St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302701
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302701
Hospital Revenue Code	634
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302801
Hospital Revenue Code	634
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302801
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 200 MCG/ML IJ SOLN

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551300601
Hospital Revenue Code	634
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 200 MCG/ML IJ SOLN

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551300601
Hospital Revenue Code	634
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY

Facility

$552.86

Service Code	HCPCS J0881
Hospital Charge Code	5551305701
Hospital Revenue Code	634
Min. Negotiated Rate	$276.43
Max. Negotiated Rate	$276.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$276.43

DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY

Facility

$552.86

Service Code	HCPCS J0881
Hospital Charge Code	5551305701
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$442.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$304.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$414.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$442.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$375.94
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$359.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 25 MCG/ML IJ SOLN

Facility

$232.20

Service Code	HCPCS J0881
Hospital Charge Code	5551300204
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$185.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$174.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$185.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.90
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$150.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 25 MCG/ML IJ SOLN

Facility

$232.20

Service Code	HCPCS J0881
Hospital Charge Code	5551300204
Hospital Revenue Code	634
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$116.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$116.10

DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551311101
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551311101
Hospital Revenue Code	634
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY

Facility

$928.80

Service Code	HCPCS J0881
Hospital Charge Code	5551302104
Hospital Revenue Code	634
Min. Negotiated Rate	$464.40
Max. Negotiated Rate	$464.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.40

DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY

Facility

$928.80

Service Code	HCPCS J0881
Hospital Charge Code	5551302104
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$743.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$510.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$696.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$743.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$631.58
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$603.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 40 MCG/ML IJ SOLN

Facility

$371.52

Service Code	HCPCS J0881
Hospital Charge Code	5551300304
Hospital Revenue Code	634
Min. Negotiated Rate	$185.76
Max. Negotiated Rate	$185.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.76

DARBEPOETIN ALFA 40 MCG/ML IJ SOLN

Facility

$371.52

Service Code	HCPCS J0881
Hospital Charge Code	5551300304
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$297.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$204.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$278.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$297.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$252.63
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$241.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 500 MCG/ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551303201
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 500 MCG/ML IJ SOSY

Facility

$4.00

Service Code	HCPCS J0881
Hospital Charge Code	5551303201
Hospital Revenue Code	634
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00

DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302301
Hospital Revenue Code	634
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY

Facility

$1.00

Service Code	HCPCS J0881
Hospital Charge Code	5551302301
Hospital Revenue Code	634
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$3.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 60 MCG/ML IJ SOLN

Facility

$557.28

Service Code	HCPCS J0881
Hospital Charge Code	5551300404
Hospital Revenue Code	634
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$445.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.93
Rate for Payer: Aetna Government	$2.93
Rate for Payer: Affinity Essential Plan 1&2	$2.05
Rate for Payer: Affinity Essential Plan 3&4	$2.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.05
Rate for Payer: Brighton Health Commercial	$417.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.95
Rate for Payer: Elderplan Medicare Advantage	$2.93
Rate for Payer: EmblemHealth Commercial	$2.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.64
Rate for Payer: Fidelis Essential Plan Aliesa	$2.49
Rate for Payer: Fidelis Essential Plan QHP	$2.61
Rate for Payer: Fidelis Medicare Advantage	$2.93
Rate for Payer: Fidelis Qualified Health Plan	$3.08
Rate for Payer: Group Health Inc Commercial	$2.93
Rate for Payer: Group Health Inc Medicare	$2.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.93
Rate for Payer: Hamaspik Choice Inc Medicare	$2.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.93
Rate for Payer: Healthfirst Medicare Advantage	$2.49
Rate for Payer: Healthfirst QHP	$2.93
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Senior Whole Health Medicare Advantage	$2.93
Rate for Payer: United Healthcare Medicare Advantage	$2.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.78
Rate for Payer: Wellcare Medicare	$2.78

DARBEPOETIN ALFA 60 MCG/ML IJ SOLN

Facility

$557.28

Service Code	HCPCS J0881
Hospital Charge Code	5551300404
Hospital Revenue Code	634
Min. Negotiated Rate	$278.64
Max. Negotiated Rate	$278.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.64

DARUNAVIR 600 MG PO TABS

Facility

$43.16

Service Code	NDC 5967656201
Hospital Charge Code	5967656201
Hospital Revenue Code	250
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$21.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.58

DARUNAVIR 600 MG PO TABS

Facility

$43.16

Service Code	NDC 5967656201
Hospital Charge Code	5967656201
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$34.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.58
Rate for Payer: Aetna Government	$21.58
Rate for Payer: Brighton Health Commercial	$32.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.35
Rate for Payer: EmblemHealth Commercial	$21.58
Rate for Payer: Group Health Inc Commercial	$21.58
Rate for Payer: Group Health Inc Medicare	$15.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.58
Rate for Payer: Hamaspik Choice Inc Medicare	$21.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.06

DARUNAVIR 800 MG PO TABS

Facility

$7.54

Service Code	NDC 7257814806
Hospital Charge Code	7257814806
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$6.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.77
Rate for Payer: Aetna Government	$3.77
Rate for Payer: Brighton Health Commercial	$5.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.13
Rate for Payer: EmblemHealth Commercial	$3.77
Rate for Payer: Group Health Inc Commercial	$3.77
Rate for Payer: Group Health Inc Medicare	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.77
Rate for Payer: Hamaspik Choice Inc Medicare	$3.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.90

Know your out-of-pocket cost for care.

All Charges