Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

DESMER/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
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	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DESMER/250MG/TAB

Facility

$3.00

Hospital Charge Code	60634371
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$933.15

Hospital Charge Code	60628997
Hospital Revenue Code	250
Min. Negotiated Rate	$139.97
Max. Negotiated Rate	$139.97
Rate for Payer: Qualcare PPO/HMO/WC	$139.97

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$3,114.56

Service Code	NDC 75245201
Hospital Charge Code	6063943094
Hospital Revenue Code	250
Min. Negotiated Rate	$467.18
Max. Negotiated Rate	$467.18
Rate for Payer: Qualcare PPO/HMO/WC	$467.18

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$3,114.56

Service Code	NDC 75245201
Hospital Charge Code	6063943094
Hospital Revenue Code	250
Min. Negotiated Rate	$75.06
Max. Negotiated Rate	$1,557.28
Rate for Payer: Aetna Commercial	$1,183.53
Rate for Payer: Aetna Medicare Advantage	$934.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$794.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$794.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$794.21
Rate for Payer: Cigna Commercial	$1,557.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.37
Rate for Payer: Oxford Commercial	$622.91
Rate for Payer: Qualcare PPO/HMO/WC	$467.18
Rate for Payer: UnitedHealthcare Commercial	$622.91
Rate for Payer: UnitedHealthcare Community & State	$75.06
Rate for Payer: Wellpoint Medicaid Managed Care	$82.54

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$933.15

Hospital Charge Code	60628997
Hospital Revenue Code	250
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$466.57
Rate for Payer: Aetna Commercial	$354.60
Rate for Payer: Aetna Medicare Advantage	$279.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.95
Rate for Payer: Cigna Commercial	$466.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.94
Rate for Payer: Oxford Commercial	$186.63
Rate for Payer: Qualcare PPO/HMO/WC	$139.97
Rate for Payer: UnitedHealthcare Commercial	$186.63
Rate for Payer: UnitedHealthcare Community & State	$22.49
Rate for Payer: Wellpoint Medicaid Managed Care	$24.73

DESMOPRESSIN 0.1 MG TAB

Facility

$16.80

Hospital Charge Code	60629903
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.52

DESMOPRESSIN 0.1 MG TAB

Facility

$16.80

Hospital Charge Code	60629903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.40
Rate for Payer: Aetna Commercial	$6.38
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.28
Rate for Payer: Cigna Commercial	$8.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.04
Rate for Payer: Oxford Commercial	$3.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.52
Rate for Payer: UnitedHealthcare Commercial	$3.36
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

DESMOPRESSIN 4MCG/ML INJ 10 ML

Facility

$4,778.71

Service Code	HCPCS J2597
Hospital Charge Code	6001648
Hospital Revenue Code	636
Min. Negotiated Rate	$716.81
Max. Negotiated Rate	$1,156.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.45
Rate for Payer: Qualcare PPO/HMO/WC	$716.81

DESMOPRESSIN 4MCG/ML INJ 10 ML

Facility

$4,778.71

Service Code	HCPCS J2597
Hospital Charge Code	6001648
Hospital Revenue Code	636
Min. Negotiated Rate	$115.17
Max. Negotiated Rate	$2,389.36
Rate for Payer: Aetna Commercial	$1,815.91
Rate for Payer: Aetna Medicare Advantage	$1,433.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.57
Rate for Payer: Cigna Commercial	$2,389.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.45
Rate for Payer: Qualcare PPO/HMO/WC	$716.81
Rate for Payer: UnitedHealthcare Community & State	$115.17
Rate for Payer: Wellpoint Medicaid Managed Care	$126.64

DESMOPRESSIN 4MCG/ML INJ 1 ML

Facility

$477.84

Service Code	HCPCS J2597
Hospital Charge Code	60632357
Hospital Revenue Code	636
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$238.92
Rate for Payer: Aetna Commercial	$181.58
Rate for Payer: Aetna Medicare Advantage	$143.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.85
Rate for Payer: Cigna Commercial	$238.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.64
Rate for Payer: Qualcare PPO/HMO/WC	$71.68
Rate for Payer: UnitedHealthcare Community & State	$11.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12.66

DESMOPRESSIN 4MCG/ML INJ 1 ML

Facility

$477.84

Service Code	HCPCS J2597
Hospital Charge Code	60632357
Hospital Revenue Code	636
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$115.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.64
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

DESMOPRESSIN INJ 4MCG/ML 2.5ML

Facility

$489.60

Hospital Charge Code	6001655
Hospital Revenue Code	250
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$73.44
Rate for Payer: Qualcare PPO/HMO/WC	$73.44

DESMOPRESSIN INJ 4MCG/ML 2.5ML

Facility

$489.60

Hospital Charge Code	6001655
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$244.80
Rate for Payer: Aetna Commercial	$186.05
Rate for Payer: Aetna Medicare Advantage	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.85
Rate for Payer: Cigna Commercial	$244.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.88
Rate for Payer: Oxford Commercial	$97.92
Rate for Payer: Qualcare PPO/HMO/WC	$73.44
Rate for Payer: UnitedHealthcare Commercial	$97.92
Rate for Payer: UnitedHealthcare Community & State	$11.80
Rate for Payer: Wellpoint Medicaid Managed Care	$12.97

DESONIDE 0.05% CRE 15 GM

Facility

$143.75

Hospital Charge Code	60628374
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$71.88
Rate for Payer: Aetna Commercial	$54.62
Rate for Payer: Aetna Medicare Advantage	$43.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.66
Rate for Payer: Cigna Commercial	$71.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.12
Rate for Payer: Oxford Commercial	$28.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.56
Rate for Payer: UnitedHealthcare Commercial	$28.75
Rate for Payer: UnitedHealthcare Community & State	$3.46
Rate for Payer: Wellpoint Medicaid Managed Care	$3.81

DESONIDE 0.05% CRE 15 GM

Facility

$143.75

Hospital Charge Code	60628374
Hospital Revenue Code	250
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$21.56
Rate for Payer: Qualcare PPO/HMO/WC	$21.56

DESONIDE CRM 0.05% 15GM

Facility

$86.40

Hospital Charge Code	6008585
Hospital Revenue Code	252
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

DESONIDE CRM 0.05% 15GM

Facility

$86.40

Hospital Charge Code	6008585
Hospital Revenue Code	252
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

DESOXIMETASONE 0.05% GEL 15 G

Facility

$586.72

Service Code	NDC 61748020515
Hospital Charge Code	606390044
Hospital Revenue Code	250
Min. Negotiated Rate	$88.01
Max. Negotiated Rate	$88.01
Rate for Payer: Qualcare PPO/HMO/WC	$88.01

DESOXIMETASONE 0.05% GEL 15 G

Facility

$586.72

Service Code	NDC 61748020515
Hospital Charge Code	606390044
Hospital Revenue Code	250
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$293.36
Rate for Payer: Aetna Commercial	$222.95
Rate for Payer: Aetna Medicare Advantage	$176.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.61
Rate for Payer: Cigna Commercial	$293.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.02
Rate for Payer: Oxford Commercial	$117.34
Rate for Payer: Qualcare PPO/HMO/WC	$88.01
Rate for Payer: UnitedHealthcare Commercial	$117.34
Rate for Payer: UnitedHealthcare Community & State	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$15.55

DESOXIMETASONE 0.25 % CRE

Facility

$45.23

Service Code	NDC 51672127001
Hospital Charge Code	60628377
Hospital Revenue Code	250
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$6.78

DESOXIMETASONE 0.25 % CRE

Facility

$45.23

Service Code	NDC 51672127001
Hospital Charge Code	60628377
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.53
Rate for Payer: Cigna Commercial	$22.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.57
Rate for Payer: Oxford Commercial	$9.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.78
Rate for Payer: UnitedHealthcare Commercial	$9.05
Rate for Payer: UnitedHealthcare Community & State	$1.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

DESOXIMETASONE 0.25% OIN

Facility

$4.00

Service Code	NDC 168015160
Hospital Charge Code	60628375
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DESOXIMETASONE 0.25% OIN

Facility

$4.00

Service Code	NDC 168015160
Hospital Charge Code	60628375
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

Know your out-of-pocket cost for care.

All Charges