Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	5300042
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SCANNING & RPT

Facility

$300.85

Service Code	HCPCS 93226
Hospital Charge Code	94053055
Hospital Revenue Code	731
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$45.13
Rate for Payer: Qualcare PPO/HMO/WC	$45.13

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74116013
Hospital Revenue Code	731
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCANNING & RPT

Facility

$5,400.00

Service Code	HCPCS 93226
Hospital Charge Code	74117013
Hospital Revenue Code	731
Min. Negotiated Rate	$66.58
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCAN, RPT, SET

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115012
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74117012
Hospital Revenue Code	731
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.03
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.52
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$10.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.04

HOLTER MONITOR SCAN, RPT, SET

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053050
Hospital Revenue Code	731
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

HOLTER MONITOR SCAN, RPT, SET

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115012
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74116012
Hospital Revenue Code	731
Min. Negotiated Rate	$62.52
Max. Negotiated Rate	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$62.52

HOLTER MONITOR SCAN, RPT, SET

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053050
Hospital Revenue Code	731
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.94
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$11.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.89

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74117012
Hospital Revenue Code	731
Min. Negotiated Rate	$62.52
Max. Negotiated Rate	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$62.52

HOLTER MONITOR SCAN, RPT, SET

Facility

$416.78

Service Code	HCPCS 93225
Hospital Charge Code	74116012
Hospital Revenue Code	731
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.03
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.52
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$10.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.04

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	5300041
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	5300041
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053045
Hospital Revenue Code	731
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.94
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$11.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.89

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74116011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$486.45

Service Code	HCPCS 93225
Hospital Charge Code	94053045
Hospital Revenue Code	731
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74117011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74116011
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115011
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74117011
Hospital Revenue Code	731
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$2,240.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.00
Rate for Payer: Oxford Commercial	$1,404.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00
Rate for Payer: UnitedHealthcare Commercial	$2,240.00
Rate for Payer: UnitedHealthcare Community & State	$130.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$143.10

HOLTER MONITOR SETUP

Facility

$5,400.00

Service Code	HCPCS 93225
Hospital Charge Code	74115011
Hospital Revenue Code	731
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$810.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.00

HOMATROPINE 2% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60633094
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

HOMATROPINE 2% OPHTH/5ML

Facility

$49.00

Hospital Charge Code	60633094
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

HOMATROPINE 2% OPHTH SOLN

Facility

$19.25

Hospital Charge Code	6002789
Hospital Revenue Code	251
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

Know your out-of-pocket cost for care.

All Charges