St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML

Facility

$105.00

Service Code	HCPCS J1327
Hospital Charge Code	41643635
Hospital Revenue Code	636
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Cash Price	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

EPTIFIBATIDE 2000 MCG/ML INJ

Facility

$105.00

Service Code	HCPCS J1327
Hospital Charge Code	41643636
Hospital Revenue Code	636
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Cash Price	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

EPTIFIBATIDE 2000 MCG/ML INJ

Facility

$105.00

Service Code	HCPCS J1327
Hospital Charge Code	41653636
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$68.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Affinity Essential Plan 1&2	$2.34
Rate for Payer: Affinity Essential Plan 3&4	$2.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.34
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cash Price	$3.35
Rate for Payer: Cash Price	$3.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: Elderplan Medicare Advantage	$3.35
Rate for Payer: EmblemHealth Commercial	$3.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.35
Rate for Payer: Fidelis Essential Plan Aliesa	$3.35
Rate for Payer: Fidelis Essential Plan QHP	$3.51
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Fidelis Qualified Health Plan	$3.51
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: Healthfirst Medicare Advantage	$2.84
Rate for Payer: Healthfirst QHP	$3.35
Rate for Payer: Humana Medicare	$3.41
Rate for Payer: Senior Whole Health Medicare Advantage	$3.35
Rate for Payer: United Healthcare Medicare Advantage	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.68
Rate for Payer: Wellcare Medicare	$3.18

EPTIFIBATIDE 2000 MCG/ML INJ

Facility

$105.00

Service Code	HCPCS J1327
Hospital Charge Code	41653636
Hospital Revenue Code	636
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Cash Price	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

EPTIFIBATIDE 2000 MCG/ML INJ

Facility

$105.00

Service Code	HCPCS J1327
Hospital Charge Code	41643636
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$68.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.35
Rate for Payer: Aetna Government	$3.35
Rate for Payer: Affinity Essential Plan 1&2	$2.34
Rate for Payer: Affinity Essential Plan 3&4	$2.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.34
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cash Price	$3.35
Rate for Payer: Cash Price	$3.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$60.38
Rate for Payer: Elderplan Medicare Advantage	$3.35
Rate for Payer: EmblemHealth Commercial	$3.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.35
Rate for Payer: Fidelis Essential Plan Aliesa	$3.35
Rate for Payer: Fidelis Essential Plan QHP	$3.51
Rate for Payer: Fidelis Medicare Advantage	$3.35
Rate for Payer: Fidelis Qualified Health Plan	$3.51
Rate for Payer: Group Health Inc Commercial	$3.35
Rate for Payer: Group Health Inc Medicare	$3.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: Healthfirst Medicare Advantage	$2.84
Rate for Payer: Healthfirst QHP	$3.35
Rate for Payer: Humana Medicare	$3.41
Rate for Payer: Senior Whole Health Medicare Advantage	$3.35
Rate for Payer: United Healthcare Medicare Advantage	$3.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$68.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.68
Rate for Payer: Wellcare Medicare	$3.18

EPTIFIBATIDE 20 MG/10ML IV SOLN [131638]

Facility

$15.22

Service Code	NDC 70436002680
Hospital Charge Code	70436002680
Hospital Revenue Code	278
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$7.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.61
Rate for Payer: Hamaspik Choice Inc Medicare	$7.61

EPTIFIBATIDE 20 MG/10ML IV SOLN [131638]

Facility

$15.22

Service Code	NDC 70436002680
Hospital Charge Code	70436002680
Hospital Revenue Code	278
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$15.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.61
Rate for Payer: Aetna Government	$7.61
Rate for Payer: Brighton Health Commercial	$9.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.75
Rate for Payer: EmblemHealth Commercial	$7.61
Rate for Payer: Fidelis Medicare Advantage	$15.99
Rate for Payer: Group Health Inc Commercial	$7.61
Rate for Payer: Group Health Inc Medicare	$5.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.61
Rate for Payer: Hamaspik Choice Inc Medicare	$7.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.90

EPTIFIBATIDE 20 MG/10ML IV SOLN [131638]

Facility

$4.51

Service Code	NDC 70860030310
Hospital Charge Code	70860030310
Hospital Revenue Code	278
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2.25

EPTIFIBATIDE 20 MG/10ML IV SOLN [131638]

Facility

$4.51

Service Code	NDC 70860030310
Hospital Charge Code	70860030310
Hospital Revenue Code	278
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$4.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.25
Rate for Payer: Aetna Government	$2.25
Rate for Payer: Brighton Health Commercial	$2.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.59
Rate for Payer: EmblemHealth Commercial	$2.25
Rate for Payer: Fidelis Medicare Advantage	$4.73
Rate for Payer: Group Health Inc Commercial	$2.25
Rate for Payer: Group Health Inc Medicare	$1.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.93

EPTIFIBATIDE 75 MG/100ML IV SOLN [23123]

Facility

$1.80

Service Code	NDC 55150021899
Hospital Charge Code	55150021899
Hospital Revenue Code	278
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.04
Rate for Payer: EmblemHealth Commercial	$0.90
Rate for Payer: Fidelis Medicare Advantage	$1.89
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.17

EPTIFIBATIDE 75 MG/100ML IV SOLN [23123]

Facility

$4.69

Service Code	NDC 70436002780
Hospital Charge Code	70436002780
Hospital Revenue Code	278
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34

EPTIFIBATIDE 75 MG/100ML IV SOLN [23123]

Facility

$4.69

Service Code	NDC 70436002780
Hospital Charge Code	70436002780
Hospital Revenue Code	278
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$4.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.34
Rate for Payer: Aetna Government	$2.34
Rate for Payer: Brighton Health Commercial	$2.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: EmblemHealth Commercial	$2.34
Rate for Payer: Fidelis Medicare Advantage	$4.92
Rate for Payer: Group Health Inc Commercial	$2.34
Rate for Payer: Group Health Inc Medicare	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.05

EPTIFIBATIDE 75 MG/100ML IV SOLN [23123]

Facility

$1.80

Service Code	NDC 55150021899
Hospital Charge Code	55150021899
Hospital Revenue Code	278
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90

EP TRANS BALOON ANGIOPLAS

Facility

$4,502.50

Service Code	HCPCS 33476
Hospital Charge Code	66574539
Hospital Revenue Code	361
Min. Negotiated Rate	$1,496.00
Max. Negotiated Rate	$3,376.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,476.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,717.69
Rate for Payer: Aetna Government	$1,717.69
Rate for Payer: Brighton Health Commercial	$3,376.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,251.25
Rate for Payer: Group Health Inc Medicare	$1,575.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,251.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,251.25
Rate for Payer: United Healthcare Commercial	$1,496.00

EPV ABLATION ATRIOV NODE

Facility

$17,826.35

Service Code	HCPCS 93650 TC
Hospital Charge Code	66574587
Hospital Revenue Code	480
Rate for Payer: Cash Price	$8,636.37

EPV ABLATION ATRIOV NODE

Facility

$17,826.35

Service Code	HCPCS 93650 TC
Hospital Charge Code	66574587
Hospital Revenue Code	480
Min. Negotiated Rate	$316.00
Max. Negotiated Rate	$14,261.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,804.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,636.37
Rate for Payer: Aetna Government	$8,636.37
Rate for Payer: Affinity Essential Plan 1&2	$6,045.46
Rate for Payer: Affinity Essential Plan 3&4	$6,045.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,045.46
Rate for Payer: Brighton Health Commercial	$13,369.76
Rate for Payer: Cash Price	$8,636.37
Rate for Payer: Cash Price	$8,636.37
Rate for Payer: Cash Price	$8,636.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,636.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,261.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,121.92
Rate for Payer: Elderplan Medicare Advantage	$8,636.37
Rate for Payer: EmblemHealth Commercial	$8,636.37
Rate for Payer: Fidelis Essential Plan Aliesa	$7,340.91
Rate for Payer: Fidelis Essential Plan QHP	$7,686.37
Rate for Payer: Fidelis Medicare Advantage	$8,636.37
Rate for Payer: Fidelis Qualified Health Plan	$7,686.37
Rate for Payer: Group Health Inc Commercial	$8,636.37
Rate for Payer: Group Health Inc Medicare	$8,636.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,913.18
Rate for Payer: Hamaspik Choice Inc Medicare	$8,636.37
Rate for Payer: Healthfirst Medicare Advantage	$7,340.91
Rate for Payer: Healthfirst QHP	$8,636.37
Rate for Payer: Humana Medicare	$8,809.10
Rate for Payer: Senior Whole Health Medicare Advantage	$8,636.37
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$8,636.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,636.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,909.10
Rate for Payer: Wellcare Medicare	$8,204.55

EPV ADJ IMP OPT VAL ANA

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	66574558
Hospital Revenue Code	480
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.61
Rate for Payer: Aetna Government	$43.61
Rate for Payer: Affinity Essential Plan 1&2	$30.53
Rate for Payer: Affinity Essential Plan 3&4	$30.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$30.53
Rate for Payer: Brighton Health Commercial	$82.35
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Cash Price	$43.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$43.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.66
Rate for Payer: Elderplan Medicare Advantage	$43.61
Rate for Payer: EmblemHealth Commercial	$43.61
Rate for Payer: Fidelis Essential Plan Aliesa	$37.07
Rate for Payer: Fidelis Essential Plan QHP	$38.81
Rate for Payer: Fidelis Medicare Advantage	$43.61
Rate for Payer: Fidelis Qualified Health Plan	$38.81
Rate for Payer: Group Health Inc Commercial	$43.61
Rate for Payer: Group Health Inc Medicare	$43.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.90
Rate for Payer: Hamaspik Choice Inc Medicare	$43.61
Rate for Payer: Healthfirst Medicare Advantage	$37.07
Rate for Payer: Healthfirst QHP	$43.61
Rate for Payer: Humana Medicare	$44.48
Rate for Payer: Senior Whole Health Medicare Advantage	$43.61
Rate for Payer: United Healthcare Commercial	$316.00
Rate for Payer: United Healthcare Medicare Advantage	$43.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34.89
Rate for Payer: Wellcare Medicare	$41.43

EPV ADJ IMP OPT VAL ANA

Facility

$109.80

Service Code	HCPCS 93279 TC
Hospital Charge Code	66574558
Hospital Revenue Code	480
Rate for Payer: Cash Price	$43.61

EPV AORTA DUPLEX

Facility

$705.83

Service Code	HCPCS 93978 TC
Hospital Charge Code	66574605
Hospital Revenue Code	921
Rate for Payer: Cash Price	$283.37

EPV AORTA DUPLEX

Facility

$705.83

Service Code	HCPCS 93978 TC
Hospital Charge Code	66574605
Hospital Revenue Code	921
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$352.92
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

EPV ART DUPLEX BYPASS UNI

Facility

$339.45

Service Code	HCPCS 93931 TC
Hospital Charge Code	66574601
Hospital Revenue Code	920
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$254.59
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Elderplan Medicare Advantage	$127.14
Rate for Payer: EmblemHealth Commercial	$127.14
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$127.14
Rate for Payer: Group Health Inc Medicare	$127.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst Medicare Advantage	$108.07
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

EPV ART DUPLEX BYPASS UNI

Facility

$339.45

Service Code	HCPCS 93931 TC
Hospital Charge Code	66574601
Hospital Revenue Code	920
Rate for Payer: Cash Price	$127.14

EPV ARTERIAL DUPLEX

Facility

$705.83

Service Code	HCPCS 93930 TC
Hospital Charge Code	66574600
Hospital Revenue Code	920
Rate for Payer: Cash Price	$283.37

EPV ARTERIAL DUPLEX

Facility

$705.83

Service Code	HCPCS 93930 TC
Hospital Charge Code	66574600
Hospital Revenue Code	920
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$564.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$479.96
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$283.37
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$94.00
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

EPV CARDIAC STRESS

Facility

$766.58

Service Code	HCPCS 93017 TC
Hospital Charge Code	66574555
Hospital Revenue Code	482
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$697.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$697.00
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

Know your out-of-pocket cost for care.

All Charges