Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: ECTOPIC PREGNANCY PROCEDURES

Facility

$3,379.95

Service Code	EAPG 179
Min. Negotiated Rate	$1,540.57
Max. Negotiated Rate	$3,379.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,886.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,572.05
Rate for Payer: EmblemHealth Medicaid	$1,572.05
Rate for Payer: Galaxy Health Workers Comp	$1,540.57
Rate for Payer: Hamaspik Choice Medicaid	$1,572.05
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,650.67
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,379.95
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,379.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,572.05
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,650.67

EAPG 3.18: ELECTROCONVULSIVE THERAPY

Facility

$806.69

Service Code	EAPG 212
Min. Negotiated Rate	$367.69
Max. Negotiated Rate	$806.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$450.23
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$375.20
Rate for Payer: EmblemHealth Medicaid	$375.20
Rate for Payer: Galaxy Health Workers Comp	$367.69
Rate for Payer: Hamaspik Choice Medicaid	$375.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$393.97
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$806.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$806.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$375.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$393.97

EAPG 3.18: ELECTROENCEPHALOGRAM

Facility

$373.37

Service Code	EAPG 211
Min. Negotiated Rate	$170.18
Max. Negotiated Rate	$373.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$208.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$173.66
Rate for Payer: EmblemHealth Medicaid	$173.66
Rate for Payer: Galaxy Health Workers Comp	$170.18
Rate for Payer: Hamaspik Choice Medicaid	$173.66
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$182.34
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$373.37
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$373.37
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$173.66
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$182.34

EAPG 3.18: ELECTROLYTE DISORDERS

Facility

$282.20

Service Code	EAPG 694
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$282.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$157.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$131.25
Rate for Payer: EmblemHealth Medicaid	$131.25
Rate for Payer: Galaxy Health Workers Comp	$128.62
Rate for Payer: Hamaspik Choice Medicaid	$131.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$137.82
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$282.20
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$282.20
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$131.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$137.82

EAPG 3.18: ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES

Facility

$174.65

Service Code	EAPG 420
Min. Negotiated Rate	$79.61
Max. Negotiated Rate	$174.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$97.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$81.23
Rate for Payer: EmblemHealth Medicaid	$81.23
Rate for Payer: Galaxy Health Workers Comp	$79.61
Rate for Payer: Hamaspik Choice Medicaid	$81.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$85.30
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$174.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$174.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$81.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$85.30

EAPG 3.18: EMERGING TECHNOLOGY PROCEDURES

Facility

$174.65

Service Code	EAPG 4001
Min. Negotiated Rate	$79.61
Max. Negotiated Rate	$174.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$97.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$81.23
Rate for Payer: EmblemHealth Medicaid	$81.23
Rate for Payer: Galaxy Health Workers Comp	$79.61
Rate for Payer: Hamaspik Choice Medicaid	$81.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$85.30
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$174.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$174.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$81.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$85.30

EAPG 3.18: ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES

Facility

$270.86

Service Code	EAPG 867
Min. Negotiated Rate	$123.46
Max. Negotiated Rate	$270.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$151.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$125.98
Rate for Payer: EmblemHealth Medicaid	$125.98
Rate for Payer: Galaxy Health Workers Comp	$123.46
Rate for Payer: Hamaspik Choice Medicaid	$125.98
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$132.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$270.86
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$270.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$125.98
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$132.28

EAPG 3.18: ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES

Facility

$259.71

Service Code	EAPG 623
Min. Negotiated Rate	$118.38
Max. Negotiated Rate	$259.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$120.79
Rate for Payer: EmblemHealth Medicaid	$120.79
Rate for Payer: Galaxy Health Workers Comp	$118.38
Rate for Payer: Hamaspik Choice Medicaid	$120.79
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$126.84
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$259.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$259.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$120.79
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$126.84

EAPG 3.18: ESOPHAGOGASTRIC RESTRICTIVE PROCEDURES AND GASTRIC FUNDOPLICATION

Facility

$5,295.71

Service Code	EAPG 129
Min. Negotiated Rate	$2,413.77
Max. Negotiated Rate	$5,295.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,955.66
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,463.09
Rate for Payer: EmblemHealth Medicaid	$2,463.09
Rate for Payer: Galaxy Health Workers Comp	$2,413.77
Rate for Payer: Hamaspik Choice Medicaid	$2,463.09
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,586.27
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,295.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,295.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,463.09
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,586.27

EAPG 3.18: ESRD CASE MANAGEMENT

Facility

$40.90

Service Code	EAPG 261
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$40.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$22.82
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$19.02
Rate for Payer: EmblemHealth Medicaid	$19.02
Rate for Payer: Galaxy Health Workers Comp	$18.64
Rate for Payer: Hamaspik Choice Medicaid	$19.02
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$19.97
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$40.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$40.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$19.02
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$19.97

EAPG 3.18: EXERCISE TOLERANCE TESTS

Facility

$349.19

Service Code	EAPG 80
Min. Negotiated Rate	$159.16
Max. Negotiated Rate	$349.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$194.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$162.41
Rate for Payer: EmblemHealth Medicaid	$162.41
Rate for Payer: Galaxy Health Workers Comp	$159.16
Rate for Payer: Hamaspik Choice Medicaid	$162.41
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$170.53
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$349.19
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$349.19
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$162.41
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$170.53

EAPG 3.18: EXPANDED HOURS ACCESS

Facility

$29.17

Service Code	EAPG 448
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$29.17
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.28
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.57
Rate for Payer: EmblemHealth Medicaid	$13.57
Rate for Payer: Galaxy Health Workers Comp	$13.30
Rate for Payer: Hamaspik Choice Medicaid	$13.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$14.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$29.17
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$29.17
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$13.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$14.25

EAPG 3.18: EXTENDED EEG STUDIES

Facility

$676.05

Service Code	EAPG 210
Min. Negotiated Rate	$308.14
Max. Negotiated Rate	$676.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$377.32
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$314.44
Rate for Payer: EmblemHealth Medicaid	$314.44
Rate for Payer: Galaxy Health Workers Comp	$308.14
Rate for Payer: Hamaspik Choice Medicaid	$314.44
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$330.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$676.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$676.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$314.44
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$330.16

EAPG 3.18: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$346.23

Service Code	EAPG 860
Min. Negotiated Rate	$157.81
Max. Negotiated Rate	$346.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$193.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$161.04
Rate for Payer: EmblemHealth Medicaid	$161.04
Rate for Payer: Galaxy Health Workers Comp	$157.81
Rate for Payer: Hamaspik Choice Medicaid	$161.04
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$169.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$346.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$346.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$161.04
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$169.09

EAPG 3.18: FALSE LABOR

Facility

$421.07

Service Code	EAPG 764
Min. Negotiated Rate	$191.92
Max. Negotiated Rate	$421.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$235.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$195.84
Rate for Payer: EmblemHealth Medicaid	$195.84
Rate for Payer: Galaxy Health Workers Comp	$191.92
Rate for Payer: Hamaspik Choice Medicaid	$195.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$205.64
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$421.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$421.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$195.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$205.64

EAPG 3.18: FAMILY PSYCHOTHERAPY

Facility

$238.53

Service Code	EAPG 317
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: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$277.78

Service Code	EAPG 751
Min. Negotiated Rate	$126.61
Max. Negotiated Rate	$277.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$155.03
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$129.20
Rate for Payer: EmblemHealth Medicaid	$129.20
Rate for Payer: Galaxy Health Workers Comp	$126.61
Rate for Payer: Hamaspik Choice Medicaid	$129.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$135.66
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$277.78
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$277.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$129.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$135.66

EAPG 3.18: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$252.83

Service Code	EAPG 750
Min. Negotiated Rate	$115.24
Max. Negotiated Rate	$252.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$141.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$117.59
Rate for Payer: EmblemHealth Medicaid	$117.59
Rate for Payer: Galaxy Health Workers Comp	$115.24
Rate for Payer: Hamaspik Choice Medicaid	$117.59
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$123.48
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$252.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$252.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$117.59
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$123.48

EAPG 3.18: FEVER

Facility

$274.97

Service Code	EAPG 807
Min. Negotiated Rate	$125.33
Max. Negotiated Rate	$274.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$153.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$127.89
Rate for Payer: EmblemHealth Medicaid	$127.89
Rate for Payer: Galaxy Health Workers Comp	$125.33
Rate for Payer: Hamaspik Choice Medicaid	$127.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$134.29
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$274.97
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$274.97
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$127.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$134.29

EAPG 3.18: FIXATION DEVICE INSERTION OR REPLACEMENT PROCEDURES

Facility

$3,593.27

Service Code	EAPG 54
Min. Negotiated Rate	$1,637.80
Max. Negotiated Rate	$3,593.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,005.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,671.27
Rate for Payer: EmblemHealth Medicaid	$1,671.27
Rate for Payer: Galaxy Health Workers Comp	$1,637.80
Rate for Payer: Hamaspik Choice Medicaid	$1,671.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,754.84
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,593.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,593.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,671.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,754.84

EAPG 3.18: FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE

Facility

$297.76

Service Code	EAPG 648
Min. Negotiated Rate	$135.72
Max. Negotiated Rate	$297.76
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$166.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$138.49
Rate for Payer: EmblemHealth Medicaid	$138.49
Rate for Payer: Galaxy Health Workers Comp	$135.72
Rate for Payer: Hamaspik Choice Medicaid	$138.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$145.42
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$297.76
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$297.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$138.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$145.42

EAPG 3.18: FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR

Facility

$437.59

Service Code	EAPG 650
Min. Negotiated Rate	$199.45
Max. Negotiated Rate	$437.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$244.23
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$203.53
Rate for Payer: EmblemHealth Medicaid	$203.53
Rate for Payer: Galaxy Health Workers Comp	$199.45
Rate for Payer: Hamaspik Choice Medicaid	$203.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$213.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$437.59
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$437.59
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$203.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$213.71

EAPG 3.18: FRACTURES, DISLOCATIONS & OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST

Facility

$310.64

Service Code	EAPG 656
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$310.64
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$173.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.48
Rate for Payer: EmblemHealth Medicaid	$144.48
Rate for Payer: Galaxy Health Workers Comp	$141.59
Rate for Payer: Hamaspik Choice Medicaid	$144.48
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$151.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$310.64
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$310.64
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$144.48
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$151.71

EAPG 3.18: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK

Facility

$305.45

Service Code	EAPG 657
Min. Negotiated Rate	$139.22
Max. Negotiated Rate	$305.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$170.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$142.07
Rate for Payer: EmblemHealth Medicaid	$142.07
Rate for Payer: Galaxy Health Workers Comp	$139.22
Rate for Payer: Hamaspik Choice Medicaid	$142.07
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$149.17
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$305.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$305.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$142.07
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$149.17

EAPG 3.18: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP

Facility

$401.62

Service Code	EAPG 651
Min. Negotiated Rate	$183.06
Max. Negotiated Rate	$401.62
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$224.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$186.80
Rate for Payer: EmblemHealth Medicaid	$186.80
Rate for Payer: Galaxy Health Workers Comp	$183.06
Rate for Payer: Hamaspik Choice Medicaid	$186.80
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$196.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$401.62
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$401.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$186.80
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$196.14

Know your out-of-pocket cost for care.

All Charges