|
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 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
|
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
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$8.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$8.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$404.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 |
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
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$404.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$404.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 |
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$404.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 200 MCG/ 0.4 ML INJ FOR ESR
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
|
|
DARBEPOETIN 200 MCG/ 0.4 ML INJ FOR ESR
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
|
|
DARBEPOETIN 200 MCG/ 0.4 ML INJ FOR ESR
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$2.89
|
| 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 |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.77
|
| 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 |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 200 MCG/ 0.4 ML INJ FOR ESR
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.93
|
| Rate for Payer: Aetna Government |
$2.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$2.89
|
| 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 |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.77
|
| 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 |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 200 MCG/ 0.4 ML INJ FOR NON
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41653692
|
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$8.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 200 MCG/ 0.4 ML INJ FOR NON
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41643692
|
|
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 200 MCG/ 0.4 ML INJ FOR NON
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41653692
|
|
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 200 MCG/ 0.4 ML INJ FOR NON
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41643692
|
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$8.40
|
| 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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 25 MCG/ 0.42 ML INJ FOR ESR
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41654840
|
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 25 MCG/ 0.42 ML INJ FOR ESR
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41644840
|
|
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: Affinity Essential Plan 1&2 |
$2.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.90
|
| Rate for Payer: Brighton Health Commercial |
$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 Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$2.93
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| 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 25 MCG/ 0.42 ML INJ FOR ESR
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41654840
|
|
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 25 MCG/ 0.42 ML INJ FOR ESR
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41644840
|
|
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
|
|
