Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$98.67

Service Code	EAPG 486
Min. Negotiated Rate	$44.97
Max. Negotiated Rate	$98.67
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$55.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$45.89
Rate for Payer: EmblemHealth Medicaid	$45.89
Rate for Payer: Galaxy Health Workers Comp	$44.97
Rate for Payer: Hamaspik Choice Medicaid	$45.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$48.19
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$98.67
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$98.67
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$45.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$48.19

EAPG 3.18: LEVEL I BLOOD PRODUCTS

Facility

$1,137.63

Service Code	EAPG 2061
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

EAPG 3.18: LEVEL I BRACHYTHERAPY SOURCES

Facility

$2,067.55

Service Code	EAPG 335
Min. Negotiated Rate	$942.38
Max. Negotiated Rate	$2,067.55
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,153.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$961.64
Rate for Payer: EmblemHealth Medicaid	$961.64
Rate for Payer: Galaxy Health Workers Comp	$942.38
Rate for Payer: Hamaspik Choice Medicaid	$961.64
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,009.73
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,067.55
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,067.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$961.64
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,009.73

EAPG 3.18: LEVEL I BREAST PROCEDURES

Facility

$3,294.77

Service Code	EAPG 20
Min. Negotiated Rate	$1,501.75
Max. Negotiated Rate	$3,294.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,838.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,532.43
Rate for Payer: EmblemHealth Medicaid	$1,532.43
Rate for Payer: Galaxy Health Workers Comp	$1,501.75
Rate for Payer: Hamaspik Choice Medicaid	$1,532.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,609.07
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,294.77
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,294.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,532.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,609.07

EAPG 3.18: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility

$488.94

Service Code	EAPG 75
Min. Negotiated Rate	$222.86
Max. Negotiated Rate	$488.94
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$272.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$227.41
Rate for Payer: EmblemHealth Medicaid	$227.41
Rate for Payer: Galaxy Health Workers Comp	$222.86
Rate for Payer: Hamaspik Choice Medicaid	$227.41
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$238.79
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$488.94
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$488.94
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$227.41
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$238.79

EAPG 3.18: LEVEL I CHEMISTRY TESTS

Facility

$23.35

Service Code	EAPG 400
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$23.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.03
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.86
Rate for Payer: EmblemHealth Medicaid	$10.86
Rate for Payer: Galaxy Health Workers Comp	$10.64
Rate for Payer: Hamaspik Choice Medicaid	$10.86
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$11.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$23.35
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$23.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.86
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$11.40

EAPG 3.18: LEVEL I CLOTTING TESTS

Facility

$28.87

Service Code	EAPG 406
Min. Negotiated Rate	$13.16
Max. Negotiated Rate	$28.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.43
Rate for Payer: EmblemHealth Medicaid	$13.43
Rate for Payer: Galaxy Health Workers Comp	$13.16
Rate for Payer: Hamaspik Choice Medicaid	$13.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$14.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$28.87
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$28.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$13.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$14.10

EAPG 3.18: LEVEL I COMPUTED TOMOGRAPHY

Facility

$565.43

Service Code	EAPG 299
Min. Negotiated Rate	$257.73
Max. Negotiated Rate	$565.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$315.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$262.99
Rate for Payer: EmblemHealth Medicaid	$262.99
Rate for Payer: Galaxy Health Workers Comp	$257.73
Rate for Payer: Hamaspik Choice Medicaid	$262.99
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$276.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$565.43
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$565.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$262.99
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$276.14

EAPG 3.18: LEVEL I CONVENTIONAL RADIOLOGY

Facility

$65.90

Service Code	EAPG 471
Min. Negotiated Rate	$30.04
Max. Negotiated Rate	$65.90
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: Galaxy Health Workers Comp	$30.04
Rate for Payer: Hamaspik Choice Medicaid	$30.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$32.18
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 3.18: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$3,378.87

Service Code	EAPG 247
Min. Negotiated Rate	$1,540.08
Max. Negotiated Rate	$3,378.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,885.82
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,571.55
Rate for Payer: EmblemHealth Medicaid	$1,571.55
Rate for Payer: Galaxy Health Workers Comp	$1,540.08
Rate for Payer: Hamaspik Choice Medicaid	$1,571.55
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,650.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,378.87
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,378.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,571.55
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,650.14

EAPG 3.18: LEVEL I CRANIOFACIAL BONE PROCEDURES

Facility

$5,335.34

Service Code	EAPG 227
Min. Negotiated Rate	$2,431.83
Max. Negotiated Rate	$5,335.34
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,977.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,481.52
Rate for Payer: EmblemHealth Medicaid	$2,481.52
Rate for Payer: Galaxy Health Workers Comp	$2,431.83
Rate for Payer: Hamaspik Choice Medicaid	$2,481.52
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,605.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,335.34
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,335.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,481.52
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,605.62

EAPG 3.18: LEVEL I DENTAL FILM

Facility

$51.43

Service Code	EAPG 373
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$51.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.92
Rate for Payer: EmblemHealth Medicaid	$23.92
Rate for Payer: Galaxy Health Workers Comp	$23.44
Rate for Payer: Hamaspik Choice Medicaid	$23.92
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$25.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$51.43
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$51.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$23.92
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$25.12

EAPG 3.18: LEVEL I DENTAL RESTORATIONS

Facility

$252.18

Service Code	EAPG 361
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$252.18
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$140.75
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$117.29
Rate for Payer: EmblemHealth Medicaid	$117.29
Rate for Payer: Galaxy Health Workers Comp	$114.94
Rate for Payer: Hamaspik Choice Medicaid	$117.29
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$123.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$252.18
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$252.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$117.29
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$123.16

EAPG 3.18: LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$1,740.80

Service Code	EAPG 334
Min. Negotiated Rate	$793.45
Max. Negotiated Rate	$1,740.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$971.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$809.67
Rate for Payer: EmblemHealth Medicaid	$809.67
Rate for Payer: Galaxy Health Workers Comp	$793.45
Rate for Payer: Hamaspik Choice Medicaid	$809.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$850.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,740.80
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,740.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$809.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$850.16

EAPG 3.18: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE

Facility

$716.75

Service Code	EAPG 331
Min. Negotiated Rate	$326.69
Max. Negotiated Rate	$716.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$400.04
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$333.37
Rate for Payer: EmblemHealth Medicaid	$333.37
Rate for Payer: Galaxy Health Workers Comp	$326.69
Rate for Payer: Hamaspik Choice Medicaid	$333.37
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$350.04
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$716.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$716.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$333.37
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$350.04

EAPG 3.18: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$309.41

Service Code	EAPG 288
Min. Negotiated Rate	$141.03
Max. Negotiated Rate	$309.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$172.69
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.91
Rate for Payer: EmblemHealth Medicaid	$143.91
Rate for Payer: Galaxy Health Workers Comp	$141.03
Rate for Payer: Hamaspik Choice Medicaid	$143.91
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$151.11
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$309.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$309.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$143.91
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$151.11

EAPG 3.18: LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$2,612.23

Service Code	EAPG 252
Min. Negotiated Rate	$1,190.64
Max. Negotiated Rate	$2,612.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,457.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,214.97
Rate for Payer: EmblemHealth Medicaid	$1,214.97
Rate for Payer: Galaxy Health Workers Comp	$1,190.64
Rate for Payer: Hamaspik Choice Medicaid	$1,214.97
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,275.73
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,612.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,612.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,214.97
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,275.73

EAPG 3.18: LEVEL I ENDOCRINOLOGY TESTS

Facility

$54.80

Service Code	EAPG 398
Min. Negotiated Rate	$24.98
Max. Negotiated Rate	$54.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.49
Rate for Payer: EmblemHealth Medicaid	$25.49
Rate for Payer: Galaxy Health Workers Comp	$24.98
Rate for Payer: Hamaspik Choice Medicaid	$25.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$26.76
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$54.80
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$54.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$25.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$26.76

EAPG 3.18: LEVEL I ENDODONTICS

Facility

$240.26

Service Code	EAPG 364
Min. Negotiated Rate	$109.51
Max. Negotiated Rate	$240.26
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$134.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$111.75
Rate for Payer: EmblemHealth Medicaid	$111.75
Rate for Payer: Galaxy Health Workers Comp	$109.51
Rate for Payer: Hamaspik Choice Medicaid	$111.75
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$117.34
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$240.26
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$240.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$111.75
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$117.34

EAPG 3.18: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$800.35

Service Code	EAPG 62
Min. Negotiated Rate	$364.80
Max. Negotiated Rate	$800.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$446.69
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$372.25
Rate for Payer: EmblemHealth Medicaid	$372.25
Rate for Payer: Galaxy Health Workers Comp	$364.80
Rate for Payer: Hamaspik Choice Medicaid	$372.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$390.87
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$800.35
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$800.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$372.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$390.87

EAPG 3.18: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$2,729.96

Service Code	EAPG 138
Min. Negotiated Rate	$1,244.30
Max. Negotiated Rate	$2,729.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,523.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,269.73
Rate for Payer: EmblemHealth Medicaid	$1,269.73
Rate for Payer: Galaxy Health Workers Comp	$1,244.30
Rate for Payer: Hamaspik Choice Medicaid	$1,269.73
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,333.23
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,729.96
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,729.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,269.73
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,333.23

EAPG 3.18: LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$3,757.54

Service Code	EAPG 125
Min. Negotiated Rate	$1,712.67
Max. Negotiated Rate	$3,757.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,097.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,747.67
Rate for Payer: EmblemHealth Medicaid	$1,747.67
Rate for Payer: Galaxy Health Workers Comp	$1,712.67
Rate for Payer: Hamaspik Choice Medicaid	$1,747.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,835.07
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,757.54
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,757.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,747.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,835.07

EAPG 3.18: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$2,499.07

Service Code	EAPG 258
Min. Negotiated Rate	$1,139.07
Max. Negotiated Rate	$2,499.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,394.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,162.34
Rate for Payer: EmblemHealth Medicaid	$1,162.34
Rate for Payer: Galaxy Health Workers Comp	$1,139.07
Rate for Payer: Hamaspik Choice Medicaid	$1,162.34
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,220.47
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,499.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,499.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,162.34
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,220.47

EAPG 3.18: LEVEL I FETAL PROCEDURES

Facility

$498.48

Service Code	EAPG 191
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$498.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$278.21
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$231.85
Rate for Payer: EmblemHealth Medicaid	$231.85
Rate for Payer: Galaxy Health Workers Comp	$227.20
Rate for Payer: Hamaspik Choice Medicaid	$231.85
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$243.44
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$498.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$498.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$231.85
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$243.44

EAPG 3.18: LEVEL I FOOT PROCEDURES

Facility

$3,419.07

Service Code	EAPG 35
Min. Negotiated Rate	$1,558.40
Max. Negotiated Rate	$3,419.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,908.26
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,590.25
Rate for Payer: EmblemHealth Medicaid	$1,590.25
Rate for Payer: Galaxy Health Workers Comp	$1,558.40
Rate for Payer: Hamaspik Choice Medicaid	$1,590.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,669.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,419.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,419.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,590.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,669.77

Know your out-of-pocket cost for care.

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