Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN

Facility

IP

$3.29

Service Code	HCPCS J0665
Hospital Charge Code	0409176110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.65

BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN

Facility

OP

$1.71

Service Code	HCPCS J0665
Hospital Charge Code	0409361311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.16
Rate for Payer: EmblemHealth Commercial	$0.86
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN

Facility

OP

$3.29

Service Code	HCPCS J0665
Hospital Charge Code	0409176110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.65
Rate for Payer: Aetna Government	$1.65
Rate for Payer: Brighton Health Commercial	$2.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.24
Rate for Payer: EmblemHealth Commercial	$1.65
Rate for Payer: Group Health Inc Commercial	$1.65
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.14

BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN

Facility

IP

$1.71

Service Code	HCPCS J0665
Hospital Charge Code	0409361301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM

Facility

IP

$21.55

Service Code	NDC 1249612123
Hospital Charge Code	1249612123
Hospital Revenue Code	250
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$10.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM

Facility

OP

$17.58

Service Code	NDC 4778135811
Hospital Charge Code	4778135811
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	$13.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: EmblemHealth Commercial	$8.79
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

Facility

IP

$17.60

Service Code	NDC 4359858101
Hospital Charge Code	4359858101
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$8.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.80

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM

Facility

IP

$17.58

Service Code	NDC 4778135803
Hospital Charge Code	4778135803
Hospital Revenue Code	250
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$8.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM

Facility

OP

$17.58

Service Code	NDC 4778135803
Hospital Charge Code	4778135803
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	$13.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: EmblemHealth Commercial	$8.79
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

Facility

OP

$17.60

Service Code	NDC 4359858101
Hospital Charge Code	4359858101
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: EmblemHealth Commercial	$8.80
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

Facility

IP

$17.58

Service Code	NDC 4778135811
Hospital Charge Code	4778135811
Hospital Revenue Code	250
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$8.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79

BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM

Facility

OP

$21.55

Service Code	NDC 1249612123
Hospital Charge Code	1249612123
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: EmblemHealth Commercial	$10.78
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)

Facility

OP

$17.60

Service Code	NDC 4359858101
Hospital Charge Code	4359858101
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: EmblemHealth Commercial	$8.80
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)

Facility

IP

$21.55

Service Code	NDC 1249612123
Hospital Charge Code	1249612123
Hospital Revenue Code	250
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$10.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.78

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

Facility

IP

$17.60

Service Code	NDC 4359858101
Hospital Charge Code	4359858101
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$8.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.80

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

Facility

IP

$17.58

Service Code	NDC 4778135803
Hospital Charge Code	4778135803
Hospital Revenue Code	250
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$8.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79

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

Facility

OP

$17.58

Service Code	NDC 4778135811
Hospital Charge Code	4778135811
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	$13.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: EmblemHealth Commercial	$8.79
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)

Facility

OP

$17.58

Service Code	NDC 4778135803
Hospital Charge Code	4778135803
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	$13.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: EmblemHealth Commercial	$8.79
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)

Facility

IP

$17.58

Service Code	NDC 4778135811
Hospital Charge Code	4778135811
Hospital Revenue Code	250
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$8.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.79

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

Facility

OP

$21.55

Service Code	NDC 1249612123
Hospital Charge Code	1249612123
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: EmblemHealth Commercial	$10.78
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 2-0.5 MG SL FILM

Facility

OP

$4.91

Service Code	NDC 4359857930
Hospital Charge Code	4359857930
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: EmblemHealth Commercial	$2.46
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

Facility

IP

$4.91

Service Code	NDC 4359857930
Hospital Charge Code	4359857930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM

Facility

IP

$4.91

Service Code	NDC 4359857901
Hospital Charge Code	4359857901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.46

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM

Facility

IP

$4.91

Service Code	NDC 4778135511
Hospital Charge Code	4778135511
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.45

BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM

Facility

OP

$4.91

Service Code	NDC 4359857901
Hospital Charge Code	4359857901
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: EmblemHealth Commercial	$2.46
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

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