St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$31.25

Service Code	HCPCS Q9968
Hospital Charge Code	0517037401
Hospital Revenue Code	258
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$25.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.73
Rate for Payer: Aetna Government	$8.73
Rate for Payer: Affinity Essential Plan 1&2	$6.11
Rate for Payer: Affinity Essential Plan 3&4	$6.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.11
Rate for Payer: Brighton Health Commercial	$23.44
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.25
Rate for Payer: Elderplan Medicare Advantage	$8.73
Rate for Payer: EmblemHealth Commercial	$8.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.86
Rate for Payer: Fidelis Essential Plan Aliesa	$7.42
Rate for Payer: Fidelis Essential Plan QHP	$7.77
Rate for Payer: Fidelis Medicare Advantage	$8.73
Rate for Payer: Fidelis Qualified Health Plan	$7.77
Rate for Payer: Group Health Inc Commercial	$8.73
Rate for Payer: Group Health Inc Medicare	$8.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.73
Rate for Payer: Hamaspik Choice Inc Medicare	$8.73
Rate for Payer: Healthfirst Medicare Advantage	$7.42
Rate for Payer: Healthfirst QHP	$8.73
Rate for Payer: Humana Medicare	$8.90
Rate for Payer: Senior Whole Health Medicare Advantage	$8.73
Rate for Payer: United Healthcare Medicare Advantage	$8.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.29
Rate for Payer: Wellcare Medicare	$8.29

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$31.25

Service Code	HCPCS Q9968
Hospital Charge Code	0517037405
Hospital Revenue Code	258
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$25.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.73
Rate for Payer: Aetna Government	$8.73
Rate for Payer: Affinity Essential Plan 1&2	$6.11
Rate for Payer: Affinity Essential Plan 3&4	$6.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.11
Rate for Payer: Brighton Health Commercial	$23.44
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.25
Rate for Payer: Elderplan Medicare Advantage	$8.73
Rate for Payer: EmblemHealth Commercial	$8.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.86
Rate for Payer: Fidelis Essential Plan Aliesa	$7.42
Rate for Payer: Fidelis Essential Plan QHP	$7.77
Rate for Payer: Fidelis Medicare Advantage	$8.73
Rate for Payer: Fidelis Qualified Health Plan	$7.77
Rate for Payer: Group Health Inc Commercial	$8.73
Rate for Payer: Group Health Inc Medicare	$8.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.73
Rate for Payer: Hamaspik Choice Inc Medicare	$8.73
Rate for Payer: Healthfirst Medicare Advantage	$7.42
Rate for Payer: Healthfirst QHP	$8.73
Rate for Payer: Humana Medicare	$8.90
Rate for Payer: Senior Whole Health Medicare Advantage	$8.73
Rate for Payer: United Healthcare Medicare Advantage	$8.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.29
Rate for Payer: Wellcare Medicare	$8.29

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$28.13

Service Code	NDC 7128881110
Hospital Charge Code	7128881110
Hospital Revenue Code	258
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$14.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.06

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$3.57

Service Code	NDC 1478911907
Hospital Charge Code	1478911907
Hospital Revenue Code	258
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.78
Rate for Payer: Aetna Government	$1.78
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	$1.78
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.32

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$28.13

Service Code	NDC 7128881110
Hospital Charge Code	7128881110
Hospital Revenue Code	258
Min. Negotiated Rate	$9.84
Max. Negotiated Rate	$22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.06
Rate for Payer: Aetna Government	$14.06
Rate for Payer: Brighton Health Commercial	$21.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.13
Rate for Payer: EmblemHealth Commercial	$14.06
Rate for Payer: Group Health Inc Commercial	$14.06
Rate for Payer: Group Health Inc Medicare	$9.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.06
Rate for Payer: Hamaspik Choice Inc Medicare	$14.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.28

METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN

Facility

$43.75

Service Code	NDC 0517038101
Hospital Charge Code	0517038101
Hospital Revenue Code	258
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$35.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.88
Rate for Payer: Aetna Government	$21.88
Rate for Payer: Brighton Health Commercial	$32.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.75
Rate for Payer: EmblemHealth Commercial	$21.88
Rate for Payer: Group Health Inc Commercial	$21.88
Rate for Payer: Group Health Inc Medicare	$15.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.88
Rate for Payer: Hamaspik Choice Inc Medicare	$21.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.44

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$36.44

Service Code	HCPCS J2210
Hospital Charge Code	0517074020
Hospital Revenue Code	250
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$29.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.62
Rate for Payer: Aetna Government	$19.62
Rate for Payer: Brighton Health Commercial	$27.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.78
Rate for Payer: EmblemHealth Commercial	$18.22
Rate for Payer: Group Health Inc Commercial	$18.22
Rate for Payer: Group Health Inc Medicare	$12.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.22
Rate for Payer: Hamaspik Choice Inc Medicare	$18.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.69

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$23.71

Service Code	HCPCS J2210
Hospital Charge Code	5199114417
Hospital Revenue Code	250
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$11.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.86

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$36.44

Service Code	HCPCS J2210
Hospital Charge Code	0517074001
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$29.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.62
Rate for Payer: Aetna Government	$19.62
Rate for Payer: Brighton Health Commercial	$27.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.78
Rate for Payer: EmblemHealth Commercial	$18.22
Rate for Payer: Group Health Inc Commercial	$18.22
Rate for Payer: Group Health Inc Medicare	$12.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.22
Rate for Payer: Hamaspik Choice Inc Medicare	$18.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.69

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$36.44

Service Code	HCPCS J2210
Hospital Charge Code	0517074001
Hospital Revenue Code	250
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.22

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$23.71

Service Code	HCPCS J2210
Hospital Charge Code	5199114417
Hospital Revenue Code	250
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$20.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.62
Rate for Payer: Aetna Government	$19.62
Rate for Payer: Brighton Health Commercial	$17.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.12
Rate for Payer: EmblemHealth Commercial	$11.86
Rate for Payer: Group Health Inc Commercial	$11.86
Rate for Payer: Group Health Inc Medicare	$8.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.86
Rate for Payer: Hamaspik Choice Inc Medicare	$11.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.41

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$36.44

Service Code	HCPCS J2210
Hospital Charge Code	0517074020
Hospital Revenue Code	250
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.22

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$23.71

Service Code	HCPCS J2210
Hospital Charge Code	5199114499
Hospital Revenue Code	250
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$20.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.62
Rate for Payer: Aetna Government	$19.62
Rate for Payer: Brighton Health Commercial	$17.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.12
Rate for Payer: EmblemHealth Commercial	$11.86
Rate for Payer: Group Health Inc Commercial	$11.86
Rate for Payer: Group Health Inc Medicare	$8.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.86
Rate for Payer: Hamaspik Choice Inc Medicare	$11.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.41

METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN

Facility

$23.71

Service Code	HCPCS J2210
Hospital Charge Code	5199114499
Hospital Revenue Code	250
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$11.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.86

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$70.97

Service Code	NDC 1657173521
Hospital Charge Code	1657173521
Hospital Revenue Code	250
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$56.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.48
Rate for Payer: Aetna Government	$35.48
Rate for Payer: Brighton Health Commercial	$53.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.26
Rate for Payer: EmblemHealth Commercial	$35.48
Rate for Payer: Group Health Inc Commercial	$35.48
Rate for Payer: Group Health Inc Medicare	$24.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.48
Rate for Payer: Hamaspik Choice Inc Medicare	$35.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.13

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$70.92

Service Code	NDC 1657173528
Hospital Charge Code	1657173528
Hospital Revenue Code	250
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$35.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.46

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$70.97

Service Code	NDC 1657173521
Hospital Charge Code	1657173521
Hospital Revenue Code	250
Min. Negotiated Rate	$35.48
Max. Negotiated Rate	$35.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.48

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$70.92

Service Code	NDC 1657173528
Hospital Charge Code	1657173528
Hospital Revenue Code	250
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$56.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.46
Rate for Payer: Aetna Government	$35.46
Rate for Payer: Brighton Health Commercial	$53.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.23
Rate for Payer: EmblemHealth Commercial	$35.46
Rate for Payer: Group Health Inc Commercial	$35.46
Rate for Payer: Group Health Inc Medicare	$24.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.46
Rate for Payer: Hamaspik Choice Inc Medicare	$35.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.10

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$67.23

Service Code	NDC 6923816052
Hospital Charge Code	6923816052
Hospital Revenue Code	250
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$33.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.61

METHYLERGONOVINE MALEATE 0.2 MG PO TABS

Facility

$67.23

Service Code	NDC 6923816052
Hospital Charge Code	6923816052
Hospital Revenue Code	250
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$53.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$33.61
Rate for Payer: Aetna Government	$33.61
Rate for Payer: Brighton Health Commercial	$50.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.72
Rate for Payer: EmblemHealth Commercial	$33.61
Rate for Payer: Group Health Inc Commercial	$33.61
Rate for Payer: Group Health Inc Medicare	$23.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.61
Rate for Payer: Hamaspik Choice Inc Medicare	$33.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.70

METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN

Facility

$320.62

Service Code	NDC 6564955102
Hospital Charge Code	6564955102
Hospital Revenue Code	250
Min. Negotiated Rate	$160.31
Max. Negotiated Rate	$160.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.31

METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN

Facility

$320.62

Service Code	NDC 6564955107
Hospital Charge Code	6564955107
Hospital Revenue Code	250
Min. Negotiated Rate	$112.22
Max. Negotiated Rate	$256.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.31
Rate for Payer: Aetna Government	$160.31
Rate for Payer: Brighton Health Commercial	$240.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.02
Rate for Payer: EmblemHealth Commercial	$160.31
Rate for Payer: Group Health Inc Commercial	$160.31
Rate for Payer: Group Health Inc Medicare	$112.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.31
Rate for Payer: Hamaspik Choice Inc Medicare	$160.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.40

METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN

Facility

$320.62

Service Code	NDC 6564955107
Hospital Charge Code	6564955107
Hospital Revenue Code	250
Min. Negotiated Rate	$160.31
Max. Negotiated Rate	$160.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.31

METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN

Facility

$320.62

Service Code	NDC 6564955102
Hospital Charge Code	6564955102
Hospital Revenue Code	250
Min. Negotiated Rate	$112.22
Max. Negotiated Rate	$256.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.31
Rate for Payer: Aetna Government	$160.31
Rate for Payer: Brighton Health Commercial	$240.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$218.02
Rate for Payer: EmblemHealth Commercial	$160.31
Rate for Payer: Group Health Inc Commercial	$160.31
Rate for Payer: Group Health Inc Medicare	$112.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.31
Rate for Payer: Hamaspik Choice Inc Medicare	$160.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$208.40

METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN

Facility

$480.93

Service Code	NDC 6564955204
Hospital Charge Code	6564955204
Hospital Revenue Code	250
Min. Negotiated Rate	$168.33
Max. Negotiated Rate	$384.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$240.46
Rate for Payer: Aetna Government	$240.46
Rate for Payer: Brighton Health Commercial	$360.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$384.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$327.03
Rate for Payer: EmblemHealth Commercial	$240.46
Rate for Payer: Group Health Inc Commercial	$240.46
Rate for Payer: Group Health Inc Medicare	$168.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.46
Rate for Payer: Hamaspik Choice Inc Medicare	$240.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.60

Know your out-of-pocket cost for care.

All Charges