|
BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL [34713]
|
Facility
|
OP
|
$5.83
|
|
|
Service Code
|
NDC 00054018813
|
| Hospital Charge Code |
00054018813
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.91
|
| Rate for Payer: Aetna Government |
$2.91
|
| Rate for Payer: Brighton Health Commercial |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.96
|
| Rate for Payer: Group Health Inc Commercial |
$2.91
|
| Rate for Payer: Group Health Inc Medicare |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.79
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM [119050]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035603
|
| Hospital Charge Code |
47781035603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM [119050]
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 43598058001
|
| Hospital Charge Code |
43598058001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.72
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM [119050]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035611
|
| Hospital Charge Code |
47781035611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM [119050]
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
NDC 12496120403
|
| Hospital Charge Code |
12496120403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Brighton Health Commercial |
$8.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.00
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX) [401308]
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 43598058001
|
| Hospital Charge Code |
43598058001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.72
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX) [401308]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035603
|
| Hospital Charge Code |
47781035603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX) [401308]
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
NDC 12496120403
|
| Hospital Charge Code |
12496120403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Brighton Health Commercial |
$8.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.00
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX) [401308]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035611
|
| Hospital Charge Code |
47781035611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM [106177]
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
NDC 12496120803
|
| Hospital Charge Code |
12496120803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Brighton Health Commercial |
$8.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.33
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.00
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM [106177]
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 00378876793
|
| Hospital Charge Code |
00378876793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Brighton Health Commercial |
$6.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.28
|
| Rate for Payer: Group Health Inc Commercial |
$4.61
|
| Rate for Payer: Group Health Inc Medicare |
$3.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.00
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM [106177]
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 43598058230
|
| Hospital Charge Code |
43598058230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.72
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM [106177]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035711
|
| Hospital Charge Code |
47781035711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM [106177]
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 47781035703
|
| Hospital Charge Code |
47781035703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.40
|
| Rate for Payer: Aetna Government |
$4.40
|
| Rate for Payer: Brighton Health Commercial |
$6.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.40
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM (4W DETOX) [401309]
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 00378876793
|
| Hospital Charge Code |
00378876793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Brighton Health Commercial |
$6.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.28
|
| Rate for Payer: Group Health Inc Commercial |
$4.61
|
| Rate for Payer: Group Health Inc Medicare |
$3.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.00
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL [34714]
|
Facility
|
OP
|
$8.46
|
|
|
Service Code
|
NDC 50383028793
|
| Hospital Charge Code |
50383028793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.23
|
| Rate for Payer: Aetna Government |
$4.23
|
| Rate for Payer: Brighton Health Commercial |
$6.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$4.23
|
| Rate for Payer: Group Health Inc Medicare |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.50
|
|
|
BUPRENORPHINE/NALOX 12-3MG DETOX
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0575
|
| Hospital Charge Code |
41649003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
|
|
BUPRENORPHINE/NALOX 12-3MG DETOX
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0575
|
| Hospital Charge Code |
41649003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.85
|
| Rate for Payer: Aetna Government |
$12.85
|
| Rate for Payer: Brighton Health Commercial |
$10.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
BUPRENORPHINE/NALOX 12-3MG DETOX
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0575
|
| Hospital Charge Code |
41659003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.85
|
| Rate for Payer: Aetna Government |
$12.85
|
| Rate for Payer: Brighton Health Commercial |
$10.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
BUPRENORPHINE/NALOX 12-3MG DETOX
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0575
|
| Hospital Charge Code |
41659003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
|
|
BUPRENORPHINE/NALOX 2-0.5MG DETOX
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
41649000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
|
|
BUPRENORPHINE/NALOX 2-0.5MG DETOX
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
41659000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.88
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
BUPRENORPHINE/NALOX 2-0.5MG DETOX
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
41649000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.88
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
BUPRENORPHINE/NALOX 2-0.5MG DETOX
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
41659000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
|
|
BUPRENORPHINE + NALOXONE 2 MG-0.5 MG TAB
|
Facility
|
OP
|
$8.06
|
|
| Hospital Charge Code |
41644955
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$6.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.03
|
| Rate for Payer: Aetna Government |
$4.03
|
| Rate for Payer: Brighton Health Commercial |
$6.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Group Health Inc Commercial |
$4.03
|
| Rate for Payer: Group Health Inc Medicare |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.24
|
|
