Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$4,001.57

Service Code	EAPG 241
Min. Negotiated Rate	$1,823.90
Max. Negotiated Rate	$4,001.57
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,233.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,861.17
Rate for Payer: EmblemHealth Medicaid	$1,861.17
Rate for Payer: Galaxy Health Workers Comp	$1,823.90
Rate for Payer: Hamaspik Choice Medicaid	$1,861.17
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,954.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,001.57
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,001.57
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,861.17
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,954.25

EAPG 3.18: LEVEL II SHOULDER AND UPPER ARM PROCEDURES

Facility

$4,778.86

Service Code	EAPG 58
Min. Negotiated Rate	$2,178.19
Max. Negotiated Rate	$4,778.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,667.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,222.70
Rate for Payer: EmblemHealth Medicaid	$2,222.70
Rate for Payer: Galaxy Health Workers Comp	$2,178.19
Rate for Payer: Hamaspik Choice Medicaid	$2,222.70
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,333.85
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,778.86
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,778.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,222.70
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,333.85

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

Facility

$2,593.51

Service Code	EAPG 10
Min. Negotiated Rate	$1,182.11
Max. Negotiated Rate	$2,593.51
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,447.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,206.27
Rate for Payer: EmblemHealth Medicaid	$1,206.27
Rate for Payer: Galaxy Health Workers Comp	$1,182.11
Rate for Payer: Hamaspik Choice Medicaid	$1,206.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,266.59
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,593.51
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,593.51
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,206.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,266.59

EAPG 3.18: LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$1,277.80

Service Code	EAPG 4
Min. Negotiated Rate	$582.42
Max. Negotiated Rate	$1,277.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$713.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$594.32
Rate for Payer: EmblemHealth Medicaid	$594.32
Rate for Payer: Galaxy Health Workers Comp	$582.42
Rate for Payer: Hamaspik Choice Medicaid	$594.32
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$624.04
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,277.80
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,277.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$594.32
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$624.04

EAPG 3.18: LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$5,290.37

Service Code	EAPG 128
Min. Negotiated Rate	$2,411.33
Max. Negotiated Rate	$5,290.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,952.67
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,460.61
Rate for Payer: EmblemHealth Medicaid	$2,460.61
Rate for Payer: Galaxy Health Workers Comp	$2,411.33
Rate for Payer: Hamaspik Choice Medicaid	$2,460.61
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,583.66
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,290.37
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,290.37
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,460.61
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,583.66

EAPG 3.18: LEVEL II SPINE PROCEDURES

Facility

$8,209.12

Service Code	EAPG 29
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 II SURGICAL PATHOLOGY TESTS

Facility

$167.58

Service Code	EAPG 306
Min. Negotiated Rate	$76.38
Max. Negotiated Rate	$167.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$93.53
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$77.94
Rate for Payer: EmblemHealth Medicaid	$77.94
Rate for Payer: Galaxy Health Workers Comp	$76.38
Rate for Payer: Hamaspik Choice Medicaid	$77.94
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$81.84
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$167.58
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$167.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$77.94
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$81.84

EAPG 3.18: LEVEL II THORACIC AND CHEST PROCEDURES

Facility

$4,888.41

Service Code	EAPG 70
Min. Negotiated Rate	$2,228.12
Max. Negotiated Rate	$4,888.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,728.33
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,273.65
Rate for Payer: EmblemHealth Medicaid	$2,273.65
Rate for Payer: Galaxy Health Workers Comp	$2,228.12
Rate for Payer: Hamaspik Choice Medicaid	$2,273.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,387.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,888.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,888.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,273.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,387.35

EAPG 3.18: LEVEL II UPPER GI ENDOSCOPY

Facility

$1,932.33

Service Code	EAPG 135
Min. Negotiated Rate	$880.75
Max. Negotiated Rate	$1,932.33
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,078.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$898.75
Rate for Payer: EmblemHealth Medicaid	$898.75
Rate for Payer: Galaxy Health Workers Comp	$880.75
Rate for Payer: Hamaspik Choice Medicaid	$898.75
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$943.69
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,932.33
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,932.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$898.75
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$943.69

EAPG 3.18: LEVEL II URETHRAL PROCEDURES

Facility

$5,309.55

Service Code	EAPG 167
Min. Negotiated Rate	$2,420.07
Max. Negotiated Rate	$5,309.55
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,963.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,469.53
Rate for Payer: EmblemHealth Medicaid	$2,469.53
Rate for Payer: Galaxy Health Workers Comp	$2,420.07
Rate for Payer: Hamaspik Choice Medicaid	$2,469.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,593.03
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,309.55
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,309.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,469.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,593.03

EAPG 3.18: LEVEL II VARICOSE VEIN AND RELATED PROCEDURES

Facility

$5,027.93

Service Code	EAPG 103
Min. Negotiated Rate	$2,291.71
Max. Negotiated Rate	$5,027.93
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,806.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,338.54
Rate for Payer: EmblemHealth Medicaid	$2,338.54
Rate for Payer: Galaxy Health Workers Comp	$2,291.71
Rate for Payer: Hamaspik Choice Medicaid	$2,338.54
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,455.49
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,027.93
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,027.93
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,338.54
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,455.49

EAPG 3.18: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$743.58

Service Code	EAPG 279
Min. Negotiated Rate	$338.92
Max. Negotiated Rate	$743.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$415.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$345.85
Rate for Payer: EmblemHealth Medicaid	$345.85
Rate for Payer: Galaxy Health Workers Comp	$338.92
Rate for Payer: Hamaspik Choice Medicaid	$345.85
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$363.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$743.58
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$743.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$345.85
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$363.14

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

Facility

$614.82

Service Code	EAPG 49
Min. Negotiated Rate	$280.23
Max. Negotiated Rate	$614.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$343.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$285.96
Rate for Payer: EmblemHealth Medicaid	$285.96
Rate for Payer: Galaxy Health Workers Comp	$280.23
Rate for Payer: Hamaspik Choice Medicaid	$285.96
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$300.26
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$614.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$614.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$285.96
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$300.26

EAPG 3.18: LEVEL I KIDNEY AND URETERAL PROCEDURES

Facility

$2,300.20

Service Code	EAPG 170
Min. Negotiated Rate	$1,048.42
Max. Negotiated Rate	$2,300.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,283.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,069.85
Rate for Payer: EmblemHealth Medicaid	$1,069.85
Rate for Payer: Galaxy Health Workers Comp	$1,048.42
Rate for Payer: Hamaspik Choice Medicaid	$1,069.85
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,123.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,300.20
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,300.20
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,069.85
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,123.35

EAPG 3.18: LEVEL I KNEE AND LOWER LEG PROCEDURES

Facility

$3,681.17

Service Code	EAPG 26
Min. Negotiated Rate	$1,677.86
Max. Negotiated Rate	$3,681.17
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,054.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,712.15
Rate for Payer: EmblemHealth Medicaid	$1,712.15
Rate for Payer: Galaxy Health Workers Comp	$1,677.86
Rate for Payer: Hamaspik Choice Medicaid	$1,712.15
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,797.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,681.17
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,681.17
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,712.15
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,797.77

EAPG 3.18: LEVEL I LAPAROSCOPY

Facility

$3,898.29

Service Code	EAPG 145
Min. Negotiated Rate	$1,776.83
Max. Negotiated Rate	$3,898.29
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,175.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,813.14
Rate for Payer: EmblemHealth Medicaid	$1,813.14
Rate for Payer: Galaxy Health Workers Comp	$1,776.83
Rate for Payer: Hamaspik Choice Medicaid	$1,813.14
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,903.81
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,898.29
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,898.29
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,813.14
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,903.81

EAPG 3.18: LEVEL I LOWER AIRWAY ENDOSCOPY

Facility

$2,457.83

Service Code	EAPG 64
Min. Negotiated Rate	$1,120.27
Max. Negotiated Rate	$2,457.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,371.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,143.16
Rate for Payer: EmblemHealth Medicaid	$1,143.16
Rate for Payer: Galaxy Health Workers Comp	$1,120.27
Rate for Payer: Hamaspik Choice Medicaid	$1,143.16
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,200.33
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,457.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,457.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,143.16
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,200.33

EAPG 3.18: LEVEL I LOWER GI ENDOSCOPY

Facility

$1,622.92

Service Code	EAPG 136
Min. Negotiated Rate	$739.72
Max. Negotiated Rate	$1,622.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$905.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$754.84
Rate for Payer: EmblemHealth Medicaid	$754.84
Rate for Payer: Galaxy Health Workers Comp	$739.72
Rate for Payer: Hamaspik Choice Medicaid	$754.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$792.59
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,622.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,622.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$754.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$792.59

EAPG 3.18: LEVEL I MAXILLOFACIAL PROSTHETICS

Facility

$98.47

Service Code	EAPG 359
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$98.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$54.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$45.80
Rate for Payer: EmblemHealth Medicaid	$45.80
Rate for Payer: Galaxy Health Workers Comp	$44.88
Rate for Payer: Hamaspik Choice Medicaid	$45.80
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$48.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$98.47
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$98.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$45.80
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$48.09

EAPG 3.18: LEVEL I MICROBIOLOGY TESTS

Facility

$21.01

Service Code	EAPG 396
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$21.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$11.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.77
Rate for Payer: EmblemHealth Medicaid	$9.77
Rate for Payer: Galaxy Health Workers Comp	$9.57
Rate for Payer: Hamaspik Choice Medicaid	$9.77
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$10.26
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$21.01
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$21.01
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.77
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$10.26

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

Facility

$2,783.38

Service Code	EAPG 217
Min. Negotiated Rate	$1,268.66
Max. Negotiated Rate	$2,783.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,553.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,294.58
Rate for Payer: EmblemHealth Medicaid	$1,294.58
Rate for Payer: Galaxy Health Workers Comp	$1,268.66
Rate for Payer: Hamaspik Choice Medicaid	$1,294.58
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,359.32
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,783.38
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,783.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,294.58
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,359.32

EAPG 3.18: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$971.39

Service Code	EAPG 214
Min. Negotiated Rate	$442.76
Max. Negotiated Rate	$971.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$542.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$451.81
Rate for Payer: EmblemHealth Medicaid	$451.81
Rate for Payer: Galaxy Health Workers Comp	$442.76
Rate for Payer: Hamaspik Choice Medicaid	$451.81
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$474.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$971.39
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$971.39
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$451.81
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$474.40

EAPG 3.18: LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$287.92

Service Code	EAPG 367
Min. Negotiated Rate	$131.23
Max. Negotiated Rate	$287.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$160.70
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$133.92
Rate for Payer: EmblemHealth Medicaid	$133.92
Rate for Payer: Galaxy Health Workers Comp	$131.23
Rate for Payer: Hamaspik Choice Medicaid	$133.92
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$140.61
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$287.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$287.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$133.92
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$140.61

EAPG 3.18: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$2,929.44

Service Code	EAPG 207
Min. Negotiated Rate	$1,335.23
Max. Negotiated Rate	$2,929.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,634.99
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,362.51
Rate for Payer: EmblemHealth Medicaid	$1,362.51
Rate for Payer: Galaxy Health Workers Comp	$1,335.23
Rate for Payer: Hamaspik Choice Medicaid	$1,362.51
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,430.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,929.44
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,929.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,362.51
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,430.65

EAPG 3.18: LEVEL I PATHOLOGY TESTS

Facility

$80.75

Service Code	EAPG 390
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$80.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$45.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$37.56
Rate for Payer: EmblemHealth Medicaid	$37.56
Rate for Payer: Galaxy Health Workers Comp	$36.81
Rate for Payer: Hamaspik Choice Medicaid	$37.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$39.44
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$80.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$80.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$37.56
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$39.44

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