Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA

Facility

$247.03

Service Code	EAPG 562
Min. Negotiated Rate	$112.59
Max. Negotiated Rate	$247.03
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$137.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$114.90
Rate for Payer: EmblemHealth Medicaid	$114.90
Rate for Payer: Galaxy Health Workers Comp	$112.59
Rate for Payer: Hamaspik Choice Medicaid	$114.90
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$120.64
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$247.03
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$247.03
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$114.90
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$120.64

EAPG 3.18: INFLAMMATORY BOWEL DISEASE

Facility

$236.92

Service Code	EAPG 626
Min. Negotiated Rate	$107.99
Max. Negotiated Rate	$236.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$132.23
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$110.19
Rate for Payer: EmblemHealth Medicaid	$110.19
Rate for Payer: Galaxy Health Workers Comp	$107.99
Rate for Payer: Hamaspik Choice Medicaid	$110.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$115.70
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$236.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$236.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$110.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$115.70

EAPG 3.18: INGUINAL, FEMORAL AND UMBILICAL HERNIA REPAIR

Facility

$4,370.40

Service Code	EAPG 3033
Min. Negotiated Rate	$1,992.02
Max. Negotiated Rate	$4,370.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,439.22
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,032.72
Rate for Payer: EmblemHealth Medicaid	$2,032.72
Rate for Payer: Galaxy Health Workers Comp	$1,992.02
Rate for Payer: Hamaspik Choice Medicaid	$2,032.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,134.38
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,370.40
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,370.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,032.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,134.38

EAPG 3.18: INJECTION(S) FOR RADIOLOGICAL IMAGING

Facility

$972.43

Service Code	EAPG 278
Min. Negotiated Rate	$443.23
Max. Negotiated Rate	$972.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$542.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$452.29
Rate for Payer: EmblemHealth Medicaid	$452.29
Rate for Payer: Galaxy Health Workers Comp	$443.23
Rate for Payer: Hamaspik Choice Medicaid	$452.29
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$474.91
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$972.43
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$972.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$452.29
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$474.91

EAPG 3.18: INSERTION OF PENILE PROSTHESIS

Facility

$11,091.44

Service Code	EAPG 182
Min. Negotiated Rate	$5,055.44
Max. Negotiated Rate	$11,091.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6,190.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5,158.75
Rate for Payer: EmblemHealth Medicaid	$5,158.75
Rate for Payer: Galaxy Health Workers Comp	$5,055.44
Rate for Payer: Hamaspik Choice Medicaid	$5,158.75
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$5,416.73
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$11,091.44
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$11,091.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5,158.75
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$5,416.73

EAPG 3.18: INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE

Facility

$675.13

Service Code	EAPG 307
Min. Negotiated Rate	$307.72
Max. Negotiated Rate	$675.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$376.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$314.01
Rate for Payer: EmblemHealth Medicaid	$314.01
Rate for Payer: Galaxy Health Workers Comp	$307.72
Rate for Payer: Hamaspik Choice Medicaid	$314.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$329.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$675.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$675.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$314.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$329.71

EAPG 3.18: INTELLECTUAL DISABILITY

Facility

$263.25

Service Code	EAPG 828
Min. Negotiated Rate	$119.99
Max. Negotiated Rate	$263.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$146.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.44
Rate for Payer: EmblemHealth Medicaid	$122.44
Rate for Payer: Galaxy Health Workers Comp	$119.99
Rate for Payer: Hamaspik Choice Medicaid	$122.44
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$128.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$263.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$263.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$122.44
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$128.56

EAPG 3.18: INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT

Facility

$294.38

Service Code	EAPG 327
Min. Negotiated Rate	$134.18
Max. Negotiated Rate	$294.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$164.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$136.92
Rate for Payer: EmblemHealth Medicaid	$136.92
Rate for Payer: Galaxy Health Workers Comp	$134.18
Rate for Payer: Hamaspik Choice Medicaid	$136.92
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$143.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$294.38
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$294.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$136.92
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$143.77

EAPG 3.18: INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$347.81

Service Code	EAPG 832
Min. Negotiated Rate	$158.53
Max. Negotiated Rate	$347.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$194.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$161.77
Rate for Payer: EmblemHealth Medicaid	$161.77
Rate for Payer: Galaxy Health Workers Comp	$158.53
Rate for Payer: Hamaspik Choice Medicaid	$161.77
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$169.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$347.81
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$347.81
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$161.77
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$169.86

EAPG 3.18: INTERMEDIATE WOUND REPAIR AND TREATMENT

Facility

$1,462.72

Service Code	EAPG 17
Min. Negotiated Rate	$666.70
Max. Negotiated Rate	$1,462.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$816.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$680.33
Rate for Payer: EmblemHealth Medicaid	$680.33
Rate for Payer: Galaxy Health Workers Comp	$666.70
Rate for Payer: Hamaspik Choice Medicaid	$680.33
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$714.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,462.72
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,462.72
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$680.33
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$714.35

EAPG 3.18: INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES

Facility

$357.45

Service Code	EAPG 582
Min. Negotiated Rate	$162.93
Max. Negotiated Rate	$357.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$199.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$166.26
Rate for Payer: EmblemHealth Medicaid	$166.26
Rate for Payer: Galaxy Health Workers Comp	$162.93
Rate for Payer: Hamaspik Choice Medicaid	$166.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$174.57
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$357.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$357.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$166.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$174.57

EAPG 3.18: INTESTINAL OBSTRUCTION DIAGNOSES

Facility

$286.39

Service Code	EAPG 618
Min. Negotiated Rate	$130.53
Max. Negotiated Rate	$286.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$159.84
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$133.20
Rate for Payer: EmblemHealth Medicaid	$133.20
Rate for Payer: Galaxy Health Workers Comp	$130.53
Rate for Payer: Hamaspik Choice Medicaid	$133.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$139.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$286.39
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$286.39
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$133.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$139.86

EAPG 3.18: INTRACRANIAL HEMORRHAGE

Facility

$291.81

Service Code	EAPG 539
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$291.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$162.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$135.72
Rate for Payer: EmblemHealth Medicaid	$135.72
Rate for Payer: Galaxy Health Workers Comp	$133.00
Rate for Payer: Hamaspik Choice Medicaid	$135.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$142.51
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$291.81
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$291.81
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$135.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$142.51

EAPG 3.18: IRRITABLE BOWEL SYNDROME

Facility

$219.32

Service Code	EAPG 632
Min. Negotiated Rate	$99.96
Max. Negotiated Rate	$219.32
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$102.01
Rate for Payer: EmblemHealth Medicaid	$102.01
Rate for Payer: Galaxy Health Workers Comp	$99.96
Rate for Payer: Hamaspik Choice Medicaid	$102.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$107.11
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$219.32
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$219.32
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$102.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$107.11

EAPG 3.18: KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$288.12

Service Code	EAPG 721
Min. Negotiated Rate	$131.32
Max. Negotiated Rate	$288.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$160.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$134.01
Rate for Payer: EmblemHealth Medicaid	$134.01
Rate for Payer: Galaxy Health Workers Comp	$131.32
Rate for Payer: Hamaspik Choice Medicaid	$134.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$140.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$288.12
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$288.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$134.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$140.71

EAPG 3.18: LABOR AND DELIVERY RELATED DIAGNOSES

Facility

$243.22

Service Code	EAPG 760
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$243.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.75
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.13
Rate for Payer: EmblemHealth Medicaid	$113.13
Rate for Payer: Galaxy Health Workers Comp	$110.86
Rate for Payer: Hamaspik Choice Medicaid	$113.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$118.78
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.22
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.78

EAPG 3.18: LASER EYE PROCEDURES

Facility

$1,134.21

Service Code	EAPG 232
Min. Negotiated Rate	$516.97
Max. Negotiated Rate	$1,134.21
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$633.03
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$527.53
Rate for Payer: EmblemHealth Medicaid	$527.53
Rate for Payer: Galaxy Health Workers Comp	$516.97
Rate for Payer: Hamaspik Choice Medicaid	$527.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$553.91
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,134.21
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,134.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$527.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$553.91

EAPG 3.18: LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$178.30

Service Code	EAPG 350
Min. Negotiated Rate	$81.27
Max. Negotiated Rate	$178.30
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$99.52
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$82.93
Rate for Payer: EmblemHealth Medicaid	$82.93
Rate for Payer: Galaxy Health Workers Comp	$81.27
Rate for Payer: Hamaspik Choice Medicaid	$82.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$87.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$178.30
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$178.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$82.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$87.08

EAPG 3.18: LEVEL I ANAL AND RECTAL PROCEDURES

Facility

$2,286.17

Service Code	EAPG 141
Min. Negotiated Rate	$1,042.03
Max. Negotiated Rate	$2,286.17
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,275.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,063.32
Rate for Payer: EmblemHealth Medicaid	$1,063.32
Rate for Payer: Galaxy Health Workers Comp	$1,042.03
Rate for Payer: Hamaspik Choice Medicaid	$1,063.32
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,116.50
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,286.17
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,286.17
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,063.32
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,116.50

EAPG 3.18: LEVEL I ANCILLARY THERAPEUTIC SERVICES

Facility

$53.00

Service Code	EAPG 493
Min. Negotiated Rate	$24.16
Max. Negotiated Rate	$53.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$29.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$24.65
Rate for Payer: EmblemHealth Medicaid	$24.65
Rate for Payer: Galaxy Health Workers Comp	$24.16
Rate for Payer: Hamaspik Choice Medicaid	$24.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$25.89
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$53.00
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$53.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$24.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$25.89

EAPG 3.18: LEVEL I ANTERIOR SEGMENT EYE PROCEDURES

Facility

$3,432.72

Service Code	EAPG 234
Min. Negotiated Rate	$1,564.62
Max. Negotiated Rate	$3,432.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,915.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,596.59
Rate for Payer: EmblemHealth Medicaid	$1,596.59
Rate for Payer: Galaxy Health Workers Comp	$1,564.62
Rate for Payer: Hamaspik Choice Medicaid	$1,596.59
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,676.44
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,432.72
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,432.72
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,596.59
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,676.44

EAPG 3.18: LEVEL I ARTHROPLASTY

Facility

$6,378.42

Service Code	EAPG 46
Min. Negotiated Rate	$2,907.26
Max. Negotiated Rate	$6,378.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,559.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,966.67
Rate for Payer: EmblemHealth Medicaid	$2,966.67
Rate for Payer: Galaxy Health Workers Comp	$2,907.26
Rate for Payer: Hamaspik Choice Medicaid	$2,966.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,115.03
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,378.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,378.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,966.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,115.03

EAPG 3.18: LEVEL I ARTHROSCOPY

Facility

$3,824.73

Service Code	EAPG 37
Min. Negotiated Rate	$1,743.30
Max. Negotiated Rate	$3,824.73
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,134.67
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,778.92
Rate for Payer: EmblemHealth Medicaid	$1,778.92
Rate for Payer: Galaxy Health Workers Comp	$1,743.30
Rate for Payer: Hamaspik Choice Medicaid	$1,778.92
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,867.88
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,824.73
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,824.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,778.92
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,867.88

EAPG 3.18: LEVEL I BLADDER AND URETERAL PROCEDURES

Facility

$3,400.74

Service Code	EAPG 173
Min. Negotiated Rate	$1,550.05
Max. Negotiated Rate	$3,400.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,898.03
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,581.72
Rate for Payer: EmblemHealth Medicaid	$1,581.72
Rate for Payer: Galaxy Health Workers Comp	$1,550.05
Rate for Payer: Hamaspik Choice Medicaid	$1,581.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,660.82
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,400.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,400.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,581.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,660.82

EAPG 3.18: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$1,137.63

Service Code	EAPG 113
Min. Negotiated Rate	$518.53
Max. Negotiated Rate	$1,137.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$634.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$529.12
Rate for Payer: EmblemHealth Medicaid	$529.12
Rate for Payer: Galaxy Health Workers Comp	$518.53
Rate for Payer: Hamaspik Choice Medicaid	$529.12
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$555.58
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,137.63
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,137.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$529.12
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$555.58

Know your out-of-pocket cost for care.

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