|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
OP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41647832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$82.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$61.70
|
| Rate for Payer: EmblemHealth Commercial |
$61.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.45
|
| Rate for Payer: Healthfirst QHP |
$61.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.36
|
| Rate for Payer: Wellcare Medicare |
$58.62
|
|
|
DARATUMUMAB 400MG/20ML INJECTION
|
Facility
IP
|
$127.46
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
41657832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.73 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Cash Price |
$61.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.73
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
OP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41650359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.05
|
| Rate for Payer: Aetna Government |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$49.05
|
| Rate for Payer: EmblemHealth Commercial |
$49.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.50
|
| Rate for Payer: Group Health Inc Commercial |
$49.05
|
| Rate for Payer: Group Health Inc Medicare |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.69
|
| Rate for Payer: Healthfirst QHP |
$49.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.73
|
| Rate for Payer: SOMOS Essential |
$51.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Wellcare Medicare |
$46.60
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
OP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41640359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.05
|
| Rate for Payer: Aetna Government |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$49.05
|
| Rate for Payer: EmblemHealth Commercial |
$49.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.50
|
| Rate for Payer: Group Health Inc Commercial |
$49.05
|
| Rate for Payer: Group Health Inc Medicare |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.69
|
| Rate for Payer: Healthfirst QHP |
$49.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.73
|
| Rate for Payer: SOMOS Essential |
$51.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Wellcare Medicare |
$46.60
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
IP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41640359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
|
|
DARATUMUMAB AND HYALURONIDASE
|
Facility
IP
|
$109.62
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
41650359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.81
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
IP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41651842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
IP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41641842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
OP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41641842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| 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 |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$4.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR ESRD
|
Facility
OP
|
$4.89
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41651842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$2.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| 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 |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$4.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR NON
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$7.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR NON
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR NON
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
|
|
DARBEPOETIN 100 MCG/ 0.5 ML INJ FOR NON
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$7.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR ESRD
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41644126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR ESRD
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41654126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$370.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$337.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR ESRD
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41654126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR ESRD
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41644126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$370.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$337.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR NON
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$370.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$337.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR NON
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR NON
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
|
|
DARBEPOETIN 150 MCG/ 0.3 ML INJ FOR NON
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$370.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$337.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$387.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.08
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR ESRD
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41644917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| 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 |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$4.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR ESRD
|
Facility
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41654917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| 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 |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.30
|
| 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 |
$4.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.10
|
| Rate for Payer: Healthfirst Essential Plan |
$4.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.10
|
| Rate for Payer: SOMOS Essential |
$4.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR ESRD
|
Facility
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41644917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.24
|
|
