Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: POISONING OF MEDICINAL AGENTS

Facility

$385.78

Service Code	EAPG 851
Min. Negotiated Rate	$175.84
Max. Negotiated Rate	$385.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$215.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$179.43
Rate for Payer: EmblemHealth Medicaid	$179.43
Rate for Payer: Galaxy Health Workers Comp	$175.84
Rate for Payer: Hamaspik Choice Medicaid	$179.43
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$188.40
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$385.78
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$385.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$179.43
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$188.40

EAPG 3.18: POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS AND COMPLICATIONS

Facility

$299.42

Service Code	EAPG 806
Min. Negotiated Rate	$136.47
Max. Negotiated Rate	$299.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$167.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$139.26
Rate for Payer: EmblemHealth Medicaid	$139.26
Rate for Payer: Galaxy Health Workers Comp	$136.47
Rate for Payer: Hamaspik Choice Medicaid	$139.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$146.23
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$299.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$299.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$139.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$146.23

EAPG 3.18: POSTPARTUM AND POST ABORTION DIAGNOSES

Facility

$277.05

Service Code	EAPG 761
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$277.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$154.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$128.86
Rate for Payer: EmblemHealth Medicaid	$128.86
Rate for Payer: Galaxy Health Workers Comp	$126.28
Rate for Payer: Hamaspik Choice Medicaid	$128.86
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$135.30
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$277.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$277.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$128.86
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$135.30

EAPG 3.18: PRESSURE ULCERS

Facility

$306.10

Service Code	EAPG 676
Min. Negotiated Rate	$139.52
Max. Negotiated Rate	$306.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$170.84
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$142.37
Rate for Payer: EmblemHealth Medicaid	$142.37
Rate for Payer: Galaxy Health Workers Comp	$139.52
Rate for Payer: Hamaspik Choice Medicaid	$142.37
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$149.49
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$306.10
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$306.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$142.37
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$149.49

EAPG 3.18: PRETERM LABOR DIAGNOSES

Facility

$355.99

Service Code	EAPG 762
Min. Negotiated Rate	$162.26
Max. Negotiated Rate	$355.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$198.69
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$165.58
Rate for Payer: EmblemHealth Medicaid	$165.58
Rate for Payer: Galaxy Health Workers Comp	$162.26
Rate for Payer: Hamaspik Choice Medicaid	$165.58
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$173.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$355.99
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$355.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$165.58
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$173.86

EAPG 3.18: PREVENTIVE DENTAL PROCEDURES

Facility

$125.42

Service Code	EAPG 377
Min. Negotiated Rate	$57.16
Max. Negotiated Rate	$125.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$70.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$58.33
Rate for Payer: EmblemHealth Medicaid	$58.33
Rate for Payer: Galaxy Health Workers Comp	$57.16
Rate for Payer: Hamaspik Choice Medicaid	$58.33
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$61.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$125.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$125.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$58.33
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$61.25

EAPG 3.18: PREVENTIVE OR SCREENING ENCOUNTER

Facility

$267.82

Service Code	EAPG 879
Min. Negotiated Rate	$122.07
Max. Negotiated Rate	$267.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$149.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$124.57
Rate for Payer: EmblemHealth Medicaid	$124.57
Rate for Payer: Galaxy Health Workers Comp	$122.07
Rate for Payer: Hamaspik Choice Medicaid	$124.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$130.80
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$267.82
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$267.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$124.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$130.80

EAPG 3.18: PROCEDURES FOR REVISION OR REMOVAL OF NEUROSTIMULATOR DEVICES

Facility

$4,051.69

Service Code	EAPG 276
Min. Negotiated Rate	$1,846.75
Max. Negotiated Rate	$4,051.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,261.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,884.49
Rate for Payer: EmblemHealth Medicaid	$1,884.49
Rate for Payer: Galaxy Health Workers Comp	$1,846.75
Rate for Payer: Hamaspik Choice Medicaid	$1,884.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,978.73
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,051.69
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,051.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,884.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,978.73

EAPG 3.18: PROSTATITIS

Facility

$250.56

Service Code	EAPG 743
Min. Negotiated Rate	$114.21
Max. Negotiated Rate	$250.56
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$139.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$116.54
Rate for Payer: EmblemHealth Medicaid	$116.54
Rate for Payer: Galaxy Health Workers Comp	$114.21
Rate for Payer: Hamaspik Choice Medicaid	$116.54
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$122.37
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$250.56
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$250.56
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$116.54
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$122.37

EAPG 3.18: PULMONARY EMBOLISM

Facility

$309.83

Service Code	EAPG 586
Min. Negotiated Rate	$141.22
Max. Negotiated Rate	$309.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$172.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.11
Rate for Payer: EmblemHealth Medicaid	$144.11
Rate for Payer: Galaxy Health Workers Comp	$141.22
Rate for Payer: Hamaspik Choice Medicaid	$144.11
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$151.31
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$309.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$309.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$144.11
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$151.31

EAPG 3.18: PULMONARY FUNCTION TESTS

Facility

$573.16

Service Code	EAPG 60
Min. Negotiated Rate	$261.24
Max. Negotiated Rate	$573.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$319.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$266.58
Rate for Payer: EmblemHealth Medicaid	$266.58
Rate for Payer: Galaxy Health Workers Comp	$261.24
Rate for Payer: Hamaspik Choice Medicaid	$266.58
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$279.91
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$573.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$573.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$266.58
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$279.91

EAPG 3.18: PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA

Facility

$335.05

Service Code	EAPG 581
Min. Negotiated Rate	$152.71
Max. Negotiated Rate	$335.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$187.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$155.83
Rate for Payer: EmblemHealth Medicaid	$155.83
Rate for Payer: Galaxy Health Workers Comp	$152.71
Rate for Payer: Hamaspik Choice Medicaid	$155.83
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$163.63
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$335.05
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$335.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$155.83
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$163.63

EAPG 3.18: RADIATION THERAPY MANAGEMENT

Facility

$659.91

Service Code	EAPG 483
Min. Negotiated Rate	$300.78
Max. Negotiated Rate	$659.91
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$368.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$306.93
Rate for Payer: EmblemHealth Medicaid	$306.93
Rate for Payer: Galaxy Health Workers Comp	$300.78
Rate for Payer: Hamaspik Choice Medicaid	$306.93
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$322.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$659.91
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$659.91
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$306.93
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$322.28

EAPG 3.18: RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES

Facility

$743.58

Service Code	EAPG 474
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: RADIOSURGERY

Facility

$10,029.37

Service Code	EAPG 346
Min. Negotiated Rate	$4,571.36
Max. Negotiated Rate	$10,029.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5,597.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,664.77
Rate for Payer: EmblemHealth Medicaid	$4,664.77
Rate for Payer: Galaxy Health Workers Comp	$4,571.36
Rate for Payer: Hamaspik Choice Medicaid	$4,664.77
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$4,898.05
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$10,029.37
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$10,029.37
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4,664.77
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$4,898.05

EAPG 3.18: RADIOTHERAPY

Facility

$232.23

Service Code	EAPG 802
Min. Negotiated Rate	$105.85
Max. Negotiated Rate	$232.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$129.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$108.01
Rate for Payer: EmblemHealth Medicaid	$108.01
Rate for Payer: Galaxy Health Workers Comp	$105.85
Rate for Payer: Hamaspik Choice Medicaid	$108.01
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$113.41
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$232.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$232.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$108.01
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$113.41

EAPG 3.18: REHABILITATION

Facility

$238.23

Service Code	EAPG 870
Min. Negotiated Rate	$108.58
Max. Negotiated Rate	$238.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$132.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$110.80
Rate for Payer: EmblemHealth Medicaid	$110.80
Rate for Payer: Galaxy Health Workers Comp	$108.58
Rate for Payer: Hamaspik Choice Medicaid	$110.80
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$116.34
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$238.23
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$238.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$110.80
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$116.34

EAPG 3.18: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES

Facility

$4,761.41

Service Code	EAPG 87
Min. Negotiated Rate	$2,170.24
Max. Negotiated Rate	$4,761.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,657.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,214.58
Rate for Payer: EmblemHealth Medicaid	$2,214.58
Rate for Payer: Galaxy Health Workers Comp	$2,170.24
Rate for Payer: Hamaspik Choice Medicaid	$2,214.58
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,325.33
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$4,761.41
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$4,761.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,214.58
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,325.33

EAPG 3.18: RENAL FAILURE

Facility

$256.75

Service Code	EAPG 720
Min. Negotiated Rate	$117.03
Max. Negotiated Rate	$256.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$119.42
Rate for Payer: EmblemHealth Medicaid	$119.42
Rate for Payer: Galaxy Health Workers Comp	$117.03
Rate for Payer: Hamaspik Choice Medicaid	$119.42
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$125.39
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$256.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$256.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$119.42
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$125.39

EAPG 3.18: RESPIRATORY FAILURE

Facility

$296.99

Service Code	EAPG 587
Min. Negotiated Rate	$135.37
Max. Negotiated Rate	$296.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$165.76
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$138.14
Rate for Payer: EmblemHealth Medicaid	$138.14
Rate for Payer: Galaxy Health Workers Comp	$135.37
Rate for Payer: Hamaspik Choice Medicaid	$138.14
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$145.04
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$296.99
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$296.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$138.14
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$145.04

EAPG 3.18: RESPIRATORY MALIGNANCY

Facility

$263.63

Service Code	EAPG 571
Min. Negotiated Rate	$120.16
Max. Negotiated Rate	$263.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$147.14
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.62
Rate for Payer: EmblemHealth Medicaid	$122.62
Rate for Payer: Galaxy Health Workers Comp	$120.16
Rate for Payer: Hamaspik Choice Medicaid	$122.62
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$128.75
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$263.63
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$263.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$122.62
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$128.75

EAPG 3.18: RESUSCITATION

Facility

$1,202.47

Service Code	EAPG 92
Min. Negotiated Rate	$548.08
Max. Negotiated Rate	$1,202.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$671.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$559.28
Rate for Payer: EmblemHealth Medicaid	$559.28
Rate for Payer: Galaxy Health Workers Comp	$548.08
Rate for Payer: Hamaspik Choice Medicaid	$559.28
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$587.25
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,202.47
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,202.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$559.28
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$587.25

EAPG 3.18: REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE

Facility

$1,722.36

Service Code	EAPG 76
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$1,722.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$961.29
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$801.09
Rate for Payer: EmblemHealth Medicaid	$801.09
Rate for Payer: Galaxy Health Workers Comp	$785.04
Rate for Payer: Hamaspik Choice Medicaid	$801.09
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$841.15
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,722.36
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,722.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$801.09
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$841.15

EAPG 3.18: REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT

Facility

$5,511.68

Service Code	EAPG 74
Min. Negotiated Rate	$2,512.21
Max. Negotiated Rate	$5,511.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,076.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,563.54
Rate for Payer: EmblemHealth Medicaid	$2,563.54
Rate for Payer: Galaxy Health Workers Comp	$2,512.21
Rate for Payer: Hamaspik Choice Medicaid	$2,563.54
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$2,691.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$5,511.68
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$5,511.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,563.54
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$2,691.74

EAPG 3.18: ROUTINE PRENATAL CARE

Facility

$282.85

Service Code	EAPG 766
Min. Negotiated Rate	$128.92
Max. Negotiated Rate	$282.85
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$157.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$131.56
Rate for Payer: EmblemHealth Medicaid	$131.56
Rate for Payer: Galaxy Health Workers Comp	$128.92
Rate for Payer: Hamaspik Choice Medicaid	$131.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$138.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$282.85
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$282.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$131.56
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$138.14

Know your out-of-pocket cost for care.

All Charges