|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 4359858030
|
| Hospital Charge Code |
4359858030
|
|
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: EmblemHealth Commercial |
$4.40
|
| 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
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 4778135611
|
| Hospital Charge Code |
4778135611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX)
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 4778135603
|
| Hospital Charge Code |
4778135603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX)
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 4778135603
|
| Hospital Charge Code |
4778135603
|
|
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 |
$4.39
|
| Rate for Payer: Aetna Government |
$4.39
|
| 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: EmblemHealth Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| 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)
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 4778135611
|
| Hospital Charge Code |
4778135611
|
|
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 |
$4.39
|
| Rate for Payer: Aetna Government |
$4.39
|
| 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: EmblemHealth Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| 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)
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 4778135611
|
| Hospital Charge Code |
4778135611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX)
|
Facility
|
IP
|
$8.80
|
|
|
Service Code
|
NDC 4359858001
|
| Hospital Charge Code |
4359858001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX)
|
Facility
|
IP
|
$10.78
|
|
|
Service Code
|
NDC 1249612043
|
| Hospital Charge Code |
1249612043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM (4W DETOX)
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
NDC 1249612043
|
| Hospital Charge Code |
1249612043
|
|
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: EmblemHealth Commercial |
$5.39
|
| 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)
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 4359858001
|
| Hospital Charge Code |
4359858001
|
|
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: EmblemHealth Commercial |
$4.40
|
| 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
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 4359858230
|
| Hospital Charge Code |
4359858230
|
|
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: EmblemHealth Commercial |
$4.40
|
| 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
|
Facility
|
IP
|
$8.80
|
|
|
Service Code
|
NDC 4359858230
|
| Hospital Charge Code |
4359858230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.40
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM
|
Facility
|
IP
|
$9.23
|
|
|
Service Code
|
NDC 0378876793
|
| Hospital Charge Code |
0378876793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.61
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 4778135703
|
| Hospital Charge Code |
4778135703
|
|
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 |
$4.39
|
| Rate for Payer: Aetna Government |
$4.39
|
| 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: EmblemHealth Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| 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
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 4778135703
|
| Hospital Charge Code |
4778135703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM
|
Facility
|
IP
|
$10.78
|
|
|
Service Code
|
NDC 1249612083
|
| Hospital Charge Code |
1249612083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM
|
Facility
|
OP
|
$10.78
|
|
|
Service Code
|
NDC 1249612083
|
| Hospital Charge Code |
1249612083
|
|
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: EmblemHealth Commercial |
$5.39
|
| 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
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 0378876793
|
| Hospital Charge Code |
0378876793
|
|
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: EmblemHealth Commercial |
$4.61
|
| 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
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
NDC 4778135711
|
| Hospital Charge Code |
4778135711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
NDC 4778135711
|
| Hospital Charge Code |
4778135711
|
|
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 |
$4.39
|
| Rate for Payer: Aetna Government |
$4.39
|
| 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: EmblemHealth Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Commercial |
$4.39
|
| Rate for Payer: Group Health Inc Medicare |
$3.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.39
|
| 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)
|
Facility
|
OP
|
$9.23
|
|
|
Service Code
|
NDC 0378876793
|
| Hospital Charge Code |
0378876793
|
|
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: EmblemHealth Commercial |
$4.61
|
| 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 (4W DETOX)
|
Facility
|
IP
|
$9.23
|
|
|
Service Code
|
NDC 0378876793
|
| Hospital Charge Code |
0378876793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.61
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL
|
Facility
|
IP
|
$8.46
|
|
|
Service Code
|
NDC 5038328793
|
| Hospital Charge Code |
5038328793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.23
|
|
|
BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL
|
Facility
|
OP
|
$8.46
|
|
|
Service Code
|
NDC 5038328793
|
| Hospital Charge Code |
5038328793
|
|
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: EmblemHealth Commercial |
$4.23
|
| 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
|
|
|
BUPROPION HCL 100 MG PO TABS
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
NDC 0904663661
|
| Hospital Charge Code |
0904663661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.98
|
| Rate for Payer: Aetna Government |
$0.98
|
| Rate for Payer: Brighton Health Commercial |
$1.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.34
|
| Rate for Payer: EmblemHealth Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.28
|
|
