St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHOCARBAMOL 750 MG PO TABS

Facility

$0.34

Service Code	NDC 6373999210
Hospital Charge Code	6373999210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
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

METHOCARBAMOL 750 MG PO TABS

Facility

$0.34

Service Code	NDC 6373999210
Hospital Charge Code	6373999210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

METHOCARBAMOL 750 MG PO TABS

Facility

$0.37

Service Code	NDC 6068756801
Hospital Charge Code	6068756801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

METHOCARBAMOL 750 MG PO TABS

Facility

$0.73

Service Code	NDC 7638512401
Hospital Charge Code	7638512401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

METHOCARBAMOL 750 MG PO TABS

Facility

$0.73

Service Code	NDC 7001077001
Hospital Charge Code	7001077001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

METHOCARBAMOL 750 MG PO TABS

Facility

$0.73

Service Code	NDC 7001077001
Hospital Charge Code	7001077001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

METHOCARBAMOL 750 MG PO TABS

Facility

$0.73

Service Code	NDC 7638512401
Hospital Charge Code	7638512401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.49
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.47

METHOCARBAMOL 750 MG PO TABS

Facility

$0.37

Service Code	NDC 6068756801
Hospital Charge Code	6068756801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

METHOCARBAMOL 750 MG PO TABS

Facility

$0.39

Service Code	NDC 0904705861
Hospital Charge Code	0904705861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

METHOCARBAMOL 750 MG PO TABS

Facility

$0.39

Service Code	NDC 0904705861
Hospital Charge Code	0904705861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

METHOTREXATE 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$3.12
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

METHOTREXATE 2.5 MG PO TABS

Facility

$3.56

Service Code	HCPCS J8610
Hospital Charge Code	6838277501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.78

METHOTREXATE 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

METHOTREXATE 2.5 MG PO TABS

Facility

$4.05

Service Code	HCPCS J8610
Hospital Charge Code	6923814231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$2.02
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

METHOTREXATE 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$3.12
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.05

METHOTREXATE 2.5 MG PO TABS

Facility

$3.56

Service Code	HCPCS J8610
Hospital Charge Code	6838277501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$1.78
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

METHOTREXATE 2.5 MG PO TABS

Facility

$4.05

Service Code	HCPCS J8610
Hospital Charge Code	6923814231
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.02

METHOTREXATE 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967005
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

METHOTREXATE (PF) 25 MG/0.5ML SC SOAJ

Facility

$338.40

Service Code	HCPCS J9260
Hospital Charge Code	5913754004
Hospital Revenue Code	250
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$169.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.20

METHOTREXATE (PF) 25 MG/0.5ML SC SOAJ

Facility

$338.40

Service Code	HCPCS J9260
Hospital Charge Code	5913754004
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$270.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.16
Rate for Payer: Aetna Government	$2.16
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: EmblemHealth Commercial	$169.20
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: Healthfirst CHP/FHP/Medicaid	$2.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$219.96

METHOTREXATE SODIUM 2.5 MG PO TABS

Facility

$3.56

Service Code	HCPCS J8610
Hospital Charge Code	6838277501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$1.78
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

METHOTREXATE SODIUM 2.5 MG PO TABS

Facility

$4.05

Service Code	HCPCS J8610
Hospital Charge Code	6923814231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
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: EmblemHealth Commercial	$2.02
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: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.63

METHOTREXATE SODIUM 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967005
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

METHOTREXATE SODIUM 2.5 MG PO TABS

Facility

$6.24

Service Code	HCPCS J8610
Hospital Charge Code	5107967001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

METHOTREXATE SODIUM 2.5 MG PO TABS

Facility

$3.58

Service Code	HCPCS J8610
Hospital Charge Code	0904714110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$2.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$2.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.43
Rate for Payer: EmblemHealth Commercial	$1.79
Rate for Payer: Group Health Inc Commercial	$1.79
Rate for Payer: Group Health Inc Medicare	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.79
Rate for Payer: Hamaspik Choice Inc Medicare	$1.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.33

Know your out-of-pocket cost for care.

All Charges