Heights University Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN POLY GRAM OPH SOL

Facility

$415.00

Service Code	NDC 24208079062
Hospital Charge Code	60628019
Hospital Revenue Code	250
Min. Negotiated Rate	$53.95
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$124.50
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	$53.95
Rate for Payer: Oxford Commercial	$207.50
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Commercial	$207.50

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 GRAM OPH SOL 10M

Facility

$74.90

Hospital Charge Code	6003909
Hospital Revenue Code	251
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$22.47
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	$9.74
Rate for Payer: Oxford Commercial	$37.45
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$37.45

NEOMYCIN POLY HC OPH SOL

Facility

$206.43

Service Code	NDC 24208063562
Hospital Charge Code	60628020
Hospital Revenue Code	250
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$103.22
Rate for Payer: Aetna Commercial	$61.93
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	$26.84
Rate for Payer: Oxford Commercial	$103.22
Rate for Payer: Qualcare PPO/HMO/WC	$30.96
Rate for Payer: UnitedHealthcare Commercial	$103.22

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	$162.96
Max. Negotiated Rate	$626.78
Rate for Payer: Aetna Commercial	$376.07
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	$162.96
Rate for Payer: Oxford Commercial	$626.78
Rate for Payer: Qualcare PPO/HMO/WC	$188.04
Rate for Payer: UnitedHealthcare Commercial	$626.78

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	$24.24
Max. Negotiated Rate	$93.22
Rate for Payer: Aetna Commercial	$55.94
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	$24.24
Rate for Payer: Oxford Commercial	$93.22
Rate for Payer: Qualcare PPO/HMO/WC	$27.97
Rate for Payer: UnitedHealthcare Commercial	$93.22

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,SERUM

Facility

$376.00

Service Code	HCPCS 80299
Hospital Charge Code	38473113
Hospital Revenue Code	301
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$60.39
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.30
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	$11.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.30
Rate for Payer: Cigna Commercial	$18.64
Rate for Payer: Cigna Medicare Advantage	$9.32
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: MagnaCare PPO/Direct Plus/Exchange/WC	$48.88
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.76
Rate for Payer: Wellcare Medicare Advantage	$18.64

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

$106,800.39

Service Code	APR-DRG 8634
Min. Negotiated Rate	$90,184.36
Max. Negotiated Rate	$106,800.39
Rate for Payer: Aetna Better Health Medicaid	$104,706.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$106,800.39
Rate for Payer: Wellpoint Medicaid Managed Care	$90,184.36

NEONATAL AFTERCARE

Facility

$56,878.82

Service Code	APR-DRG 8633
Min. Negotiated Rate	$37,748.21
Max. Negotiated Rate	$56,878.82
Rate for Payer: Aetna Better Health Medicaid	$55,763.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$56,878.82
Rate for Payer: Wellpoint Medicaid Managed Care	$37,748.21

NEONATAL AFTERCARE

Facility

$11,824.92

Service Code	APR-DRG 8631
Min. Negotiated Rate	$7,459.97
Max. Negotiated Rate	$11,824.92
Rate for Payer: Aetna Better Health Medicaid	$11,593.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,824.92
Rate for Payer: Wellpoint Medicaid Managed Care	$7,459.97

NEONATAL AFTERCARE

Facility

$29,206.94

Service Code	APR-DRG 8632
Min. Negotiated Rate	$21,086.28
Max. Negotiated Rate	$29,206.94
Rate for Payer: Aetna Better Health Medicaid	$28,634.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$29,206.94
Rate for Payer: Wellpoint Medicaid Managed Care	$21,086.28

NEONATAL ARMBOARD

Facility

$2,332.00

Hospital Charge Code	270610488
Hospital Revenue Code	270
Min. Negotiated Rate	$303.16
Max. Negotiated Rate	$1,166.00
Rate for Payer: Aetna Commercial	$699.60
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	$303.16
Rate for Payer: Oxford Commercial	$1,166.00
Rate for Payer: Qualcare PPO/HMO/WC	$349.80
Rate for Payer: UnitedHealthcare Commercial	$1,166.00

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 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	$2.51
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.39
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	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.39
Rate for Payer: Cigna Commercial	$5.02
Rate for Payer: Cigna Medicare Advantage	$2.51
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: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.32
Rate for Payer: Wellcare Medicare Advantage	$5.02

NEONATAL PULSE OXIMETER SENSOR

Facility

$31.25

Hospital Charge Code	270652478
Hospital Revenue Code	270
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$15.62
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.06
Rate for Payer: Oxford Commercial	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$15.62

NEONATAL PULSE OXIMETER SENSOR

Facility

$31.25

Hospital Charge Code	270652478
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$179,305.75

Service Code	APR-DRG 6034
Min. Negotiated Rate	$130,195.09
Max. Negotiated Rate	$179,305.75
Rate for Payer: Aetna Better Health Medicaid	$175,789.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$179,305.75
Rate for Payer: Wellpoint Medicaid Managed Care	$130,195.09

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$50,321.74

Service Code	APR-DRG 6032
Min. Negotiated Rate	$42,572.05
Max. Negotiated Rate	$50,321.74
Rate for Payer: Aetna Better Health Medicaid	$42,572.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$43,423.49
Rate for Payer: Wellpoint Medicaid Managed Care	$50,321.74

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$21,907.67

Service Code	APR-DRG 6031
Min. Negotiated Rate	$2,040.50
Max. Negotiated Rate	$21,907.67
Rate for Payer: Aetna Better Health Medicaid	$2,040.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,081.31
Rate for Payer: Wellpoint Medicaid Managed Care	$21,907.67

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$86,581.50

Service Code	APR-DRG 6033
Min. Negotiated Rate	$74,775.96
Max. Negotiated Rate	$86,581.50
Rate for Payer: Aetna Better Health Medicaid	$84,883.82
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$86,581.50
Rate for Payer: Wellpoint Medicaid Managed Care	$74,775.96

Know your out-of-pocket cost for care.

All Charges