Heights 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	$245.34
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$566.17
Rate for Payer: Aetna Medicare Advantage	$566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.24
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.34
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

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	$148.23
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$342.06
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	$148.23
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.03
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

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	$216.35
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$499.27
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	$216.35
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$249.64
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

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	$2.56
Max. Negotiated Rate	$9.85
Rate for Payer: Aetna Commercial	$5.91
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	$2.56
Rate for Payer: Oxford Commercial	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.96
Rate for Payer: UnitedHealthcare Commercial	$9.85

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 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	$0.68
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Commercial	$1.56
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	$0.68
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$2.60

DESIPRAMINE/10MG/TAB

Facility

$4.00

Hospital Charge Code	60632802
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

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	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

DESIPRAMINE 25 MG TAB

Facility

$4.85

Hospital Charge Code	60627761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.46
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	$0.63
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$2.42

DESIPRAMINE (NORPRAMINE)

Facility

$148.55

Service Code	HCPCS 80335
Hospital Charge Code	3007358
Hospital Revenue Code	301
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.56
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	$19.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.28
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

DESIPRAMINE SERUM

Facility

$370.00

Service Code	HCPCS 80335
Hospital Charge Code	38473106
Hospital Revenue Code	301
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$111.00
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	$48.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
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	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

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	$1.58
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$3.66
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	$1.58
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$6.09

DESITIN CREAM (60GM)

Facility

$22.78

Service Code	NDC 74300000300
Hospital Charge Code	606361039
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$11.39
Rate for Payer: Aetna Commercial	$6.83
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	$2.96
Rate for Payer: Oxford Commercial	$11.39
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Commercial	$11.39

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 OINTMENT/30GM

Facility

$2.00

Hospital Charge Code	60634299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

Know your out-of-pocket cost for care.

All Charges