St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN

Facility

$9.00

Service Code	HCPCS J0171
Hospital Charge Code	7632990600
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50

EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN

Facility

$9.00

Service Code	HCPCS J0171
Hospital Charge Code	7632990600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: EmblemHealth Commercial	$4.50
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN

Facility

$10.02

Service Code	HCPCS J0169
Hospital Charge Code	4202316801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$8.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.01
Rate for Payer: Aetna Government	$5.01
Rate for Payer: Brighton Health Commercial	$7.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.82
Rate for Payer: EmblemHealth Commercial	$5.01
Rate for Payer: Group Health Inc Commercial	$5.01
Rate for Payer: Group Health Inc Medicare	$3.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.01
Rate for Payer: Hamaspik Choice Inc Medicare	$5.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.51

EPINEPHRINE HCL-DEXTROSE 4-5 MG/250ML-% IV SOLN

Facility

$0.19

Service Code	NDC 7128570181
Hospital Charge Code	7128570181
Hospital Revenue Code	258
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

EPINEPHRINE HCL-DEXTROSE 4-5 MG/250ML-% IV SOLN

Facility

$0.19

Service Code	NDC 7128570181
Hospital Charge Code	7128570181
Hospital Revenue Code	258
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

EPINEPHRINE HCL-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.22

Service Code	NDC 7128580931
Hospital Charge Code	7128580931
Hospital Revenue Code	258
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11

EPINEPHRINE HCL-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.22

Service Code	NDC 7128580931
Hospital Charge Code	7128580931
Hospital Revenue Code	258
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.15
Rate for Payer: EmblemHealth Commercial	$0.11
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.43

Service Code	HCPCS J0163
Hospital Charge Code	4202331510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.43

Service Code	HCPCS J0163
Hospital Charge Code	4202331501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.43

Service Code	HCPCS J0163
Hospital Charge Code	4202331510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN

Facility

$0.43

Service Code	HCPCS J0163
Hospital Charge Code	4202331501
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

EPINEPHRINE PF 1 MG/ML IJ SOLN

Facility

$17.50

Service Code	HCPCS J0166
Hospital Charge Code	5428810310
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$14.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.75
Rate for Payer: Aetna Government	$8.75
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.90
Rate for Payer: EmblemHealth Commercial	$8.75
Rate for Payer: Group Health Inc Commercial	$8.75
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.38

EPINEPHRINE PF 1 MG/ML IJ SOLN

Facility

$17.50

Service Code	HCPCS J0166
Hospital Charge Code	5428810310
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75

EPINEPHRINE PF 1 MG/ML IJ SOLN

Facility

$17.50

Service Code	HCPCS J0166
Hospital Charge Code	5428810301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$14.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.75
Rate for Payer: Aetna Government	$8.75
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.90
Rate for Payer: EmblemHealth Commercial	$8.75
Rate for Payer: Group Health Inc Commercial	$8.75
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.38

EPINEPHRINE PF 1 MG/ML IJ SOLN

Facility

$17.50

Service Code	HCPCS J0166
Hospital Charge Code	5428810301
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.75

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$198.96

Service Code	HCPCS J0885
Hospital Charge Code	5551314401
Hospital Revenue Code	635
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,226.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.54
Rate for Payer: Aetna Government	$8.54
Rate for Payer: Affinity Essential Plan 1&2	$27.59
Rate for Payer: Affinity Essential Plan 3&4	$27.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.26
Rate for Payer: Amida Care Medicaid	$12.26
Rate for Payer: Brighton Health Commercial	$149.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.29
Rate for Payer: Elderplan Medicare Advantage	$8.54
Rate for Payer: EmblemHealth Commercial	$8.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.59
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.26
Rate for Payer: Fidelis Essential Plan Aliesa	$27.59
Rate for Payer: Fidelis Essential Plan QHP	$27.59
Rate for Payer: Fidelis Medicare Advantage	$8.54
Rate for Payer: Fidelis Qualified Health Plan	$12.87
Rate for Payer: Group Health Inc Commercial	$8.54
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,226.00
Rate for Payer: Healthfirst Essential Plan	$27.59
Rate for Payer: Healthfirst Medicare Advantage	$7.26
Rate for Payer: Healthfirst QHP	$19.98
Rate for Payer: Humana Medicare	$8.71
Rate for Payer: Senior Whole Health Medicare Advantage	$8.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.26
Rate for Payer: SOMOS Essential	$27.59
Rate for Payer: United Healthcare Essential Plan 1&2	$27.59
Rate for Payer: United Healthcare Essential Plan 3&4	$13.49
Rate for Payer: United Healthcare Medicaid	$12.26
Rate for Payer: United Healthcare Medicare Advantage	$8.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.26
Rate for Payer: Wellcare Medicare	$8.11

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$198.96

Service Code	HCPCS J0885
Hospital Charge Code	5551314410
Hospital Revenue Code	635
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,226.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.54
Rate for Payer: Aetna Government	$8.54
Rate for Payer: Affinity Essential Plan 1&2	$27.59
Rate for Payer: Affinity Essential Plan 3&4	$27.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.26
Rate for Payer: Amida Care Medicaid	$12.26
Rate for Payer: Brighton Health Commercial	$149.22
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$135.29
Rate for Payer: Elderplan Medicare Advantage	$8.54
Rate for Payer: EmblemHealth Commercial	$8.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.59
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.26
Rate for Payer: Fidelis Essential Plan Aliesa	$27.59
Rate for Payer: Fidelis Essential Plan QHP	$27.59
Rate for Payer: Fidelis Medicare Advantage	$8.54
Rate for Payer: Fidelis Qualified Health Plan	$12.87
Rate for Payer: Group Health Inc Commercial	$8.54
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,226.00
Rate for Payer: Healthfirst Essential Plan	$27.59
Rate for Payer: Healthfirst Medicare Advantage	$7.26
Rate for Payer: Healthfirst QHP	$19.98
Rate for Payer: Humana Medicare	$8.71
Rate for Payer: Senior Whole Health Medicare Advantage	$8.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.26
Rate for Payer: SOMOS Essential	$27.59
Rate for Payer: United Healthcare Essential Plan 1&2	$27.59
Rate for Payer: United Healthcare Essential Plan 3&4	$13.49
Rate for Payer: United Healthcare Medicaid	$12.26
Rate for Payer: United Healthcare Medicare Advantage	$8.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.26
Rate for Payer: Wellcare Medicare	$8.11

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$320.70

Service Code	HCPCS J0885
Hospital Charge Code	5967631001
Hospital Revenue Code	635
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,226.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.54
Rate for Payer: Aetna Government	$8.54
Rate for Payer: Affinity Essential Plan 1&2	$27.59
Rate for Payer: Affinity Essential Plan 3&4	$27.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.26
Rate for Payer: Amida Care Medicaid	$12.26
Rate for Payer: Brighton Health Commercial	$240.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.08
Rate for Payer: Elderplan Medicare Advantage	$8.54
Rate for Payer: EmblemHealth Commercial	$8.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.59
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.26
Rate for Payer: Fidelis Essential Plan Aliesa	$27.59
Rate for Payer: Fidelis Essential Plan QHP	$27.59
Rate for Payer: Fidelis Medicare Advantage	$8.54
Rate for Payer: Fidelis Qualified Health Plan	$12.87
Rate for Payer: Group Health Inc Commercial	$8.54
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,226.00
Rate for Payer: Healthfirst Essential Plan	$27.59
Rate for Payer: Healthfirst Medicare Advantage	$7.26
Rate for Payer: Healthfirst QHP	$19.98
Rate for Payer: Humana Medicare	$8.71
Rate for Payer: Senior Whole Health Medicare Advantage	$8.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.26
Rate for Payer: SOMOS Essential	$27.59
Rate for Payer: United Healthcare Essential Plan 1&2	$27.59
Rate for Payer: United Healthcare Essential Plan 3&4	$13.49
Rate for Payer: United Healthcare Medicaid	$12.26
Rate for Payer: United Healthcare Medicare Advantage	$8.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.26
Rate for Payer: Wellcare Medicare	$8.11

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$198.96

Service Code	HCPCS J0885
Hospital Charge Code	5551314401
Hospital Revenue Code	635
Min. Negotiated Rate	$99.48
Max. Negotiated Rate	$99.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.48

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$320.70

Service Code	HCPCS J0885
Hospital Charge Code	5967631001
Hospital Revenue Code	635
Min. Negotiated Rate	$160.35
Max. Negotiated Rate	$160.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.35

EPOETIN ALFA 10000 UNIT/ML IJ SOLN

Facility

$198.96

Service Code	HCPCS J0885
Hospital Charge Code	5551314410
Hospital Revenue Code	635
Min. Negotiated Rate	$99.48
Max. Negotiated Rate	$99.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.48

EPOETIN ALFA 2000 UNIT/ML IJ SOLN

Facility

$64.15

Service Code	HCPCS J0885
Hospital Charge Code	5967630201
Hospital Revenue Code	635
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,226.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.54
Rate for Payer: Aetna Government	$8.54
Rate for Payer: Affinity Essential Plan 1&2	$27.59
Rate for Payer: Affinity Essential Plan 3&4	$27.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.26
Rate for Payer: Amida Care Medicaid	$12.26
Rate for Payer: Brighton Health Commercial	$48.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.62
Rate for Payer: Elderplan Medicare Advantage	$8.54
Rate for Payer: EmblemHealth Commercial	$8.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.59
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.26
Rate for Payer: Fidelis Essential Plan Aliesa	$27.59
Rate for Payer: Fidelis Essential Plan QHP	$27.59
Rate for Payer: Fidelis Medicare Advantage	$8.54
Rate for Payer: Fidelis Qualified Health Plan	$12.87
Rate for Payer: Group Health Inc Commercial	$8.54
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,226.00
Rate for Payer: Healthfirst Essential Plan	$27.59
Rate for Payer: Healthfirst Medicare Advantage	$7.26
Rate for Payer: Healthfirst QHP	$19.98
Rate for Payer: Humana Medicare	$8.71
Rate for Payer: Senior Whole Health Medicare Advantage	$8.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.26
Rate for Payer: SOMOS Essential	$27.59
Rate for Payer: United Healthcare Essential Plan 1&2	$27.59
Rate for Payer: United Healthcare Essential Plan 3&4	$13.49
Rate for Payer: United Healthcare Medicaid	$12.26
Rate for Payer: United Healthcare Medicare Advantage	$8.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.26
Rate for Payer: Wellcare Medicare	$8.11

EPOETIN ALFA 2000 UNIT/ML IJ SOLN

Facility

$39.79

Service Code	HCPCS J0885
Hospital Charge Code	5551312610
Hospital Revenue Code	635
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$1,226.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.54
Rate for Payer: Aetna Government	$8.54
Rate for Payer: Affinity Essential Plan 1&2	$27.59
Rate for Payer: Affinity Essential Plan 3&4	$27.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.26
Rate for Payer: Amida Care Medicaid	$12.26
Rate for Payer: Brighton Health Commercial	$29.84
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.06
Rate for Payer: Elderplan Medicare Advantage	$8.54
Rate for Payer: EmblemHealth Commercial	$8.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$27.59
Rate for Payer: EmblemHealth Essential Plan 3&4	$12.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12.26
Rate for Payer: Fidelis Essential Plan Aliesa	$27.59
Rate for Payer: Fidelis Essential Plan QHP	$27.59
Rate for Payer: Fidelis Medicare Advantage	$8.54
Rate for Payer: Fidelis Qualified Health Plan	$12.87
Rate for Payer: Group Health Inc Commercial	$8.54
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.26
Rate for Payer: Hamaspik Choice Inc Medicare	$8.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,226.00
Rate for Payer: Healthfirst Essential Plan	$27.59
Rate for Payer: Healthfirst Medicare Advantage	$7.26
Rate for Payer: Healthfirst QHP	$19.98
Rate for Payer: Humana Medicare	$8.71
Rate for Payer: Senior Whole Health Medicare Advantage	$8.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.26
Rate for Payer: SOMOS Essential	$27.59
Rate for Payer: United Healthcare Essential Plan 1&2	$27.59
Rate for Payer: United Healthcare Essential Plan 3&4	$13.49
Rate for Payer: United Healthcare Medicaid	$12.26
Rate for Payer: United Healthcare Medicare Advantage	$8.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.26
Rate for Payer: Wellcare Medicare	$8.11

EPOETIN ALFA 2000 UNIT/ML IJ SOLN

Facility

$39.79

Service Code	HCPCS J0885
Hospital Charge Code	5551312610
Hospital Revenue Code	635
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.90

EPOETIN ALFA 2000 UNIT/ML IJ SOLN

Facility

$64.15

Service Code	HCPCS J0885
Hospital Charge Code	5967630201
Hospital Revenue Code	635
Min. Negotiated Rate	$32.08
Max. Negotiated Rate	$32.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.08

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