Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

METHYLENE BLUE 10MG/ML 1ML INJ

Facility

$52.33

Service Code	HCPCS Q9968
Hospital Charge Code	60632334
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$37.14
Rate for Payer: Aetna Commercial	$27.99
Rate for Payer: Aetna Medicare Advantage	$33.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.14
Rate for Payer: Cigna Medicare Advantage	$10.29
Rate for Payer: Clover Medicare Advantage	$9.78
Rate for Payer: EmblemHealth Commercial	$30.87
Rate for Payer: Humana Medicare Advantage	$10.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.85
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.29
Rate for Payer: Wellcare Medicare Advantage	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

METHYLENE BLUE 10MG/ML 1ML INJ

Facility

$52.33

Service Code	HCPCS Q9968
Hospital Charge Code	60632334
Hospital Revenue Code	636
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$12.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.85

METHYLENE BLUE 10 MG/ML SOL

Facility

$1,349.11

Service Code	NDC 17478050410
Hospital Charge Code	60628533
Hospital Revenue Code	250
Min. Negotiated Rate	$202.37
Max. Negotiated Rate	$202.37
Rate for Payer: Qualcare PPO/HMO/WC	$202.37

METHYLENE BLUE 10 MG/ML SOL

Facility

$1,349.11

Service Code	NDC 17478050410
Hospital Charge Code	60628533
Hospital Revenue Code	250
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$674.55
Rate for Payer: Aetna Commercial	$512.66
Rate for Payer: Aetna Medicare Advantage	$404.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.02
Rate for Payer: Cigna Commercial	$674.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.73
Rate for Payer: Oxford Commercial	$269.82
Rate for Payer: Qualcare PPO/HMO/WC	$202.37
Rate for Payer: UnitedHealthcare Commercial	$269.82
Rate for Payer: UnitedHealthcare Community & State	$32.51
Rate for Payer: Wellpoint Medicaid Managed Care	$35.75

METHYLENE BLUE 10ML

Facility

$43.55

Hospital Charge Code	6012835
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

METHYLENE BLUE 10ML

Facility

$43.55

Hospital Charge Code	6012835
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

METHYLENE BLUE 1%/10ML

Facility

$51.00

Hospital Charge Code	60633406
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

METHYLENE BLUE 1%/10ML

Facility

$51.00

Hospital Charge Code	60633406
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

METHYLENE BLUE INJ 10MG/ML 10M

Facility

$43.55

Hospital Charge Code	6003628
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$16.55
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.06
Rate for Payer: Oxford Commercial	$8.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$8.71
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

METHYLENE BLUE INJ 10MG/ML 10M

Facility

$43.55

Hospital Charge Code	6003628
Hospital Revenue Code	250
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

METHYLENE TETRA HYDRFOLATE 1

Facility

$111.00

Hospital Charge Code	3036050A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

METHYLENE TETRA HYDRFOLATE 1

Facility

$111.00

Hospital Charge Code	3036050A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

METHYLENE TETRA HYDRFOLATE 2

Facility

$163.60

Hospital Charge Code	3036050B
Hospital Revenue Code	301
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$24.54
Rate for Payer: Qualcare PPO/HMO/WC	$24.54

METHYLENE TETRA HYDRFOLATE 2

Facility

$163.60

Hospital Charge Code	3036050B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.17
Rate for Payer: Aetna Medicare Advantage	$49.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.72
Rate for Payer: Cigna Commercial	$81.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.34

METHYLENE TETRA HYDRFOLATE 3

Facility

$204.00

Hospital Charge Code	3036050C
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

METHYLENE TETRA HYDRFOLATE 3

Facility

$204.00

Hospital Charge Code	3036050C
Hospital Revenue Code	301
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

METHYLENE TETRA HYDRFOLATE 4

Facility

$128.00

Hospital Charge Code	3036050D
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

METHYLENE TETRA HYDRFOLATE 4

Facility

$128.00

Hospital Charge Code	3036050D
Hospital Revenue Code	301
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

METHYLENE TETRA HYDRFOLATE 5

Facility

$111.00

Hospital Charge Code	3036050E
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

METHYLENE TETRA HYDRFOLATE 5

Facility

$111.00

Hospital Charge Code	3036050E
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

METHYLERGONOVINE MAL INJ .2MG

Facility

$57.49

Service Code	HCPCS J2210
Hospital Charge Code	6009161
Hospital Revenue Code	636
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$13.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Qualcare PPO/HMO/WC	$8.62

METHYLERGONOVINE MAL INJ .2MG

Facility

$57.49

Service Code	HCPCS J2210
Hospital Charge Code	6009161
Hospital Revenue Code	636
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.75
Rate for Payer: Aetna Commercial	$21.85
Rate for Payer: Aetna Medicare Advantage	$17.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$28.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Qualcare PPO/HMO/WC	$8.62
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

METHYLERGONOVINE TAB 0.2MG

Facility

$187.20

Service Code	NDC 43386014007
Hospital Charge Code	60628283
Hospital Revenue Code	250
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$28.08
Rate for Payer: Qualcare PPO/HMO/WC	$28.08

METHYLERGONOVINE TAB 0.2MG

Facility

$187.20

Service Code	NDC 43386014007
Hospital Charge Code	60628283
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$93.60
Rate for Payer: Aetna Commercial	$71.14
Rate for Payer: Aetna Medicare Advantage	$56.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.74
Rate for Payer: Cigna Commercial	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.16
Rate for Payer: Oxford Commercial	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$28.08
Rate for Payer: UnitedHealthcare Commercial	$37.44
Rate for Payer: UnitedHealthcare Community & State	$4.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

METHYLMALONIC ACID

Facility

$509.00

Service Code	HCPCS 83921
Hospital Charge Code	38473073
Hospital Revenue Code	301
Min. Negotiated Rate	$76.35
Max. Negotiated Rate	$76.35
Rate for Payer: Qualcare PPO/HMO/WC	$76.35

Know your out-of-pocket cost for care.

All Charges