Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METHOCARBAMOL 500 MG TAB

Facility

$4.00

Service Code	NDC 31722053301
Hospital Charge Code	60627486
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

METHOCARBAMOL 500 MG TAB

Facility

$4.00

Service Code	NDC 31722053301
Hospital Charge Code	60627486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHOCARBAMOL/500MG/TAB

Facility

$4.00

Hospital Charge Code	60633386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHOCARBAMOL/500MG/TAB

Facility

$4.00

Hospital Charge Code	60633386
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

METHOCARBAMOL 750 MG TAB

Facility

$4.89

Service Code	NDC 31722053401
Hospital Charge Code	60627487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.44
Rate for Payer: Aetna Commercial	$1.86
Rate for Payer: Aetna Medicare Advantage	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.25
Rate for Payer: Cigna Commercial	$2.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.47
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.98
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

METHOCARBAMOL 750 MG TAB

Facility

$4.89

Service Code	NDC 31722053401
Hospital Charge Code	60627487
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

METHOCARBAMOL/750MG/TAB

Facility

$3.00

Hospital Charge Code	60633385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

METHOCARBAMOL/750MG/TAB

Facility

$4.00

Hospital Charge Code	60633387
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHOCARBAMOL/750MG/TAB

Facility

$4.00

Hospital Charge Code	60633387
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

METHOCARBAMOL/750MG/TAB

Facility

$3.00

Hospital Charge Code	60633385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHOCHOLINE CHALLENGE***

Facility

$283.00

Service Code	HCPCS 94070
Hospital Charge Code	9500139
Hospital Revenue Code	419
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$1,600.25
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$867.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,600.25
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.90
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$6.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

METHOCHOLINE CHALLENGE***

Facility

$283.00

Service Code	HCPCS 94070
Hospital Charge Code	9500139
Hospital Revenue Code	419
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$42.45
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

METHOHEXITAL NA 500MG INJ

Facility

$434.90

Service Code	NDC 54569391200
Hospital Charge Code	6063943065
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$217.45
Rate for Payer: Aetna Commercial	$165.26
Rate for Payer: Aetna Medicare Advantage	$130.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.90
Rate for Payer: Cigna Commercial	$217.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.47
Rate for Payer: Oxford Commercial	$86.98
Rate for Payer: Qualcare PPO/HMO/WC	$65.23
Rate for Payer: UnitedHealthcare Commercial	$86.98
Rate for Payer: UnitedHealthcare Community & State	$10.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.52

METHOHEXITAL NA 500MG INJ

Facility

$434.90

Service Code	NDC 54569391200
Hospital Charge Code	6063943065
Hospital Revenue Code	250
Min. Negotiated Rate	$65.23
Max. Negotiated Rate	$65.23
Rate for Payer: Qualcare PPO/HMO/WC	$65.23

METHOHEXITAL SOD INJ 500MG

Facility

$53.80

Hospital Charge Code	6003602
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

METHOHEXITAL SOD INJ 500MG

Facility

$53.80

Hospital Charge Code	6003602
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

METHOTREXATE

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3008233
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

METHOTREXATE

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3008233
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

METHOTREXATE 2.5 MG TAB

Facility

$41.81

Service Code	NDC 378001401
Hospital Charge Code	60631731
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$6.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.27

METHOTREXATE 2.5 MG TAB

Facility

$41.81

Service Code	NDC 378001401
Hospital Charge Code	60631731
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$20.91
Rate for Payer: Aetna Commercial	$15.89
Rate for Payer: Aetna Medicare Advantage	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.66
Rate for Payer: Cigna Commercial	$20.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.54
Rate for Payer: Oxford Commercial	$8.36
Rate for Payer: Qualcare PPO/HMO/WC	$6.27
Rate for Payer: UnitedHealthcare Commercial	$8.36
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

METHOTREXATE/2.5MG/TAB

Facility

$18.00

Hospital Charge Code	60633389
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

METHOTREXATE/2.5MG/TAB

Facility

$18.00

Hospital Charge Code	60633389
Hospital Revenue Code	636
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

METHOTREXATE/2.5MG/TAB

Facility

$13.00

Hospital Charge Code	60633388
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

METHOTREXATE/2.5MG/TAB

Facility

$13.00

Hospital Charge Code	60633388
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

METHOTREXATE 50 MG/2 ML INJ

Facility

$169.51

Service Code	HCPCS J9260
Hospital Charge Code	60627400
Hospital Revenue Code	636
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$84.75
Rate for Payer: Aetna Commercial	$64.41
Rate for Payer: Aetna Medicare Advantage	$50.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.23
Rate for Payer: Cigna Commercial	$84.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.02
Rate for Payer: Qualcare PPO/HMO/WC	$25.43
Rate for Payer: UnitedHealthcare Community & State	$4.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.49

Know your out-of-pocket cost for care.

All Charges