|
BUPRENORPHINE/NALOXONE 8-2MGDETOX
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41649002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
BUPRENORPHINE/NALOXONE 8-2MGDETOX
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41649002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.43
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7.08
|
| Rate for Payer: Healthfirst QHP |
$7.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.08
|
| Rate for Payer: SOMOS Essential |
$7.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.08
|
|
|
BUPRENORPHINE/NALOXONE 8-2MGDETOX
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41659002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
BUPRENORPHINE+NALOXONE 8MG-2MG
|
Facility
OP
|
$14.48
|
|
| Hospital Charge Code |
41646001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.24
|
| Rate for Payer: Aetna Government |
$7.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.85
|
| Rate for Payer: Group Health Inc Commercial |
$7.24
|
| Rate for Payer: Group Health Inc Medicare |
$5.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.41
|
|
|
BUPRENORPHINE + NALOXONE 8 MG-2MG TAB
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
41644954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
BUPRENORPHINE + NALOXONE 8 MG-2MG TAB
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
41654954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
BUPRENORPHINE/NALOX SL/FL 12-3MG
|
Facility
IP
|
$40.68
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41647841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.34
|
|
|
BUPRENORPHINE/NALOX SL/FL 12-3MG
|
Facility
OP
|
$40.68
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41647841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.43
|
| Rate for Payer: Group Health Inc Commercial |
$20.34
|
| Rate for Payer: Group Health Inc Medicare |
$14.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7.08
|
| Rate for Payer: Healthfirst QHP |
$7.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.08
|
| Rate for Payer: SOMOS Essential |
$7.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.08
|
|
|
BUPRENORPHINE/NALOX SL/FL 12-3MG
|
Facility
IP
|
$40.68
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41657841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.34
|
|
|
BUPRENORPHINE/NALOX SL/FL 12-3MG
|
Facility
OP
|
$40.68
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41657841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.43
|
| Rate for Payer: Group Health Inc Commercial |
$20.34
|
| Rate for Payer: Group Health Inc Medicare |
$14.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7.08
|
| Rate for Payer: Healthfirst QHP |
$7.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.08
|
| Rate for Payer: SOMOS Essential |
$7.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.08
|
|
|
BUPRENORPHINE/NALOX SL/FL 2-0.5MG
|
Facility
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J0572
|
| Hospital Charge Code |
41647838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$409.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.24
|
| Rate for Payer: Aetna Government |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$4.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$409.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.29
|
| Rate for Payer: Group Health Inc Commercial |
$8.52
|
| Rate for Payer: Group Health Inc Medicare |
$5.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.09
|
| Rate for Payer: Healthfirst Essential Plan |
$4.09
|
| Rate for Payer: Healthfirst QHP |
$4.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.09
|
|
|
BUPRENORPHINE/NALOX SL/FL 2-0.5MG
|
Facility
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J0572
|
| Hospital Charge Code |
41657838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$409.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.24
|
| Rate for Payer: Aetna Government |
$3.24
|
| Rate for Payer: Amida Care Medicaid |
$4.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$409.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.29
|
| Rate for Payer: Group Health Inc Commercial |
$8.52
|
| Rate for Payer: Group Health Inc Medicare |
$5.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.09
|
| Rate for Payer: Healthfirst Essential Plan |
$4.09
|
| Rate for Payer: Healthfirst QHP |
$4.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.09
|
| Rate for Payer: SOMOS Essential |
$4.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.09
|
|
|
BUPRENORPHINE/NALOX SL/FL 2-0.5MG
|
Facility
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J0572
|
| Hospital Charge Code |
41657838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
|
|
BUPRENORPHINE/NALOX SL/FL 2-0.5MG
|
Facility
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J0572
|
| Hospital Charge Code |
41647838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
|
|
BUPRENORPHINE/NALOX SL/FL 4-1MG
|
Facility
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J0573
|
| Hospital Charge Code |
41647840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
|
|
BUPRENORPHINE/NALOX SL/FL 4-1MG
|
Facility
IP
|
$17.03
|
|
|
Service Code
|
HCPCS J0573
|
| Hospital Charge Code |
41657840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
|
|
BUPRENORPHINE/NALOX SL/FL 4-1MG
|
Facility
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J0573
|
| Hospital Charge Code |
41647840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$5.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.26
|
| Rate for Payer: Group Health Inc Commercial |
$8.52
|
| Rate for Payer: Group Health Inc Medicare |
$5.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.01
|
| Rate for Payer: Healthfirst Essential Plan |
$5.01
|
| Rate for Payer: Healthfirst QHP |
$5.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.01
|
| Rate for Payer: SOMOS Essential |
$5.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.01
|
|
|
BUPRENORPHINE/NALOX SL/FL 4-1MG
|
Facility
OP
|
$17.03
|
|
|
Service Code
|
HCPCS J0573
|
| Hospital Charge Code |
41657840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$5.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.26
|
| Rate for Payer: Group Health Inc Commercial |
$8.52
|
| Rate for Payer: Group Health Inc Medicare |
$5.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.01
|
| Rate for Payer: Healthfirst Essential Plan |
$5.01
|
| Rate for Payer: Healthfirst QHP |
$5.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.01
|
| Rate for Payer: SOMOS Essential |
$5.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.01
|
|
|
BUPRENORPHINE/NALOX SL/FL 8-2MG
|
Facility
OP
|
$20.35
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41657839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.43
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$7.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7.08
|
| Rate for Payer: Healthfirst QHP |
$7.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.08
|
| Rate for Payer: SOMOS Essential |
$7.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.08
|
|
|
BUPRENORPHINE/NALOX SL/FL 8-2MG
|
Facility
IP
|
$20.35
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41647839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
|
|
BUPRENORPHINE/NALOX SL/FL 8-2MG
|
Facility
OP
|
$20.35
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41647839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.42
|
| Rate for Payer: Aetna Government |
$6.42
|
| Rate for Payer: Amida Care Medicaid |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.43
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$7.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.08
|
| Rate for Payer: Healthfirst Essential Plan |
$7.08
|
| Rate for Payer: Healthfirst QHP |
$7.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.08
|
| Rate for Payer: SOMOS Essential |
$7.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.08
|
|
|
BUPRENORPHINE/NALOX SL/FL 8-2MG
|
Facility
IP
|
$20.35
|
|
|
Service Code
|
HCPCS J0574
|
| Hospital Charge Code |
41657839
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
|
|
BUPRENORPHINE, ORAL, 1MG
|
Facility
OP
|
$0.08
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
30401103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Amida Care Medicaid |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.24
|
| Rate for Payer: Healthfirst Essential Plan |
$0.24
|
| Rate for Payer: Healthfirst QHP |
$0.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.24
|
| Rate for Payer: SOMOS Essential |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.24
|
|
|
BUPRENORPHINE, ORAL, 1MG
|
Facility
IP
|
$0.08
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
30401103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
BUPRENORPHINE TAKE-HOME ADMIN WK2
|
Facility
OP
|
$86.26
|
|
|
Service Code
|
HCPCS H0030
|
| Hospital Charge Code |
30400267
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$69.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.66
|
| Rate for Payer: Group Health Inc Commercial |
$43.13
|
| Rate for Payer: Group Health Inc Medicare |
$30.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.13
|
|
