|
EPOETIN ALFA ESRD 2,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 4,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 4,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA NON-ESRD 10,000
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 10,000
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 10,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 10,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 40,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 40,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
