|
EPOETIN ALFA NON-ESRD 10,000
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 10,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 10,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 2,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 3,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 40,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 40,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41646874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA NON-ESRD 4,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: 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 |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst 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: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EPOETIN FOR ESRD 10,000 UNITS/ML INJ
|
Facility
|
OP
|
$20.68
|
|
| Hospital Charge Code |
41644352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| Rate for Payer: Brighton Health Commercial |
$15.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.34
|
| Rate for Payer: Group Health Inc Medicare |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
|
|
EPOETIN FOR ESRD 10,000 UNITS/ML INJ
|
Facility
|
OP
|
$20.68
|
|
| Hospital Charge Code |
41654352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| Rate for Payer: Brighton Health Commercial |
$15.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.34
|
| Rate for Payer: Group Health Inc Medicare |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41654855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: 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 |
$126.60
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$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 Commercial |
$8.25
|
| 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 |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
|
OP
|
$211.00
|
|
| Hospital Charge Code |
41644855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$168.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.50
|
| Rate for Payer: Aetna Government |
$105.50
|
| Rate for Payer: Brighton Health Commercial |
$158.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.48
|
| Rate for Payer: Group Health Inc Commercial |
$105.50
|
| Rate for Payer: Group Health Inc Medicare |
$73.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.15
|
|
|
EPOETIN FOR ESRD 20,000 UNITS/2 ML INJ
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41654855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR ESRD 2,000 UNITS/ML INJ
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
41644349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
EPOETIN FOR ESRD 2,000 UNITS/ML INJ
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
41654349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
EPOETIN FOR ESRD 3,000 UNITS/ML INJ
|
Facility
|
OP
|
$33.34
|
|
| Hospital Charge Code |
41644350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Brighton Health Commercial |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
