St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHYLPHENIDATE HCL 5 MG PO TABS [4988]

Facility

$0.70

Service Code	NDC 00115180001
Hospital Charge Code	00115180001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR [28750]

Facility

$13.21

Service Code	NDC 31722095201
Hospital Charge Code	31722095201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$10.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.60
Rate for Payer: Aetna Government	$6.60
Rate for Payer: Brighton Health Commercial	$9.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.98
Rate for Payer: Group Health Inc Commercial	$6.60
Rate for Payer: Group Health Inc Medicare	$4.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60
Rate for Payer: Hamaspik Choice Inc Medicare	$6.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.59

METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR [28750]

Facility

$7.60

Service Code	NDC 60687053221
Hospital Charge Code	60687053221
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$6.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.80
Rate for Payer: Aetna Government	$3.80
Rate for Payer: Brighton Health Commercial	$5.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.17
Rate for Payer: Group Health Inc Commercial	$3.80
Rate for Payer: Group Health Inc Medicare	$2.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.80
Rate for Payer: Hamaspik Choice Inc Medicare	$3.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.94

METHYLPHENIDATE HCL ER (OSM) 18 MG PO TBCR [28750]

Facility

$7.60

Service Code	NDC 60687053211
Hospital Charge Code	60687053211
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$6.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.80
Rate for Payer: Aetna Government	$3.80
Rate for Payer: Brighton Health Commercial	$5.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.17
Rate for Payer: Group Health Inc Commercial	$3.80
Rate for Payer: Group Health Inc Medicare	$2.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.80
Rate for Payer: Hamaspik Choice Inc Medicare	$3.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.94

METHYLPREDNISOLONE 16 MG PO TABS [4992]

Facility

$3.54

Service Code	HCPCS J7509
Hospital Charge Code	59762005001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$2.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$2.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.41
Rate for Payer: Group Health Inc Commercial	$1.77
Rate for Payer: Group Health Inc Medicare	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.77
Rate for Payer: Hamaspik Choice Inc Medicare	$1.77
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.25
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	$2.30

METHYLPREDNISOLONE 16 MG TAB

Facility

$1.55

Service Code	HCPCS J7509
Hospital Charge Code	41642635
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
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	$1.01

METHYLPREDNISOLONE 16 MG TAB

Facility

$1.55

Service Code	HCPCS J7509
Hospital Charge Code	41642635
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

METHYLPREDNISOLONE 16 MG TAB

Facility

$1.55

Service Code	HCPCS J7509
Hospital Charge Code	41652635
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
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	$1.01

METHYLPREDNISOLONE 16 MG TAB

Facility

$1.55

Service Code	HCPCS J7509
Hospital Charge Code	41652635
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78

METHYLPREDNISOLONE 30MG/NS 50ML

Facility

$6.00

Hospital Charge Code	41657108
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

METHYLPREDNISOLONE 30MG/NS 50ML

Facility

$6.00

Hospital Charge Code	41647108
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

METHYLPREDNISOLONE 32 MG PO TABS [10575]

Facility

$5.18

Service Code	HCPCS J7509
Hospital Charge Code	59762005101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$3.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.52
Rate for Payer: Group Health Inc Commercial	$2.59
Rate for Payer: Group Health Inc Medicare	$1.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.59
Rate for Payer: Hamaspik Choice Inc Medicare	$2.59
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.25
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	$3.37

METHYLPREDNISOLONE 32 MG TAB

Facility

$0.92

Service Code	HCPCS J7509
Hospital Charge Code	41650540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46

METHYLPREDNISOLONE 32 MG TAB

Facility

$0.92

Service Code	HCPCS J7509
Hospital Charge Code	41650540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
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	$0.60

METHYLPREDNISOLONE 32 MG TAB

Facility

$0.92

Service Code	HCPCS J7509
Hospital Charge Code	41640540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
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	$0.60

METHYLPREDNISOLONE 32 MG TAB

Facility

$0.92

Service Code	HCPCS J7509
Hospital Charge Code	41640540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46

METHYLPREDNISOLONE 40MG INJ PED

Facility

$7.01

Service Code	HCPCS J2930
Hospital Charge Code	41646587
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

METHYLPREDNISOLONE 40MG INJ PED

Facility

$7.01

Service Code	HCPCS J2930
Hospital Charge Code	41656587
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$4.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.03
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.56

METHYLPREDNISOLONE 40MG INJ PED

Facility

$7.01

Service Code	HCPCS J2930
Hospital Charge Code	41656587
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

METHYLPREDNISOLONE 40MG INJ PED

Facility

$7.01

Service Code	HCPCS J2930
Hospital Charge Code	41646587
Hospital Revenue Code	636
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$4.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.03
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.56

METHYLPREDNISOLONE 40MG/NS 50ML

Facility

$6.00

Hospital Charge Code	41657109
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

METHYLPREDNISOLONE 40MG/NS 50ML

Facility

$6.00

Hospital Charge Code	41647109
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

METHYLPREDNISOLONE 4 MG PO TABS [4993]

Facility

$1.65

Service Code	HCPCS J7509
Hospital Charge Code	59746000106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$1.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.25
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	$1.07

METHYLPREDNISOLONE 4 MG PO TABS [4993]

Facility

$1.43

Service Code	HCPCS J7509
Hospital Charge Code	00603459321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.25
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	$0.93

METHYLPREDNISOLONE 4 MG PO TABS [4993]

Facility

$2.23

Service Code	HCPCS J7509
Hospital Charge Code	00904691461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Brighton Health Commercial	$1.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.25
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	$1.45

Know your out-of-pocket cost for care.

All Charges