Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

EAPG 189: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$2,914.38

Service Code	EAPG 0189
Min. Negotiated Rate	$1,295.28
Max. Negotiated Rate	$2,914.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,914.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,295.28
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,295.28
Rate for Payer: CDPHP Essential Plan	$2,914.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,554.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,295.28
Rate for Payer: EmblemHealth Medicaid	$1,295.28
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,914.38
Rate for Payer: Hamaspik Choice Medicaid	$1,295.28
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,295.28
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,784.85
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,784.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,295.28
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,360.04

EAPG 18: COMPLEX WOUND REPAIR AND TREATMENT

Facility

$2,771.01

Service Code	EAPG 0018
Min. Negotiated Rate	$1,231.56
Max. Negotiated Rate	$2,771.01
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,771.01
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,231.56
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,231.56
Rate for Payer: CDPHP Essential Plan	$2,771.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,477.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,231.56
Rate for Payer: EmblemHealth Medicaid	$1,231.56
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,771.01
Rate for Payer: Hamaspik Choice Medicaid	$1,231.56
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,231.56
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,647.85
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,647.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,231.56
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,293.14

EAPG 191: LEVEL I FETAL PROCEDURES

Facility

$474.23

Service Code	EAPG 0191
Min. Negotiated Rate	$210.77
Max. Negotiated Rate	$474.23
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$474.23
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$210.77
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$210.77
Rate for Payer: CDPHP Essential Plan	$474.23
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$252.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$210.77
Rate for Payer: EmblemHealth Medicaid	$210.77
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$474.23
Rate for Payer: Hamaspik Choice Medicaid	$210.77
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$210.77
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$453.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$453.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$210.77
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$221.31

EAPG 192: LEVEL II FETAL PROCEDURES

Facility

$1,420.85

Service Code	EAPG 0192
Min. Negotiated Rate	$631.49
Max. Negotiated Rate	$1,420.85
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$1,420.85
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$631.49
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$631.49
Rate for Payer: CDPHP Essential Plan	$1,420.85
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$757.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$631.49
Rate for Payer: EmblemHealth Medicaid	$631.49
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$1,420.85
Rate for Payer: Hamaspik Choice Medicaid	$631.49
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$631.49
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,357.70
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,357.70
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$631.49
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$663.06

EAPG 194: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES

Facility

$1,516.66

Service Code	EAPG 0194
Min. Negotiated Rate	$674.07
Max. Negotiated Rate	$1,516.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$1,516.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$674.07
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$674.07
Rate for Payer: CDPHP Essential Plan	$1,516.66
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$808.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$674.07
Rate for Payer: EmblemHealth Medicaid	$674.07
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$1,516.66
Rate for Payer: Hamaspik Choice Medicaid	$674.07
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$674.07
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,449.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,449.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$674.07
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$707.77

EAPG 195: VAGINAL DELIVERY PROCEDURES

Facility

$3,989.14

Service Code	EAPG 0195
Min. Negotiated Rate	$1,772.95
Max. Negotiated Rate	$3,989.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$3,989.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,772.95
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,772.95
Rate for Payer: CDPHP Essential Plan	$3,989.14
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,127.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,772.95
Rate for Payer: EmblemHealth Medicaid	$1,772.95
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$3,989.14
Rate for Payer: Hamaspik Choice Medicaid	$1,772.95
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,772.95
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,811.84
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,811.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,772.95
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,861.60

EAPG 19: MOHS MICROGRAPHIC SURGERY

Facility

$2,467.40

Service Code	EAPG 0019
Min. Negotiated Rate	$1,096.62
Max. Negotiated Rate	$2,467.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,467.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,096.62
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,096.62
Rate for Payer: CDPHP Essential Plan	$2,467.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,315.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,096.62
Rate for Payer: EmblemHealth Medicaid	$1,096.62
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,467.40
Rate for Payer: Hamaspik Choice Medicaid	$1,096.62
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,096.62
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,357.73
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,357.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,096.62
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,151.45

EAPG 2008: INCIDENTAL INTRAOPERATIVE PROCEDURES

Facility

$3,387.53

Service Code	EAPG 2008
Min. Negotiated Rate	$1,505.57
Max. Negotiated Rate	$3,387.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$3,387.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,505.57
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,505.57
Rate for Payer: CDPHP Essential Plan	$3,387.53
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,806.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,505.57
Rate for Payer: EmblemHealth Medicaid	$1,505.57
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$3,387.53
Rate for Payer: Galaxy Health Workers Comp	$2,213.19
Rate for Payer: Hamaspik Choice Medicaid	$1,505.57
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,505.57
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,236.98
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,236.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,505.57
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,580.85

EAPG 2010: INCIDENTAL SKIN SUBSTITUTES

Facility

$2,361.20

Service Code	EAPG 2010
Min. Negotiated Rate	$1,049.42
Max. Negotiated Rate	$2,361.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,361.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,049.42
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,049.42
Rate for Payer: CDPHP Essential Plan	$2,361.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,259.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,049.42
Rate for Payer: EmblemHealth Medicaid	$1,049.42
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,361.20
Rate for Payer: Galaxy Health Workers Comp	$1,542.65
Rate for Payer: Hamaspik Choice Medicaid	$1,049.42
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,049.42
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,256.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,256.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,049.42
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,101.89

EAPG 2016: LEVEL II ALLERGY TESTS

Facility

$504.58

Service Code	EAPG 2016
Min. Negotiated Rate	$224.26
Max. Negotiated Rate	$504.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$504.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$224.26
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$224.26
Rate for Payer: CDPHP Essential Plan	$504.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$269.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$224.26
Rate for Payer: EmblemHealth Medicaid	$224.26
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$504.58
Rate for Payer: Galaxy Health Workers Comp	$329.66
Rate for Payer: Hamaspik Choice Medicaid	$224.26
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$224.26
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$482.16
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$482.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$224.26
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$235.47

EAPG 2020: NONINVASIVE VENTILATION SUPPORT

Facility

$375.44

Service Code	EAPG 2020
Min. Negotiated Rate	$166.86
Max. Negotiated Rate	$375.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$375.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$166.86
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$166.86
Rate for Payer: CDPHP Essential Plan	$375.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$200.23
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$166.86
Rate for Payer: EmblemHealth Medicaid	$166.86
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$375.44
Rate for Payer: Galaxy Health Workers Comp	$245.28
Rate for Payer: Hamaspik Choice Medicaid	$166.86
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$166.86
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$358.75
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$358.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$166.86
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$175.20

EAPG 2030: MINOR MUSCULOSKELETAL PROCEDURES

Facility

$943.42

Service Code	EAPG 2030
Min. Negotiated Rate	$419.30
Max. Negotiated Rate	$943.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$943.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$419.30
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$419.30
Rate for Payer: CDPHP Essential Plan	$943.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$503.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$419.30
Rate for Payer: EmblemHealth Medicaid	$419.30
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$943.42
Rate for Payer: Galaxy Health Workers Comp	$616.37
Rate for Payer: Hamaspik Choice Medicaid	$419.30
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$419.30
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$901.50
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$901.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$419.30
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$440.26

EAPG 2043: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$93.87

Service Code	EAPG 2043
Min. Negotiated Rate	$41.72
Max. Negotiated Rate	$93.87
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$93.87
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$41.72
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$41.72
Rate for Payer: CDPHP Essential Plan	$93.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$41.72
Rate for Payer: EmblemHealth Medicaid	$41.72
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$93.87
Rate for Payer: Galaxy Health Workers Comp	$61.33
Rate for Payer: Hamaspik Choice Medicaid	$41.72
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$41.72
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$89.70
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$89.70
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$41.72
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$43.81

EAPG 204: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$2,395.46

Service Code	EAPG 0204
Min. Negotiated Rate	$1,064.65
Max. Negotiated Rate	$2,395.46
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,395.46
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,064.65
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,064.65
Rate for Payer: CDPHP Essential Plan	$2,395.46
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,277.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,064.65
Rate for Payer: EmblemHealth Medicaid	$1,064.65
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,395.46
Rate for Payer: Hamaspik Choice Medicaid	$1,064.65
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,064.65
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,289.00
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,289.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,064.65
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,117.88

EAPG 205: OBSTETRICAL PROCEDURES

Facility

$2,056.68

Service Code	EAPG 0205
Min. Negotiated Rate	$914.08
Max. Negotiated Rate	$2,056.68
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,056.68
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$914.08
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$914.08
Rate for Payer: CDPHP Essential Plan	$2,056.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,096.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$914.08
Rate for Payer: EmblemHealth Medicaid	$914.08
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,056.68
Rate for Payer: Hamaspik Choice Medicaid	$914.08
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$914.08
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,965.27
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,965.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$914.08
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$959.78

EAPG 2061: LEVEL I BLOOD PRODUCTS

Facility

$1,082.32

Service Code	EAPG 2061
Min. Negotiated Rate	$481.03
Max. Negotiated Rate	$1,082.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$1,082.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$481.03
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$481.03
Rate for Payer: CDPHP Essential Plan	$1,082.32
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$577.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$481.03
Rate for Payer: EmblemHealth Medicaid	$481.03
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$1,082.32
Rate for Payer: Galaxy Health Workers Comp	$707.11
Rate for Payer: Hamaspik Choice Medicaid	$481.03
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$481.03
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,034.21
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,034.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$481.03
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$505.08

EAPG 2062: LEVEL II BLOOD PRODUCTS

Facility

$1,332.00

Service Code	EAPG 2062
Min. Negotiated Rate	$592.00
Max. Negotiated Rate	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$592.00
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$592.00
Rate for Payer: CDPHP Essential Plan	$1,332.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$710.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$592.00
Rate for Payer: EmblemHealth Medicaid	$592.00
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$1,332.00
Rate for Payer: Galaxy Health Workers Comp	$870.24
Rate for Payer: Hamaspik Choice Medicaid	$592.00
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$592.00
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,272.80
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,272.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$592.00
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$621.60

EAPG 206: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$4,098.92

Service Code	EAPG 0206
Min. Negotiated Rate	$1,821.74
Max. Negotiated Rate	$4,098.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$4,098.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,821.74
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,821.74
Rate for Payer: CDPHP Essential Plan	$4,098.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,186.09
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,821.74
Rate for Payer: EmblemHealth Medicaid	$1,821.74
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$4,098.92
Rate for Payer: Hamaspik Choice Medicaid	$1,821.74
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,821.74
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,916.74
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,916.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,821.74
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,912.83

EAPG 207: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$2,786.98

Service Code	EAPG 0207
Min. Negotiated Rate	$1,238.66
Max. Negotiated Rate	$2,786.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$2,786.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,238.66
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,238.66
Rate for Payer: CDPHP Essential Plan	$2,786.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,486.39
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,238.66
Rate for Payer: EmblemHealth Medicaid	$1,238.66
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$2,786.98
Rate for Payer: Hamaspik Choice Medicaid	$1,238.66
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,238.66
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,663.12
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,663.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,238.66
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,300.59

EAPG 208: LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$3,443.69

Service Code	EAPG 0208
Min. Negotiated Rate	$1,530.53
Max. Negotiated Rate	$3,443.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$3,443.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,530.53
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,530.53
Rate for Payer: CDPHP Essential Plan	$3,443.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,836.64
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,530.53
Rate for Payer: EmblemHealth Medicaid	$1,530.53
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$3,443.69
Rate for Payer: Hamaspik Choice Medicaid	$1,530.53
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,530.53
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$3,290.64
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$3,290.64
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,530.53
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,607.06

EAPG 209: OTHER GYNECOLOGICAL PROCEDURES

Facility

$1,125.07

Service Code	EAPG 0209
Min. Negotiated Rate	$500.03
Max. Negotiated Rate	$1,125.07
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$1,125.07
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$500.03
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$500.03
Rate for Payer: CDPHP Essential Plan	$1,125.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$600.04
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$500.03
Rate for Payer: EmblemHealth Medicaid	$500.03
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$1,125.07
Rate for Payer: Hamaspik Choice Medicaid	$500.03
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$500.03
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$1,075.06
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$1,075.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$500.03
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$525.03

EAPG 20: LEVEL I BREAST PROCEDURES

Facility

$3,134.56

Service Code	EAPG 0020
Min. Negotiated Rate	$1,393.14
Max. Negotiated Rate	$3,134.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$3,134.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$1,393.14
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$1,393.14
Rate for Payer: CDPHP Essential Plan	$3,134.56
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,671.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,393.14
Rate for Payer: EmblemHealth Medicaid	$1,393.14
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$3,134.56
Rate for Payer: Hamaspik Choice Medicaid	$1,393.14
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$1,393.14
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$2,995.25
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$2,995.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,393.14
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$1,462.80

EAPG 210: EXTENDED EEG STUDIES

Facility

$643.16

Service Code	EAPG 0210
Min. Negotiated Rate	$285.85
Max. Negotiated Rate	$643.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$643.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$285.85
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$285.85
Rate for Payer: CDPHP Essential Plan	$643.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$343.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$285.85
Rate for Payer: EmblemHealth Medicaid	$285.85
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$643.16
Rate for Payer: Hamaspik Choice Medicaid	$285.85
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$285.85
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$614.58
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$614.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$285.85
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$300.14

EAPG 211: ELECTROENCEPHALOGRAM

Facility

$355.21

Service Code	EAPG 0211
Min. Negotiated Rate	$157.87
Max. Negotiated Rate	$355.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$355.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$157.87
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$157.87
Rate for Payer: CDPHP Essential Plan	$355.21
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$189.44
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$157.87
Rate for Payer: EmblemHealth Medicaid	$157.87
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$355.21
Rate for Payer: Hamaspik Choice Medicaid	$157.87
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$157.87
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$339.42
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$339.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$157.87
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$165.76

EAPG 212: ELECTROCONVULSIVE THERAPY

Facility

$767.45

Service Code	EAPG 0212
Min. Negotiated Rate	$341.09
Max. Negotiated Rate	$767.45
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan	$767.45
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid	$341.09
Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan	$341.09
Rate for Payer: CDPHP Essential Plan	$767.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$409.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$341.09
Rate for Payer: EmblemHealth Medicaid	$341.09
Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid	$767.45
Rate for Payer: Hamaspik Choice Medicaid	$341.09
Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid	$341.09
Rate for Payer: MVP Health Care of NY Essential Plan 1&2	$733.34
Rate for Payer: MVP Health Care of NY Essential Plan 3&4	$733.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$341.09
Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid	$358.14

Know your out-of-pocket cost for care.

All Charges