Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$140.14
Max. Negotiated Rate	$539.00
Rate for Payer: Aetna Commercial	$323.40
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	$140.14
Rate for Payer: Oxford Commercial	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.70
Rate for Payer: UnitedHealthcare Commercial	$539.00

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	$13.64
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.48
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	$13.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.74
Rate for Payer: UnitedHealthcare Commercial	$114.00

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

METHSUXIMIDE AS METAB

Facility

$132.50

Service Code	HCPCS 80339
Hospital Charge Code	3035147
Hospital Revenue Code	301
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$39.75
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	$17.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$114.00

METHYLDOPA/125MG/TAB

Facility

$3.00

Hospital Charge Code	60633397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

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	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

METHYLDOPA 250 MG TAB

Facility

$5.00

Hospital Charge Code	60627637
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
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	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

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

$4.00

Hospital Charge Code	60633394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633398
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

METHYLDOPA/250MG/TAB

Facility

$3.00

Hospital Charge Code	60633395
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

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/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

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

$3.00

Hospital Charge Code	60633392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

METHYLDOPA/250MG/TAB

Facility

$4.00

Service Code	NDC 51079020020
Hospital Charge Code	60633399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

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/500MG/TAB

Facility

$8.71

Service Code	NDC 93293201
Hospital Charge Code	60633396
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$2.61
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	$1.13
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$4.36

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

$4.00

Hospital Charge Code	60633393
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
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	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

METHYLDOPA/HCTZ 250-15

Facility

$3.00

Hospital Charge Code	60633400
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
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	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

Know your out-of-pocket cost for care.

All Charges