St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHOTREXATE 25 MG/ML INJ 4 ML PF

Facility

$1.23

Service Code	HCPCS J9250
Hospital Charge Code	41652953
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

METHOTREXATE 25 MG/ML INJ 4 ML PF

Facility

$1.23

Service Code	HCPCS J9250
Hospital Charge Code	41642953
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

METHOTREXATE 25 MG/ML INJ 4 ML PF

Facility

$1.23

Service Code	HCPCS J9250
Hospital Charge Code	41652953
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

METHOTREXATE 25 MG/ML INJ 4 ML PF

Facility

$1.23

Service Code	HCPCS J9250
Hospital Charge Code	41642953
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

METHOTREXATE 2.5 MG PO TABS [4973]

Facility

$3.56

Service Code	HCPCS J8610
Hospital Charge Code	68382077501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$2.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.42
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

METHOTREXATE 2.5 MG PO TABS [4973]

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	51079067001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

METHOTREXATE 2.5 MG PO TABS [4973]

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	51079067005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.05

METHOTREXATE 2.5 MG PO TABS [4973]

Facility

$4.05

Service Code	HCPCS J8610
Hospital Charge Code	69238142301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$3.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.75
Rate for Payer: Group Health Inc Commercial	$2.02
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.02
Rate for Payer: Hamaspik Choice Inc Medicare	$2.02
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

METHOTREXATE 2.5 MG TAB

Facility

$1.47

Service Code	HCPCS J8610
Hospital Charge Code	41650893
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.26
Rate for Payer: SOMOS Essential	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

METHOTREXATE 2.5 MG TAB

Facility

$1.47

Service Code	HCPCS J8610
Hospital Charge Code	41640893
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74

METHOTREXATE 2.5 MG TAB

Facility

$1.47

Service Code	HCPCS J8610
Hospital Charge Code	41640893
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.26
Rate for Payer: SOMOS Essential	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

METHOTREXATE 2.5 MG TAB

Facility

$1.47

Service Code	HCPCS J8610
Hospital Charge Code	41650893
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74

METHOTREXATE PF 1000MG/40ML -5MG

Facility

$0.16

Service Code	HCPCS J9250
Hospital Charge Code	41658100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

METHOTREXATE PF 1000MG/40ML -5MG

Facility

$0.16

Service Code	HCPCS J9250
Hospital Charge Code	41648100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

METHOTREXATE PF 1000MG/40ML -5MG

Facility

$0.16

Service Code	HCPCS J9250
Hospital Charge Code	41648100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08

METHOTREXATE PF 1000MG/40ML -5MG

Facility

$0.16

Service Code	HCPCS J9250
Hospital Charge Code	41658100
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.10

METHOTREXATE (PF) 25 MG/0.5ML SC SOAJ [126526]

Facility

$338.40

Service Code	NDC 59137054004
Hospital Charge Code	59137054004
Hospital Revenue Code	250
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$270.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.20
Rate for Payer: Aetna Government	$169.20
Rate for Payer: Brighton Health Commercial	$253.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$270.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.11
Rate for Payer: Group Health Inc Commercial	$169.20
Rate for Payer: Group Health Inc Medicare	$118.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.20
Rate for Payer: Hamaspik Choice Inc Medicare	$169.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.96

METHOTREXATE SODIUM 2.5 MG PO TABS [13594]

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	51079067001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

METHOTREXATE SODIUM 2.5 MG PO TABS [13594]

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	51079067005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.05

METHOTREXATE SODIUM 2.5 MG PO TABS [13594]

Facility

$4.05

Service Code	HCPCS J8610
Hospital Charge Code	69238142301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$3.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$3.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.75
Rate for Payer: Group Health Inc Commercial	$2.02
Rate for Payer: Group Health Inc Medicare	$1.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.02
Rate for Payer: Hamaspik Choice Inc Medicare	$2.02
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

METHOTREXATE SODIUM 2.5 MG PO TABS [13594]

Facility

$3.56

Service Code	HCPCS J8610
Hospital Charge Code	68382077501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$2.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$2.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.42
Rate for Payer: Group Health Inc Commercial	$1.78
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1.78
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.24
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.26
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.26
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

METHOTREXATE SODIUM 50 MG/2ML IJ SOLN [88042]

Facility

$4.36

Service Code	HCPCS J9250
Hospital Charge Code	61703035038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$3.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.97
Rate for Payer: Group Health Inc Commercial	$2.18
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.83

METHOTREXATE SODIUM 50 MG/2ML IJ SOLN [88042]

Facility

$4.36

Service Code	HCPCS J9250
Hospital Charge Code	61703035037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$3.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.96
Rate for Payer: Group Health Inc Commercial	$2.18
Rate for Payer: Group Health Inc Medicare	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.18
Rate for Payer: Hamaspik Choice Inc Medicare	$2.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.83

METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN [117032]

Facility

$1.10

Service Code	HCPCS J9260
Hospital Charge Code	61703040841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$2.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
Rate for Payer: Brighton Health Commercial	$0.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: Group Health Inc Commercial	$0.55
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.55
Rate for Payer: Hamaspik Choice Inc Medicare	$0.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2.57
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$2.73
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$2.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$2.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.72

METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN [117030]

Facility

$2.02

Service Code	HCPCS J9250
Hospital Charge Code	00143951910
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$1.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$1.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: Group Health Inc Commercial	$1.01
Rate for Payer: Group Health Inc Medicare	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01
Rate for Payer: Hamaspik Choice Inc Medicare	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

Know your out-of-pocket cost for care.

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