Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN POLY DEXAMTH OPH SSP

Facility

$133.06

Service Code	NDC 24208083060
Hospital Charge Code	60628018
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 SSP

Facility

$15.40

Hospital Charge Code	6022877
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

NEOMYCIN POLY DEXAMTH OPH SSP

Facility

$15.40

Hospital Charge Code	6022877
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

NEOMYCIN POLY FOR IRRIGATION

Facility

$72.85

Hospital Charge Code	60627981
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

NEOMYCIN POLY FOR IRRIGATION

Facility

$72.85

Hospital Charge Code	60627981
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

NEOMYCIN POLY GRAM OPH SOL

Facility

$415.00

Service Code	NDC 24208079062
Hospital Charge Code	60628019
Hospital Revenue Code	250
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$157.70
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.50
Rate for Payer: Oxford Commercial	$83.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Commercial	$83.00
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.00

NEOMYCIN POLY GRAM OPH SOL

Facility

$415.00

Service Code	NDC 24208079062
Hospital Charge Code	60628019
Hospital Revenue Code	250
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$62.25
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

NEOMYCIN POLY GRAM OPH SOL 10M

Facility

$74.90

Hospital Charge Code	6003909
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

NEOMYCIN POLY GRAM OPH SOL 10M

Facility

$74.90

Hospital Charge Code	6003909
Hospital Revenue Code	251
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

NEOMYCIN POLY HC OPH SOL

Facility

$206.43

Service Code	NDC 24208063562
Hospital Charge Code	60628020
Hospital Revenue Code	250
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$103.22
Rate for Payer: Aetna Commercial	$78.44
Rate for Payer: Aetna Medicare Advantage	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.64
Rate for Payer: Cigna Commercial	$103.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.93
Rate for Payer: Oxford Commercial	$41.29
Rate for Payer: Qualcare PPO/HMO/WC	$30.96
Rate for Payer: UnitedHealthcare Commercial	$41.29
Rate for Payer: UnitedHealthcare Community & State	$4.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.47

NEOMYCIN POLY HC OPH SOL

Facility

$206.43

Service Code	NDC 24208063562
Hospital Charge Code	60628020
Hospital Revenue Code	250
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$30.96
Rate for Payer: Qualcare PPO/HMO/WC	$30.96

NEOMYCIN POLY HC OPH SSP

Facility

$1,253.57

Service Code	NDC 61314064175
Hospital Charge Code	60628021
Hospital Revenue Code	250
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$626.78
Rate for Payer: Aetna Commercial	$476.36
Rate for Payer: Aetna Medicare Advantage	$376.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.66
Rate for Payer: Cigna Commercial	$626.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.07
Rate for Payer: Oxford Commercial	$250.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.04
Rate for Payer: UnitedHealthcare Commercial	$250.71
Rate for Payer: UnitedHealthcare Community & State	$30.21
Rate for Payer: Wellpoint Medicaid Managed Care	$33.22

NEOMYCIN POLY HC OPH SSP

Facility

$1,253.57

Service Code	NDC 61314064175
Hospital Charge Code	60628021
Hospital Revenue Code	250
Min. Negotiated Rate	$188.04
Max. Negotiated Rate	$188.04
Rate for Payer: Qualcare PPO/HMO/WC	$188.04

NEOMYCIN POLY PRED OPH SSP

Facility

$186.45

Hospital Charge Code	60628040
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$27.97
Rate for Payer: Qualcare PPO/HMO/WC	$27.97

NEOMYCIN POLY PRED OPH SSP

Facility

$186.45

Hospital Charge Code	60628040
Hospital Revenue Code	250
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$93.22
Rate for Payer: Aetna Commercial	$70.85
Rate for Payer: Aetna Medicare Advantage	$55.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.54
Rate for Payer: Cigna Commercial	$93.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.94
Rate for Payer: Oxford Commercial	$37.29
Rate for Payer: Qualcare PPO/HMO/WC	$27.97
Rate for Payer: UnitedHealthcare Commercial	$37.29
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

NEOMYCIN,SERUM

Facility

$376.00

Service Code	HCPCS 80299
Hospital Charge Code	38473113
Hospital Revenue Code	301
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$188.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$188.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.96

NEOMYCIN,SERUM

Facility

$376.00

Service Code	HCPCS 80299
Hospital Charge Code	38473113
Hospital Revenue Code	301
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$56.40
Rate for Payer: Qualcare PPO/HMO/WC	$56.40

NEONATAL AFTERCARE

Facility

$51,707.98

Service Code	APR-DRG 8633
Min. Negotiated Rate	$50,694.10
Max. Negotiated Rate	$51,707.98
Rate for Payer: UnitedHealthcare Community & State	$50,694.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,707.98
Rate for Payer: Wellpoint Medicaid Managed Care	$50,694.10

NEONATAL AFTERCARE

Facility

$97,091.19

Service Code	APR-DRG 8634
Min. Negotiated Rate	$95,187.44
Max. Negotiated Rate	$97,091.19
Rate for Payer: UnitedHealthcare Community & State	$95,187.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$97,091.19
Rate for Payer: Wellpoint Medicaid Managed Care	$95,187.44

NEONATAL AFTERCARE

Facility

$10,749.92

Service Code	APR-DRG 8631
Min. Negotiated Rate	$10,539.14
Max. Negotiated Rate	$10,749.92
Rate for Payer: UnitedHealthcare Community & State	$10,539.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,749.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10,539.14

NEONATAL AFTERCARE

Facility

$26,551.74

Service Code	APR-DRG 8632
Min. Negotiated Rate	$26,031.12
Max. Negotiated Rate	$26,551.74
Rate for Payer: UnitedHealthcare Community & State	$26,031.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,551.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26,031.12

NEONATAL ARMBOARD

Facility

$2,332.00

Hospital Charge Code	270610488
Hospital Revenue Code	270
Min. Negotiated Rate	$349.80
Max. Negotiated Rate	$349.80
Rate for Payer: Qualcare PPO/HMO/WC	$349.80

NEONATAL ARMBOARD

Facility

$2,332.00

Hospital Charge Code	270610488
Hospital Revenue Code	270
Min. Negotiated Rate	$56.20
Max. Negotiated Rate	$1,166.00
Rate for Payer: Aetna Commercial	$886.16
Rate for Payer: Aetna Medicare Advantage	$699.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$594.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$594.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$594.66
Rate for Payer: Cigna Commercial	$1,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.60
Rate for Payer: Oxford Commercial	$466.40
Rate for Payer: Qualcare PPO/HMO/WC	$349.80
Rate for Payer: UnitedHealthcare Commercial	$466.40
Rate for Payer: UnitedHealthcare Community & State	$56.20
Rate for Payer: Wellpoint Medicaid Managed Care	$61.80

NEONATAL BILIRUBIN

Facility

$245.00

Service Code	HCPCS 82247
Hospital Charge Code	38479028
Hospital Revenue Code	301
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

NEONATAL BILIRUBIN

Facility

$245.00

Service Code	HCPCS 82247
Hospital Charge Code	38479028
Hospital Revenue Code	301
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Medicare Advantage	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.12
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: Cigna Medicare Advantage	$5.02
Rate for Payer: Clover Medicare Advantage	$4.77
Rate for Payer: EmblemHealth Commercial	$15.06
Rate for Payer: Humana Medicare Advantage	$5.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.02
Rate for Payer: Wellcare Medicare Advantage	$5.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

Know your out-of-pocket cost for care.

All Charges