Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METHOTRIMERAZINE INJ 20MG 10ML

Facility

$1,536.00

Service Code	HCPCS J1970
Hospital Charge Code	6017107
Hospital Revenue Code	250
Min. Negotiated Rate	$37.02
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$583.68
Rate for Payer: Aetna Medicare Advantage	$460.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.68
Rate for Payer: Cigna Commercial	$768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$460.80
Rate for Payer: Oxford Commercial	$307.20
Rate for Payer: Qualcare PPO/HMO/WC	$230.40
Rate for Payer: UnitedHealthcare Commercial	$307.20
Rate for Payer: UnitedHealthcare Community & State	$37.02
Rate for Payer: Wellpoint Medicaid Managed Care	$40.70

METHOTRIMERAZINE INJ 20MG 10ML

Facility

$1,536.00

Service Code	HCPCS J1970
Hospital Charge Code	6017107
Hospital Revenue Code	250
Min. Negotiated Rate	$230.40
Max. Negotiated Rate	$230.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.40

METHOXAMINE 20MG/ML

Facility

$283.00

Service Code	HCPCS J3390
Hospital Charge Code	6006621
Hospital Revenue Code	250
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$42.45
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

METHOXAMINE 20MG/ML

Facility

$283.00

Service Code	HCPCS J3390
Hospital Charge Code	6006621
Hospital Revenue Code	250
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$141.50
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Medicare Advantage	$84.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.17
Rate for Payer: Cigna Commercial	$141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.90
Rate for Payer: Oxford Commercial	$56.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Commercial	$56.60
Rate for Payer: UnitedHealthcare Community & State	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

METHOXAMINE INJ 20MG/1ML

Facility

$314.00

Service Code	HCPCS J3390
Hospital Charge Code	60627462
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.20
Rate for Payer: Oxford Commercial	$62.80
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$62.80
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

METHOXAMINE INJ 20MG/1ML

Facility

$314.00

Service Code	HCPCS J3390
Hospital Charge Code	60627462
Hospital Revenue Code	250
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

METHOXOMINE VIAL 20MG

Facility

$1,078.00

Service Code	HCPCS J3390
Hospital Charge Code	6012827
Hospital Revenue Code	250
Min. Negotiated Rate	$161.70
Max. Negotiated Rate	$161.70
Rate for Payer: Qualcare PPO/HMO/WC	$161.70

METHOXOMINE VIAL 20MG

Facility

$1,078.00

Service Code	HCPCS J3390
Hospital Charge Code	6012827
Hospital Revenue Code	250
Min. Negotiated Rate	$25.98
Max. Negotiated Rate	$539.00
Rate for Payer: Aetna Commercial	$409.64
Rate for Payer: Aetna Medicare Advantage	$323.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.89
Rate for Payer: Cigna Commercial	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$323.40
Rate for Payer: Oxford Commercial	$215.60
Rate for Payer: Qualcare PPO/HMO/WC	$161.70
Rate for Payer: UnitedHealthcare Commercial	$215.60
Rate for Payer: UnitedHealthcare Community & State	$25.98
Rate for Payer: Wellpoint Medicaid Managed Care	$28.57

METHSUXIMIDE

Facility

$104.94

Service Code	HCPCS 80339
Hospital Charge Code	38477127
Hospital Revenue Code	301
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$15.74
Rate for Payer: Qualcare PPO/HMO/WC	$15.74

METHSUXIMIDE

Facility

$104.94

Service Code	HCPCS 80339
Hospital Charge Code	38477127
Hospital Revenue Code	301
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.88
Rate for Payer: Aetna Medicare Advantage	$31.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.76
Rate for Payer: Cigna Commercial	$52.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.48
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.74
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

METHSUXIMIDE AS METAB

Facility

$132.50

Service Code	HCPCS 80339
Hospital Charge Code	3035147
Hospital Revenue Code	301
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.35
Rate for Payer: Aetna Medicare Advantage	$39.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$66.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

METHSUXIMIDE AS METAB

Facility

$132.50

Service Code	HCPCS 80339
Hospital Charge Code	3035147
Hospital Revenue Code	301
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$19.88

METHYLDOPA/125MG/TAB

Facility

$3.00

Hospital Charge Code	60633397
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

METHYLDOPA/125MG/TAB

Facility

$3.00

Hospital Charge Code	60633397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHYLDOPA 250 MG TAB

Facility

$5.00

Hospital Charge Code	60627637
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

METHYLDOPA 250 MG TAB

Facility

$5.00

Hospital Charge Code	60627637
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

METHYLDOPA/250MG/TAB

Facility

$4.00

Service Code	NDC 51079020020
Hospital Charge Code	60633399
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

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633398
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

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633395
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

METHYLDOPA/250MG/TAB

Facility

$4.00

Hospital Charge Code	60633394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHYLDOPA/250MG/TAB

Facility

$4.00

Service Code	NDC 51079020020
Hospital Charge Code	60633399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHYLDOPA/250MG/TAB

Facility

$4.00

Hospital Charge Code	60633394
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

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633392
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

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges