Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: MAMMOGRAPHY & OTHER RELATED PROCEDURES

Facility

$232.35

Service Code	EAPG 286
Min. Negotiated Rate	$105.91
Max. Negotiated Rate	$232.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$129.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$108.07
Rate for Payer: EmblemHealth Medicaid	$108.07
Rate for Payer: Galaxy Health Workers Comp	$105.91
Rate for Payer: Hamaspik Choice Medicaid	$108.07
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.47
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$232.35
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$232.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$108.07
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$113.47

EAPG 3.18: MEDICATION ADMINISTRATION & OBSERVATION

Facility

$45.32

Service Code	EAPG 322
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$45.32
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.29
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$21.08
Rate for Payer: EmblemHealth Medicaid	$21.08
Rate for Payer: Galaxy Health Workers Comp	$20.65
Rate for Payer: Hamaspik Choice Medicaid	$21.08
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$22.13
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$45.32
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$45.32
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$21.08
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$22.13

EAPG 3.18: MIGRAINE

Facility

$307.87

Service Code	EAPG 531
Min. Negotiated Rate	$140.33
Max. Negotiated Rate	$307.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$171.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.19
Rate for Payer: EmblemHealth Medicaid	$143.19
Rate for Payer: Galaxy Health Workers Comp	$140.33
Rate for Payer: Hamaspik Choice Medicaid	$143.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$150.36
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$307.87
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$307.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$143.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$150.36

EAPG 3.18: MINOR AUDIOMETRIC TESTS AND SCREENING SERVICES

Facility

$169.46

Service Code	EAPG 229
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$169.46
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$94.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$78.82
Rate for Payer: EmblemHealth Medicaid	$78.82
Rate for Payer: Galaxy Health Workers Comp	$77.24
Rate for Payer: Hamaspik Choice Medicaid	$78.82
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$82.76
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$169.46
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$169.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$78.82
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$82.76

EAPG 3.18: MINOR DERMATOLOGY SERVICES

Facility

$89.33

Service Code	EAPG 177
Min. Negotiated Rate	$40.71
Max. Negotiated Rate	$89.33
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$49.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$41.55
Rate for Payer: EmblemHealth Medicaid	$41.55
Rate for Payer: Galaxy Health Workers Comp	$40.71
Rate for Payer: Hamaspik Choice Medicaid	$41.55
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$43.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$89.33
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$89.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$41.55
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$43.62

EAPG 3.18: MINOR DEVICE EVALUATION AND INTERROGATION

Facility

$174.65

Service Code	EAPG 488
Min. Negotiated Rate	$79.61
Max. Negotiated Rate	$174.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$97.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$81.23
Rate for Payer: EmblemHealth Medicaid	$81.23
Rate for Payer: Galaxy Health Workers Comp	$79.61
Rate for Payer: Hamaspik Choice Medicaid	$81.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$85.30
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$174.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$174.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$81.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$85.30

EAPG 3.18: MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$280.89

Service Code	EAPG 249
Min. Negotiated Rate	$128.03
Max. Negotiated Rate	$280.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$156.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$130.65
Rate for Payer: EmblemHealth Medicaid	$130.65
Rate for Payer: Galaxy Health Workers Comp	$128.03
Rate for Payer: Hamaspik Choice Medicaid	$130.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$137.18
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$280.89
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$280.89
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$130.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$137.18

EAPG 3.18: MINOR FEMALE REPRODUCTIVE PROCEDURES

Facility

$309.06

Service Code	EAPG 417
Min. Negotiated Rate	$140.87
Max. Negotiated Rate	$309.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$172.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.75
Rate for Payer: EmblemHealth Medicaid	$143.75
Rate for Payer: Galaxy Health Workers Comp	$140.87
Rate for Payer: Hamaspik Choice Medicaid	$143.75
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$150.94
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$309.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$309.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$143.75
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$150.94

EAPG 3.18: MINOR MUSCULOSKELETAL PROCEDURES

Facility

$991.65

Service Code	EAPG 2030
Min. Negotiated Rate	$451.99
Max. Negotiated Rate	$991.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$553.46
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$461.23
Rate for Payer: EmblemHealth Medicaid	$461.23
Rate for Payer: Galaxy Health Workers Comp	$451.99
Rate for Payer: Hamaspik Choice Medicaid	$461.23
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$484.29
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$991.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$991.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$461.23
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$484.29

EAPG 3.18: MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS

Facility

$190.34

Service Code	EAPG 419
Min. Negotiated Rate	$86.75
Max. Negotiated Rate	$190.34
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$106.23
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$88.53
Rate for Payer: EmblemHealth Medicaid	$88.53
Rate for Payer: Galaxy Health Workers Comp	$86.75
Rate for Payer: Hamaspik Choice Medicaid	$88.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$92.95
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$190.34
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$190.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$88.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$92.95

EAPG 3.18: MINOR PULMONARY TESTS AND SERVICES

Facility

$155.09

Service Code	EAPG 412
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$155.09
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$86.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$72.13
Rate for Payer: EmblemHealth Medicaid	$72.13
Rate for Payer: Galaxy Health Workers Comp	$70.69
Rate for Payer: Hamaspik Choice Medicaid	$72.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$75.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$155.09
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$155.09
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$72.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$75.74

EAPG 3.18: MINOR SPECIMEN COLLECTION SERVICES

Facility

$83.48

Service Code	EAPG 304
Min. Negotiated Rate	$38.05
Max. Negotiated Rate	$83.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$46.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$38.83
Rate for Payer: EmblemHealth Medicaid	$38.83
Rate for Payer: Galaxy Health Workers Comp	$38.05
Rate for Payer: Hamaspik Choice Medicaid	$38.83
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$40.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$83.48
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$83.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$38.83
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$40.77

EAPG 3.18: MINOR SPLINT AND STRAPPING APPLICATION

Facility

$444.78

Service Code	EAPG 40
Min. Negotiated Rate	$202.73
Max. Negotiated Rate	$444.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$248.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$206.87
Rate for Payer: EmblemHealth Medicaid	$206.87
Rate for Payer: Galaxy Health Workers Comp	$202.73
Rate for Payer: Hamaspik Choice Medicaid	$206.87
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$217.22
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$444.78
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$444.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$206.87
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$217.22

EAPG 3.18: MINOR UROLOGY SERVICES

Facility

$820.95

Service Code	EAPG 159
Min. Negotiated Rate	$374.19
Max. Negotiated Rate	$820.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$458.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$381.83
Rate for Payer: EmblemHealth Medicaid	$381.83
Rate for Payer: Galaxy Health Workers Comp	$374.19
Rate for Payer: Hamaspik Choice Medicaid	$381.83
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$400.93
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$820.95
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$820.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$381.83
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$400.93

EAPG 3.18: MOHS MICROGRAPHIC SURGERY

Facility

$2,593.51

Service Code	EAPG 19
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: MRI GUIDANCE

Facility

$549.71

Service Code	EAPG 475
Min. Negotiated Rate	$250.56
Max. Negotiated Rate	$549.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$306.81
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$255.68
Rate for Payer: EmblemHealth Medicaid	$255.68
Rate for Payer: Galaxy Health Workers Comp	$250.56
Rate for Payer: Hamaspik Choice Medicaid	$255.68
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$268.46
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$549.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$549.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$255.68
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$268.46

EAPG 3.18: MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES

Facility

$256.25

Service Code	EAPG 523
Min. Negotiated Rate	$116.80
Max. Negotiated Rate	$256.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$119.19
Rate for Payer: EmblemHealth Medicaid	$119.19
Rate for Payer: Galaxy Health Workers Comp	$116.80
Rate for Payer: Hamaspik Choice Medicaid	$119.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$125.15
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$256.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$256.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$119.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$125.15

EAPG 3.18: MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES

Facility

$2,251.73

Service Code	EAPG 51
Min. Negotiated Rate	$1,026.33
Max. Negotiated Rate	$2,251.73
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,256.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,047.31
Rate for Payer: EmblemHealth Medicaid	$1,047.31
Rate for Payer: Galaxy Health Workers Comp	$1,026.33
Rate for Payer: Hamaspik Choice Medicaid	$1,047.31
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,099.68
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,251.73
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,251.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,047.31
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,099.68

EAPG 3.18: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY

Facility

$327.82

Service Code	EAPG 653
Min. Negotiated Rate	$149.42
Max. Negotiated Rate	$327.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$182.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$152.47
Rate for Payer: EmblemHealth Medicaid	$152.47
Rate for Payer: Galaxy Health Workers Comp	$149.42
Rate for Payer: Hamaspik Choice Medicaid	$152.47
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$160.10
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$327.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$327.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$152.47
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$160.10

EAPG 3.18: MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES

Facility

$1,250.13

Service Code	EAPG 284
Min. Negotiated Rate	$569.81
Max. Negotiated Rate	$1,250.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$697.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$581.45
Rate for Payer: EmblemHealth Medicaid	$581.45
Rate for Payer: Galaxy Health Workers Comp	$569.81
Rate for Payer: Hamaspik Choice Medicaid	$581.45
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$610.53
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,250.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,250.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$581.45
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$610.53

EAPG 3.18: NAIL PROCEDURES

Facility

$192.53

Service Code	EAPG 5
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$192.53
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$107.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$89.55
Rate for Payer: EmblemHealth Medicaid	$89.55
Rate for Payer: Galaxy Health Workers Comp	$87.75
Rate for Payer: Hamaspik Choice Medicaid	$89.55
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$94.02
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$192.53
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$192.53
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$89.55
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$94.02

EAPG 3.18: NEEDLE AND CATHETER BIOPSY, ASPIRATION, LAVAGE AND INTUBATION

Facility

$1,264.51

Service Code	EAPG 61
Min. Negotiated Rate	$576.36
Max. Negotiated Rate	$1,264.51
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$705.75
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$588.14
Rate for Payer: EmblemHealth Medicaid	$588.14
Rate for Payer: Galaxy Health Workers Comp	$576.36
Rate for Payer: Hamaspik Choice Medicaid	$588.14
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$617.55
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,264.51
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,264.51
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$588.14
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$617.55

EAPG 3.18: NEONATAL AFTERCARE

Facility

$285.43

Service Code	EAPG 873
Min. Negotiated Rate	$130.10
Max. Negotiated Rate	$285.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$159.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$132.75
Rate for Payer: EmblemHealth Medicaid	$132.75
Rate for Payer: Galaxy Health Workers Comp	$130.10
Rate for Payer: Hamaspik Choice Medicaid	$132.75
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$139.39
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$285.43
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$285.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$132.75
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$139.39

EAPG 3.18: NEONATAL DIAGNOSES

Facility

$297.15

Service Code	EAPG 771
Min. Negotiated Rate	$135.44
Max. Negotiated Rate	$297.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$165.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$138.21
Rate for Payer: EmblemHealth Medicaid	$138.21
Rate for Payer: Galaxy Health Workers Comp	$135.44
Rate for Payer: Hamaspik Choice Medicaid	$138.21
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$145.12
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$297.15
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$297.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$138.21
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$145.12

EAPG 3.18: NEPHRITIS AND NEPHROSIS

Facility

$284.85

Service Code	EAPG 722
Min. Negotiated Rate	$129.83
Max. Negotiated Rate	$284.85
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$158.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$132.49
Rate for Payer: EmblemHealth Medicaid	$132.49
Rate for Payer: Galaxy Health Workers Comp	$129.83
Rate for Payer: Hamaspik Choice Medicaid	$132.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$139.11
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$284.85
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$284.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$132.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$139.11

Know your out-of-pocket cost for care.

All Charges