Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METFORMIN 1000MG TAB

Facility

$6.00

Hospital Charge Code	60635629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

METFORMIN 500MG ER

Facility

$8.98

Service Code	NDC 50268053115
Hospital Charge Code	60635578
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

METFORMIN 500MG ER

Facility

$8.98

Service Code	NDC 50268053115
Hospital Charge Code	60635578
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.49
Rate for Payer: Aetna Commercial	$3.41
Rate for Payer: Aetna Medicare Advantage	$2.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.69
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

METFORMIN (GLUCOPHAGE) 1000MG

Facility

$10.18

Service Code	NDC 62584045201
Hospital Charge Code	60630139
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.53

METFORMIN (GLUCOPHAGE) 1000MG

Facility

$10.18

Service Code	NDC 62584045201
Hospital Charge Code	60630139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna Commercial	$3.87
Rate for Payer: Aetna Medicare Advantage	$3.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.60
Rate for Payer: Cigna Commercial	$5.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.05
Rate for Payer: Oxford Commercial	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.53
Rate for Payer: UnitedHealthcare Commercial	$2.04
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

METFORMIN HCL TAB 500MG

Facility

$4.50

Hospital Charge Code	6017966
Hospital Revenue Code	252
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

METFORMIN HCL TAB 500MG

Facility

$4.50

Hospital Charge Code	6017966
Hospital Revenue Code	252
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

METFORMIN TAB 500MG

Facility

$5.23

Service Code	NDC 51079017220
Hospital Charge Code	60628240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$1.99
Rate for Payer: Aetna Medicare Advantage	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.33
Rate for Payer: Cigna Commercial	$2.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

METFORMIN TAB 500MG

Facility

$5.23

Service Code	NDC 51079017220
Hospital Charge Code	60628240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.78

METFORMIN TAB 850MG

Facility

$8.04

Service Code	NDC 23155010301
Hospital Charge Code	60628879
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

METFORMIN TAB 850MG

Facility

$8.04

Service Code	NDC 23155010301
Hospital Charge Code	60628879
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

METFROMIN ER 750

Facility

$8.04

Service Code	NDC 53746017901
Hospital Charge Code	60635579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.41
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

METFROMIN ER 750

Facility

$8.04

Service Code	NDC 53746017901
Hospital Charge Code	60635579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

METHADONE

Facility

$259.00

Service Code	HCPCS 80358
Hospital Charge Code	38472497
Hospital Revenue Code	301
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$129.50
Rate for Payer: Aetna Commercial	$98.42
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

METHADONE

Facility

$259.00

Service Code	HCPCS 80358
Hospital Charge Code	38472497
Hospital Revenue Code	301
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

METHADONE 10 MG TABLET

Facility

$4.00

Service Code	NDC 54855424
Hospital Charge Code	60629336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

METHADONE 10 MG TABLET

Facility

$4.00

Service Code	NDC 54855424
Hospital Charge Code	60629336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHADONE,40MG

Facility

$4.00

Service Code	NDC 406054034
Hospital Charge Code	60635464
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

METHADONE,40MG

Facility

$4.00

Service Code	NDC 406054034
Hospital Charge Code	60635464
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHADONE 5 MG TABLET

Facility

$4.00

Service Code	NDC 54855324
Hospital Charge Code	60629335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

METHADONE 5 MG TABLET

Facility

$4.00

Service Code	NDC 54855324
Hospital Charge Code	60629335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHADONE INJ 10MG/1ML

Facility

$117.80

Hospital Charge Code	60627711
Hospital Revenue Code	250
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

METHADONE INJ 10MG/1ML

Facility

$117.80

Hospital Charge Code	60627711
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$58.90
Rate for Payer: Aetna Commercial	$44.76
Rate for Payer: Aetna Medicare Advantage	$35.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.04
Rate for Payer: Cigna Commercial	$58.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.34
Rate for Payer: Oxford Commercial	$23.56
Rate for Payer: Qualcare PPO/HMO/WC	$17.67
Rate for Payer: UnitedHealthcare Commercial	$23.56
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

METHADONE LIQ 1MG/ML QT

Facility

$2.45

Hospital Charge Code	6003560
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

METHADONE LIQ 1MG/ML QT

Facility

$2.45

Hospital Charge Code	6003560
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

Know your out-of-pocket cost for care.

All Charges