Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEOGUARD 15.2x244 COVER 610941

Facility

$146.25

Hospital Charge Code	270641249
Hospital Revenue Code	272
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$21.94
Rate for Payer: Qualcare PPO/HMO/WC	$21.94

NEOGUARD 15.2x244 COVER 610941

Facility

$146.25

Hospital Charge Code	270641249
Hospital Revenue Code	272
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$73.12
Rate for Payer: Aetna Commercial	$55.58
Rate for Payer: Aetna Medicare Advantage	$43.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.29
Rate for Payer: Cigna Commercial	$73.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.88
Rate for Payer: Oxford Commercial	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.94
Rate for Payer: UnitedHealthcare Commercial	$29.25
Rate for Payer: UnitedHealthcare Community & State	$3.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

NEOGUARD TRANSDUCER COVER

Facility

$29.17

Hospital Charge Code	270667952
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.59
Rate for Payer: Aetna Commercial	$11.08
Rate for Payer: Aetna Medicare Advantage	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.44
Rate for Payer: Cigna Commercial	$14.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.75
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.38
Rate for Payer: UnitedHealthcare Commercial	$5.83
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

NEOGUARD TRANSDUCER COVER

Facility

$29.17

Hospital Charge Code	270667952
Hospital Revenue Code	270
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.38

NEOMYCIN 500 MG TAB

Facility

$9.98

Service Code	NDC 93117701
Hospital Charge Code	60627242
Hospital Revenue Code	251
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

NEOMYCIN 500 MG TAB

Facility

$9.98

Service Code	NDC 93117701
Hospital Charge Code	60627242
Hospital Revenue Code	251
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.99
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.99
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

NEOMYCIN/BACITRACIN/POLYM

Facility

$12.00

Hospital Charge Code	60633524
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

NEOMYCIN/BACITRACIN/POLYM

Facility

$12.00

Hospital Charge Code	60633524
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

NEOMYCIN DECADRON SOL

Facility

$52.50

Hospital Charge Code	6008460
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

NEOMYCIN DECADRON SOL

Facility

$52.50

Hospital Charge Code	6008460
Hospital Revenue Code	251
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

NEOMYCIN POLY B 1ML

Facility

$40.35

Hospital Charge Code	6013015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.18
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.29
Rate for Payer: Cigna Commercial	$20.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.11
Rate for Payer: Oxford Commercial	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$8.07
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

NEOMYCIN POLY B 1ML

Facility

$40.35

Hospital Charge Code	6013015
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

NEOMYCIN POLY BACIT OINT

Facility

$54.67

Service Code	NDC 472017956
Hospital Charge Code	60628328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.34
Rate for Payer: Aetna Commercial	$20.77
Rate for Payer: Aetna Medicare Advantage	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.94
Rate for Payer: Cigna Commercial	$27.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.40
Rate for Payer: Oxford Commercial	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$8.20
Rate for Payer: UnitedHealthcare Commercial	$10.93
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

NEOMYCIN POLY BACIT OINT

Facility

$54.67

Service Code	NDC 472017956
Hospital Charge Code	60628328
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.20

NEOMYCIN POLY BACIT OINT 15GM

Facility

$30.10

Hospital Charge Code	6003925
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

NEOMYCIN POLY BACIT OINT 15GM

Facility

$30.10

Hospital Charge Code	6003925
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

NEOMYCIN POLY BACIT OINT PKT

Facility

$1.95

Hospital Charge Code	60628329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

NEOMYCIN POLY BACIT OINT PKT

Facility

$1.95

Hospital Charge Code	60628329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

NEOMYCIN POLY BACIT OPH 3.5GM

Facility

$105.00

Hospital Charge Code	6003917
Hospital Revenue Code	251
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

NEOMYCIN POLY BACIT OPH 3.5GM

Facility

$105.00

Hospital Charge Code	6003917
Hospital Revenue Code	251
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

NEOMYCIN POLY BACIT OPH IONT

Facility

$370.18

Service Code	NDC 17478023535
Hospital Charge Code	60628016
Hospital Revenue Code	250
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.09
Rate for Payer: Aetna Commercial	$140.67
Rate for Payer: Aetna Medicare Advantage	$111.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.40
Rate for Payer: Cigna Commercial	$185.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.05
Rate for Payer: Oxford Commercial	$74.04
Rate for Payer: Qualcare PPO/HMO/WC	$55.53
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.81

NEOMYCIN POLY BACIT OPH IONT

Facility

$370.18

Service Code	NDC 17478023535
Hospital Charge Code	60628016
Hospital Revenue Code	250
Min. Negotiated Rate	$55.53
Max. Negotiated Rate	$55.53
Rate for Payer: Qualcare PPO/HMO/WC	$55.53

NEOMYCIN POLY DEXAMTH OPH OINT

Facility

$133.06

Service Code	NDC 24208079535
Hospital Charge Code	60628017
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.53
Rate for Payer: Aetna Commercial	$50.56
Rate for Payer: Aetna Medicare Advantage	$39.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.93
Rate for Payer: Cigna Commercial	$66.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.92
Rate for Payer: Oxford Commercial	$26.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.96
Rate for Payer: UnitedHealthcare Commercial	$26.61
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

NEOMYCIN POLY DEXAMTH OPH OINT

Facility

$133.06

Service Code	NDC 24208079535
Hospital Charge Code	60628017
Hospital Revenue Code	250
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$19.96
Rate for Payer: Qualcare PPO/HMO/WC	$19.96

NEOMYCIN POLY DEXAMTH OPH SSP

Facility

$133.06

Service Code	NDC 24208083060
Hospital Charge Code	60628018
Hospital Revenue Code	250
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$19.96
Rate for Payer: Qualcare PPO/HMO/WC	$19.96

Know your out-of-pocket cost for care.

All Charges