Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HOMATROPINE 2% OPHTH SOLN

Facility

$19.25

Hospital Charge Code	6002789
Hospital Revenue Code	251
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

Homatropine 5% oph soln 5ml

Facility

$127.84

Service Code	NDC 59390019205
Hospital Charge Code	6063943293
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$63.92
Rate for Payer: Aetna Commercial	$48.58
Rate for Payer: Aetna Medicare Advantage	$38.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.60
Rate for Payer: Cigna Commercial	$63.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.35
Rate for Payer: Oxford Commercial	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$25.57
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

Homatropine 5% oph soln 5ml

Facility

$127.84

Service Code	NDC 59390019205
Hospital Charge Code	6063943293
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

HOMATROPINE 5% OPHTH/5ML

Facility

$60.00

Hospital Charge Code	60633095
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

HOMATROPINE 5% OPHTH/5ML

Facility

$60.00

Hospital Charge Code	60633095
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

HOMATROPINE 5% OPHTH SOLN

Facility

$168.30

Hospital Charge Code	60628066
Hospital Revenue Code	250
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$84.15
Rate for Payer: Aetna Commercial	$63.95
Rate for Payer: Aetna Medicare Advantage	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.92
Rate for Payer: Cigna Commercial	$84.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.49
Rate for Payer: Oxford Commercial	$33.66
Rate for Payer: Qualcare PPO/HMO/WC	$25.25
Rate for Payer: UnitedHealthcare Commercial	$33.66
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.46

HOMATROPINE 5% OPHTH SOLN

Facility

$168.30

Hospital Charge Code	60628066
Hospital Revenue Code	250
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$25.25
Rate for Payer: Qualcare PPO/HMO/WC	$25.25

HOMATROPINE HBR 2% OPHTH

Facility

$4.00

Hospital Charge Code	60633093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HOMATROPINE HBR 2% OPHTH

Facility

$4.00

Hospital Charge Code	60633093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HOMATROPINE HBR SOL OPH 2%

Facility

$61.45

Hospital Charge Code	6002786
Hospital Revenue Code	251
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$23.35
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$12.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$12.29
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

HOMATROPINE HBR SOL OPH 2%

Facility

$61.45

Hospital Charge Code	6002786
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

HOMATROPINE HBR SOL OPH 5%

Facility

$70.40

Hospital Charge Code	6002794
Hospital Revenue Code	251
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

HOMATROPINE HBR SOL OPH 5%

Facility

$70.40

Hospital Charge Code	6002794
Hospital Revenue Code	251
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

HOMATROPINE SOL OPH 2%/5ML

Facility

$36.60

Hospital Charge Code	6062789
Hospital Revenue Code	251
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.30
Rate for Payer: Aetna Commercial	$13.91
Rate for Payer: Aetna Medicare Advantage	$10.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.98
Rate for Payer: Oxford Commercial	$7.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

HOMATROPINE SOL OPH 2%/5ML

Facility

$36.60

Hospital Charge Code	6062789
Hospital Revenue Code	251
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

HOME SLEEP TEST/TYPE 3 PORATAB

Facility

$30,000.00

Service Code	HCPCS G0399
Hospital Charge Code	90000055
Hospital Revenue Code	920
Min. Negotiated Rate	$243.69
Max. Negotiated Rate	$13,534.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,000.00
Rate for Payer: Oxford Commercial	$7,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Commercial	$13,534.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

HOME SLEEP TEST/TYPE 3 PORATAB

Facility

$30,000.00

Service Code	HCPCS G0399
Hospital Charge Code	90000055
Hospital Revenue Code	920
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

HOMOCYSTEINE

Facility

$1,243.00

Service Code	HCPCS 82131
Hospital Charge Code	38473072
Hospital Revenue Code	301
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$186.45
Rate for Payer: Qualcare PPO/HMO/WC	$186.45

HOMOCYSTEINE

Facility

$1,243.00

Service Code	HCPCS 82131
Hospital Charge Code	38473072
Hospital Revenue Code	301
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$621.50
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$621.50
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$32.94

HOMOCYSTEINE

Facility

$986.00

Service Code	HCPCS 82131
Hospital Charge Code	38472013
Hospital Revenue Code	301
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$493.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$493.00
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$26.13

HOMOCYSTEINE

Facility

$986.00

Service Code	HCPCS 82131
Hospital Charge Code	38472013
Hospital Revenue Code	301
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$147.90
Rate for Payer: Qualcare PPO/HMO/WC	$147.90

HOMOCYSTEINE,CARD

Facility

$1,243.00

Service Code	HCPCS 82131
Hospital Charge Code	38479100
Hospital Revenue Code	301
Min. Negotiated Rate	$186.45
Max. Negotiated Rate	$186.45
Rate for Payer: Qualcare PPO/HMO/WC	$186.45

HOMOCYSTEINE,CARD

Facility

$1,243.00

Service Code	HCPCS 82131
Hospital Charge Code	38479100
Hospital Revenue Code	301
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$621.50
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$621.50
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$32.94

HOMOCYSTEINE (CARDIO),FPI

Facility

$390.00

Service Code	HCPCS 83090
Hospital Charge Code	39990005EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HOMOCYSTEINE (CARDIO),FPI

Facility

$390.00

Service Code	HCPCS 83090
Hospital Charge Code	39990005EX
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.74
Rate for Payer: Aetna Medicare Advantage	$58.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.92
Rate for Payer: Clover Medicare Advantage	$17.02
Rate for Payer: EmblemHealth Commercial	$53.76
Rate for Payer: Humana Medicare Advantage	$18.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.92
Rate for Payer: Wellcare Medicare Advantage	$17.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

Know your out-of-pocket cost for care.

All Charges