St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BUPIVACAINE PF 0.5% 10ML INJ

Facility

$0.33

Service Code	HCPCS J3490
Hospital Charge Code	41647821
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17

BUPIVACAINE PF 0.5% 10ML INJ

Facility

$0.33

Service Code	HCPCS J3490
Hospital Charge Code	41647821
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

BUPIVACAINE PF 0.5% 10ML INJ

Facility

$0.33

Service Code	HCPCS J3490
Hospital Charge Code	41657821
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

BUPIVACAINE PF 7.5MG IN DEX 2ML I

Facility

$5.10

Service Code	HCPCS J3490
Hospital Charge Code	41647830
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55

BUPIVACAINE PF 7.5MG IN DEX 2ML I

Facility

$5.10

Service Code	HCPCS J3490
Hospital Charge Code	41647830
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.55
Rate for Payer: Aetna Government	$2.55
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.93
Rate for Payer: Group Health Inc Commercial	$2.55
Rate for Payer: Group Health Inc Medicare	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.32

BUPIVACAINE PF 7.5ML IN DEX 2ML I

Facility

$5.10

Service Code	HCPCS J3490
Hospital Charge Code	41657830
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$3.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.55
Rate for Payer: Aetna Government	$2.55
Rate for Payer: Brighton Health Commercial	$3.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.93
Rate for Payer: Group Health Inc Commercial	$2.55
Rate for Payer: Group Health Inc Medicare	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.32

BUPIVACAINE PF 7.5ML IN DEX 2ML I

Facility

$5.10

Service Code	HCPCS J3490
Hospital Charge Code	41657830
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM [119051]

Facility

$17.60

Service Code	NDC 43598058101
Hospital Charge Code	43598058101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$14.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.80
Rate for Payer: Aetna Government	$8.80
Rate for Payer: Brighton Health Commercial	$13.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.97
Rate for Payer: Group Health Inc Commercial	$8.80
Rate for Payer: Group Health Inc Medicare	$6.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.80
Rate for Payer: Hamaspik Choice Inc Medicare	$8.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.44

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM [119051]

Facility

$21.55

Service Code	NDC 12496121203
Hospital Charge Code	12496121203
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$17.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.78
Rate for Payer: Aetna Government	$10.78
Rate for Payer: Brighton Health Commercial	$16.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.66
Rate for Payer: Group Health Inc Commercial	$10.78
Rate for Payer: Group Health Inc Medicare	$7.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78
Rate for Payer: Hamaspik Choice Inc Medicare	$10.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.01

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM [119051]

Facility

$17.58

Service Code	NDC 47781035811
Hospital Charge Code	47781035811
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$14.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.79
Rate for Payer: Aetna Government	$8.79
Rate for Payer: Brighton Health Commercial	$13.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: Group Health Inc Commercial	$8.79
Rate for Payer: Group Health Inc Medicare	$6.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79
Rate for Payer: Hamaspik Choice Inc Medicare	$8.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.43

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM [119051]

Facility

$17.58

Service Code	NDC 47781035803
Hospital Charge Code	47781035803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$14.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.79
Rate for Payer: Aetna Government	$8.79
Rate for Payer: Brighton Health Commercial	$13.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: Group Health Inc Commercial	$8.79
Rate for Payer: Group Health Inc Medicare	$6.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79
Rate for Payer: Hamaspik Choice Inc Medicare	$8.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.43

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM (4W DETOX) [401314]

Facility

$17.60

Service Code	NDC 43598058101
Hospital Charge Code	43598058101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$14.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.80
Rate for Payer: Aetna Government	$8.80
Rate for Payer: Brighton Health Commercial	$13.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.97
Rate for Payer: Group Health Inc Commercial	$8.80
Rate for Payer: Group Health Inc Medicare	$6.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.80
Rate for Payer: Hamaspik Choice Inc Medicare	$8.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.44

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM (4W DETOX) [401314]

Facility

$17.58

Service Code	NDC 47781035811
Hospital Charge Code	47781035811
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$14.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.79
Rate for Payer: Aetna Government	$8.79
Rate for Payer: Brighton Health Commercial	$13.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: Group Health Inc Commercial	$8.79
Rate for Payer: Group Health Inc Medicare	$6.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79
Rate for Payer: Hamaspik Choice Inc Medicare	$8.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.43

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM (4W DETOX) [401314]

Facility

$21.55

Service Code	NDC 12496121203
Hospital Charge Code	12496121203
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$17.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.78
Rate for Payer: Aetna Government	$10.78
Rate for Payer: Brighton Health Commercial	$16.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.66
Rate for Payer: Group Health Inc Commercial	$10.78
Rate for Payer: Group Health Inc Medicare	$7.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78
Rate for Payer: Hamaspik Choice Inc Medicare	$10.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.01

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM (4W DETOX) [401314]

Facility

$17.58

Service Code	NDC 47781035803
Hospital Charge Code	47781035803
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$14.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.79
Rate for Payer: Aetna Government	$8.79
Rate for Payer: Brighton Health Commercial	$13.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: Group Health Inc Commercial	$8.79
Rate for Payer: Group Health Inc Medicare	$6.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79
Rate for Payer: Hamaspik Choice Inc Medicare	$8.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.43

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM [106176]

Facility

$4.91

Service Code	NDC 43598057901
Hospital Charge Code	43598057901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.46
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM [106176]

Facility

$4.91

Service Code	NDC 47781035503
Hospital Charge Code	47781035503
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.45
Rate for Payer: Aetna Government	$2.45
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.45
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM [106176]

Facility

$4.91

Service Code	NDC 47781035511
Hospital Charge Code	47781035511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.45
Rate for Payer: Aetna Government	$2.45
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.45
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM [106176]

Facility

$4.91

Service Code	NDC 43598057930
Hospital Charge Code	43598057930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.46
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM [106176]

Facility

$6.01

Service Code	NDC 12496120203
Hospital Charge Code	12496120203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.01
Rate for Payer: Aetna Government	$3.01
Rate for Payer: Brighton Health Commercial	$4.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.09
Rate for Payer: Group Health Inc Commercial	$3.01
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.01
Rate for Payer: Hamaspik Choice Inc Medicare	$3.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.91

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM (4W DETOX) [401313]

Facility

$4.91

Service Code	NDC 47781035503
Hospital Charge Code	47781035503
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.45
Rate for Payer: Aetna Government	$2.45
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.45
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM (4W DETOX) [401313]

Facility

$6.01

Service Code	NDC 12496120203
Hospital Charge Code	12496120203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.01
Rate for Payer: Aetna Government	$3.01
Rate for Payer: Brighton Health Commercial	$4.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.09
Rate for Payer: Group Health Inc Commercial	$3.01
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.01
Rate for Payer: Hamaspik Choice Inc Medicare	$3.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.91

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM (4W DETOX) [401313]

Facility

$4.91

Service Code	NDC 47781035511
Hospital Charge Code	47781035511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.45
Rate for Payer: Aetna Government	$2.45
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.45
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM (4W DETOX) [401313]

Facility

$4.91

Service Code	NDC 43598057930
Hospital Charge Code	43598057930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.46
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM (4W DETOX) [401313]

Facility

$4.91

Service Code	NDC 43598057901
Hospital Charge Code	43598057901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Brighton Health Commercial	$3.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.34
Rate for Payer: Group Health Inc Commercial	$2.46
Rate for Payer: Group Health Inc Medicare	$1.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46
Rate for Payer: Hamaspik Choice Inc Medicare	$2.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.19

Know your out-of-pocket cost for care.

All Charges