Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility

$6,714.31

Service Code	EAPG 228
Min. Negotiated Rate	$3,060.36
Max. Negotiated Rate	$6,714.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,747.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,122.90
Rate for Payer: EmblemHealth Medicaid	$3,122.90
Rate for Payer: Galaxy Health Workers Comp	$3,060.36
Rate for Payer: Hamaspik Choice Medicaid	$3,122.90
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,279.07
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,714.31
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,714.31
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,122.90
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,279.07

EAPG 3.18: LEVEL II DENTAL FILM

Facility

$178.00

Service Code	EAPG 374
Min. Negotiated Rate	$81.13
Max. Negotiated Rate	$178.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$99.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$82.79
Rate for Payer: EmblemHealth Medicaid	$82.79
Rate for Payer: Galaxy Health Workers Comp	$81.13
Rate for Payer: Hamaspik Choice Medicaid	$82.79
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$86.93
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$178.00
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$178.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$82.79
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$86.93

EAPG 3.18: LEVEL II DENTAL RESTORATIONS

Facility

$378.36

Service Code	EAPG 362
Min. Negotiated Rate	$172.46
Max. Negotiated Rate	$378.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$211.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$175.98
Rate for Payer: EmblemHealth Medicaid	$175.98
Rate for Payer: Galaxy Health Workers Comp	$172.46
Rate for Payer: Hamaspik Choice Medicaid	$175.98
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$184.78
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$378.36
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$378.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$175.98
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$184.78

EAPG 3.18: LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$2,676.88

Service Code	EAPG 338
Min. Negotiated Rate	$1,220.11
Max. Negotiated Rate	$2,676.88
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,494.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,245.04
Rate for Payer: EmblemHealth Medicaid	$1,245.04
Rate for Payer: Galaxy Health Workers Comp	$1,220.11
Rate for Payer: Hamaspik Choice Medicaid	$1,245.04
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,307.31
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,676.88
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,676.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,245.04
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,307.31

EAPG 3.18: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$1,564.23

Service Code	EAPG 332
Min. Negotiated Rate	$712.97
Max. Negotiated Rate	$1,564.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$873.03
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$727.54
Rate for Payer: EmblemHealth Medicaid	$727.54
Rate for Payer: Galaxy Health Workers Comp	$712.97
Rate for Payer: Hamaspik Choice Medicaid	$727.54
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$763.92
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,564.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,564.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$727.54
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$763.92

EAPG 3.18: LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$1,342.11

Service Code	EAPG 289
Min. Negotiated Rate	$611.73
Max. Negotiated Rate	$1,342.11
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$749.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$624.23
Rate for Payer: EmblemHealth Medicaid	$624.23
Rate for Payer: Galaxy Health Workers Comp	$611.73
Rate for Payer: Hamaspik Choice Medicaid	$624.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$655.45
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,342.11
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,342.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$624.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$655.45

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

Facility

$3,514.05

Service Code	EAPG 253
Min. Negotiated Rate	$1,601.69
Max. Negotiated Rate	$3,514.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,961.27
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,634.42
Rate for Payer: EmblemHealth Medicaid	$1,634.42
Rate for Payer: Galaxy Health Workers Comp	$1,601.69
Rate for Payer: Hamaspik Choice Medicaid	$1,634.42
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,716.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,514.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,514.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,634.42
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,716.16

EAPG 3.18: LEVEL II ENDOCRINOLOGY TESTS

Facility

$77.16

Service Code	EAPG 399
Min. Negotiated Rate	$35.17
Max. Negotiated Rate	$77.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$43.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$35.89
Rate for Payer: EmblemHealth Medicaid	$35.89
Rate for Payer: Galaxy Health Workers Comp	$35.17
Rate for Payer: Hamaspik Choice Medicaid	$35.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$37.68
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$77.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$77.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$35.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$37.68

EAPG 3.18: LEVEL II ENDODONTICS

Facility

$432.06

Service Code	EAPG 365
Min. Negotiated Rate	$196.93
Max. Negotiated Rate	$432.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$241.14
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$200.96
Rate for Payer: EmblemHealth Medicaid	$200.96
Rate for Payer: Galaxy Health Workers Comp	$196.93
Rate for Payer: Hamaspik Choice Medicaid	$200.96
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$211.00
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$432.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$432.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$200.96
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$211.00

EAPG 3.18: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$3,535.00

Service Code	EAPG 63
Min. Negotiated Rate	$1,611.24
Max. Negotiated Rate	$3,535.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,972.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,644.17
Rate for Payer: EmblemHealth Medicaid	$1,644.17
Rate for Payer: Galaxy Health Workers Comp	$1,611.24
Rate for Payer: Hamaspik Choice Medicaid	$1,644.17
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,726.39
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,535.00
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,535.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,644.17
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,726.39

EAPG 3.18: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$3,002.97

Service Code	EAPG 153
Min. Negotiated Rate	$1,368.74
Max. Negotiated Rate	$3,002.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,676.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,396.71
Rate for Payer: EmblemHealth Medicaid	$1,396.71
Rate for Payer: Galaxy Health Workers Comp	$1,368.74
Rate for Payer: Hamaspik Choice Medicaid	$1,396.71
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,466.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,002.97
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,002.97
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,396.71
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,466.56

EAPG 3.18: LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$5,035.62

Service Code	EAPG 126
Min. Negotiated Rate	$2,295.22
Max. Negotiated Rate	$5,035.62
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,810.49
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,342.12
Rate for Payer: EmblemHealth Medicaid	$2,342.12
Rate for Payer: Galaxy Health Workers Comp	$2,295.22
Rate for Payer: Hamaspik Choice Medicaid	$2,342.12
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,459.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,035.62
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,035.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,342.12
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,459.25

EAPG 3.18: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$3,772.61

Service Code	EAPG 259
Min. Negotiated Rate	$1,719.54
Max. Negotiated Rate	$3,772.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,105.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,754.68
Rate for Payer: EmblemHealth Medicaid	$1,754.68
Rate for Payer: Galaxy Health Workers Comp	$1,719.54
Rate for Payer: Hamaspik Choice Medicaid	$1,754.68
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,842.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,772.61
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,772.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,754.68
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,842.43

EAPG 3.18: LEVEL II FETAL PROCEDURES

Facility

$1,493.47

Service Code	EAPG 192
Min. Negotiated Rate	$680.72
Max. Negotiated Rate	$1,493.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$833.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$694.63
Rate for Payer: EmblemHealth Medicaid	$694.63
Rate for Payer: Galaxy Health Workers Comp	$680.72
Rate for Payer: Hamaspik Choice Medicaid	$694.63
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$729.37
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,493.47
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,493.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$694.63
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$729.37

EAPG 3.18: LEVEL II FOOT PROCEDURES

Facility

$4,374.90

Service Code	EAPG 36
Min. Negotiated Rate	$1,994.07
Max. Negotiated Rate	$4,374.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,441.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,034.81
Rate for Payer: EmblemHealth Medicaid	$2,034.81
Rate for Payer: Galaxy Health Workers Comp	$1,994.07
Rate for Payer: Hamaspik Choice Medicaid	$2,034.81
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,136.57
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,374.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,374.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,034.81
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,136.57

EAPG 3.18: LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$4,749.15

Service Code	EAPG 24
Min. Negotiated Rate	$2,164.65
Max. Negotiated Rate	$4,749.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,650.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,208.88
Rate for Payer: EmblemHealth Medicaid	$2,208.88
Rate for Payer: Galaxy Health Workers Comp	$2,164.65
Rate for Payer: Hamaspik Choice Medicaid	$2,208.88
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,319.34
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,749.15
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,749.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,208.88
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,319.34

EAPG 3.18: LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$5,069.90

Service Code	EAPG 144
Min. Negotiated Rate	$2,310.84
Max. Negotiated Rate	$5,069.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,829.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,358.07
Rate for Payer: EmblemHealth Medicaid	$2,358.07
Rate for Payer: Galaxy Health Workers Comp	$2,310.84
Rate for Payer: Hamaspik Choice Medicaid	$2,358.07
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,475.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,069.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,069.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,358.07
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,475.99

EAPG 3.18: LEVEL II HAND PROCEDURES

Facility

$4,390.20

Service Code	EAPG 34
Min. Negotiated Rate	$2,001.04
Max. Negotiated Rate	$4,390.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,450.27
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,041.93
Rate for Payer: EmblemHealth Medicaid	$2,041.93
Rate for Payer: Galaxy Health Workers Comp	$2,001.04
Rate for Payer: Hamaspik Choice Medicaid	$2,041.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,144.04
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,390.20
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,390.20
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,041.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,144.04

EAPG 3.18: LEVEL II HEMATOLOGY TESTS

Facility

$58.54

Service Code	EAPG 409
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$58.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$32.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.23
Rate for Payer: EmblemHealth Medicaid	$27.23
Rate for Payer: Galaxy Health Workers Comp	$26.69
Rate for Payer: Hamaspik Choice Medicaid	$27.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$28.59
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$58.54
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$58.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$28.59

EAPG 3.18: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$4,815.49

Service Code	EAPG 152
Min. Negotiated Rate	$2,194.89
Max. Negotiated Rate	$4,815.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,687.64
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,239.74
Rate for Payer: EmblemHealth Medicaid	$2,239.74
Rate for Payer: Galaxy Health Workers Comp	$2,194.89
Rate for Payer: Hamaspik Choice Medicaid	$2,239.74
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,351.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,815.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,815.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,239.74
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,351.74

EAPG 3.18: LEVEL II HIP AND FEMUR PROCEDURES

Facility

$4,597.37

Service Code	EAPG 55
Min. Negotiated Rate	$2,095.47
Max. Negotiated Rate	$4,597.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,565.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,138.29
Rate for Payer: EmblemHealth Medicaid	$2,138.29
Rate for Payer: Galaxy Health Workers Comp	$2,095.47
Rate for Payer: Hamaspik Choice Medicaid	$2,138.29
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,245.22
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,597.37
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,597.37
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,138.29
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,245.22

EAPG 3.18: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$4,308.41

Service Code	EAPG 206
Min. Negotiated Rate	$1,963.76
Max. Negotiated Rate	$4,308.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,404.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,003.89
Rate for Payer: EmblemHealth Medicaid	$2,003.89
Rate for Payer: Galaxy Health Workers Comp	$1,963.76
Rate for Payer: Hamaspik Choice Medicaid	$2,003.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,104.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,308.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,308.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,003.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,104.10

EAPG 3.18: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES

Facility

$6,628.98

Service Code	EAPG 236
Min. Negotiated Rate	$3,021.47
Max. Negotiated Rate	$6,628.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,699.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,083.21
Rate for Payer: EmblemHealth Medicaid	$3,083.21
Rate for Payer: Galaxy Health Workers Comp	$3,021.47
Rate for Payer: Hamaspik Choice Medicaid	$3,083.21
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,237.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,628.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,628.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,083.21
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,237.40

EAPG 3.18: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$98.67

Service Code	EAPG 2043
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 III BLOOD PRODUCT EXCHANGE SERVICES

Facility

$4,287.15

Service Code	EAPG 155
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

Know your out-of-pocket cost for care.

All Charges