Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL III BRACHYTHERAPY SOURCES

Facility

$30,171.18

Service Code	EAPG 337
Min. Negotiated Rate	$13,751.92
Max. Negotiated Rate	$30,171.18
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16,839.22
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$14,032.94
Rate for Payer: EmblemHealth Medicaid	$14,032.94
Rate for Payer: Galaxy Health Workers Comp	$13,751.92
Rate for Payer: Hamaspik Choice Medicaid	$14,032.94
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$14,734.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$30,171.18
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$30,171.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$14,032.94
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$14,734.71

EAPG 3.18: LEVEL III BREAST PROCEDURES

Facility

$6,663.42

Service Code	EAPG 22
Min. Negotiated Rate	$3,037.16
Max. Negotiated Rate	$6,663.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,719.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,099.23
Rate for Payer: EmblemHealth Medicaid	$3,099.23
Rate for Payer: Galaxy Health Workers Comp	$3,037.16
Rate for Payer: Hamaspik Choice Medicaid	$3,099.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,254.22
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,663.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,663.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,099.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,254.22

EAPG 3.18: LEVEL III CHEMISTRY TESTS

Facility

$112.85

Service Code	EAPG 384
Min. Negotiated Rate	$51.44
Max. Negotiated Rate	$112.85
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$62.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$52.49
Rate for Payer: EmblemHealth Medicaid	$52.49
Rate for Payer: Galaxy Health Workers Comp	$51.44
Rate for Payer: Hamaspik Choice Medicaid	$52.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$55.11
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$112.85
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$112.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$52.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$55.11

EAPG 3.18: LEVEL III DENTAL RESTORATIONS

Facility

$902.25

Service Code	EAPG 363
Min. Negotiated Rate	$411.24
Max. Negotiated Rate	$902.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$503.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$419.64
Rate for Payer: EmblemHealth Medicaid	$419.64
Rate for Payer: Galaxy Health Workers Comp	$411.24
Rate for Payer: Hamaspik Choice Medicaid	$419.64
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$440.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$902.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$902.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$419.64
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$440.63

EAPG 3.18: LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$3,817.92

Service Code	EAPG 339
Min. Negotiated Rate	$1,740.20
Max. Negotiated Rate	$3,817.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,130.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,775.76
Rate for Payer: EmblemHealth Medicaid	$1,775.76
Rate for Payer: Galaxy Health Workers Comp	$1,740.20
Rate for Payer: Hamaspik Choice Medicaid	$1,775.76
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,864.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,817.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,817.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,775.76
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,864.56

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

Facility

$4,980.65

Service Code	EAPG 254
Min. Negotiated Rate	$2,270.16
Max. Negotiated Rate	$4,980.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,779.81
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,316.56
Rate for Payer: EmblemHealth Medicaid	$2,316.56
Rate for Payer: Galaxy Health Workers Comp	$2,270.16
Rate for Payer: Hamaspik Choice Medicaid	$2,316.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,432.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,980.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,980.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,316.56
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,432.40

EAPG 3.18: LEVEL III ENDODONTICS

Facility

$435.25

Service Code	EAPG 366
Min. Negotiated Rate	$198.39
Max. Negotiated Rate	$435.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$242.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$202.44
Rate for Payer: EmblemHealth Medicaid	$202.44
Rate for Payer: Galaxy Health Workers Comp	$198.39
Rate for Payer: Hamaspik Choice Medicaid	$202.44
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$212.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$435.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$435.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$202.44
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$212.56

EAPG 3.18: LEVEL III KIDNEY AND URETERAL PROCEDURES

Facility

$4,111.50

Service Code	EAPG 172
Min. Negotiated Rate	$1,874.01
Max. Negotiated Rate	$4,111.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,294.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,912.30
Rate for Payer: EmblemHealth Medicaid	$1,912.30
Rate for Payer: Galaxy Health Workers Comp	$1,874.01
Rate for Payer: Hamaspik Choice Medicaid	$1,912.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,007.93
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,111.50
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,111.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,912.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,007.93

EAPG 3.18: LEVEL III LAPAROSCOPY

Facility

$6,766.24

Service Code	EAPG 148
Min. Negotiated Rate	$3,084.03
Max. Negotiated Rate	$6,766.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,776.39
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,147.05
Rate for Payer: EmblemHealth Medicaid	$3,147.05
Rate for Payer: Galaxy Health Workers Comp	$3,084.03
Rate for Payer: Hamaspik Choice Medicaid	$3,147.05
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,304.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,766.24
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,766.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,147.05
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,304.43

EAPG 3.18: LEVEL III MICROBIOLOGY TESTS

Facility

$128.07

Service Code	EAPG 388
Min. Negotiated Rate	$58.37
Max. Negotiated Rate	$128.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$71.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$59.57
Rate for Payer: EmblemHealth Medicaid	$59.57
Rate for Payer: Galaxy Health Workers Comp	$58.37
Rate for Payer: Hamaspik Choice Medicaid	$59.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$62.54
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$128.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$128.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$59.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$62.54

EAPG 3.18: LEVEL II IMMUNIZATION

Facility

$129.22

Service Code	EAPG 415
Min. Negotiated Rate	$58.90
Max. Negotiated Rate	$129.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$72.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$60.10
Rate for Payer: EmblemHealth Medicaid	$60.10
Rate for Payer: Galaxy Health Workers Comp	$58.90
Rate for Payer: Hamaspik Choice Medicaid	$60.10
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$63.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$129.22
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$129.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$60.10
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$63.10

EAPG 3.18: LEVEL II IMMUNOLOGY TESTS

Facility

$81.23

Service Code	EAPG 395
Min. Negotiated Rate	$37.02
Max. Negotiated Rate	$81.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$45.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$37.78
Rate for Payer: EmblemHealth Medicaid	$37.78
Rate for Payer: Galaxy Health Workers Comp	$37.02
Rate for Payer: Hamaspik Choice Medicaid	$37.78
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$39.67
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$81.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$81.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$37.78
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$39.67

EAPG 3.18: LEVEL III NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$26,898.46

Service Code	EAPG 223
Min. Negotiated Rate	$12,260.69
Max. Negotiated Rate	$26,898.46
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$15,013.09
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12,510.91
Rate for Payer: EmblemHealth Medicaid	$12,510.91
Rate for Payer: Galaxy Health Workers Comp	$12,260.69
Rate for Payer: Hamaspik Choice Medicaid	$12,510.91
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$13,136.46
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$26,898.46
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$26,898.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12,510.91
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$13,136.46

EAPG 3.18: LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$797.59

Service Code	EAPG 369
Min. Negotiated Rate	$363.54
Max. Negotiated Rate	$797.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$445.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$370.97
Rate for Payer: EmblemHealth Medicaid	$370.97
Rate for Payer: Galaxy Health Workers Comp	$363.54
Rate for Payer: Hamaspik Choice Medicaid	$370.97
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$389.52
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$797.59
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$797.59
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$370.97
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$389.52

EAPG 3.18: LEVEL III PATHOLOGY TESTS

Facility

$178.88

Service Code	EAPG 308
Min. Negotiated Rate	$81.53
Max. Negotiated Rate	$178.88
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$99.84
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$83.20
Rate for Payer: EmblemHealth Medicaid	$83.20
Rate for Payer: Galaxy Health Workers Comp	$81.53
Rate for Payer: Hamaspik Choice Medicaid	$83.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$87.36
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$178.88
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$178.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$83.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$87.36

EAPG 3.18: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$5,598.93

Service Code	EAPG 85
Min. Negotiated Rate	$2,551.98
Max. Negotiated Rate	$5,598.93
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,124.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,604.12
Rate for Payer: EmblemHealth Medicaid	$2,604.12
Rate for Payer: Galaxy Health Workers Comp	$2,551.98
Rate for Payer: Hamaspik Choice Medicaid	$2,604.12
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,734.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,598.93
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,598.93
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,604.12
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,734.35

EAPG 3.18: LEVEL III PROSTHODONTICS, FIXED

Facility

$809.27

Service Code	EAPG 355
Min. Negotiated Rate	$368.86
Max. Negotiated Rate	$809.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$451.67
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$376.40
Rate for Payer: EmblemHealth Medicaid	$376.40
Rate for Payer: Galaxy Health Workers Comp	$368.86
Rate for Payer: Hamaspik Choice Medicaid	$376.40
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$395.22
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$809.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$809.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$376.40
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$395.22

EAPG 3.18: LEVEL III PROSTHODONTICS, REMOVABLE

Facility

$521.96

Service Code	EAPG 358
Min. Negotiated Rate	$237.91
Max. Negotiated Rate	$521.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$291.32
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$242.77
Rate for Payer: EmblemHealth Medicaid	$242.77
Rate for Payer: Galaxy Health Workers Comp	$237.91
Rate for Payer: Hamaspik Choice Medicaid	$242.77
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$254.91
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$521.96
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$521.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$242.77
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$254.91

EAPG 3.18: LEVEL III RADIATION THERAPY

Facility

$1,618.19

Service Code	EAPG 348
Min. Negotiated Rate	$737.57
Max. Negotiated Rate	$1,618.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$903.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$752.64
Rate for Payer: EmblemHealth Medicaid	$752.64
Rate for Payer: Galaxy Health Workers Comp	$737.57
Rate for Payer: Hamaspik Choice Medicaid	$752.64
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$790.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,618.19
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,618.19
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$752.64
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$790.28

EAPG 3.18: LEVEL III RADIATION TREATMENT PREPARATION & PLANNING

Facility

$352.84

Service Code	EAPG 478
Min. Negotiated Rate	$160.82
Max. Negotiated Rate	$352.84
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$196.93
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$164.11
Rate for Payer: EmblemHealth Medicaid	$164.11
Rate for Payer: Galaxy Health Workers Comp	$160.82
Rate for Payer: Hamaspik Choice Medicaid	$164.11
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$172.32
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$352.84
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$352.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$164.11
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$172.32

EAPG 3.18: LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$4,348.07

Service Code	EAPG 11
Min. Negotiated Rate	$1,981.84
Max. Negotiated Rate	$4,348.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,426.76
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,022.34
Rate for Payer: EmblemHealth Medicaid	$2,022.34
Rate for Payer: Galaxy Health Workers Comp	$1,981.84
Rate for Payer: Hamaspik Choice Medicaid	$2,022.34
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,123.47
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,348.07
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,348.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,022.34
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,123.47

EAPG 3.18: LEVEL III SPINE PROCEDURES

Facility

$8,209.12

Service Code	EAPG 57
Min. Negotiated Rate	$3,741.69
Max. Negotiated Rate	$8,209.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,581.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,818.15
Rate for Payer: EmblemHealth Medicaid	$3,818.15
Rate for Payer: Galaxy Health Workers Comp	$3,741.69
Rate for Payer: Hamaspik Choice Medicaid	$3,818.15
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$4,009.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$8,209.12
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$8,209.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,818.15
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$4,009.09

EAPG 3.18: LEVEL III UPPER GI ENDOSCOPY

Facility

$2,049.25

Service Code	EAPG 154
Min. Negotiated Rate	$934.04
Max. Negotiated Rate	$2,049.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,143.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$953.13
Rate for Payer: EmblemHealth Medicaid	$953.13
Rate for Payer: Galaxy Health Workers Comp	$934.04
Rate for Payer: Hamaspik Choice Medicaid	$953.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,000.79
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,049.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,049.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$953.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,000.79

EAPG 3.18: LEVEL III VASCULAR RADIOLOGICAL PROCEDURES

Facility

$1,941.98

Service Code	EAPG 280
Min. Negotiated Rate	$885.15
Max. Negotiated Rate	$1,941.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,083.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$903.24
Rate for Payer: EmblemHealth Medicaid	$903.24
Rate for Payer: Galaxy Health Workers Comp	$885.15
Rate for Payer: Hamaspik Choice Medicaid	$903.24
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$948.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,941.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,941.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$903.24
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$948.40

EAPG 3.18: LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$1,115.72

Service Code	EAPG 50
Min. Negotiated Rate	$508.54
Max. Negotiated Rate	$1,115.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$622.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$518.93
Rate for Payer: EmblemHealth Medicaid	$518.93
Rate for Payer: Galaxy Health Workers Comp	$508.54
Rate for Payer: Hamaspik Choice Medicaid	$518.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$544.88
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,115.72
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,115.72
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$518.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$544.88

Know your out-of-pocket cost for care.

All Charges