Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHYLDOPA/500MG/TAB

Facility

$8.71

Service Code	NDC 93293201
Hospital Charge Code	60633396
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

METHYLDOPA/500MG/TAB

Facility

$8.71

Service Code	NDC 93293201
Hospital Charge Code	60633396
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.61
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

METHYLDOPA/500MG/TAB

Facility

$4.00

Hospital Charge Code	60633393
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/500MG/TAB

Facility

$4.00

Hospital Charge Code	60633393
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHYLDOPA/HCTZ 250-15

Facility

$3.00

Hospital Charge Code	60633400
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHYLDOPA/HCTZ 250-15

Facility

$3.00

Hospital Charge Code	60633400
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/HCTZ 250-25

Facility

$4.00

Hospital Charge Code	60633402
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/HCTZ 250-25

Facility

$3.00

Hospital Charge Code	60633401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

METHYLDOPA/HCTZ 250-25

Facility

$3.00

Hospital Charge Code	60633401
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/HCTZ 250-25

Facility

$4.00

Hospital Charge Code	60633402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

METHYLDOPA HCTZ TAB 250/25MG

Facility

$3.85

Hospital Charge Code	60628769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

METHYLDOPA HCTZ TAB 250/25MG

Facility

$3.85

Hospital Charge Code	60628769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

METHYLDOPA SSP 250MG/5ML

Facility

$0.69

Hospital Charge Code	60627638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna Commercial	$0.26
Rate for Payer: Aetna Medicare Advantage	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.18
Rate for Payer: Cigna Commercial	$0.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.10
Rate for Payer: UnitedHealthcare Commercial	$0.14
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

METHYLDOPA SSP 250MG/5ML

Facility

$0.69

Hospital Charge Code	60627638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

METHYLDOPATE/250MG/5ML

Facility

$38.00

Hospital Charge Code	60633403
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

METHYLDOPATE/250MG/5ML

Facility

$43.00

Hospital Charge Code	60633404
Hospital Revenue Code	636
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$10.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.41
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

METHYLDOPATE/250MG/5ML

Facility

$43.00

Hospital Charge Code	60633404
Hospital Revenue Code	636
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.41
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

METHYLDOPATE/250MG/5ML

Facility

$38.00

Hospital Charge Code	60633403
Hospital Revenue Code	636
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$9.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

METHYLDOPATE ADDV/250MG

Facility

$49.00

Hospital Charge Code	60634460
Hospital Revenue Code	636
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$11.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

METHYLDOPATE ADDV/250MG

Facility

$49.00

Hospital Charge Code	60634460
Hospital Revenue Code	636
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

METHYLDOPATE ADDV/500MG

Facility

$89.00

Hospital Charge Code	60634461
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

METHYLDOPATE ADDV/500MG

Facility

$89.00

Hospital Charge Code	60634461
Hospital Revenue Code	636
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$21.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

METHYLDOPATE INJ 250MG/5ML

Facility

$335.00

Service Code	HCPCS J0210
Hospital Charge Code	60627639
Hospital Revenue Code	636
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$81.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.07
Rate for Payer: Qualcare PPO/HMO/WC	$50.25

METHYLDOPATE INJ 250MG/5ML

Facility

$335.00

Service Code	HCPCS J0210
Hospital Charge Code	60627639
Hospital Revenue Code	636
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$167.50
Rate for Payer: Aetna Commercial	$127.30
Rate for Payer: Aetna Medicare Advantage	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.42
Rate for Payer: Cigna Commercial	$167.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.07
Rate for Payer: Qualcare PPO/HMO/WC	$50.25
Rate for Payer: UnitedHealthcare Community & State	$8.07
Rate for Payer: Wellpoint Medicaid Managed Care	$8.88

Know your out-of-pocket cost for care.

All Charges