|
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 NON
|
Facility
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$621.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.00
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR NON
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$683.10
|
| 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 |
$621.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$714.15
|
| 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 |
$621.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.00
|
| 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 |
$807.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR NON
|
Facility
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$621.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.00
|
|
|
DARBEPOETIN 300 MCG/ 0.6 ML INJ FOR NON
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$683.10
|
| 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 |
$621.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$714.15
|
| 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 |
$621.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.00
|
| 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 |
$807.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR ESRD
|
Facility
OP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.68
|
| 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 |
$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 |
$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 |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| 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 |
$3.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR ESRD
|
Facility
IP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645193
|
|
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 40 MCG/0.4 ML INJ FOR ESRD
|
Facility
OP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.68
|
| 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 |
$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 |
$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 |
$2.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.44
|
| 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 |
$3.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR ESRD
|
Facility
IP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655193
|
|
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 40 MCG/0.4 ML INJ FOR NON ES
|
Facility
OP
|
$5.11
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.81
|
| 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 |
$2.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.94
|
| 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 |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.56
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR NON ES
|
Facility
IP
|
$5.11
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.56
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR NON ES
|
Facility
IP
|
$5.11
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.56
|
|
|
DARBEPOETIN 40 MCG/0.4 ML INJ FOR NON ES
|
Facility
OP
|
$5.11
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.81
|
| 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 |
$2.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.94
|
| 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 |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.56
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR ESRD
|
Facility
IP
|
$24.35
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$12.18 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.18
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR ESRD
|
Facility
OP
|
$24.35
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$15.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.39
|
| 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 |
$12.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.00
|
| 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 |
$12.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.18
|
| 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 |
$15.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR ESRD
|
Facility
OP
|
$24.35
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$15.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.39
|
| 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 |
$12.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.00
|
| 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 |
$12.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.18
|
| 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 |
$15.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR ESRD
|
Facility
IP
|
$24.35
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$12.18 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.18
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR NON ESRD
|
Facility
OP
|
$3,116.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,713.80
|
| 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 |
$1,558.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,791.70
|
| 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 |
$1,558.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.00
|
| 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 |
$2,025.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR NON ESRD
|
Facility
IP
|
$3,116.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,558.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.00
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR NON ESRD
|
Facility
IP
|
$3,116.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,558.00 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,558.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.00
|
|
|
DARBEPOETIN 500 MCG/ML INJ FOR NON ESRD
|
Facility
OP
|
$3,116.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,713.80
|
| 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 |
$1,558.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,791.70
|
| 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 |
$1,558.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.00
|
| 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 |
$2,025.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR ESRD
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41645170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| 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 |
$2.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| 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 |
$2.55
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR ESRD
|
Facility
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41655170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| 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 |
$2.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.93
|
| 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 |
$2.55
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR ESRD
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41645170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR ESRD
|
Facility
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J0882
|
| Hospital Charge Code |
41655170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
|
