Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$4,167.31

Service Code	EAPG 23
Min. Negotiated Rate	$1,899.45
Max. Negotiated Rate	$4,167.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,325.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,938.26
Rate for Payer: EmblemHealth Medicaid	$1,938.26
Rate for Payer: Galaxy Health Workers Comp	$1,899.45
Rate for Payer: Hamaspik Choice Medicaid	$1,938.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,035.19
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,167.31
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,167.31
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,938.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,035.19

EAPG 3.18: LEVEL I GASTROINTESTINAL PROCEDURES

Facility

$2,526.01

Service Code	EAPG 143
Min. Negotiated Rate	$1,151.35
Max. Negotiated Rate	$2,526.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,409.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,174.88
Rate for Payer: EmblemHealth Medicaid	$1,174.88
Rate for Payer: Galaxy Health Workers Comp	$1,151.35
Rate for Payer: Hamaspik Choice Medicaid	$1,174.88
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,233.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,526.01
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,526.01
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,174.88
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,233.63

EAPG 3.18: LEVEL I HAND PROCEDURES

Facility

$2,654.27

Service Code	EAPG 33
Min. Negotiated Rate	$1,209.81
Max. Negotiated Rate	$2,654.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,481.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,234.53
Rate for Payer: EmblemHealth Medicaid	$1,234.53
Rate for Payer: Galaxy Health Workers Comp	$1,209.81
Rate for Payer: Hamaspik Choice Medicaid	$1,234.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,296.27
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,654.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,654.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,234.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,296.27

EAPG 3.18: LEVEL I HEMATOLOGY TESTS

Facility

$24.02

Service Code	EAPG 408
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$24.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$11.17
Rate for Payer: EmblemHealth Medicaid	$11.17
Rate for Payer: Galaxy Health Workers Comp	$10.95
Rate for Payer: Hamaspik Choice Medicaid	$11.17
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$11.73
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$24.02
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$24.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.17
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$11.73

EAPG 3.18: LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$3,034.79

Service Code	EAPG 151
Min. Negotiated Rate	$1,383.25
Max. Negotiated Rate	$3,034.79
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,693.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,411.51
Rate for Payer: EmblemHealth Medicaid	$1,411.51
Rate for Payer: Galaxy Health Workers Comp	$1,383.25
Rate for Payer: Hamaspik Choice Medicaid	$1,411.51
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,482.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,034.79
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,034.79
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,411.51
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,482.10

EAPG 3.18: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$2,517.90

Service Code	EAPG 204
Min. Negotiated Rate	$1,147.65
Max. Negotiated Rate	$2,517.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,405.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,171.10
Rate for Payer: EmblemHealth Medicaid	$1,171.10
Rate for Payer: Galaxy Health Workers Comp	$1,147.65
Rate for Payer: Hamaspik Choice Medicaid	$1,171.10
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,229.67
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,517.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,517.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,171.10
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,229.67

EAPG 3.18: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$502.47

Service Code	EAPG 351
Min. Negotiated Rate	$229.03
Max. Negotiated Rate	$502.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$280.44
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$233.71
Rate for Payer: EmblemHealth Medicaid	$233.71
Rate for Payer: Galaxy Health Workers Comp	$229.03
Rate for Payer: Hamaspik Choice Medicaid	$233.71
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$245.39
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$502.47
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$502.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$233.71
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$245.39

EAPG 3.18: LEVEL II ALLERGY TESTS

Facility

$530.38

Service Code	EAPG 2016
Min. Negotiated Rate	$241.74
Max. Negotiated Rate	$530.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$296.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$246.68
Rate for Payer: EmblemHealth Medicaid	$246.68
Rate for Payer: Galaxy Health Workers Comp	$241.74
Rate for Payer: Hamaspik Choice Medicaid	$246.68
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$259.02
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$530.38
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$530.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$246.68
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$259.02

EAPG 3.18: LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$3,217.71

Service Code	EAPG 142
Min. Negotiated Rate	$1,466.62
Max. Negotiated Rate	$3,217.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,795.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,496.59
Rate for Payer: EmblemHealth Medicaid	$1,496.59
Rate for Payer: Galaxy Health Workers Comp	$1,466.62
Rate for Payer: Hamaspik Choice Medicaid	$1,496.59
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,571.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,217.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,217.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,496.59
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,571.43

EAPG 3.18: LEVEL II ANCLLARY THERAPEUTIC SERVICES

Facility

$149.44

Service Code	EAPG 269
Min. Negotiated Rate	$68.11
Max. Negotiated Rate	$149.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$83.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$69.51
Rate for Payer: EmblemHealth Medicaid	$69.51
Rate for Payer: Galaxy Health Workers Comp	$68.11
Rate for Payer: Hamaspik Choice Medicaid	$69.51
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$72.98
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$149.44
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$149.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$69.51
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$72.98

EAPG 3.18: LEVEL II ANTERIOR SEGMENT EYE PROCEDURES

Facility

$4,599.98

Service Code	EAPG 235
Min. Negotiated Rate	$2,096.66
Max. Negotiated Rate	$4,599.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,567.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,139.50
Rate for Payer: EmblemHealth Medicaid	$2,139.50
Rate for Payer: Galaxy Health Workers Comp	$2,096.66
Rate for Payer: Hamaspik Choice Medicaid	$2,139.50
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,246.49
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,599.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,599.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,139.50
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,246.49

EAPG 3.18: LEVEL II ARTHROPLASTY

Facility

$7,327.82

Service Code	EAPG 47
Min. Negotiated Rate	$3,340.00
Max. Negotiated Rate	$7,327.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,089.82
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,408.25
Rate for Payer: EmblemHealth Medicaid	$3,408.25
Rate for Payer: Galaxy Health Workers Comp	$3,340.00
Rate for Payer: Hamaspik Choice Medicaid	$3,408.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,578.69
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$7,327.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$7,327.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,408.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,578.69

EAPG 3.18: LEVEL II ARTHROSCOPY

Facility

$7,268.48

Service Code	EAPG 38
Min. Negotiated Rate	$3,312.95
Max. Negotiated Rate	$7,268.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,056.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,380.65
Rate for Payer: EmblemHealth Medicaid	$3,380.65
Rate for Payer: Galaxy Health Workers Comp	$3,312.95
Rate for Payer: Hamaspik Choice Medicaid	$3,380.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,549.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$7,268.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$7,268.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,380.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,549.71

EAPG 3.18: LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$4,081.52

Service Code	EAPG 174
Min. Negotiated Rate	$1,860.34
Max. Negotiated Rate	$4,081.52
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,277.99
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,898.36
Rate for Payer: EmblemHealth Medicaid	$1,898.36
Rate for Payer: Galaxy Health Workers Comp	$1,860.34
Rate for Payer: Hamaspik Choice Medicaid	$1,898.36
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,993.29
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,081.52
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,081.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,898.36
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,993.29

EAPG 3.18: LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$4,287.15

Service Code	EAPG 114
Min. Negotiated Rate	$1,954.07
Max. Negotiated Rate	$4,287.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,392.76
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,994.00
Rate for Payer: EmblemHealth Medicaid	$1,994.00
Rate for Payer: Galaxy Health Workers Comp	$1,954.07
Rate for Payer: Hamaspik Choice Medicaid	$1,994.00
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,093.72
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,287.15
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,287.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,994.00
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,093.72

EAPG 3.18: LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$89.20

Service Code	EAPG 393
Min. Negotiated Rate	$40.66
Max. Negotiated Rate	$89.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$49.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$41.49
Rate for Payer: EmblemHealth Medicaid	$41.49
Rate for Payer: Galaxy Health Workers Comp	$40.66
Rate for Payer: Hamaspik Choice Medicaid	$41.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$43.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$89.20
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$89.20
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$41.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$43.56

EAPG 3.18: LEVEL II BLOOD PRODUCTS

Facility

$1,400.07

Service Code	EAPG 2062
Min. Negotiated Rate	$638.15
Max. Negotiated Rate	$1,400.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$781.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$651.19
Rate for Payer: EmblemHealth Medicaid	$651.19
Rate for Payer: Galaxy Health Workers Comp	$638.15
Rate for Payer: Hamaspik Choice Medicaid	$651.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$683.75
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,400.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,400.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$651.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$683.75

EAPG 3.18: LEVEL II BRACHYTHERAPY SOURCES

Facility

$2,894.58

Service Code	EAPG 336
Min. Negotiated Rate	$1,319.34
Max. Negotiated Rate	$2,894.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,615.53
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,346.30
Rate for Payer: EmblemHealth Medicaid	$1,346.30
Rate for Payer: Galaxy Health Workers Comp	$1,319.34
Rate for Payer: Hamaspik Choice Medicaid	$1,346.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,413.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,894.58
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,894.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,346.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,413.63

EAPG 3.18: LEVEL II BREAST PROCEDURES

Facility

$4,652.52

Service Code	EAPG 21
Min. Negotiated Rate	$2,120.60
Max. Negotiated Rate	$4,652.52
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,596.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,163.94
Rate for Payer: EmblemHealth Medicaid	$2,163.94
Rate for Payer: Galaxy Health Workers Comp	$2,120.60
Rate for Payer: Hamaspik Choice Medicaid	$2,163.94
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,272.15
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,652.52
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,652.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,163.94
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,272.15

EAPG 3.18: LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$2,909.22

Service Code	EAPG 83
Min. Negotiated Rate	$1,326.01
Max. Negotiated Rate	$2,909.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,623.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,353.11
Rate for Payer: EmblemHealth Medicaid	$1,353.11
Rate for Payer: Galaxy Health Workers Comp	$1,326.01
Rate for Payer: Hamaspik Choice Medicaid	$1,353.11
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,420.78
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,909.22
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,909.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,353.11
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,420.78

EAPG 3.18: LEVEL II CHEMISTRY TESTS

Facility

$72.86

Service Code	EAPG 401
Min. Negotiated Rate	$33.21
Max. Negotiated Rate	$72.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$40.67
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$33.89
Rate for Payer: EmblemHealth Medicaid	$33.89
Rate for Payer: Galaxy Health Workers Comp	$33.21
Rate for Payer: Hamaspik Choice Medicaid	$33.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$35.58
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$72.86
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$72.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$33.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$35.58

EAPG 3.18: LEVEL II CLOTTING TESTS

Facility

$86.56

Service Code	EAPG 407
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$86.56
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$48.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$40.26
Rate for Payer: EmblemHealth Medicaid	$40.26
Rate for Payer: Galaxy Health Workers Comp	$39.45
Rate for Payer: Hamaspik Choice Medicaid	$40.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$42.27
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$86.56
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$86.56
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$42.27

EAPG 3.18: LEVEL II COMPUTED TOMOGRAPHY

Facility

$675.75

Service Code	EAPG 300
Min. Negotiated Rate	$308.01
Max. Negotiated Rate	$675.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$377.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$314.30
Rate for Payer: EmblemHealth Medicaid	$314.30
Rate for Payer: Galaxy Health Workers Comp	$308.01
Rate for Payer: Hamaspik Choice Medicaid	$314.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$330.01
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$675.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$675.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$314.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$330.01

EAPG 3.18: LEVEL II CONVENTIONAL RADIOLOGY

Facility

$535.41

Service Code	EAPG 389
Min. Negotiated Rate	$244.04
Max. Negotiated Rate	$535.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$298.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$249.03
Rate for Payer: EmblemHealth Medicaid	$249.03
Rate for Payer: Galaxy Health Workers Comp	$244.04
Rate for Payer: Hamaspik Choice Medicaid	$249.03
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$261.48
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$535.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$535.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$249.03
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$261.48

EAPG 3.18: LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$6,175.59

Service Code	EAPG 248
Min. Negotiated Rate	$2,814.81
Max. Negotiated Rate	$6,175.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,446.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,872.33
Rate for Payer: EmblemHealth Medicaid	$2,872.33
Rate for Payer: Galaxy Health Workers Comp	$2,814.81
Rate for Payer: Hamaspik Choice Medicaid	$2,872.33
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,015.97
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,175.59
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,175.59
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,872.33
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,015.97

Know your out-of-pocket cost for care.

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