Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I PENILE PROCEDURES

Facility

$1,983.95

Service Code	EAPG 183
Min. Negotiated Rate	$904.28
Max. Negotiated Rate	$1,983.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,107.29
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$922.76
Rate for Payer: EmblemHealth Medicaid	$922.76
Rate for Payer: Galaxy Health Workers Comp	$904.28
Rate for Payer: Hamaspik Choice Medicaid	$922.76
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$968.90
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,983.95
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,983.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$922.76
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$968.90

EAPG 3.18: LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$5,598.93

Service Code	EAPG 99
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 I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$2,716.93

Service Code	EAPG 188
Min. Negotiated Rate	$1,238.37
Max. Negotiated Rate	$2,716.93
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,516.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,263.67
Rate for Payer: EmblemHealth Medicaid	$1,263.67
Rate for Payer: Galaxy Health Workers Comp	$1,238.37
Rate for Payer: Hamaspik Choice Medicaid	$1,263.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,326.87
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,716.93
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,716.93
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,263.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,326.87

EAPG 3.18: LEVEL I PERIODONTICS

Facility

$312.60

Service Code	EAPG 352
Min. Negotiated Rate	$142.48
Max. Negotiated Rate	$312.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$174.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$145.39
Rate for Payer: EmblemHealth Medicaid	$145.39
Rate for Payer: Galaxy Health Workers Comp	$142.48
Rate for Payer: Hamaspik Choice Medicaid	$145.39
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$152.66
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$312.60
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$312.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$145.39
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$152.66

EAPG 3.18: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$4,642.65

Service Code	EAPG 77
Min. Negotiated Rate	$2,116.10
Max. Negotiated Rate	$4,642.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,591.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,159.34
Rate for Payer: EmblemHealth Medicaid	$2,159.34
Rate for Payer: Galaxy Health Workers Comp	$2,116.10
Rate for Payer: Hamaspik Choice Medicaid	$2,159.34
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,267.33
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,642.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,642.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,159.34
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,267.33

EAPG 3.18: LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$5,360.94

Service Code	EAPG 78
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 I POSTERIOR SEGMENT EYE PROCEDURES

Facility

$1,218.69

Service Code	EAPG 237
Min. Negotiated Rate	$555.47
Max. Negotiated Rate	$1,218.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$680.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$566.83
Rate for Payer: EmblemHealth Medicaid	$566.83
Rate for Payer: Galaxy Health Workers Comp	$555.47
Rate for Payer: Hamaspik Choice Medicaid	$566.83
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$595.17
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,218.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,218.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$566.83
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$595.17

EAPG 3.18: LEVEL I PROSTATE PROCEDURES

Facility

$4,176.69

Service Code	EAPG 176
Min. Negotiated Rate	$1,903.72
Max. Negotiated Rate	$4,176.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,331.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,942.62
Rate for Payer: EmblemHealth Medicaid	$1,942.62
Rate for Payer: Galaxy Health Workers Comp	$1,903.72
Rate for Payer: Hamaspik Choice Medicaid	$1,942.62
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,039.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,176.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,176.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,942.62
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,039.77

EAPG 3.18: LEVEL I PROSTHODONTICS, FIXED

Facility

$174.88

Service Code	EAPG 353
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$174.88
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$97.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$81.34
Rate for Payer: EmblemHealth Medicaid	$81.34
Rate for Payer: Galaxy Health Workers Comp	$79.71
Rate for Payer: Hamaspik Choice Medicaid	$81.34
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$85.41
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$174.88
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$174.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$81.34
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$85.41

EAPG 3.18: LEVEL I PROSTHODONTICS, REMOVABLE

Facility

$354.42

Service Code	EAPG 356
Min. Negotiated Rate	$161.54
Max. Negotiated Rate	$354.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$197.81
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$164.84
Rate for Payer: EmblemHealth Medicaid	$164.84
Rate for Payer: Galaxy Health Workers Comp	$161.54
Rate for Payer: Hamaspik Choice Medicaid	$164.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$173.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$354.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$354.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$164.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$173.09

EAPG 3.18: LEVEL I RADIATION THERAPY

Facility

$731.36

Service Code	EAPG 343
Min. Negotiated Rate	$333.35
Max. Negotiated Rate	$731.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$408.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$340.16
Rate for Payer: EmblemHealth Medicaid	$340.16
Rate for Payer: Galaxy Health Workers Comp	$333.35
Rate for Payer: Hamaspik Choice Medicaid	$340.16
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$357.17
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$731.36
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$731.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$340.16
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$357.17

EAPG 3.18: LEVEL I RADIATION TREATMENT PREPARATION & PLANNING

Facility

$980.16

Service Code	EAPG 476
Min. Negotiated Rate	$446.75
Max. Negotiated Rate	$980.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$547.05
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$455.88
Rate for Payer: EmblemHealth Medicaid	$455.88
Rate for Payer: Galaxy Health Workers Comp	$446.75
Rate for Payer: Hamaspik Choice Medicaid	$455.88
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$478.68
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$980.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$980.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$455.88
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$478.68

EAPG 3.18: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$1,605.32

Service Code	EAPG 240
Min. Negotiated Rate	$731.70
Max. Negotiated Rate	$1,605.32
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$895.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$746.65
Rate for Payer: EmblemHealth Medicaid	$746.65
Rate for Payer: Galaxy Health Workers Comp	$731.70
Rate for Payer: Hamaspik Choice Medicaid	$746.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$783.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,605.32
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,605.32
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$746.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$783.99

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

Facility

$1,320.70

Service Code	EAPG 9
Min. Negotiated Rate	$601.97
Max. Negotiated Rate	$1,320.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$737.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$614.27
Rate for Payer: EmblemHealth Medicaid	$614.27
Rate for Payer: Galaxy Health Workers Comp	$601.97
Rate for Payer: Hamaspik Choice Medicaid	$614.27
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$644.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,320.70
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,320.70
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$614.27
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$644.99

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

Facility

$675.13

Service Code	EAPG 3
Min. Negotiated Rate	$307.72
Max. Negotiated Rate	$675.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$376.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$314.01
Rate for Payer: EmblemHealth Medicaid	$314.01
Rate for Payer: Galaxy Health Workers Comp	$307.72
Rate for Payer: Hamaspik Choice Medicaid	$314.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$329.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$675.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$675.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$314.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$329.71

EAPG 3.18: LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$4,822.80

Service Code	EAPG 127
Min. Negotiated Rate	$2,198.21
Max. Negotiated Rate	$4,822.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,691.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,243.13
Rate for Payer: EmblemHealth Medicaid	$2,243.13
Rate for Payer: Galaxy Health Workers Comp	$2,198.21
Rate for Payer: Hamaspik Choice Medicaid	$2,243.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,355.31
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,822.80
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,822.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,243.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,355.31

EAPG 3.18: LEVEL I SPINE PROCEDURES

Facility

$6,768.66

Service Code	EAPG 28
Min. Negotiated Rate	$3,085.13
Max. Negotiated Rate	$6,768.66
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,777.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,148.18
Rate for Payer: EmblemHealth Medicaid	$3,148.18
Rate for Payer: Galaxy Health Workers Comp	$3,085.13
Rate for Payer: Hamaspik Choice Medicaid	$3,148.18
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,305.61
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$6,768.66
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$6,768.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,148.18
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,305.61

EAPG 3.18: LEVEL I SURGICAL PATHOLOGY TESTS

Facility

$118.92

Service Code	EAPG 305
Min. Negotiated Rate	$54.20
Max. Negotiated Rate	$118.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$66.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$55.31
Rate for Payer: EmblemHealth Medicaid	$55.31
Rate for Payer: Galaxy Health Workers Comp	$54.20
Rate for Payer: Hamaspik Choice Medicaid	$55.31
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$58.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$118.92
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$118.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$55.31
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$58.08

EAPG 3.18: LEVEL I THORACIC AND CHEST PROCEDURES

Facility

$3,766.69

Service Code	EAPG 69
Min. Negotiated Rate	$1,716.84
Max. Negotiated Rate	$3,766.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,102.27
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,751.93
Rate for Payer: EmblemHealth Medicaid	$1,751.93
Rate for Payer: Galaxy Health Workers Comp	$1,716.84
Rate for Payer: Hamaspik Choice Medicaid	$1,751.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,839.54
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,766.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,766.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,751.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,839.54

EAPG 3.18: LEVEL I UPPER GI ENDOSCOPY

Facility

$1,689.45

Service Code	EAPG 134
Min. Negotiated Rate	$770.05
Max. Negotiated Rate	$1,689.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$942.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$785.78
Rate for Payer: EmblemHealth Medicaid	$785.78
Rate for Payer: Galaxy Health Workers Comp	$770.05
Rate for Payer: Hamaspik Choice Medicaid	$785.78
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$825.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,689.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,689.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$785.78
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$825.08

EAPG 3.18: LEVEL I URETHRAL PROCEDURES

Facility

$2,104.79

Service Code	EAPG 166
Min. Negotiated Rate	$959.36
Max. Negotiated Rate	$2,104.79
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,174.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$978.96
Rate for Payer: EmblemHealth Medicaid	$978.96
Rate for Payer: Galaxy Health Workers Comp	$959.36
Rate for Payer: Hamaspik Choice Medicaid	$978.96
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,027.92
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,104.79
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,104.79
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$978.96
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,027.92

EAPG 3.18: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES

Facility

$2,197.27

Service Code	EAPG 90
Min. Negotiated Rate	$1,001.51
Max. Negotiated Rate	$2,197.27
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,226.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,021.97
Rate for Payer: EmblemHealth Medicaid	$1,021.97
Rate for Payer: Galaxy Health Workers Comp	$1,001.51
Rate for Payer: Hamaspik Choice Medicaid	$1,021.97
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,073.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,197.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,197.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,021.97
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,073.08

EAPG 3.18: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES

Facility

$669.21

Service Code	EAPG 277
Min. Negotiated Rate	$305.02
Max. Negotiated Rate	$669.21
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$373.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$311.26
Rate for Payer: EmblemHealth Medicaid	$311.26
Rate for Payer: Galaxy Health Workers Comp	$305.02
Rate for Payer: Hamaspik Choice Medicaid	$311.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$326.82
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$669.21
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$669.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$311.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$326.82

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

Facility

$7,170.77

Service Code	EAPG 255
Min. Negotiated Rate	$3,268.41
Max. Negotiated Rate	$7,170.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,002.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,335.20
Rate for Payer: EmblemHealth Medicaid	$3,335.20
Rate for Payer: Galaxy Health Workers Comp	$3,268.41
Rate for Payer: Hamaspik Choice Medicaid	$3,335.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$3,501.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$7,170.77
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$7,170.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,335.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$3,501.99

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

Facility

$35,829.75

Service Code	EAPG 224
Min. Negotiated Rate	$16,331.70
Max. Negotiated Rate	$35,829.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$19,998.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16,665.00
Rate for Payer: EmblemHealth Medicaid	$16,665.00
Rate for Payer: Galaxy Health Workers Comp	$16,331.70
Rate for Payer: Hamaspik Choice Medicaid	$16,665.00
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$17,498.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$35,829.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$35,829.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16,665.00
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$17,498.25

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