St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHANOL

Facility

$32.15

Service Code	HCPCS 80320
Hospital Charge Code	40609015
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$25.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$24.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.86
Rate for Payer: Group Health Inc Commercial	$16.08
Rate for Payer: Group Health Inc Medicare	$11.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.08
Rate for Payer: Hamaspik Choice Inc Medicare	$16.08
Rate for Payer: United Healthcare Commercial	$21.17

METHAQUALONE CONF (GC/MS)

Facility

$105.00

Service Code	HCPCS 80375
Hospital Charge Code	40609024
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50
Rate for Payer: United Healthcare Commercial	$19.94

METHAQUALONE SCREEN, URINE

Facility

$155.35

Service Code	HCPCS 80358
Hospital Charge Code	40609877
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

METHAZOLAMIDE 25 MG PO TABS [4961]

Facility

$2.76

Service Code	NDC 00574079001
Hospital Charge Code	00574079001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.88
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

METHAZOLAMIDE 25 MG TAB

Facility

$2.00

Hospital Charge Code	41643417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

METHAZOLAMIDE 25 MG TAB

Facility

$2.00

Hospital Charge Code	41653417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

METHAZOLAMIDE 50 MG PO TABS [4962]

Facility

$5.52

Service Code	NDC 00574079101
Hospital Charge Code	00574079101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$4.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Brighton Health Commercial	$4.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.75
Rate for Payer: Group Health Inc Commercial	$2.76
Rate for Payer: Group Health Inc Medicare	$1.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.76
Rate for Payer: Hamaspik Choice Inc Medicare	$2.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.59

METHAZOLAMIDE 50 MG TAB

Facility

$5.00

Hospital Charge Code	41653418
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
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

METHAZOLAMIDE 50 MG TAB

Facility

$5.00

Hospital Charge Code	41643418
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.50
Rate for Payer: Aetna Government	$2.50
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.40
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
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

METHEMOGLOBIN

Facility

$16.23

Service Code	HCPCS 83045
Hospital Charge Code	40602655
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$12.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.49
Rate for Payer: Aetna Government	$6.49
Rate for Payer: Affinity Essential Plan 1&2	$4.54
Rate for Payer: Affinity Essential Plan 3&4	$4.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.54
Rate for Payer: Brighton Health Commercial	$12.17
Rate for Payer: Cash Price	$6.49
Rate for Payer: Cash Price	$6.49
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.67
Rate for Payer: Elderplan Medicare Advantage	$6.49
Rate for Payer: EmblemHealth Commercial	$6.49
Rate for Payer: Fidelis Essential Plan Aliesa	$5.52
Rate for Payer: Fidelis Essential Plan QHP	$5.78
Rate for Payer: Fidelis Medicare Advantage	$6.49
Rate for Payer: Fidelis Qualified Health Plan	$5.78
Rate for Payer: Group Health Inc Commercial	$6.49
Rate for Payer: Group Health Inc Medicare	$6.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.12
Rate for Payer: Hamaspik Choice Inc Medicare	$6.49
Rate for Payer: Healthfirst Medicare Advantage	$6.49
Rate for Payer: Healthfirst QHP	$6.49
Rate for Payer: Humana Medicare	$6.62
Rate for Payer: Senior Whole Health Medicare Advantage	$6.49
Rate for Payer: United Healthcare Commercial	$6.27
Rate for Payer: United Healthcare Medicare Advantage	$6.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.19
Rate for Payer: Wellcare Medicare	$5.84

METHEMOGLOBIN

Facility

$16.23

Service Code	HCPCS 83045
Hospital Charge Code	40602655
Hospital Revenue Code	301
Rate for Payer: Cash Price	$6.49

METHIMAZOLE 10 MG PO TABS [10552]

Facility

$1.00

Service Code	NDC 60687068011
Hospital Charge Code	60687068011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

METHIMAZOLE 10 MG PO TABS [10552]

Facility

$0.77

Service Code	NDC 23155007101
Hospital Charge Code	23155007101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.52
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

METHIMAZOLE 10 MG TAB

Facility

$0.75

Hospital Charge Code	41653649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

METHIMAZOLE 10 MG TAB

Facility

$0.75

Hospital Charge Code	41643649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.38
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38
Rate for Payer: Hamaspik Choice Inc Medicare	$0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

METHIMAZOLE 5 MG PO TABS [10553]

Facility

$0.60

Service Code	NDC 60687035701
Hospital Charge Code	60687035701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

METHIMAZOLE 5 MG PO TABS [10553]

Facility

$0.60

Service Code	NDC 60687035711
Hospital Charge Code	60687035711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

METHIMAZOLE 5 MG PO TABS [10553]

Facility

$0.44

Service Code	NDC 23155007001
Hospital Charge Code	23155007001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
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	$0.36
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	$0.16
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

METHIMAZOLE 5 MG TAB

Facility

$0.60

Hospital Charge Code	41643648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

METHIMAZOLE 5 MG TAB

Facility

$0.60

Hospital Charge Code	41653648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

METHOCARBAMOL 1000 MG/10ML IJ SOLN [127749]

Facility

$2.06

Service Code	HCPCS J2800
Hospital Charge Code	70069010101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$6.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.95
Rate for Payer: Aetna Government	$6.95
Rate for Payer: Brighton Health Commercial	$1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.40
Rate for Payer: Group Health Inc Commercial	$1.03
Rate for Payer: Group Health Inc Medicare	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03
Rate for Payer: Hamaspik Choice Inc Medicare	$1.03
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.17
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.54
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.54
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.34

METHOCARBAMOL 1000 MG/10ML IJ SOLN [127749]

Facility

$0.75

Service Code	HCPCS J2800
Hospital Charge Code	70069010125
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$6.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.95
Rate for Payer: Aetna Government	$6.95
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.17
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$6.54
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$6.54
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$6.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.48

METHOCARBAMOL 100 MG/ML INJ

Facility

$150.00

Service Code	HCPCS J2800
Hospital Charge Code	41643229
Hospital Revenue Code	636
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

METHOCARBAMOL 100 MG/ML INJ

Facility

$150.00

Service Code	HCPCS J2800
Hospital Charge Code	41653229
Hospital Revenue Code	636
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

METHOCARBAMOL 100 MG/ML INJ

Facility

$150.00

Service Code	HCPCS J2800
Hospital Charge Code	41643229
Hospital Revenue Code	636
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$97.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.95
Rate for Payer: Aetna Government	$6.95
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.54
Rate for Payer: SOMOS Essential	$6.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

Know your out-of-pocket cost for care.

All Charges