|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656874
|
|
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 |
41646874
|
|
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 FOR ESRD 10,000 UNITS/ML INJ
|
Facility
OP
|
$20.68
|
|
| Hospital Charge Code |
41644352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.34
|
| Rate for Payer: Group Health Inc Medicare |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
|
|
EPOETIN FOR ESRD 10,000 UNITS/ML INJ
|
Facility
OP
|
$20.68
|
|
| Hospital Charge Code |
41654352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.34
|
| Rate for Payer: Group Health Inc Medicare |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41654855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41654855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$12.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
OP
|
$211.00
|
|
| Hospital Charge Code |
41644855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$168.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.50
|
| Rate for Payer: Aetna Government |
$105.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.48
|
| Rate for Payer: Group Health Inc Commercial |
$105.50
|
| Rate for Payer: Group Health Inc Medicare |
$73.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.15
|
|
|
EPOETIN FOR ESRD 2,000 UNITS/ML INJ
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
41654349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
EPOETIN FOR ESRD 2,000 UNITS/ML INJ
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
41644349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
EPOETIN FOR ESRD 3,000 UNITS/ML INJ
|
Facility
OP
|
$33.34
|
|
| Hospital Charge Code |
41644350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR ESRD 3,000 UNITS/ML INJ
|
Facility
OP
|
$33.34
|
|
| Hospital Charge Code |
41654350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR ESRD 4,000 UNITS/ML INJ
|
Facility
OP
|
$37.92
|
|
| Hospital Charge Code |
41644351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$13.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.65
|
|
|
EPOETIN FOR ESRD 4,000 UNITS/ML INJ
|
Facility
OP
|
$37.92
|
|
| Hospital Charge Code |
41654351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$13.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.65
|
|
|
EPOETIN FOR NON ESRD 10,000 UNITS/ML INJ
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
41653712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 10,000 UNITS/ML INJ
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
41643712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41655567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$12.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41645567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$12.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41645567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41655567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR NON ESRD 2,000 UNITS/ML INJ
|
Facility
OP
|
$36.27
|
|
| Hospital Charge Code |
41643709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$12.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.58
|
|
|
EPOETIN FOR NON ESRD 2,000 UNITS/ML INJ
|
Facility
OP
|
$36.27
|
|
| Hospital Charge Code |
41653709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$12.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.58
|
|
|
EPOETIN FOR NON ESRD 3,000 UNITS/ML INJ
|
Facility
OP
|
$33.34
|
|
| Hospital Charge Code |
41643710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR NON ESRD 3,000 UNITS/ML INJ
|
Facility
OP
|
$33.34
|
|
| Hospital Charge Code |
41653710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR NON ESRD 40,000 UNITS/ML INJ
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
41653713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 40,000 UNITS/ML INJ
|
Facility
OP
|
$41.00
|
|
| Hospital Charge Code |
41643713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
