|
EPOETIN ALFA 3000 UNIT/ML IJ SOLN [9940]
|
Facility
|
OP
|
$59.69
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
55513026710
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$44.77
|
| 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 |
$47.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.59
|
| 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 |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| 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: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 3000 UNIT/ML IJ SOLN [9940]
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
59676030301
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$72.16
|
| 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 |
$76.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.43
|
| 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 |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| 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: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 4000 UNIT/ML IJ SOLN [9941]
|
Facility
|
OP
|
$128.28
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
59676030401
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$96.21
|
| 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 |
$102.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.23
|
| 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 |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| 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: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 4000 UNIT/ML IJ SOLN [9941]
|
Facility
|
OP
|
$79.58
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
55513014810
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$59.69
|
| 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 |
$63.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.12
|
| 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 |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| 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: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN [160716]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130810
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$99.27
|
| 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 |
$105.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$66.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN [160716]
|
Facility
|
OP
|
$132.36
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130801
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$99.27
|
| 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 |
$105.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$66.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN [160713]
|
Facility
|
OP
|
$26.47
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130510
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$21.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$19.85
|
| 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 |
$21.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA-EPBX 3000 UNIT/ML IJ SOLN [160714]
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130610
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$31.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$29.78
|
| 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 |
$31.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$19.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN [160717]
|
Facility
|
OP
|
$529.44
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130904
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$423.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$397.08
|
| 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 |
$423.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$264.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN [160715]
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
00069130710
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$39.71
|
| 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 |
$42.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.96
|
| 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 |
$26.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 3,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 4,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 4,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA NON-ESRD 10,000
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
