Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IOHEXOL(OMNI)350/ML150ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630202
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.43
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

IOHEXOL(OMNI)350/ML 50ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

IOHEXOL(OMNI)350/ML 50ML PERML

Facility

$3.75

Service Code	HCPCS Q9967
Hospital Charge Code	60630203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.43
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
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

IOL ACROSOF MN60AC 16.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667366
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

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
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

IOL ACROSOF MN60AC 23.50

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270667367
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

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$251.06
Max. Negotiated Rate	$405.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$368.21
Rate for Payer: Qualcare PPO/HMO/WC	$251.06

IOL ACRYSOF 21.00 W BLUE LIGHT

Facility

$1,673.70

Service Code	HCPCS V2632
Hospital Charge Code	270656051
Hospital Revenue Code	276
Min. Negotiated Rate	$40.34
Max. Negotiated Rate	$836.85
Rate for Payer: Aetna Commercial	$636.01
Rate for Payer: Aetna Medicare Advantage	$502.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.79
Rate for Payer: Cigna Commercial	$836.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$368.21
Rate for Payer: Qualcare PPO/HMO/WC	$251.06
Rate for Payer: UnitedHealthcare Community & State	$40.34
Rate for Payer: Wellpoint Medicaid Managed Care	$44.35

IOL ACRYSOFT RES-SN60D3/SN6AD3

Facility

$861.00

Hospital Charge Code	270339005
Hospital Revenue Code	276
Min. Negotiated Rate	$129.15
Max. Negotiated Rate	$208.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$129.15

IOL ACRYSOFT RES-SN60D3/SN6AD3

Facility

$861.00

Hospital Charge Code	270339005
Hospital Revenue Code	276
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$430.50
Rate for Payer: Aetna Commercial	$327.18
Rate for Payer: Aetna Medicare Advantage	$258.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.56
Rate for Payer: Cigna Commercial	$430.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$129.15
Rate for Payer: UnitedHealthcare Community & State	$20.75
Rate for Payer: Wellpoint Medicaid Managed Care	$22.82

IOL ACRYSOF W/ BLUE LIGHT

Facility

$745.00

Hospital Charge Code	270656054
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

IOL ACRYSOF W/ BLUE LIGHT

Facility

$745.00

Hospital Charge Code	270656050
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

IOL ACRYSOF W/ BLUE LIGHT

Facility

$745.00

Hospital Charge Code	270656054
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

IOL ACRYSOF W/ BLUE LIGHT

Facility

$745.00

Hospital Charge Code	270656050
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

IOL BLUE LT ACRY

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270656048
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

IOL BLUE LT ACRY

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270656048
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

IO LENS

Facility

$745.00

Hospital Charge Code	2706565077
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

IO LENS

Facility

$745.00

Hospital Charge Code	2706565077
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

IO LENS 16.0D

Facility

$745.00

Hospital Charge Code	270656090
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

IO LENS 16.0D

Facility

$745.00

Hospital Charge Code	270656090
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

IO LENS 18.5 D

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270664942
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

IO LENS 18.5 D

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270664942
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

IO LENS 19.5D

Facility

$745.00

Hospital Charge Code	270652459
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

IO LENS 19.5D

Facility

$745.00

Hospital Charge Code	270652459
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

Know your out-of-pocket cost for care.

All Charges