Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACRYSOF LENS 29.00

Facility

$750.00

Hospital Charge Code	270668381
Hospital Revenue Code	276
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

ACRYSOF LENS 9.5

Facility

$745.00

Hospital Charge Code	270667808
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

ACRYSOF LENS 9.5

Facility

$745.00

Hospital Charge Code	270667808
Hospital Revenue Code	276
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

ACRYSOF NATURAL IOL W. BLU

Facility

$375.00

Hospital Charge Code	270665496
Hospital Revenue Code	276
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

ACRYSOF NATURAL IOL W. BLU

Facility

$375.00

Hospital Charge Code	270665496
Hospital Revenue Code	276
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ACRYSOFT LENS 21.5

Facility

$745.00

Hospital Charge Code	270669985
Hospital Revenue Code	276
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

ACRYSOFT LENS 21.5

Facility

$745.00

Hospital Charge Code	270669985
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

ACRYSOFT LENS 28.5

Facility

$745.00

Hospital Charge Code	270669986
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

ACRYSOFT LENS 28.5

Facility

$745.00

Hospital Charge Code	270669986
Hospital Revenue Code	276
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

ACS SD VAR 15MM

Facility

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	270705058
Hospital Revenue Code	278
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$277.40
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

ACS SD VAR 15MM

Facility

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	270705058
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$176.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

ACS SD VAR 17MM

Facility

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	270705059
Hospital Revenue Code	278
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$277.40
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

ACS SD VAR 17MM

Facility

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	270705059
Hospital Revenue Code	278
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$176.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

ACTAB LINER G7 VE NEUT 40 MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698346
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

ACTAB LINER G7 VE NEUT 40 MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	698346
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

ACTAB LINER G7 VE NEUT 40 MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698346
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

ACTAB LINER G7 VE NEUT 40 MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	698346
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

ACT ARTC HD ARCOM XL 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270681099
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

ACT ARTC HD ARCOM XL 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270681099
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ACT ARTIC E1 HIP BRG 28 X40MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690414
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

ACT ARTIC E1 HIP BRG 28 X40MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690414
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

ACT ARTIC E1 HIP BRG 28 X 46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686417
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

ACT ARTIC E1 HIP BRG 28 X 46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686417
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

ACT ARTIC EL HP BRG 28 X 44MM

Facility

$18,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681906
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$4,356.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,356.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,960.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

ACT ARTIC EL HP BRG 28 X 44MM

Facility

$18,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681906
Hospital Revenue Code	278
Min. Negotiated Rate	$433.80
Max. Negotiated Rate	$9,000.00
Rate for Payer: Aetna Commercial	$6,840.00
Rate for Payer: Aetna Medicare Advantage	$5,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,590.00
Rate for Payer: Cigna Commercial	$9,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,356.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,960.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00
Rate for Payer: UnitedHealthcare Community & State	$433.80
Rate for Payer: Wellpoint Medicaid Managed Care	$477.00

Know your out-of-pocket cost for care.

All Charges