Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: SCHIZOPHRENIA

Facility

$254.45

Service Code	EAPG 820
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: SCIATICA

Facility

$322.90

Service Code	EAPG 658
Min. Negotiated Rate	$147.18
Max. Negotiated Rate	$322.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$180.22
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$150.18
Rate for Payer: EmblemHealth Medicaid	$150.18
Rate for Payer: Galaxy Health Workers Comp	$147.18
Rate for Payer: Hamaspik Choice Medicaid	$150.18
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$157.70
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$322.90
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$322.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$150.18
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$157.70

EAPG 3.18: SCREENING COLORECTAL SERVICES

Facility

$1,622.92

Service Code	EAPG 149
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: SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT

Facility

$107.74

Service Code	EAPG 324
Min. Negotiated Rate	$49.11
Max. Negotiated Rate	$107.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$60.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.11
Rate for Payer: EmblemHealth Medicaid	$50.11
Rate for Payer: Galaxy Health Workers Comp	$49.11
Rate for Payer: Hamaspik Choice Medicaid	$50.11
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$52.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$107.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$107.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$50.11
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$52.62

EAPG 3.18: SEALANT

Facility

$78.83

Service Code	EAPG 372
Min. Negotiated Rate	$35.93
Max. Negotiated Rate	$78.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$44.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$36.67
Rate for Payer: EmblemHealth Medicaid	$36.67
Rate for Payer: Galaxy Health Workers Comp	$35.93
Rate for Payer: Hamaspik Choice Medicaid	$36.67
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$38.50
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$78.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$78.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$36.67
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$38.50

EAPG 3.18: SEIZURE

Facility

$299.84

Service Code	EAPG 529
Min. Negotiated Rate	$136.67
Max. Negotiated Rate	$299.84
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$167.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$139.46
Rate for Payer: EmblemHealth Medicaid	$139.46
Rate for Payer: Galaxy Health Workers Comp	$136.67
Rate for Payer: Hamaspik Choice Medicaid	$139.46
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$146.43
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$299.84
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$299.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$139.46
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$146.43

EAPG 3.18: SEPTICEMIA AND DISSEMINATED INFECTIONS

Facility

$354.65

Service Code	EAPG 805
Min. Negotiated Rate	$161.65
Max. Negotiated Rate	$354.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$197.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$164.95
Rate for Payer: EmblemHealth Medicaid	$164.95
Rate for Payer: Galaxy Health Workers Comp	$161.65
Rate for Payer: Hamaspik Choice Medicaid	$164.95
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$173.20
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$354.65
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$354.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$164.95
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$173.20

EAPG 3.18: SHOULDER AND UPPER ARM PROCEDURES

Facility

$4,778.86

Service Code	EAPG 25
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: SICKLE CELL ANEMIA CRISIS

Facility

$669.13

Service Code	EAPG 783
Min. Negotiated Rate	$304.99
Max. Negotiated Rate	$669.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$373.46
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$311.22
Rate for Payer: EmblemHealth Medicaid	$311.22
Rate for Payer: Galaxy Health Workers Comp	$304.99
Rate for Payer: Hamaspik Choice Medicaid	$311.22
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$326.78
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$669.13
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$669.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$311.22
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$326.78

EAPG 3.18: SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$267.82

Service Code	EAPG 871
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: SIMPLE WOUND REPAIR AND TREATMENT

Facility

$960.71

Service Code	EAPG 16
Min. Negotiated Rate	$437.89
Max. Negotiated Rate	$960.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$536.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$446.84
Rate for Payer: EmblemHealth Medicaid	$446.84
Rate for Payer: Galaxy Health Workers Comp	$437.89
Rate for Payer: Hamaspik Choice Medicaid	$446.84
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$469.18
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$960.71
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$960.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$446.84
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$469.18

EAPG 3.18: SKIN AND CONNECTIVE TISSUE GRAFTING AND FLAP PROCEDURES

Facility

$3,040.67

Service Code	EAPG 56
Min. Negotiated Rate	$1,385.93
Max. Negotiated Rate	$3,040.67
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,697.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,414.25
Rate for Payer: EmblemHealth Medicaid	$1,414.25
Rate for Payer: Galaxy Health Workers Comp	$1,385.93
Rate for Payer: Hamaspik Choice Medicaid	$1,414.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,484.97
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,040.67
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,040.67
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,414.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,484.97

EAPG 3.18: SLEEP STUDIES ATTENDED

Facility

$1,798.38

Service Code	EAPG 222
Min. Negotiated Rate	$819.70
Max. Negotiated Rate	$1,798.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,003.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$836.45
Rate for Payer: EmblemHealth Medicaid	$836.45
Rate for Payer: Galaxy Health Workers Comp	$819.70
Rate for Payer: Hamaspik Choice Medicaid	$836.45
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$878.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,798.38
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,798.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$836.45
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$878.28

EAPG 3.18: SLEEP STUDIES UNATTENDED

Facility

$1,013.44

Service Code	EAPG 226
Min. Negotiated Rate	$461.92
Max. Negotiated Rate	$1,013.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$565.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$471.36
Rate for Payer: EmblemHealth Medicaid	$471.36
Rate for Payer: Galaxy Health Workers Comp	$461.92
Rate for Payer: Hamaspik Choice Medicaid	$471.36
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$494.93
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,013.44
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,013.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$471.36
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$494.93

EAPG 3.18: SPEECH THERAPY AND EVALUATION

Facility

$254.45

Service Code	EAPG 272
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: SPINAL DIAGNOSES AND INJURIES

Facility

$298.96

Service Code	EAPG 520
Min. Negotiated Rate	$136.26
Max. Negotiated Rate	$298.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$166.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$139.05
Rate for Payer: EmblemHealth Medicaid	$139.05
Rate for Payer: Galaxy Health Workers Comp	$136.26
Rate for Payer: Hamaspik Choice Medicaid	$139.05
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$146.00
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$298.96
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$298.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$139.05
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$146.00

EAPG 3.18: SPINAL IMPLANTATION OF DRUG INFUSION DEVICE

Facility

$29,756.77

Service Code	EAPG 3030
Min. Negotiated Rate	$13,563.03
Max. Negotiated Rate	$29,756.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16,607.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13,840.19
Rate for Payer: EmblemHealth Medicaid	$13,840.19
Rate for Payer: Galaxy Health Workers Comp	$13,563.03
Rate for Payer: Hamaspik Choice Medicaid	$13,840.19
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$14,532.32
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$29,756.77
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$29,756.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$13,840.19
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$14,532.32

EAPG 3.18: SPINE INJECTIONS AND OTHER RELATED PROCEDURES

Facility

$1,162.42

Service Code	EAPG 53
Min. Negotiated Rate	$529.83
Max. Negotiated Rate	$1,162.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$648.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$540.65
Rate for Payer: EmblemHealth Medicaid	$540.65
Rate for Payer: Galaxy Health Workers Comp	$529.83
Rate for Payer: Hamaspik Choice Medicaid	$540.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$567.69
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,162.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,162.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$540.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$567.69

EAPG 3.18: STATUS ASTHMATICUS

Facility

$280.04

Service Code	EAPG 579
Min. Negotiated Rate	$127.64
Max. Negotiated Rate	$280.04
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$156.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$130.25
Rate for Payer: EmblemHealth Medicaid	$130.25
Rate for Payer: Galaxy Health Workers Comp	$127.64
Rate for Payer: Hamaspik Choice Medicaid	$130.25
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$136.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$280.04
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$280.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$130.25
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$136.77

EAPG 3.18: STRABISMUS AND MUSCLE EYE PROCEDURES

Facility

$3,646.12

Service Code	EAPG 239
Min. Negotiated Rate	$1,661.89
Max. Negotiated Rate	$3,646.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,034.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,695.85
Rate for Payer: EmblemHealth Medicaid	$1,695.85
Rate for Payer: Galaxy Health Workers Comp	$1,661.89
Rate for Payer: Hamaspik Choice Medicaid	$1,695.85
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,780.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,646.12
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,646.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,695.85
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,780.65

EAPG 3.18: SUPERFICIAL INJURY TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$351.42

Service Code	EAPG 777
Min. Negotiated Rate	$160.18
Max. Negotiated Rate	$351.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$196.14
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$163.45
Rate for Payer: EmblemHealth Medicaid	$163.45
Rate for Payer: Galaxy Health Workers Comp	$160.18
Rate for Payer: Hamaspik Choice Medicaid	$163.45
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$171.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$351.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$351.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$163.45
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$171.62

EAPG 3.18: SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION

Facility

$1,062.22

Service Code	EAPG 2
Min. Negotiated Rate	$484.16
Max. Negotiated Rate	$1,062.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$592.85
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$494.05
Rate for Payer: EmblemHealth Medicaid	$494.05
Rate for Payer: Galaxy Health Workers Comp	$484.16
Rate for Payer: Hamaspik Choice Medicaid	$494.05
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$518.76
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,062.22
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,062.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$494.05
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$518.76

EAPG 3.18: SYNCOPE AND COLLAPSE

Facility

$315.98

Service Code	EAPG 605
Min. Negotiated Rate	$144.02
Max. Negotiated Rate	$315.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$176.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$146.97
Rate for Payer: EmblemHealth Medicaid	$146.97
Rate for Payer: Galaxy Health Workers Comp	$144.02
Rate for Payer: Hamaspik Choice Medicaid	$146.97
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$154.32
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$315.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$315.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$146.97
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$154.32

EAPG 3.18: TESTICULAR AND EPIDIDYMAL PROCEDURES

Facility

$2,727.38

Service Code	EAPG 180
Min. Negotiated Rate	$1,243.13
Max. Negotiated Rate	$2,727.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,522.21
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,268.53
Rate for Payer: EmblemHealth Medicaid	$1,268.53
Rate for Payer: Galaxy Health Workers Comp	$1,243.13
Rate for Payer: Hamaspik Choice Medicaid	$1,268.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,331.97
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,727.38
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,727.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,268.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,331.97

EAPG 3.18: THERAPEUTIC DRUG MONITORING

Facility

$36.83

Service Code	EAPG 405
Min. Negotiated Rate	$16.79
Max. Negotiated Rate	$36.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$20.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$17.13
Rate for Payer: EmblemHealth Medicaid	$17.13
Rate for Payer: Galaxy Health Workers Comp	$16.79
Rate for Payer: Hamaspik Choice Medicaid	$17.13
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$17.99
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$36.83
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$36.83
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.13
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$17.99

Know your out-of-pocket cost for care.

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