Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCCULAR+12.5 DIOPTER

Facility

$887.00

Hospital Charge Code	270655270
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 INTRAOCCULAR 13.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270655347
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 INTRAOCCULAR 13.0 DIOPTER

Facility

$425.00

Hospital Charge Code	270653267
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 INTRAOCCULAR 13.0 DIOPTER

Facility

$425.00

Hospital Charge Code	270653267
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 INTRAOCCULAR 13.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270655347
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 INTRAOCCULAR+13.0 DIOPTER

Facility

$887.00

Hospital Charge Code	270671559
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 INTRAOCCULAR+13.0 DIOPTER

Facility

$887.00

Hospital Charge Code	270671559
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 INTRAOCCULAR 13.0DIOPTER

Facility

$425.00

Service Code	HCPCS V2632
Hospital Charge Code	270664996
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 INTRAOCCULAR 13.0DIOPTER

Facility

$425.00

Service Code	HCPCS V2632
Hospital Charge Code	270664996
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 INTRAOCCULAR 13.5 DIOPTER

Facility

$425.00

Hospital Charge Code	270664997
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 INTRAOCCULAR 13.5 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270655345
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 13.5 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270655345
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 13.5 DIOPTER

Facility

$425.00

Hospital Charge Code	270664997
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 INTRAOCCULAR+13.5 DIOPTER

Facility

$887.00

Hospital Charge Code	270650712
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 INTRAOCCULAR+13.5 DIOPTER

Facility

$887.00

Hospital Charge Code	270650712
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 INTRAOCCULAR+13.5 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653278
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+13.5 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653278
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

LENS INTRAOCCULAR 14.0

Facility

$300.00

Hospital Charge Code	270653250
Hospital Revenue Code	276
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

LENS INTRAOCCULAR 14.0

Facility

$300.00

Hospital Charge Code	270653250
Hospital Revenue Code	276
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

LENS INTRAOCCULAR 14.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270655288
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

LENS INTRAOCCULAR 14.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270655288
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 14.0 DIOPTER

Facility

$425.00

Hospital Charge Code	270653261
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 INTRAOCCULAR 14.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653295
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 14.0 DIOPTER

Facility

$425.00

Hospital Charge Code	270653261
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 INTRAOCCULAR 14.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653295
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

Know your out-of-pocket cost for care.

All Charges