Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS CHIROFLEX C11UB 29.0

Facility

$590.25

Hospital Charge Code	270633585
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 29.5

Facility

$590.25

Hospital Charge Code	270631195
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 29.5

Facility

$590.25

Hospital Charge Code	270631195
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 29.5

Facility

$590.25

Hospital Charge Code	27063115
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 29.5

Facility

$590.25

Hospital Charge Code	27063115
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 FOLDABLE AA4204VL 20.5

Facility

$550.00

Hospital Charge Code	270624211
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

LENS FOLDABLE AA4204VL 20.5

Facility

$550.00

Hospital Charge Code	270624211
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

LENS GLIDE

Facility

$29.00

Hospital Charge Code	270335130
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

LENS GLIDE

Facility

$29.00

Hospital Charge Code	270335130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.39
Rate for Payer: Cigna Commercial	$14.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.70
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$5.80
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

LENS INTAOCCULAR 15.5 DIOPTER

Facility

$425.00

Hospital Charge Code	270653268
Hospital Revenue Code	276
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

LENS INTAOCCULAR 15.5 DIOPTER

Facility

$425.00

Hospital Charge Code	270653268
Hospital Revenue Code	276
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

LENS INTERAOCCULAR 29.0 DIO

Facility

$887.00

Service Code	HCPCS V2632
Hospital Charge Code	270653273
Hospital Revenue Code	276
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$337.06
Rate for Payer: Aetna Medicare Advantage	$266.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.14
Rate for Payer: Qualcare PPO/HMO/WC	$133.05
Rate for Payer: UnitedHealthcare Community & State	$21.38
Rate for Payer: Wellpoint Medicaid Managed Care	$23.51

LENS INTERAOCCULAR 29.0 DIO

Facility

$887.00

Service Code	HCPCS V2632
Hospital Charge Code	270653273
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$195.14
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRACOULAR CZ7OBD

Facility

$900.00

Hospital Charge Code	270659170
Hospital Revenue Code	276
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

LENS INTRACOULAR CZ7OBD

Facility

$900.00

Hospital Charge Code	270659170
Hospital Revenue Code	276
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

LENS INTRAOCCUALR 27.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270662233
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 INTRAOCCUALR 27.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270662233
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 INTRAOCCUALR 27.5 DIOPTER

Facility

$725.00

Service Code	HCPCS V2632
Hospital Charge Code	270677920
Hospital Revenue Code	276
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

LENS INTRAOCCUALR 27.5 DIOPTER

Facility

$725.00

Service Code	HCPCS V2632
Hospital Charge Code	270677920
Hospital Revenue Code	276
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

LENS INTRAOCCULAR 0 DIOPTER

Facility

$670.00

Service Code	HCPCS V2632
Hospital Charge Code	270655300
Hospital Revenue Code	276
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.40
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Community & State	$16.15
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

LENS INTRAOCCULAR 0 DIOPTER

Facility

$670.00

Service Code	HCPCS V2632
Hospital Charge Code	270655300
Hospital Revenue Code	276
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.40
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

LENS INTRAOCCULAR 10.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653313
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 INTRAOCCULAR 10.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653313
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 INTRAOCCULAR 10.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653284
Hospital Revenue Code	276
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$360.20
Rate for Payer: Aetna Commercial	$273.75
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$360.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.49
Rate for Payer: Qualcare PPO/HMO/WC	$108.06
Rate for Payer: UnitedHealthcare Community & State	$17.36
Rate for Payer: Wellpoint Medicaid Managed Care	$19.09

LENS INTRAOCCULAR 10.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653284
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$174.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.49
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

Know your out-of-pocket cost for care.

All Charges