Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IO LENS 25.5D

Facility

$745.00

Hospital Charge Code	270652484
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 26.0D

Facility

$745.00

Hospital Charge Code	270656076
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 26.0D

Facility

$745.00

Hospital Charge Code	270656076
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 FOLDABLE AA4204VF 21.5

Facility

$550.00

Hospital Charge Code	270638325
Hospital Revenue Code	276
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

IO LENS FOLDABLE AA4204VF 21.5

Facility

$550.00

Hospital Charge Code	270638325
Hospital Revenue Code	276
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

IOL LENS

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270661727
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 LENS

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270661727
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 STAAR SURGICAL

Facility

$950.00

Hospital Charge Code	270339093
Hospital Revenue Code	276
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

IOL STAAR SURGICAL

Facility

$950.00

Hospital Charge Code	270339093
Hospital Revenue Code	276
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$16.52

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.09
Rate for Payer: Cigna Commercial	$55.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.05
Rate for Payer: Oxford Commercial	$22.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.52
Rate for Payer: UnitedHealthcare Commercial	$22.03
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$98.64
Rate for Payer: Qualcare PPO/HMO/WC	$98.64

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$328.81
Rate for Payer: Aetna Commercial	$249.89
Rate for Payer: Aetna Medicare Advantage	$197.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.69
Rate for Payer: Cigna Commercial	$328.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.28
Rate for Payer: Oxford Commercial	$131.52
Rate for Payer: Qualcare PPO/HMO/WC	$98.64
Rate for Payer: UnitedHealthcare Commercial	$131.52
Rate for Payer: UnitedHealthcare Community & State	$15.85
Rate for Payer: Wellpoint Medicaid Managed Care	$17.43

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$112.91
Rate for Payer: Qualcare PPO/HMO/WC	$112.91

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.38
Rate for Payer: Aetna Commercial	$286.05
Rate for Payer: Aetna Medicare Advantage	$225.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.95
Rate for Payer: Cigna Commercial	$376.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.82
Rate for Payer: Oxford Commercial	$150.55
Rate for Payer: Qualcare PPO/HMO/WC	$112.91
Rate for Payer: UnitedHealthcare Commercial	$150.55
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.95

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$26.44
Max. Negotiated Rate	$548.57
Rate for Payer: Aetna Commercial	$416.91
Rate for Payer: Aetna Medicare Advantage	$329.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.77
Rate for Payer: Cigna Commercial	$548.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.14
Rate for Payer: Oxford Commercial	$219.43
Rate for Payer: Qualcare PPO/HMO/WC	$164.57
Rate for Payer: UnitedHealthcare Commercial	$219.43
Rate for Payer: UnitedHealthcare Community & State	$26.44
Rate for Payer: Wellpoint Medicaid Managed Care	$29.07

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$164.57
Max. Negotiated Rate	$164.57
Rate for Payer: Qualcare PPO/HMO/WC	$164.57

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$21.95

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$73.17
Rate for Payer: Aetna Commercial	$55.61
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.31
Rate for Payer: Cigna Commercial	$73.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.90
Rate for Payer: Oxford Commercial	$29.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.95
Rate for Payer: UnitedHealthcare Commercial	$29.27
Rate for Payer: UnitedHealthcare Community & State	$3.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

Know your out-of-pocket cost for care.

All Charges