES

Facility

$4,274.74

Service Code	EAPG 233
Min. Negotiated Rate	$1,948.41
Max. Negotiated Rate	$4,274.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,385.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,988.23
Rate for Payer: EmblemHealth Medicaid	$1,988.23
Rate for Payer: Galaxy Health Workers Comp	$1,948.41
Rate for Payer: Hamaspik Choice Medicaid	$1,988.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,087.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,274.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,274.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,988.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,087.65

EAPG 3.18: CATARACTS

Facility

$262.63

Service Code	EAPG 551
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$262.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$146.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.15
Rate for Payer: EmblemHealth Medicaid	$122.15
Rate for Payer: Galaxy Health Workers Comp	$119.71
Rate for Payer: Hamaspik Choice Medicaid	$122.15
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$128.26
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$262.63
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$262.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$122.15
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$128.26

EAPG 3.18: CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS

Facility

$256.10

Service Code	EAPG 673
Min. Negotiated Rate	$116.73
Max. Negotiated Rate	$256.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$142.93
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$119.11
Rate for Payer: EmblemHealth Medicaid	$119.11
Rate for Payer: Galaxy Health Workers Comp	$116.73
Rate for Payer: Hamaspik Choice Medicaid	$119.11
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$125.07
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$256.10
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$256.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$119.11
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$125.07

EAPG 3.18: CEREBRAL PALSY

Facility

$316.02

Service Code	EAPG 536
Min. Negotiated Rate	$144.04
Max. Negotiated Rate	$316.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$176.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$146.98
Rate for Payer: EmblemHealth Medicaid	$146.98
Rate for Payer: Galaxy Health Workers Comp	$144.04
Rate for Payer: Hamaspik Choice Medicaid	$146.98
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$154.34
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$316.02
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$316.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$146.98
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$154.34

EAPG 3.18: CHEMOTHERAPY

Facility

$335.74

Service Code	EAPG 803
Min. Negotiated Rate	$153.03
Max. Negotiated Rate	$335.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$187.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$156.16
Rate for Payer: EmblemHealth Medicaid	$156.16
Rate for Payer: Galaxy Health Workers Comp	$153.03
Rate for Payer: Hamaspik Choice Medicaid	$156.16
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$163.96
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$335.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$335.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$156.16
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$163.96

EAPG 3.18: CHEST PAIN

Facility

$351.27

Service Code	EAPG 604
Min. Negotiated Rate	$160.11
Max. Negotiated Rate	$351.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$196.05
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$163.38
Rate for Payer: EmblemHealth Medicaid	$163.38
Rate for Payer: Galaxy Health Workers Comp	$160.11
Rate for Payer: Hamaspik Choice Medicaid	$163.38
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$171.55
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$351.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$351.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$163.38
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$171.55

EAPG 3.18: CHILDHOOD BEHAVIORAL DIAGNOSES

Facility

$263.13

Service Code	EAPG 829
Min. Negotiated Rate	$119.94
Max. Negotiated Rate	$263.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$146.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.39
Rate for Payer: EmblemHealth Medicaid	$122.39
Rate for Payer: Galaxy Health Workers Comp	$119.94
Rate for Payer: Hamaspik Choice Medicaid	$122.39
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$128.51
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$263.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$263.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$122.39
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$128.51

EAPG 3.18: CHILD PREVENTIVE MEDICINE

Facility

$267.82

Service Code	EAPG 877
Min. Negotiated Rate	$122.07
Max. Negotiated Rate	$267.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$149.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$124.57
Rate for Payer: EmblemHealth Medicaid	$124.57
Rate for Payer: Galaxy Health Workers Comp	$122.07
Rate for Payer: Hamaspik Choice Medicaid	$124.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$130.80
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$267.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$267.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$124.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$130.80

EAPG 3.18: CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES

Facility

$5,653.97

Service Code	EAPG 107
Min. Negotiated Rate	$2,577.06
Max. Negotiated Rate	$5,653.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,155.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,629.72
Rate for Payer: EmblemHealth Medicaid	$2,629.72
Rate for Payer: Galaxy Health Workers Comp	$2,577.06
Rate for Payer: Hamaspik Choice Medicaid	$2,629.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,761.23
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,653.97
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,653.97
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,629.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,761.23

EAPG 3.18: CHOLECYSTITIS

Facility

$241.19

Service Code	EAPG 638
Min. Negotiated Rate	$109.93
Max. Negotiated Rate	$241.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$134.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$112.18
Rate for Payer: EmblemHealth Medicaid	$112.18
Rate for Payer: Galaxy Health Workers Comp	$109.93
Rate for Payer: Hamaspik Choice Medicaid	$112.18
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$117.79
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$241.19
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$241.19
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$112.18
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$117.79

EAPG 3.18: CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$254.87

Service Code	EAPG 574
Min. Negotiated Rate	$116.17
Max. Negotiated Rate	$254.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$142.25
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$118.54
Rate for Payer: EmblemHealth Medicaid	$118.54
Rate for Payer: Galaxy Health Workers Comp	$116.17
Rate for Payer: Hamaspik Choice Medicaid	$118.54
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$124.47
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$254.87
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$254.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$118.54
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$124.47

EAPG 3.18: CLASS III PHARMACOTHERAPY

Facility

$351.65

Service Code	EAPG 437
Min. Negotiated Rate	$160.29
Max. Negotiated Rate	$351.65
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: Galaxy Health Workers Comp	$160.29
Rate for Payer: Hamaspik Choice Medicaid	$163.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$171.74
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 3.18: CLASS III THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$2,434.27

Service Code	EAPG 245
Min. Negotiated Rate	$1,109.53
Max. Negotiated Rate	$2,434.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,358.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,132.20
Rate for Payer: EmblemHealth Medicaid	$1,132.20
Rate for Payer: Galaxy Health Workers Comp	$1,109.53
Rate for Payer: Hamaspik Choice Medicaid	$1,132.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,188.82
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,434.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,434.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,132.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,188.82

EAPG 3.18: CLASS II PHARMACOTHERAPY

Facility

$195.82

Service Code	EAPG 436
Min. Negotiated Rate	$89.26
Max. Negotiated Rate	$195.82
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: Galaxy Health Workers Comp	$89.26
Rate for Payer: Hamaspik Choice Medicaid	$91.08
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$95.63
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 3.18: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$837.83

Service Code	EAPG 244
Min. Negotiated Rate	$381.88
Max. Negotiated Rate	$837.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$467.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$389.68
Rate for Payer: EmblemHealth Medicaid	$389.68
Rate for Payer: Galaxy Health Workers Comp	$381.88
Rate for Payer: Hamaspik Choice Medicaid	$389.68
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$409.17
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$837.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$837.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$389.68
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$409.17

EAPG 3.18: CLASS I PHARMACOTHERAPY

Facility

$65.27

Service Code	EAPG 435
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$65.27
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: Galaxy Health Workers Comp	$29.75
Rate for Payer: Hamaspik Choice Medicaid	$30.36
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$31.88
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 3.18: CLASS I THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$36.13

Service Code	EAPG 243
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$36.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$20.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.80
Rate for Payer: EmblemHealth Medicaid	$16.80
Rate for Payer: Galaxy Health Workers Comp	$16.47
Rate for Payer: Hamaspik Choice Medicaid	$16.80
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$17.64
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$36.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$36.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.80
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$17.64

EAPG 3.18: CLASS IV PHARMACOTHERAPY

Facility

$589.59

Service Code	EAPG 438
Min. Negotiated Rate	$268.75
Max. Negotiated Rate	$589.59
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: Galaxy Health Workers Comp	$268.75
Rate for Payer: Hamaspik Choice Medicaid	$274.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$287.94
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 3.18: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,417.76

Service Code	EAPG 461
Min. Negotiated Rate	$2,013.67
Max. Negotiated Rate	$4,417.76
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: Galaxy Health Workers Comp	$2,013.67
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	$2,157.51
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 3.18: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$3,202.77

Service Code	EAPG 460
Min. Negotiated Rate	$1,459.87
Max. Negotiated Rate	$3,202.77
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: Galaxy Health Workers Comp	$1,459.87
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	$1,564.14
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 3.18: CLASS VII PHARMACOTHERAPY

Facility

$2,225.72

Service Code	EAPG 444
Min. Negotiated Rate	$1,014.52
Max. Negotiated Rate	$2,225.72
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: Galaxy Health Workers Comp	$1,014.52
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	$1,086.98
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 3.18: CLASS VI PHARMACOTHERAPY

Facility

$1,486.62

Service Code	EAPG 440
Min. Negotiated Rate	$677.62
Max. Negotiated Rate	$1,486.62
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: Galaxy Health Workers Comp	$677.62
Rate for Payer: Hamaspik Choice Medicaid	$691.45
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$726.02
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

Know your out-of-pocket cost for care.

All Charges