Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DESIGN MLC DEVICE FOR IMRT-GL

Facility

$1,887.22

Service Code	HCPCS 77338
Hospital Charge Code	85000645
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

DESIGN MLC DEVICE FOR IMRT-GL

Facility

$1,887.22

Service Code	HCPCS 77338
Hospital Charge Code	85000645
Hospital Revenue Code	333
Min. Negotiated Rate	$45.48
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,605.70
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.17
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$45.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$50.01

DESIGN MLC DEVICE FOR IMRT-PC

Facility

$1,140.20

Service Code	HCPCS 7733826
Hospital Charge Code	85000655
Hospital Revenue Code	333
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$433.28
Rate for Payer: Aetna Medicare Advantage	$342.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.75
Rate for Payer: Cigna Commercial	$570.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.06
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.03
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$30.22

DESIGN MLC DEVICE FOR IMRT-PC

Facility

$1,140.20

Service Code	HCPCS 7733826
Hospital Charge Code	85000655
Hospital Revenue Code	333
Min. Negotiated Rate	$171.03
Max. Negotiated Rate	$171.03
Rate for Payer: Qualcare PPO/HMO/WC	$171.03

DESIGN MLC DEVICE FOR IMRT-TC

Facility

$1,664.25

Service Code	HCPCS 77338TC
Hospital Charge Code	85000650
Hospital Revenue Code	333
Min. Negotiated Rate	$40.11
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$632.41
Rate for Payer: Aetna Medicare Advantage	$499.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$424.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$424.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$424.38
Rate for Payer: Cigna Commercial	$832.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.27
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.64
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$40.11
Rate for Payer: Wellpoint Medicaid Managed Care	$44.10

DESIGN MLC DEVICE FOR IMRT-TC

Facility

$1,664.25

Service Code	HCPCS 77338TC
Hospital Charge Code	85000650
Hospital Revenue Code	333
Min. Negotiated Rate	$249.64
Max. Negotiated Rate	$249.64
Rate for Payer: Qualcare PPO/HMO/WC	$249.64

DESIPRAMINE 100 MG TAB

Facility

$19.70

Hospital Charge Code	60627759
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.96

DESIPRAMINE 100 MG TAB

Facility

$19.70

Hospital Charge Code	60627759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.85
Rate for Payer: Aetna Commercial	$7.49
Rate for Payer: Aetna Medicare Advantage	$5.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.02
Rate for Payer: Cigna Commercial	$9.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.91
Rate for Payer: Oxford Commercial	$3.94
Rate for Payer: Qualcare PPO/HMO/WC	$2.96
Rate for Payer: UnitedHealthcare Commercial	$3.94
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

DESIPRAMINE 10 MG TAB

Facility

$5.20

Hospital Charge Code	60627760
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.78

DESIPRAMINE 10 MG TAB

Facility

$5.20

Hospital Charge Code	60627760
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna Medicare Advantage	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.33
Rate for Payer: Cigna Commercial	$2.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$1.04
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DESIPRAMINE/10MG/TAB

Facility

$4.00

Hospital Charge Code	60632802
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

DESIPRAMINE/10MG/TAB

Facility

$4.00

Hospital Charge Code	60632802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DESIPRAMINE 25 MG TAB

Facility

$4.85

Hospital Charge Code	60627761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DESIPRAMINE 25 MG TAB

Facility

$4.85

Hospital Charge Code	60627761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DESIPRAMINE (NORPRAMINE)

Facility

$148.55

Service Code	HCPCS 80335
Hospital Charge Code	3007358
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.45
Rate for Payer: Aetna Medicare Advantage	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.88
Rate for Payer: Cigna Commercial	$74.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.56
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.28
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$3.94

DESIPRAMINE (NORPRAMINE)

Facility

$148.55

Service Code	HCPCS 80335
Hospital Charge Code	3007358
Hospital Revenue Code	301
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$22.28
Rate for Payer: Qualcare PPO/HMO/WC	$22.28

DESIPRAMINE SERUM

Facility

$370.00

Service Code	HCPCS 80335
Hospital Charge Code	38473106
Hospital Revenue Code	301
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

DESIPRAMINE SERUM

Facility

$370.00

Service Code	HCPCS 80335
Hospital Charge Code	38473106
Hospital Revenue Code	301
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

DESIPRAMINE TAB 100MG

Facility

$15.40

Hospital Charge Code	6009518
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

DESIPRAMINE TAB 100MG

Facility

$15.40

Hospital Charge Code	6009518
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DESIPRANINE/25MG/U/D/TAB

Facility

$12.19

Service Code	NDC 781897201
Hospital Charge Code	60634717
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

DESIPRANINE/25MG/U/D/TAB

Facility

$12.19

Service Code	NDC 781897201
Hospital Charge Code	60634717
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DESITIN CREAM (60GM)

Facility

$22.78

Service Code	NDC 74300000300
Hospital Charge Code	606361039
Hospital Revenue Code	250
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$3.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.42

DESITIN CREAM (60GM)

Facility

$22.78

Service Code	NDC 74300000300
Hospital Charge Code	606361039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.39
Rate for Payer: Aetna Commercial	$8.66
Rate for Payer: Aetna Medicare Advantage	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.81
Rate for Payer: Cigna Commercial	$11.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.83
Rate for Payer: Oxford Commercial	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Commercial	$4.56
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

DESITIN OINTMENT/30GM

Facility

$2.00

Hospital Charge Code	60634299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

Know your out-of-pocket cost for care.

All Charges