St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHADONE HCL 40 MG PO TAB (4W OASAS)

Facility

$0.33

Service Code	NDC 0054453825
Hospital Charge Code	0054453825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

METHADONE HCL 40 MG PO TAB (4W OASAS)

Facility

$0.33

Service Code	NDC 0054453825
Hospital Charge Code	0054453825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

METHADONE HCL 40 MG PO TAB (4W OASAS)

Facility

$0.33

Service Code	NDC 0406054034
Hospital Charge Code	0406054034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

METHADONE HCL 40 MG PO TAB (4W OASAS)

Facility

$0.33

Service Code	NDC 0406054034
Hospital Charge Code	0406054034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

METHADONE HCL 40 MG PO TBSO

Facility

$0.33

Service Code	NDC 0406254001
Hospital Charge Code	0406254001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

METHADONE HCL 40 MG PO TBSO

Facility

$0.33

Service Code	NDC 0406054034
Hospital Charge Code	0406054034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

METHADONE HCL 40 MG PO TBSO

Facility

$0.33

Service Code	NDC 0406254001
Hospital Charge Code	0406254001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

METHADONE HCL 40 MG PO TBSO

Facility

$0.33

Service Code	NDC 0406054034
Hospital Charge Code	0406054034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

METHADONE HCL 5 MG PO TABS

Facility

$0.46

Service Code	NDC 0406575523
Hospital Charge Code	0406575523
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
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	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
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	$0.30

METHADONE HCL 5 MG PO TABS

Facility

$0.46

Service Code	NDC 0406575562
Hospital Charge Code	0406575562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
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	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
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	$0.30

METHADONE HCL 5 MG PO TABS

Facility

$0.46

Service Code	NDC 0406575523
Hospital Charge Code	0406575523
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

METHADONE HCL 5 MG PO TABS

Facility

$0.46

Service Code	NDC 0406575562
Hospital Charge Code	0406575562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

METHADONE HCL 5 MG PO TABS (4W OASAS)

Facility

$0.46

Service Code	NDC 0406575562
Hospital Charge Code	0406575562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

METHADONE HCL 5 MG PO TABS (4W OASAS)

Facility

$0.46

Service Code	NDC 0406575562
Hospital Charge Code	0406575562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
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	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.23
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	$0.30

METHAZOLAMIDE 25 MG PO TABS

Facility

$5.11

Service Code	NDC 6255924001
Hospital Charge Code	6255924001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55

METHAZOLAMIDE 25 MG PO TABS

Facility

$2.76

Service Code	NDC 0574079001
Hospital Charge Code	0574079001
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: EmblemHealth Commercial	$1.38
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 PO TABS

Facility

$2.76

Service Code	NDC 0574079001
Hospital Charge Code	0574079001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

METHAZOLAMIDE 25 MG PO TABS

Facility

$5.11

Service Code	NDC 6255924001
Hospital Charge Code	6255924001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$4.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.55
Rate for Payer: Aetna Government	$2.55
Rate for Payer: Brighton Health Commercial	$3.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.47
Rate for Payer: EmblemHealth Commercial	$2.55
Rate for Payer: Group Health Inc Commercial	$2.55
Rate for Payer: Group Health Inc Medicare	$1.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.55
Rate for Payer: Hamaspik Choice Inc Medicare	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.32

METHAZOLAMIDE 50 MG PO TABS

Facility

$5.52

Service Code	NDC 0574079101
Hospital Charge Code	0574079101
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: EmblemHealth Commercial	$2.76
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 PO TABS

Facility

$5.52

Service Code	NDC 0574079101
Hospital Charge Code	0574079101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$2.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.76

METHIMAZOLE 10 MG PO TABS

Facility

$1.00

Service Code	NDC 6068768011
Hospital Charge Code	6068768011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

METHIMAZOLE 10 MG PO TABS

Facility

$1.00

Service Code	NDC 6068768011
Hospital Charge Code	6068768011
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: EmblemHealth Commercial	$0.50
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

Facility

$0.77

Service Code	NDC 2315507101
Hospital Charge Code	2315507101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.38

METHIMAZOLE 10 MG PO TABS

Facility

$0.77

Service Code	NDC 2315507101
Hospital Charge Code	2315507101
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: EmblemHealth Commercial	$0.38
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 5 MG PO TABS

Facility

$0.44

Service Code	NDC 2315507001
Hospital Charge Code	2315507001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

Know your out-of-pocket cost for care.

All Charges