Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$797.59

Service Code	EAPG 370
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: LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$296.15

Service Code	EAPG 804
Min. Negotiated Rate	$134.98
Max. Negotiated Rate	$296.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$165.29
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$137.74
Rate for Payer: EmblemHealth Medicaid	$137.74
Rate for Payer: Galaxy Health Workers Comp	$134.98
Rate for Payer: Hamaspik Choice Medicaid	$137.74
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$144.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$296.15
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$296.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$137.74
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$144.63

EAPG 3.18: LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$295.11

Service Code	EAPG 801
Min. Negotiated Rate	$134.51
Max. Negotiated Rate	$295.11
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$164.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$137.26
Rate for Payer: EmblemHealth Medicaid	$137.26
Rate for Payer: Galaxy Health Workers Comp	$134.51
Rate for Payer: Hamaspik Choice Medicaid	$137.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$144.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$295.11
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$295.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$137.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$144.12

EAPG 3.18: MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$1,059.67

Service Code	EAPG 282
Min. Negotiated Rate	$483.01
Max. Negotiated Rate	$1,059.67
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$591.44
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.87
Rate for Payer: EmblemHealth Medicaid	$492.87
Rate for Payer: Galaxy Health Workers Comp	$483.01
Rate for Payer: Hamaspik Choice Medicaid	$492.87
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$517.51
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,059.67
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,059.67
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$492.87
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$517.51

EAPG 3.18: MAGNETIC RESONANCE IMAGING WITH CONTRAST

Facility

$1,248.05

Service Code	EAPG 295
Min. Negotiated Rate	$568.88
Max. Negotiated Rate	$1,248.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$696.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$580.49
Rate for Payer: EmblemHealth Medicaid	$580.49
Rate for Payer: Galaxy Health Workers Comp	$568.88
Rate for Payer: Hamaspik Choice Medicaid	$580.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$609.51
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,248.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,248.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$580.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$609.51

EAPG 3.18: MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST

Facility

$827.49

Service Code	EAPG 293
Min. Negotiated Rate	$377.18
Max. Negotiated Rate	$827.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$461.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$384.88
Rate for Payer: EmblemHealth Medicaid	$384.88
Rate for Payer: Galaxy Health Workers Comp	$377.18
Rate for Payer: Hamaspik Choice Medicaid	$384.88
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$404.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$827.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$827.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$384.88
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$404.12

EAPG 3.18: MAGNETOCEPHALOGRAPHY

Facility

$1,122.86

Service Code	EAPG 297
Min. Negotiated Rate	$511.81
Max. Negotiated Rate	$1,122.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$626.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$522.26
Rate for Payer: EmblemHealth Medicaid	$522.26
Rate for Payer: Galaxy Health Workers Comp	$511.81
Rate for Payer: Hamaspik Choice Medicaid	$522.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$548.37
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,122.86
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,122.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$522.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$548.37

EAPG 3.18: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$325.59

Service Code	EAPG 580
Min. Negotiated Rate	$148.40
Max. Negotiated Rate	$325.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$181.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$151.44
Rate for Payer: EmblemHealth Medicaid	$151.44
Rate for Payer: Galaxy Health Workers Comp	$148.40
Rate for Payer: Hamaspik Choice Medicaid	$151.44
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$159.01
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$325.59
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$325.59
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$151.44
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$159.01

EAPG 3.18: MAJOR DEPRESSIVE DIAGNOSES AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$254.45

Service Code	EAPG 821
Min. Negotiated Rate	$115.98
Max. Negotiated Rate	$254.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$142.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$118.35
Rate for Payer: EmblemHealth Medicaid	$118.35
Rate for Payer: Galaxy Health Workers Comp	$115.98
Rate for Payer: Hamaspik Choice Medicaid	$118.35
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$124.26
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$254.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$254.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$118.35
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$124.26

EAPG 3.18: MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES

Facility

$5,360.94

Service Code	EAPG 106
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: MAJOR SIGNS, SYMPTOMS AND FINDINGS

Facility

$311.45

Service Code	EAPG 510
Min. Negotiated Rate	$141.96
Max. Negotiated Rate	$311.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$173.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.86
Rate for Payer: EmblemHealth Medicaid	$144.86
Rate for Payer: Galaxy Health Workers Comp	$141.96
Rate for Payer: Hamaspik Choice Medicaid	$144.86
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$152.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$311.45
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$311.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$144.86
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$152.10

EAPG 3.18: MAJOR SKIN DIAGNOSES

Facility

$252.49

Service Code	EAPG 671
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$252.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$140.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$117.43
Rate for Payer: EmblemHealth Medicaid	$117.43
Rate for Payer: Galaxy Health Workers Comp	$115.08
Rate for Payer: Hamaspik Choice Medicaid	$117.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$123.31
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$252.49
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$252.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$117.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$123.31

EAPG 3.18: MALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$291.58

Service Code	EAPG 744
Min. Negotiated Rate	$132.90
Max. Negotiated Rate	$291.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$162.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$135.61
Rate for Payer: EmblemHealth Medicaid	$135.61
Rate for Payer: Galaxy Health Workers Comp	$132.90
Rate for Payer: Hamaspik Choice Medicaid	$135.61
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$142.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$291.58
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$291.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$135.61
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$142.40

EAPG 3.18: MALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$266.21

Service Code	EAPG 740
Min. Negotiated Rate	$121.34
Max. Negotiated Rate	$266.21
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$148.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$123.82
Rate for Payer: EmblemHealth Medicaid	$123.82
Rate for Payer: Galaxy Health Workers Comp	$121.34
Rate for Payer: Hamaspik Choice Medicaid	$123.82
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$130.01
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$266.21
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$266.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$123.82
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$130.01

EAPG 3.18: MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$340.12

Service Code	EAPG 629
Min. Negotiated Rate	$155.03
Max. Negotiated Rate	$340.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$189.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$158.19
Rate for Payer: EmblemHealth Medicaid	$158.19
Rate for Payer: Galaxy Health Workers Comp	$155.03
Rate for Payer: Hamaspik Choice Medicaid	$158.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$166.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$340.12
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$340.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$158.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$166.10

EAPG 3.18: MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC

Facility

$270.55

Service Code	EAPG 537
Min. Negotiated Rate	$123.32
Max. Negotiated Rate	$270.55
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$151.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$125.84
Rate for Payer: EmblemHealth Medicaid	$125.84
Rate for Payer: Galaxy Health Workers Comp	$123.32
Rate for Payer: Hamaspik Choice Medicaid	$125.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$132.13
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$270.55
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$270.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$125.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$132.13

EAPG 3.18: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$441.51

Service Code	EAPG 725
Min. Negotiated Rate	$201.24
Max. Negotiated Rate	$441.51
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$246.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$205.35
Rate for Payer: EmblemHealth Medicaid	$205.35
Rate for Payer: Galaxy Health Workers Comp	$201.24
Rate for Payer: Hamaspik Choice Medicaid	$205.35
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$215.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$441.51
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$441.51
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$205.35
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$215.62

EAPG 3.18: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$333.16

Service Code	EAPG 659
Min. Negotiated Rate	$151.85
Max. Negotiated Rate	$333.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$185.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$154.96
Rate for Payer: EmblemHealth Medicaid	$154.96
Rate for Payer: Galaxy Health Workers Comp	$151.85
Rate for Payer: Hamaspik Choice Medicaid	$154.96
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$162.71
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$333.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$333.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$154.96
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$162.71

EAPG 3.18: MALFUNCTION, REACTION, OR COMPLICATION OF CARDIOVASCULAR DEVICE OR PROC

Facility

$314.52

Service Code	EAPG 589
Min. Negotiated Rate	$143.36
Max. Negotiated Rate	$314.52
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$175.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$146.29
Rate for Payer: EmblemHealth Medicaid	$146.29
Rate for Payer: Galaxy Health Workers Comp	$143.36
Rate for Payer: Hamaspik Choice Medicaid	$146.29
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$153.60
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$314.52
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$314.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$146.29
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$153.60

EAPG 3.18: MALFUNCTION, REACTION, OR COMPLICATION OF OCULAR DEVICE OR PROCEDURE

Facility

$323.86

Service Code	EAPG 558
Min. Negotiated Rate	$147.62
Max. Negotiated Rate	$323.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$180.75
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$150.63
Rate for Payer: EmblemHealth Medicaid	$150.63
Rate for Payer: Galaxy Health Workers Comp	$147.62
Rate for Payer: Hamaspik Choice Medicaid	$150.63
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$158.16
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$323.86
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$323.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$150.63
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$158.16

EAPG 3.18: MALFUNCTION, REACTION, OR COMPLICATION OF OTOLARYNGOLOGIC DEVICE OR PROCEDURE

Facility

$293.54

Service Code	EAPG 566
Min. Negotiated Rate	$133.79
Max. Negotiated Rate	$293.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$163.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$136.53
Rate for Payer: EmblemHealth Medicaid	$136.53
Rate for Payer: Galaxy Health Workers Comp	$133.79
Rate for Payer: Hamaspik Choice Medicaid	$136.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$143.35
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$293.54
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$293.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$136.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$143.35

EAPG 3.18: MALFUNCTION, REACTION, OR COMPLICATION OF PULMONARY DEVICE OR PROCEDURE

Facility

$318.71

Service Code	EAPG 583
Min. Negotiated Rate	$145.27
Max. Negotiated Rate	$318.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$177.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$148.24
Rate for Payer: EmblemHealth Medicaid	$148.24
Rate for Payer: Galaxy Health Workers Comp	$145.27
Rate for Payer: Hamaspik Choice Medicaid	$148.24
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$155.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$318.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$318.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$148.24
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$155.65

EAPG 3.18: MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS

Facility

$286.39

Service Code	EAPG 634
Min. Negotiated Rate	$130.53
Max. Negotiated Rate	$286.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$159.84
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$133.20
Rate for Payer: EmblemHealth Medicaid	$133.20
Rate for Payer: Galaxy Health Workers Comp	$130.53
Rate for Payer: Hamaspik Choice Medicaid	$133.20
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$139.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$286.39
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$286.39
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$133.20
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$139.86

EAPG 3.18: MALIGNANT BREAST DIAGNOSES

Facility

$248.99

Service Code	EAPG 672
Min. Negotiated Rate	$113.49
Max. Negotiated Rate	$248.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$138.97
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$115.81
Rate for Payer: EmblemHealth Medicaid	$115.81
Rate for Payer: Galaxy Health Workers Comp	$113.49
Rate for Payer: Hamaspik Choice Medicaid	$115.81
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$121.60
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$248.99
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$248.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$115.81
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$121.60

EAPG 3.18: MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DIAGNOSES

Facility

$275.66

Service Code	EAPG 690
Min. Negotiated Rate	$125.65
Max. Negotiated Rate	$275.66
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$153.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$128.21
Rate for Payer: EmblemHealth Medicaid	$128.21
Rate for Payer: Galaxy Health Workers Comp	$125.65
Rate for Payer: Hamaspik Choice Medicaid	$128.21
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$134.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$275.66
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$275.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$128.21
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$134.63

Know your out-of-pocket cost for care.

All Charges