Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II KIDNEY AND URETERAL PROCEDURES

Facility

$3,031.41

Service Code	EAPG 171
Min. Negotiated Rate	$1,381.71
Max. Negotiated Rate	$3,031.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,691.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,409.94
Rate for Payer: EmblemHealth Medicaid	$1,409.94
Rate for Payer: Galaxy Health Workers Comp	$1,381.71
Rate for Payer: Hamaspik Choice Medicaid	$1,409.94
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,480.45
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,031.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,031.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,409.94
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,480.45

EAPG 3.18: LEVEL II KNEE AND LOWER LEG PROCEDURES

Facility

$4,195.83

Service Code	EAPG 52
Min. Negotiated Rate	$1,912.44
Max. Negotiated Rate	$4,195.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,341.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,951.52
Rate for Payer: EmblemHealth Medicaid	$1,951.52
Rate for Payer: Galaxy Health Workers Comp	$1,912.44
Rate for Payer: Hamaspik Choice Medicaid	$1,951.52
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,049.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,195.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,195.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,951.52
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,049.12

EAPG 3.18: LEVEL II LAPAROSCOPY

Facility

$5,283.26

Service Code	EAPG 146
Min. Negotiated Rate	$2,408.09
Max. Negotiated Rate	$5,283.26
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,948.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,457.30
Rate for Payer: EmblemHealth Medicaid	$2,457.30
Rate for Payer: Galaxy Health Workers Comp	$2,408.09
Rate for Payer: Hamaspik Choice Medicaid	$2,457.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,580.19
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,283.26
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,283.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,457.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,580.19

EAPG 3.18: LEVEL II LOWER AIRWAY ENDOSCOPY

Facility

$2,703.63

Service Code	EAPG 71
Min. Negotiated Rate	$1,232.30
Max. Negotiated Rate	$2,703.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,508.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,257.49
Rate for Payer: EmblemHealth Medicaid	$1,257.49
Rate for Payer: Galaxy Health Workers Comp	$1,232.30
Rate for Payer: Hamaspik Choice Medicaid	$1,257.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,320.37
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,703.63
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,703.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,257.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,320.37

EAPG 3.18: LEVEL II LOWER GI ENDOSCOPY

Facility

$1,838.74

Service Code	EAPG 137
Min. Negotiated Rate	$838.09
Max. Negotiated Rate	$1,838.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,026.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$855.22
Rate for Payer: EmblemHealth Medicaid	$855.22
Rate for Payer: Galaxy Health Workers Comp	$838.09
Rate for Payer: Hamaspik Choice Medicaid	$855.22
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$897.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,838.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,838.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$855.22
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$897.99

EAPG 3.18: LEVEL II MAXILLOFACIAL PROSTHETICS

Facility

$514.24

Service Code	EAPG 360
Min. Negotiated Rate	$234.39
Max. Negotiated Rate	$514.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$287.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$239.18
Rate for Payer: EmblemHealth Medicaid	$239.18
Rate for Payer: Galaxy Health Workers Comp	$234.39
Rate for Payer: Hamaspik Choice Medicaid	$239.18
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$251.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$514.24
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$514.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$239.18
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$251.14

EAPG 3.18: LEVEL II MICROBIOLOGY TESTS

Facility

$83.14

Service Code	EAPG 397
Min. Negotiated Rate	$37.90
Max. Negotiated Rate	$83.14
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$46.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$38.67
Rate for Payer: EmblemHealth Medicaid	$38.67
Rate for Payer: Galaxy Health Workers Comp	$37.90
Rate for Payer: Hamaspik Choice Medicaid	$38.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$40.60
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$83.14
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$83.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$38.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$40.60

EAPG 3.18: LEVEL I IMMUNIZATION

Facility

$62.31

Service Code	EAPG 414
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$62.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$34.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.98
Rate for Payer: EmblemHealth Medicaid	$28.98
Rate for Payer: Galaxy Health Workers Comp	$28.40
Rate for Payer: Hamaspik Choice Medicaid	$28.98
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$30.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$62.31
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$62.31
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$28.98
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$30.43

EAPG 3.18: LEVEL I IMMUNOLOGY TESTS

Facility

$22.70

Service Code	EAPG 394
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$22.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.67
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.56
Rate for Payer: EmblemHealth Medicaid	$10.56
Rate for Payer: Galaxy Health Workers Comp	$10.35
Rate for Payer: Hamaspik Choice Medicaid	$10.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$11.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$22.70
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$22.70
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.56
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$11.09

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

Facility

$6,719.76

Service Code	EAPG 218
Min. Negotiated Rate	$3,062.96
Max. Negotiated Rate	$6,719.76
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,750.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,125.47
Rate for Payer: EmblemHealth Medicaid	$3,125.47
Rate for Payer: Galaxy Health Workers Comp	$3,062.96
Rate for Payer: Hamaspik Choice Medicaid	$3,125.47
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,281.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,719.76
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,719.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,125.47
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,281.74

EAPG 3.18: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$1,166.84

Service Code	EAPG 220
Min. Negotiated Rate	$531.84
Max. Negotiated Rate	$1,166.84
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$651.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$542.71
Rate for Payer: EmblemHealth Medicaid	$542.71
Rate for Payer: Galaxy Health Workers Comp	$531.84
Rate for Payer: Hamaspik Choice Medicaid	$542.71
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$569.85
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,166.84
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,166.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$542.71
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$569.85

EAPG 3.18: LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$797.59

Service Code	EAPG 368
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 II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$3,619.71

Service Code	EAPG 208
Min. Negotiated Rate	$1,649.85
Max. Negotiated Rate	$3,619.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,020.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,683.57
Rate for Payer: EmblemHealth Medicaid	$1,683.57
Rate for Payer: Galaxy Health Workers Comp	$1,649.85
Rate for Payer: Hamaspik Choice Medicaid	$1,683.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,767.76
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,619.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,619.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,683.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,767.76

EAPG 3.18: LEVEL II PATHOLOGY TESTS

Facility

$150.26

Service Code	EAPG 391
Min. Negotiated Rate	$68.49
Max. Negotiated Rate	$150.26
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$83.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$69.89
Rate for Payer: EmblemHealth Medicaid	$69.89
Rate for Payer: Galaxy Health Workers Comp	$68.49
Rate for Payer: Hamaspik Choice Medicaid	$69.89
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$73.38
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$150.26
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$150.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$69.89
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$73.38

EAPG 3.18: LEVEL II PENILE PROCEDURES

Facility

$2,078.43

Service Code	EAPG 187
Min. Negotiated Rate	$947.34
Max. Negotiated Rate	$2,078.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,160.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$966.70
Rate for Payer: EmblemHealth Medicaid	$966.70
Rate for Payer: Galaxy Health Workers Comp	$947.34
Rate for Payer: Hamaspik Choice Medicaid	$966.70
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,015.04
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,078.43
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,078.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$966.70
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,015.04

EAPG 3.18: LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$5,754.06

Service Code	EAPG 121
Min. Negotiated Rate	$2,622.68
Max. Negotiated Rate	$5,754.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,211.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,676.28
Rate for Payer: EmblemHealth Medicaid	$2,676.28
Rate for Payer: Galaxy Health Workers Comp	$2,622.68
Rate for Payer: Hamaspik Choice Medicaid	$2,676.28
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,810.11
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,754.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,754.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,676.28
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,810.11

EAPG 3.18: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$3,063.35

Service Code	EAPG 189
Min. Negotiated Rate	$1,396.26
Max. Negotiated Rate	$3,063.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,709.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,424.80
Rate for Payer: EmblemHealth Medicaid	$1,424.80
Rate for Payer: Galaxy Health Workers Comp	$1,396.26
Rate for Payer: Hamaspik Choice Medicaid	$1,424.80
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,496.05
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,063.35
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,063.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,424.80
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,496.05

EAPG 3.18: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$5,598.93

Service Code	EAPG 79
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 II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$5,360.94

Service Code	EAPG 91
Min. Negotiated Rate	$2,443.50
Max. Negotiated Rate	$5,360.94
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,992.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,493.43
Rate for Payer: EmblemHealth Medicaid	$2,493.43
Rate for Payer: Galaxy Health Workers Comp	$2,443.50
Rate for Payer: Hamaspik Choice Medicaid	$2,493.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,618.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,360.94
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,360.94
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,493.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,618.12

EAPG 3.18: LEVEL II POSTERIOR SEGMENT EYE PROCEDURES

Facility

$5,825.09

Service Code	EAPG 238
Min. Negotiated Rate	$2,655.06
Max. Negotiated Rate	$5,825.09
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,251.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,709.31
Rate for Payer: EmblemHealth Medicaid	$2,709.31
Rate for Payer: Galaxy Health Workers Comp	$2,655.06
Rate for Payer: Hamaspik Choice Medicaid	$2,709.31
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,844.80
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,825.09
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,825.09
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,709.31
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,844.80

EAPG 3.18: LEVEL II PROSTATE PROCEDURES

Facility

$5,649.75

Service Code	EAPG 184
Min. Negotiated Rate	$2,575.14
Max. Negotiated Rate	$5,649.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,153.25
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,627.76
Rate for Payer: EmblemHealth Medicaid	$2,627.76
Rate for Payer: Galaxy Health Workers Comp	$2,575.14
Rate for Payer: Hamaspik Choice Medicaid	$2,627.76
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,759.17
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,649.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,649.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,627.76
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,759.17

EAPG 3.18: LEVEL II PROSTHODONTICS, FIXED

Facility

$654.22

Service Code	EAPG 354
Min. Negotiated Rate	$298.19
Max. Negotiated Rate	$654.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$365.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$304.28
Rate for Payer: EmblemHealth Medicaid	$304.28
Rate for Payer: Galaxy Health Workers Comp	$298.19
Rate for Payer: Hamaspik Choice Medicaid	$304.28
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$319.50
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$654.22
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$654.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$304.28
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$319.50

EAPG 3.18: LEVEL II PROSTHODONTICS, REMOVABLE

Facility

$678.16

Service Code	EAPG 357
Min. Negotiated Rate	$309.11
Max. Negotiated Rate	$678.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$378.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$315.42
Rate for Payer: EmblemHealth Medicaid	$315.42
Rate for Payer: Galaxy Health Workers Comp	$309.11
Rate for Payer: Hamaspik Choice Medicaid	$315.42
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$331.20
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$678.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$678.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$315.42
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$331.20

EAPG 3.18: LEVEL II RADIATION THERAPY

Facility

$336.62

Service Code	EAPG 347
Min. Negotiated Rate	$153.43
Max. Negotiated Rate	$336.62
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$187.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$156.57
Rate for Payer: EmblemHealth Medicaid	$156.57
Rate for Payer: Galaxy Health Workers Comp	$153.43
Rate for Payer: Hamaspik Choice Medicaid	$156.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$164.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$336.62
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$336.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$156.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$164.40

EAPG 3.18: LEVEL II RADIATION TREATMENT PREPARATION & PLANNING

Facility

$925.69

Service Code	EAPG 477
Min. Negotiated Rate	$421.93
Max. Negotiated Rate	$925.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$516.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$430.55
Rate for Payer: EmblemHealth Medicaid	$430.55
Rate for Payer: Galaxy Health Workers Comp	$421.93
Rate for Payer: Hamaspik Choice Medicaid	$430.55
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$452.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$925.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$925.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$430.55
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$452.08

Know your out-of-pocket cost for care.

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