Heights University Hospital

All Charges

Charge

Type

Setting

Price

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 250-25

Facility

$4.00

Hospital Charge Code	60633402
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 250-25

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 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	$0.39
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 HCTZ TAB 250/25MG

Facility

$3.85

Hospital Charge Code	60628769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.16
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	$0.50
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$1.93

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 SSP 250MG/5ML

Facility

$0.69

Hospital Charge Code	60627638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.35
Rate for Payer: Aetna Commercial	$0.21
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	$0.09
Rate for Payer: Oxford Commercial	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.10
Rate for Payer: UnitedHealthcare Commercial	$0.35

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

$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

$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/250MG/5ML

Facility

$43.00

Hospital Charge Code	60633404
Hospital Revenue Code	636
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
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

METHYLDOPATE/250MG/5ML

Facility

$38.00

Hospital Charge Code	60633403
Hospital Revenue Code	636
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$11.40
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

METHYLDOPATE ADDV/250MG

Facility

$49.00

Hospital Charge Code	60634460
Hospital Revenue Code	636
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
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

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/500MG

Facility

$89.00

Hospital Charge Code	60634461
Hospital Revenue Code	636
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
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

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	$167.50
Rate for Payer: Aetna Commercial	$100.50
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

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

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	$15.70
Rate for Payer: Aetna Commercial	$15.70
Rate for Payer: Aetna Medicare Advantage	$15.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.66
Rate for Payer: Qualcare PPO/HMO/WC	$7.85

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	$175.38
Max. Negotiated Rate	$674.55
Rate for Payer: Aetna Commercial	$404.73
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	$175.38
Rate for Payer: Oxford Commercial	$674.55
Rate for Payer: Qualcare PPO/HMO/WC	$202.37
Rate for Payer: UnitedHealthcare Commercial	$674.55

METHYLENE BLUE 10ML

Facility

$43.55

Hospital Charge Code	6012835
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
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	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

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

Know your out-of-pocket cost for care.

All Charges