|
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
|
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: 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 |
$1,869.60
|
| 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 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 |
$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 |
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 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: Affinity Essential Plan 1&2 |
$9.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.10
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| 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 |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$9.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4.51
|
| Rate for Payer: United Healthcare Medicaid |
$4.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.32
|
| 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: Affinity Essential Plan 1&2 |
$9.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.10
|
| Rate for Payer: Amida Care Medicaid |
$4.10
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| 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 |
$9.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.49
|
| Rate for Payer: Healthfirst QHP |
$4.10
|
| Rate for Payer: Humana Medicare |
$2.99
|
| 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: United Healthcare Commercial |
$3.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$9.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4.51
|
| Rate for Payer: United Healthcare Medicaid |
$4.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.32
|
| 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
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR NON ES
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645167
|
|
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 NON ES
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41645167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.32 |
| 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: 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 |
$3.06
|
| 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 |
$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 |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN 60 MCG/ 0.3ML INJ FOR NON ES
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655167
|
|
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 NON ES
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
41655167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.32 |
| 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: 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 |
$3.06
|
| 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 |
$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 |
$2.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.55
|
| 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 |
$3.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY [129774]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513002501
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$1,486.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,021.68
|
| 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 |
$1,393.20
|
| 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 |
$1,486.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,263.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$928.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,207.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 100 MCG/ML IJ SOLN [129767]
|
Facility
|
OP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513000504
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$510.84
|
| 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 |
$696.60
|
| 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 |
$743.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$631.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$464.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$603.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY [129778]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513002701
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3,715.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,554.20
|
| 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 |
$3,483.00
|
| 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 |
$3,715.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,157.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$2,322.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,018.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY [129780]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513002801
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3,715.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,554.20
|
| 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 |
$3,483.00
|
| 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 |
$3,715.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,157.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$2,322.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,018.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 200 MCG/ML IJ SOLN [129776]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513000601
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$1,486.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,021.68
|
| 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 |
$1,393.20
|
| 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 |
$1,486.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,263.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$928.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,207.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY [129764]
|
Facility
|
OP
|
$552.86
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513005701
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$442.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.07
|
| 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 |
$414.64
|
| 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 |
$442.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$276.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 25 MCG/ML IJ SOLN [129762]
|
Facility
|
OP
|
$232.20
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513000204
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$185.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.71
|
| 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 |
$174.15
|
| 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 |
$185.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$157.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$116.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY [129781]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513011101
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3,715.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,554.20
|
| 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 |
$3,483.00
|
| 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 |
$3,715.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,157.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$2,322.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,018.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY [129766]
|
Facility
|
OP
|
$928.80
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513002104
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$743.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$510.84
|
| 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 |
$696.60
|
| 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 |
$743.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$631.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$464.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$603.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 40 MCG/ML IJ SOLN [129765]
|
Facility
|
OP
|
$371.52
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513000304
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.34
|
| 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 |
$278.64
|
| 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 |
$297.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$185.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 500 MCG/ML IJ SOSY [129782]
|
Facility
|
OP
|
$4,644.00
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513003201
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3,715.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,554.20
|
| 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 |
$3,483.00
|
| 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 |
$3,715.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,157.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$2,322.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,018.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY [129768]
|
Facility
|
OP
|
$1,857.60
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513002301
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$1,486.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,021.68
|
| 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 |
$1,393.20
|
| 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 |
$1,486.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,263.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$928.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,207.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALFA 60 MCG/ML IJ SOLN [129771]
|
Facility
|
OP
|
$557.28
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
55513000404
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$445.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.50
|
| 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 |
$417.96
|
| 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 |
$445.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.93
|
| Rate for Payer: EmblemHealth Commercial |
$2.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.61
|
| 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 |
$278.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.93
|
| 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: United Healthcare Medicare Advantage |
$2.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Wellcare Medicare |
$2.78
|
|
|
DARBEPOETIN ALPHA ERSD 200MCG/1ML
|
Facility
|
OP
|
$944.40
|
|
| Hospital Charge Code |
41646078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$330.54 |
| Max. Negotiated Rate |
$755.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$519.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$472.20
|
| Rate for Payer: Aetna Government |
$472.20
|
| Rate for Payer: Brighton Health Commercial |
$708.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$755.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$642.19
|
| Rate for Payer: Group Health Inc Commercial |
$472.20
|
| Rate for Payer: Group Health Inc Medicare |
$330.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$472.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$613.86
|
|
