Heights University Hospital

All Charges

Charge

Type

Setting

Price

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 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	$1.00
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.31
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	$1.00
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$3.85

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	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
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	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

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/1ML 4ML

Facility

$70.40

Hospital Charge Code	60627401
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$21.12
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	$9.15
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$35.20

METHOTREXATE INJ 25MG/ML

Facility

$203.55

Hospital Charge Code	60627398
Hospital Revenue Code	250
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$61.06
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	$26.46
Rate for Payer: Oxford Commercial	$101.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$101.78

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	$9.31
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
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

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	$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 LPF/25MG/1ML

Facility

$131.00

Hospital Charge Code	60633391
Hospital Revenue Code	636
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$39.30
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

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	$5.31
Rate for Payer: Aetna Commercial	$5.31
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	$2.68
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	$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 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

METHOTREXATE TAB 2.5MG

Facility

$19.85

Hospital Charge Code	6003610
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
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	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

METHOTRIMEPRAZINE 20MG/ML 10ML

Facility

$3,766.00

Service Code	HCPCS J1970
Hospital Charge Code	6010417
Hospital Revenue Code	250
Min. Negotiated Rate	$489.58
Max. Negotiated Rate	$1,883.00
Rate for Payer: Aetna Commercial	$1,129.80
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	$489.58
Rate for Payer: Oxford Commercial	$1,883.00
Rate for Payer: Qualcare PPO/HMO/WC	$564.90
Rate for Payer: UnitedHealthcare Commercial	$1,883.00

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

METHOTRIMERAZINE INJ 20MG 10ML

Facility

$1,536.00

Service Code	HCPCS J1970
Hospital Charge Code	6017107
Hospital Revenue Code	250
Min. Negotiated Rate	$199.68
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$460.80
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	$199.68
Rate for Payer: Oxford Commercial	$768.00
Rate for Payer: Qualcare PPO/HMO/WC	$230.40
Rate for Payer: UnitedHealthcare Commercial	$768.00

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	$36.79
Max. Negotiated Rate	$141.50
Rate for Payer: Aetna Commercial	$84.90
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	$36.79
Rate for Payer: Oxford Commercial	$141.50
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Commercial	$141.50

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

METHOXAMINE INJ 20MG/1ML

Facility

$314.00

Service Code	HCPCS J3390
Hospital Charge Code	60627462
Hospital Revenue Code	250
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$94.20
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	$40.82
Rate for Payer: Oxford Commercial	$157.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$157.00

Know your out-of-pocket cost for care.

All Charges