Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METHOTREXATE 50 MG/2 ML INJ

Facility

$169.51

Service Code	HCPCS J9260
Hospital Charge Code	60627400
Hospital Revenue Code	636
Min. Negotiated Rate	$25.43
Max. Negotiated Rate	$41.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.02
Rate for Payer: Qualcare PPO/HMO/WC	$25.43

METHOTREXATE INJ 100MG

Facility

$15.40

Hospital Charge Code	6017164
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

METHOTREXATE INJ 100MG

Facility

$15.40

Hospital Charge Code	6017164
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

METHOTREXATE INJ 1GM

Facility

$105.00

Hospital Charge Code	6017172
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

METHOTREXATE INJ 1GM

Facility

$105.00

Hospital Charge Code	6017172
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

METHOTREXATE INJ 200MG

Facility

$19.85

Hospital Charge Code	6017156
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

METHOTREXATE INJ 200MG

Facility

$19.85

Hospital Charge Code	6017156
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

METHOTREXATE INJ 20MG

Facility

$7.70

Hospital Charge Code	6017180
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

METHOTREXATE INJ 20MG

Facility

$7.70

Hospital Charge Code	6017180
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

METHOTREXATE INJ 250MG

Facility

$21.15

Hospital Charge Code	6017198
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

METHOTREXATE INJ 250MG

Facility

$21.15

Hospital Charge Code	6017198
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

METHOTREXATE INJ 25MG/1ML 4ML

Facility

$70.40

Hospital Charge Code	60627401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

METHOTREXATE INJ 25MG/1ML 4ML

Facility

$70.40

Hospital Charge Code	60627401
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

METHOTREXATE INJ 25MG/ML

Facility

$203.55

Hospital Charge Code	60627398
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$77.35
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.06
Rate for Payer: Oxford Commercial	$40.71
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$40.71
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.39

METHOTREXATE INJ 25MG/ML

Facility

$203.55

Hospital Charge Code	60627398
Hospital Revenue Code	250
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

METHOTREXATE INJ 50MG

Facility

$62.10

Hospital Charge Code	6000186
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

METHOTREXATE INJ 50MG

Facility

$62.10

Hospital Charge Code	6000186
Hospital Revenue Code	636
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$15.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

METHOTREXATE LPF/25MG/1ML

Facility

$131.00

Hospital Charge Code	60633391
Hospital Revenue Code	636
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

METHOTREXATE LPF/25MG/1ML

Facility

$131.00

Hospital Charge Code	60633391
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$31.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

METHOTREXATE PF 25MG/ML INJ

Facility

$17.69

Service Code	HCPCS J9260
Hospital Charge Code	6063943132
Hospital Revenue Code	636
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

METHOTREXATE PF 25MG/ML INJ

Facility

$17.69

Service Code	HCPCS J9260
Hospital Charge Code	6063943132
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

METHOTREXATE TAB 2.5MG

Facility

$19.85

Hospital Charge Code	6003610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

METHOTREXATE TAB 2.5MG

Facility

$19.85

Hospital Charge Code	6003610
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

METHOTRIMEPRAZINE 20MG/ML 10ML

Facility

$3,766.00

Service Code	HCPCS J1970
Hospital Charge Code	6010417
Hospital Revenue Code	250
Min. Negotiated Rate	$90.76
Max. Negotiated Rate	$1,883.00
Rate for Payer: Aetna Commercial	$1,431.08
Rate for Payer: Aetna Medicare Advantage	$1,129.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$960.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$960.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$960.33
Rate for Payer: Cigna Commercial	$1,883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,129.80
Rate for Payer: Oxford Commercial	$753.20
Rate for Payer: Qualcare PPO/HMO/WC	$564.90
Rate for Payer: UnitedHealthcare Commercial	$753.20
Rate for Payer: UnitedHealthcare Community & State	$90.76
Rate for Payer: Wellpoint Medicaid Managed Care	$99.80

METHOTRIMEPRAZINE 20MG/ML 10ML

Facility

$3,766.00

Service Code	HCPCS J1970
Hospital Charge Code	6010417
Hospital Revenue Code	250
Min. Negotiated Rate	$564.90
Max. Negotiated Rate	$564.90
Rate for Payer: Qualcare PPO/HMO/WC	$564.90

Know your out-of-pocket cost for care.

All Charges