Heights University Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN/BACITRACIN/POLYM

Facility

$12.00

Hospital Charge Code	60633524
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
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	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

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	$6.83
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$15.75
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	$6.83
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$26.25

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 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 B 1ML

Facility

$40.35

Hospital Charge Code	6013015
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$20.18
Rate for Payer: Aetna Commercial	$12.11
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	$5.25
Rate for Payer: Oxford Commercial	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$20.18

NEOMYCIN POLY BACIT OINT

Facility

$54.67

Service Code	NDC 472017956
Hospital Charge Code	60628328
Hospital Revenue Code	250
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$27.34
Rate for Payer: Aetna Commercial	$16.40
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	$7.11
Rate for Payer: Oxford Commercial	$27.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.20
Rate for Payer: UnitedHealthcare Commercial	$27.34

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	$3.91
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$9.03
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	$3.91
Rate for Payer: Oxford Commercial	$15.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$15.05

NEOMYCIN POLY BACIT OINT PKT

Facility

$1.95

Hospital Charge Code	60628329
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.59
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	$0.25
Rate for Payer: Oxford Commercial	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.98

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 OPH 3.5GM

Facility

$105.00

Hospital Charge Code	6003917
Hospital Revenue Code	251
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
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	$13.65
Rate for Payer: Oxford Commercial	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$52.50

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	$48.12
Max. Negotiated Rate	$185.09
Rate for Payer: Aetna Commercial	$111.05
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	$48.12
Rate for Payer: Oxford Commercial	$185.09
Rate for Payer: Qualcare PPO/HMO/WC	$55.53
Rate for Payer: UnitedHealthcare Commercial	$185.09

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	$19.96
Max. Negotiated Rate	$19.96
Rate for Payer: Qualcare PPO/HMO/WC	$19.96

NEOMYCIN POLY DEXAMTH OPH OINT

Facility

$133.06

Service Code	NDC 24208079535
Hospital Charge Code	60628017
Hospital Revenue Code	250
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$66.53
Rate for Payer: Aetna Commercial	$39.92
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	$17.30
Rate for Payer: Oxford Commercial	$66.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.96
Rate for Payer: UnitedHealthcare Commercial	$66.53

NEOMYCIN POLY DEXAMTH OPH SSP

Facility

$15.40

Hospital Charge Code	6022877
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

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

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 DEXAMTH OPH SSP

Facility

$133.06

Service Code	NDC 24208083060
Hospital Charge Code	60628018
Hospital Revenue Code	250
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$66.53
Rate for Payer: Aetna Commercial	$39.92
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	$17.30
Rate for Payer: Oxford Commercial	$66.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.96
Rate for Payer: UnitedHealthcare Commercial	$66.53

NEOMYCIN POLY FOR IRRIGATION

Facility

$72.85

Hospital Charge Code	60627981
Hospital Revenue Code	250
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$21.86
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	$9.47
Rate for Payer: Oxford Commercial	$36.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$36.42

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	$62.25
Max. Negotiated Rate	$62.25
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

Know your out-of-pocket cost for care.

All Charges