Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS ACRYSOF 27.00

Facility

$825.00

Service Code	HCPCS V2632
Hospital Charge Code	270690246
Hospital Revenue Code	276
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

LENS ACRYSOF 27.00

Facility

$825.00

Service Code	HCPCS V2632
Hospital Charge Code	270690246
Hospital Revenue Code	276
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$199.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

LENS ACRYSOF 29.50

Facility

$750.00

Hospital Charge Code	270668270
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
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

LENS ACRYSOF 29.50

Facility

$750.00

Hospital Charge Code	270668270
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

LENS ACRYSOF 3.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270676474
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

LENS ACRYSOF 3.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270676474
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

LENS ADD RESTORE 15.00 +3.00

Facility

$4,345.00

Service Code	HCPCS V2788
Hospital Charge Code	270685027
Hospital Revenue Code	276
Min. Negotiated Rate	$651.75
Max. Negotiated Rate	$1,051.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,051.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$955.90
Rate for Payer: Qualcare PPO/HMO/WC	$651.75

LENS ADD RESTORE 15.00 +3.00

Facility

$4,345.00

Service Code	HCPCS V2788
Hospital Charge Code	270685027
Hospital Revenue Code	276
Min. Negotiated Rate	$104.71
Max. Negotiated Rate	$2,172.50
Rate for Payer: Aetna Commercial	$1,651.10
Rate for Payer: Aetna Medicare Advantage	$1,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,107.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,107.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,107.97
Rate for Payer: Cigna Commercial	$2,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,051.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$955.90
Rate for Payer: Qualcare PPO/HMO/WC	$651.75
Rate for Payer: UnitedHealthcare Community & State	$104.71
Rate for Payer: Wellpoint Medicaid Managed Care	$115.14

LENS ADD RESTORE 22.00

Facility

$4,475.00

Hospital Charge Code	270677204
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS ADD RESTORE 22.00

Facility

$4,475.00

Hospital Charge Code	270677204
Hospital Revenue Code	276
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

LENS ADD RESTORE 22.50

Facility

$4,475.00

Service Code	HCPCS V2788
Hospital Charge Code	270677205
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS ADD RESTORE 22.50

Facility

$4,475.00

Service Code	HCPCS V2788
Hospital Charge Code	270677205
Hospital Revenue Code	276
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

LENS CHIROFLEX C11UB 10.0

Facility

$590.25

Hospital Charge Code	270617658
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.12
Rate for Payer: Aetna Commercial	$224.29
Rate for Payer: Aetna Medicare Advantage	$177.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.51
Rate for Payer: Cigna Commercial	$295.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

LENS CHIROFLEX C11UB 10.0

Facility

$590.25

Hospital Charge Code	270617658
Hospital Revenue Code	276
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$142.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54

LENS CHIROFLEX C11UB 10.5

Facility

$590.25

Hospital Charge Code	270634187
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.12
Rate for Payer: Aetna Commercial	$224.29
Rate for Payer: Aetna Medicare Advantage	$177.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.51
Rate for Payer: Cigna Commercial	$295.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

LENS CHIROFLEX C11UB 10.5

Facility

$590.25

Hospital Charge Code	270634187
Hospital Revenue Code	276
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$142.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54

LENS CHIROFLEX C11UB 11.0

Facility

$590.25

Hospital Charge Code	270623251
Hospital Revenue Code	276
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$142.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54

LENS CHIROFLEX C11UB 11.0

Facility

$590.25

Hospital Charge Code	270623251
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.12
Rate for Payer: Aetna Commercial	$224.29
Rate for Payer: Aetna Medicare Advantage	$177.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.51
Rate for Payer: Cigna Commercial	$295.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

LENS CHIROFLEX C11UB 12.0

Facility

$744.00

Hospital Charge Code	270619577
Hospital Revenue Code	276
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$180.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.68
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS CHIROFLEX C11UB 12.0

Facility

$744.00

Hospital Charge Code	270619577
Hospital Revenue Code	276
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.68
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Community & State	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.72

LENS CHIROFLEX C11UB 13.5

Facility

$590.45

Hospital Charge Code	270619110
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.23
Rate for Payer: Aetna Commercial	$224.37
Rate for Payer: Aetna Medicare Advantage	$177.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.56
Rate for Payer: Cigna Commercial	$295.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$88.57
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.65

LENS CHIROFLEX C11UB 13.5

Facility

$590.45

Hospital Charge Code	270619110
Hospital Revenue Code	276
Min. Negotiated Rate	$88.57
Max. Negotiated Rate	$142.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$88.57

LENS CHIROFLEX C11UB 28.5

Facility

$590.25

Hospital Charge Code	270626599
Hospital Revenue Code	276
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$142.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54

LENS CHIROFLEX C11UB 28.5

Facility

$590.25

Hospital Charge Code	270626599
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.12
Rate for Payer: Aetna Commercial	$224.29
Rate for Payer: Aetna Medicare Advantage	$177.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.51
Rate for Payer: Cigna Commercial	$295.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

LENS CHIROFLEX C11UB 29.0

Facility

$590.25

Hospital Charge Code	270633585
Hospital Revenue Code	276
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$295.12
Rate for Payer: Aetna Commercial	$224.29
Rate for Payer: Aetna Medicare Advantage	$177.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.51
Rate for Payer: Cigna Commercial	$295.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.85
Rate for Payer: Qualcare PPO/HMO/WC	$88.54
Rate for Payer: UnitedHealthcare Community & State	$14.23
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

Know your out-of-pocket cost for care.

All Charges