Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: CLASS V PHARMACOTHERAPY

Facility

$953.89

Service Code	EAPG 439
Min. Negotiated Rate	$434.80
Max. Negotiated Rate	$953.89
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: Galaxy Health Workers Comp	$434.80
Rate for Payer: Hamaspik Choice Medicaid	$443.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$465.85
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 3.18: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$7,018.29

Service Code	EAPG 462
Min. Negotiated Rate	$3,199.03
Max. Negotiated Rate	$7,018.29
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: Galaxy Health Workers Comp	$3,199.03
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	$3,427.54
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 3.18: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$11,320.22

Service Code	EAPG 463
Min. Negotiated Rate	$5,159.92
Max. Negotiated Rate	$11,320.22
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: Galaxy Health Workers Comp	$5,159.92
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	$5,528.48
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 3.18: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$17,374.11

Service Code	EAPG 464
Min. Negotiated Rate	$7,919.36
Max. Negotiated Rate	$17,374.11
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: Galaxy Health Workers Comp	$7,919.36
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	$8,485.03
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 3.18: CLEFT LIP AND PALATE REPAIR

Facility

$6,439.91

Service Code	EAPG 262
Min. Negotiated Rate	$2,935.29
Max. Negotiated Rate	$6,439.91
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,594.26
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,995.27
Rate for Payer: EmblemHealth Medicaid	$2,995.27
Rate for Payer: Galaxy Health Workers Comp	$2,935.29
Rate for Payer: Hamaspik Choice Medicaid	$2,995.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,145.06
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,439.91
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,439.91
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,995.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,145.06

EAPG 3.18: CLOSED TREATMENT FX AND DISLOCATION

Facility

$1,054.45

Service Code	EAPG 41
Min. Negotiated Rate	$480.62
Max. Negotiated Rate	$1,054.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$588.51
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$490.44
Rate for Payer: EmblemHealth Medicaid	$490.44
Rate for Payer: Galaxy Health Workers Comp	$480.62
Rate for Payer: Hamaspik Choice Medicaid	$490.44
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$514.96
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,054.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,054.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$490.44
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$514.96

EAPG 3.18: COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES

Facility

$260.44

Service Code	EAPG 781
Min. Negotiated Rate	$118.71
Max. Negotiated Rate	$260.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$145.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$121.13
Rate for Payer: EmblemHealth Medicaid	$121.13
Rate for Payer: Galaxy Health Workers Comp	$118.71
Rate for Payer: Hamaspik Choice Medicaid	$121.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$127.19
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$260.44
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$260.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$121.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$127.19

EAPG 3.18: COCAINE ABUSE AND DEPENDENCE

Facility

$308.99

Service Code	EAPG 841
Min. Negotiated Rate	$140.84
Max. Negotiated Rate	$308.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$172.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.71
Rate for Payer: EmblemHealth Medicaid	$143.71
Rate for Payer: Galaxy Health Workers Comp	$140.84
Rate for Payer: Hamaspik Choice Medicaid	$143.71
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$150.90
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$308.99
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$308.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$143.71
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$150.90

EAPG 3.18: COCHLEAR DEVICE IMPLANTATION

Facility

$58,521.54

Service Code	EAPG 250
Min. Negotiated Rate	$26,674.93
Max. Negotiated Rate	$58,521.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$32,663.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27,219.32
Rate for Payer: EmblemHealth Medicaid	$27,219.32
Rate for Payer: Galaxy Health Workers Comp	$26,674.93
Rate for Payer: Hamaspik Choice Medicaid	$27,219.32
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$28,580.29
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$58,521.54
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$58,521.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27,219.32
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$28,580.29

EAPG 3.18: COMPLEX BLOOD COLLECTION SERVICES

Facility

$67.03

Service Code	EAPG 494
Min. Negotiated Rate	$30.55
Max. Negotiated Rate	$67.03
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$37.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$31.18
Rate for Payer: EmblemHealth Medicaid	$31.18
Rate for Payer: Galaxy Health Workers Comp	$30.55
Rate for Payer: Hamaspik Choice Medicaid	$31.18
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$32.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$67.03
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$67.03
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.18
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$32.74

EAPG 3.18: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS

Facility

$307.10

Service Code	EAPG 723
Min. Negotiated Rate	$139.98
Max. Negotiated Rate	$307.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$171.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$142.84
Rate for Payer: EmblemHealth Medicaid	$142.84
Rate for Payer: Galaxy Health Workers Comp	$139.98
Rate for Payer: Hamaspik Choice Medicaid	$142.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$149.98
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$307.10
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$307.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$142.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$149.98

EAPG 3.18: COMPLEX WOUND REPAIR AND TREATMENT

Facility

$2,912.64

Service Code	EAPG 18
Min. Negotiated Rate	$1,327.57
Max. Negotiated Rate	$2,912.64
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,625.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,354.70
Rate for Payer: EmblemHealth Medicaid	$1,354.70
Rate for Payer: Galaxy Health Workers Comp	$1,327.57
Rate for Payer: Hamaspik Choice Medicaid	$1,354.70
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,422.45
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,912.64
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,912.64
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,354.70
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,422.45

EAPG 3.18: COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY

Facility

$293.77

Service Code	EAPG 767
Min. Negotiated Rate	$133.90
Max. Negotiated Rate	$293.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$163.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$136.63
Rate for Payer: EmblemHealth Medicaid	$136.63
Rate for Payer: Galaxy Health Workers Comp	$133.90
Rate for Payer: Hamaspik Choice Medicaid	$136.63
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$143.47
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$293.77
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$293.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$136.63
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$143.47

EAPG 3.18: COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Facility

$716.98

Service Code	EAPG 302
Min. Negotiated Rate	$326.81
Max. Negotiated Rate	$716.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$400.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$333.48
Rate for Payer: EmblemHealth Medicaid	$333.48
Rate for Payer: Galaxy Health Workers Comp	$326.81
Rate for Payer: Hamaspik Choice Medicaid	$333.48
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$350.15
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$716.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$716.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$333.48
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$350.15

EAPG 3.18: COMPUTED TOMOGRAPHY- OTHER

Facility

$508.05

Service Code	EAPG 301
Min. Negotiated Rate	$231.57
Max. Negotiated Rate	$508.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$283.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$236.30
Rate for Payer: EmblemHealth Medicaid	$236.30
Rate for Payer: Galaxy Health Workers Comp	$231.57
Rate for Payer: Hamaspik Choice Medicaid	$236.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$248.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$508.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$508.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$236.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$248.12

EAPG 3.18: CONJUNCTIVITIS

Facility

$243.99

Service Code	EAPG 555
Min. Negotiated Rate	$111.21
Max. Negotiated Rate	$243.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$136.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.48
Rate for Payer: EmblemHealth Medicaid	$113.48
Rate for Payer: Galaxy Health Workers Comp	$111.21
Rate for Payer: Hamaspik Choice Medicaid	$113.48
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$119.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.99
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.48
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$119.16

EAPG 3.18: CONNECTIVE TISSUE DIAGNOSES

Facility

$264.63

Service Code	EAPG 655
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$264.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$147.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$123.08
Rate for Payer: EmblemHealth Medicaid	$123.08
Rate for Payer: Galaxy Health Workers Comp	$120.62
Rate for Payer: Hamaspik Choice Medicaid	$123.08
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$129.24
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$264.63
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$264.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$123.08
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$129.24

EAPG 3.18: CONSTIPATION

Facility

$326.24

Service Code	EAPG 630
Min. Negotiated Rate	$148.70
Max. Negotiated Rate	$326.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$182.08
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$151.74
Rate for Payer: EmblemHealth Medicaid	$151.74
Rate for Payer: Galaxy Health Workers Comp	$148.70
Rate for Payer: Hamaspik Choice Medicaid	$151.74
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$159.33
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$326.24
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$326.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$151.74
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$159.33

EAPG 3.18: CONTRACEPTIVE MANAGEMENT

Facility

$626.74

Service Code	EAPG 875
Min. Negotiated Rate	$285.66
Max. Negotiated Rate	$626.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$349.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$291.50
Rate for Payer: EmblemHealth Medicaid	$291.50
Rate for Payer: Galaxy Health Workers Comp	$285.66
Rate for Payer: Hamaspik Choice Medicaid	$291.50
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$306.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$626.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$626.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$291.50
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$306.08

EAPG 3.18: CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA

Facility

$368.33

Service Code	EAPG 610
Min. Negotiated Rate	$167.88
Max. Negotiated Rate	$368.33
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$205.57
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$171.32
Rate for Payer: EmblemHealth Medicaid	$171.32
Rate for Payer: Galaxy Health Workers Comp	$167.88
Rate for Payer: Hamaspik Choice Medicaid	$171.32
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$179.88
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$368.33
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$368.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$171.32
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$179.88

EAPG 3.18: CORNEAL TISSUE PROCESSING

Facility

$1,622.92

Service Code	EAPG 485
Min. Negotiated Rate	$739.72
Max. Negotiated Rate	$1,622.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$905.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$754.84
Rate for Payer: EmblemHealth Medicaid	$754.84
Rate for Payer: Galaxy Health Workers Comp	$739.72
Rate for Payer: Hamaspik Choice Medicaid	$754.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$792.59
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,622.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,622.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$754.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$792.59

EAPG 3.18: COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$238.53

Service Code	EAPG 315
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$238.53
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$133.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$110.94
Rate for Payer: EmblemHealth Medicaid	$110.94
Rate for Payer: Galaxy Health Workers Comp	$108.72
Rate for Payer: Hamaspik Choice Medicaid	$110.94
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$116.49
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$238.53
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$238.53
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$110.94
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$116.49

EAPG 3.18: CRANIAL AND SPINAL SHUNT PROCEDURES

Facility

$7,433.83

Service Code	EAPG 268
Min. Negotiated Rate	$3,388.31
Max. Negotiated Rate	$7,433.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,148.99
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,457.55
Rate for Payer: EmblemHealth Medicaid	$3,457.55
Rate for Payer: Galaxy Health Workers Comp	$3,388.31
Rate for Payer: Hamaspik Choice Medicaid	$3,457.55
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,630.46
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$7,433.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$7,433.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,457.55
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,630.46

EAPG 3.18: CRISIS INTERVENTION

Facility

$318.06

Service Code	EAPG 321
Min. Negotiated Rate	$144.97
Max. Negotiated Rate	$318.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$177.52
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$147.93
Rate for Payer: EmblemHealth Medicaid	$147.93
Rate for Payer: Galaxy Health Workers Comp	$144.97
Rate for Payer: Hamaspik Choice Medicaid	$147.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$155.33
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$318.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$318.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$147.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$155.33

EAPG 3.18: CT GUIDANCE

Facility

$409.00

Service Code	EAPG 473
Min. Negotiated Rate	$186.42
Max. Negotiated Rate	$409.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$228.27
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$190.23
Rate for Payer: EmblemHealth Medicaid	$190.23
Rate for Payer: Galaxy Health Workers Comp	$186.42
Rate for Payer: Hamaspik Choice Medicaid	$190.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$199.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$409.00
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$409.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$190.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$199.74

Know your out-of-pocket cost for care.

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