St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METFORMIN HCL 850 MG PO TABS [14719]

Facility

$0.07

Service Code	NDC 23155010301
Hospital Charge Code	23155010301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

METHADONE

Facility

$155.35

Service Code	HCPCS 80358
Hospital Charge Code	40602680
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$124.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$85.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$116.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$124.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.64
Rate for Payer: Group Health Inc Commercial	$77.68
Rate for Payer: Group Health Inc Medicare	$54.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$77.68
Rate for Payer: Hamaspik Choice Inc Medicare	$77.68
Rate for Payer: United Healthcare Commercial	$20.00

METHADONE 10 MG/ML INJ

Facility

$14.76

Service Code	HCPCS J1230
Hospital Charge Code	41644687
Hospital Revenue Code	636
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$21.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.80
Rate for Payer: Aetna Government	$17.80
Rate for Payer: Brighton Health Commercial	$8.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.49
Rate for Payer: Group Health Inc Commercial	$7.38
Rate for Payer: Group Health Inc Medicare	$5.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.84
Rate for Payer: SOMOS Essential	$21.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.59

METHADONE 10 MG/ML INJ

Facility

$14.76

Service Code	HCPCS J1230
Hospital Charge Code	41644687
Hospital Revenue Code	636
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38

METHADONE 10 MG/ML INJ

Facility

$14.76

Service Code	HCPCS J1230
Hospital Charge Code	41654687
Hospital Revenue Code	636
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38

METHADONE 10 MG/ML INJ

Facility

$14.76

Service Code	HCPCS J1230
Hospital Charge Code	41654687
Hospital Revenue Code	636
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$21.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.80
Rate for Payer: Aetna Government	$17.80
Rate for Payer: Brighton Health Commercial	$8.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.49
Rate for Payer: Group Health Inc Commercial	$7.38
Rate for Payer: Group Health Inc Medicare	$5.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.38
Rate for Payer: Hamaspik Choice Inc Medicare	$7.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.84
Rate for Payer: SOMOS Essential	$21.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.59

METHADONE 10MG TABLET

Facility

$0.14

Service Code	HCPCS J1230
Hospital Charge Code	41658423
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$21.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.80
Rate for Payer: Aetna Government	$17.80
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.84
Rate for Payer: SOMOS Essential	$21.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

METHADONE 10MG TABLET

Facility

$0.14

Service Code	HCPCS J1230
Hospital Charge Code	41658423
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07

METHADONE 40MG DISP TABLETS

Facility

$0.83

Hospital Charge Code	41650300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

METHADONE 40MG DISP TABLETS

Facility

$0.83

Hospital Charge Code	41640300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

METHADONE 40 MG DIS TAB

Facility

$0.45

Hospital Charge Code	41645203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

METHADONE 40 MG DIS TAB

Facility

$0.45

Hospital Charge Code	41655203
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

METHADONE 5 MG TAB

Facility

$0.44

Service Code	HCPCS S0109
Hospital Charge Code	41655160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

METHADONE 5 MG TAB

Facility

$0.44

Service Code	HCPCS S0109
Hospital Charge Code	41645160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

METHADONE 5 MG TAB

Facility

$0.44

Service Code	HCPCS S0109
Hospital Charge Code	41645160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22

METHADONE 5 MG TAB

Facility

$0.44

Service Code	HCPCS S0109
Hospital Charge Code	41655160
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22

METHADONE CONFIRMATION, URINE

Facility

$49.93

Service Code	HCPCS 80358
Hospital Charge Code	40609019
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$20.00

METHADONE (DETOX ONLY) 10 MG TAB

Facility

$0.50

Hospital Charge Code	41651353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

METHADONE (DETOX ONLY) 10 MG TAB

Facility

$0.50

Hospital Charge Code	41641353
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.33

METHADONE DISPENSE BUNDLE WK1,3,4

Facility

$209.19

Service Code	HCPCS G2067
Hospital Charge Code	30400263
Hospital Revenue Code	900
Min. Negotiated Rate	$73.22
Max. Negotiated Rate	$233.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$233.15
Rate for Payer: Aetna Government	$233.15
Rate for Payer: Brighton Health Commercial	$156.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.25
Rate for Payer: Group Health Inc Commercial	$104.60
Rate for Payer: Group Health Inc Medicare	$73.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.60
Rate for Payer: Hamaspik Choice Inc Medicare	$104.60
Rate for Payer: United Healthcare Commercial	$104.60

METHADONE (DOLOPHINE), SERUM

Facility

$49.93

Service Code	HCPCS 80358
Hospital Charge Code	40609020
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$20.00

METHADONE HCL 10 MG/ML IJ SOLN [10546]

Facility

$25.65

Service Code	HCPCS J1230
Hospital Charge Code	67457021720
Hospital Revenue Code	250
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$21.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.80
Rate for Payer: Aetna Government	$17.80
Rate for Payer: Brighton Health Commercial	$19.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.44
Rate for Payer: Group Health Inc Commercial	$12.82
Rate for Payer: Group Health Inc Medicare	$8.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.82
Rate for Payer: Hamaspik Choice Inc Medicare	$12.82
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$20.61
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$21.84
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$21.84
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$21.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.67

METHADONE HCL 10 MG PO TABS [4953]

Facility

$0.20

Service Code	NDC 66689083699
Hospital Charge Code	66689083699
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

METHADONE HCL 10 MG PO TABS [4953]

Facility

$0.40

Service Code	NDC 66689082010
Hospital Charge Code	66689082010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

METHADONE HCL 10 MG PO TABS [4953]

Facility

$0.44

Service Code	NDC 00054071020
Hospital Charge Code	00054071020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

Know your out-of-pocket cost for care.

All Charges