Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 842: ALCOHOL ABUSE AND DEPENDENCE

Facility

$293.96

Service Code	EAPG 0842
Min. Negotiated Rate	$130.65
Max. Negotiated Rate	$293.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$293.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$130.65
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$130.65
Rate for Payer: CDPHP Essential Plan	$293.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$156.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$130.65
Rate for Payer: EmblemHealth Medicaid	$130.65
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$293.96
Rate for Payer: Hamaspik Choice Medicaid	$130.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$130.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$280.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$280.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$130.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$137.18

EAPG 843: OTHER DRUG ABUSE AND DEPENDENCE

Facility

$293.96

Service Code	EAPG 0843
Min. Negotiated Rate	$130.65
Max. Negotiated Rate	$293.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$293.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$130.65
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$130.65
Rate for Payer: CDPHP Essential Plan	$293.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$156.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$130.65
Rate for Payer: EmblemHealth Medicaid	$130.65
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$293.96
Rate for Payer: Hamaspik Choice Medicaid	$130.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$130.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$280.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$280.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$130.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$137.18

EAPG 84: DIAGNOSTIC CARDIAC CATHETERIZATION

Facility

$3,591.02

Service Code	EAPG 0084
Min. Negotiated Rate	$1,596.01
Max. Negotiated Rate	$3,591.02
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$3,591.02
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,596.01
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,596.01
Rate for Payer: CDPHP Essential Plan	$3,591.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,915.21
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,596.01
Rate for Payer: EmblemHealth Medicaid	$1,596.01
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$3,591.02
Rate for Payer: Hamaspik Choice Medicaid	$1,596.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,596.01
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,431.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,431.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,596.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,675.81

EAPG 850: ALLERGIC REACTIONS

Facility

$318.71

Service Code	EAPG 0850
Min. Negotiated Rate	$141.65
Max. Negotiated Rate	$318.71
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$318.71
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$141.65
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$141.65
Rate for Payer: CDPHP Essential Plan	$318.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$169.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$141.65
Rate for Payer: EmblemHealth Medicaid	$141.65
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$318.71
Rate for Payer: Hamaspik Choice Medicaid	$141.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$141.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$304.55
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$304.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$141.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$148.73

EAPG 851: POISONING OF MEDICINAL AGENTS

Facility

$367.02

Service Code	EAPG 0851
Min. Negotiated Rate	$163.12
Max. Negotiated Rate	$367.02
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$367.02
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$163.12
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$163.12
Rate for Payer: CDPHP Essential Plan	$367.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$195.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$163.12
Rate for Payer: EmblemHealth Medicaid	$163.12
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$367.02
Rate for Payer: Hamaspik Choice Medicaid	$163.12
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$163.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$350.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$350.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$163.12
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$171.28

EAPG 852: OTHER COMPLICATIONS OF TREATMENT

Facility

$315.07

Service Code	EAPG 0852
Min. Negotiated Rate	$140.03
Max. Negotiated Rate	$315.07
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$315.07
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$140.03
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$140.03
Rate for Payer: CDPHP Essential Plan	$315.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.04
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$140.03
Rate for Payer: EmblemHealth Medicaid	$140.03
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$315.07
Rate for Payer: Hamaspik Choice Medicaid	$140.03
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$140.03
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$301.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$301.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$140.03
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$147.03

EAPG 853: OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES

Facility

$329.29

Service Code	EAPG 0853
Min. Negotiated Rate	$146.35
Max. Negotiated Rate	$329.29
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$329.29
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$146.35
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$146.35
Rate for Payer: CDPHP Essential Plan	$329.29
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$175.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$146.35
Rate for Payer: EmblemHealth Medicaid	$146.35
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$329.29
Rate for Payer: Hamaspik Choice Medicaid	$146.35
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$146.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$314.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$314.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$146.35
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$153.67

EAPG 854: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$286.20

Service Code	EAPG 0854
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$286.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$286.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$127.20
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$127.20
Rate for Payer: CDPHP Essential Plan	$286.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$152.64
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$127.20
Rate for Payer: EmblemHealth Medicaid	$127.20
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$286.20
Rate for Payer: Hamaspik Choice Medicaid	$127.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$127.20
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$273.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$273.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$127.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$133.56

EAPG 85: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$5,326.70

Service Code	EAPG 0085
Min. Negotiated Rate	$2,367.42
Max. Negotiated Rate	$5,326.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$5,326.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$2,367.42
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$2,367.42
Rate for Payer: CDPHP Essential Plan	$5,326.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,840.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,367.42
Rate for Payer: EmblemHealth Medicaid	$2,367.42
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$5,326.70
Rate for Payer: Hamaspik Choice Medicaid	$2,367.42
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,367.42
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,089.95
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,089.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,367.42
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,485.79

EAPG 860: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$329.40

Service Code	EAPG 0860
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$329.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$329.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$146.40
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$146.40
Rate for Payer: CDPHP Essential Plan	$329.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$175.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$146.40
Rate for Payer: EmblemHealth Medicaid	$146.40
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$329.40
Rate for Payer: Hamaspik Choice Medicaid	$146.40
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$146.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$314.76
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$314.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$146.40
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$153.72

EAPG 861: PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT

Facility

$315.63

Service Code	EAPG 0861
Min. Negotiated Rate	$140.28
Max. Negotiated Rate	$315.63
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$315.63
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$140.28
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$140.28
Rate for Payer: CDPHP Essential Plan	$315.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$140.28
Rate for Payer: EmblemHealth Medicaid	$140.28
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$315.63
Rate for Payer: Hamaspik Choice Medicaid	$140.28
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$140.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$301.60
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$301.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$140.28
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$147.29

EAPG 867: ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES

Facility

$257.69

Service Code	EAPG 0867
Min. Negotiated Rate	$114.53
Max. Negotiated Rate	$257.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$257.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$114.53
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$114.53
Rate for Payer: CDPHP Essential Plan	$257.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$137.44
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$114.53
Rate for Payer: EmblemHealth Medicaid	$114.53
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$257.69
Rate for Payer: Hamaspik Choice Medicaid	$114.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$114.53
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$246.24
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$246.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$114.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$120.26

EAPG 869: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility

$270.70

Service Code	EAPG 0869
Min. Negotiated Rate	$120.31
Max. Negotiated Rate	$270.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$270.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$120.31
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$120.31
Rate for Payer: CDPHP Essential Plan	$270.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$120.31
Rate for Payer: EmblemHealth Medicaid	$120.31
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$270.70
Rate for Payer: Hamaspik Choice Medicaid	$120.31
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$120.31
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$258.67
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$258.67
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$120.31
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$126.33

EAPG 86: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT

Facility

$12,679.36

Service Code	EAPG 0086
Min. Negotiated Rate	$5,635.27
Max. Negotiated Rate	$12,679.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$12,679.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$5,635.27
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$5,635.27
Rate for Payer: CDPHP Essential Plan	$12,679.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6,762.32
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5,635.27
Rate for Payer: EmblemHealth Medicaid	$5,635.27
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$12,679.36
Rate for Payer: Hamaspik Choice Medicaid	$5,635.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$5,635.27
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$12,115.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$12,115.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5,635.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$5,917.03

EAPG 870: REHABILITATION

Facility

$226.62

Service Code	EAPG 0870
Min. Negotiated Rate	$100.72
Max. Negotiated Rate	$226.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$226.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$100.72
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$100.72
Rate for Payer: CDPHP Essential Plan	$226.62
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$120.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$100.72
Rate for Payer: EmblemHealth Medicaid	$100.72
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$226.62
Rate for Payer: Hamaspik Choice Medicaid	$100.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$100.72
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$216.55
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$216.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$100.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$105.76

EAPG 871: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$254.81

Service Code	EAPG 0871
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$113.25
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$113.25
Rate for Payer: CDPHP Essential Plan	$254.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.25
Rate for Payer: EmblemHealth Medicaid	$113.25
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$254.81
Rate for Payer: Hamaspik Choice Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.91

EAPG 872: OTHER AFTERCARE AND CONVALESCENCE

Facility

$249.57

Service Code	EAPG 0872
Min. Negotiated Rate	$110.92
Max. Negotiated Rate	$249.57
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$249.57
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$110.92
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$110.92
Rate for Payer: CDPHP Essential Plan	$249.57
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$133.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$110.92
Rate for Payer: EmblemHealth Medicaid	$110.92
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$249.57
Rate for Payer: Hamaspik Choice Medicaid	$110.92
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$110.92
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$238.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$238.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$110.92
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$116.47

EAPG 873: NEONATAL AFTERCARE

Facility

$271.55

Service Code	EAPG 0873
Min. Negotiated Rate	$120.69
Max. Negotiated Rate	$271.55
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$271.55
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$120.69
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$120.69
Rate for Payer: CDPHP Essential Plan	$271.55
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$120.69
Rate for Payer: EmblemHealth Medicaid	$120.69
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$271.55
Rate for Payer: Hamaspik Choice Medicaid	$120.69
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$120.69
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$259.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$259.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$120.69
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$126.72

EAPG 874: AFTERCARE FOR JOINT REPLACEMENT

Facility

$239.47

Service Code	EAPG 0874
Min. Negotiated Rate	$106.43
Max. Negotiated Rate	$239.47
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$239.47
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$106.43
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$106.43
Rate for Payer: CDPHP Essential Plan	$239.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$127.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$106.43
Rate for Payer: EmblemHealth Medicaid	$106.43
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$239.47
Rate for Payer: Hamaspik Choice Medicaid	$106.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$106.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$228.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$228.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$106.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$111.75

EAPG 875: CONTRACEPTIVE MANAGEMENT

Facility

$596.27

Service Code	EAPG 0875
Min. Negotiated Rate	$265.01
Max. Negotiated Rate	$596.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$596.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$265.01
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$265.01
Rate for Payer: CDPHP Essential Plan	$596.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$318.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$265.01
Rate for Payer: EmblemHealth Medicaid	$265.01
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$596.27
Rate for Payer: Hamaspik Choice Medicaid	$265.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$265.01
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$569.77
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$569.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$265.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$278.26

EAPG 876: ADULT PREVENTIVE MEDICINE

Facility

$254.81

Service Code	EAPG 0876
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$113.25
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$113.25
Rate for Payer: CDPHP Essential Plan	$254.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.25
Rate for Payer: EmblemHealth Medicaid	$113.25
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$254.81
Rate for Payer: Hamaspik Choice Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.91

EAPG 877: CHILD PREVENTIVE MEDICINE

Facility

$254.81

Service Code	EAPG 0877
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$113.25
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$113.25
Rate for Payer: CDPHP Essential Plan	$254.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.25
Rate for Payer: EmblemHealth Medicaid	$113.25
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$254.81
Rate for Payer: Hamaspik Choice Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.91

EAPG 878: GYNECOLOGIC PREVENTIVE MEDICINE

Facility

$254.81

Service Code	EAPG 0878
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$113.25
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$113.25
Rate for Payer: CDPHP Essential Plan	$254.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.25
Rate for Payer: EmblemHealth Medicaid	$113.25
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$254.81
Rate for Payer: Hamaspik Choice Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.91

EAPG 879: PREVENTIVE OR SCREENING ENCOUNTER

Facility

$254.81

Service Code	EAPG 0879
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$254.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$113.25
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$113.25
Rate for Payer: CDPHP Essential Plan	$254.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$135.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$113.25
Rate for Payer: EmblemHealth Medicaid	$113.25
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$254.81
Rate for Payer: Hamaspik Choice Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$243.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$243.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$118.91

EAPG 87: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES

Facility

$4,529.86

Service Code	EAPG 0087
Min. Negotiated Rate	$2,013.27
Max. Negotiated Rate	$4,529.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$4,529.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$2,013.27
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$2,013.27
Rate for Payer: CDPHP Essential Plan	$4,529.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,415.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,013.27
Rate for Payer: EmblemHealth Medicaid	$2,013.27
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$4,529.86
Rate for Payer: Hamaspik Choice Medicaid	$2,013.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,013.27
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,328.53
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,328.53
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,013.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,113.93

Know your out-of-pocket cost for care.

All Charges