Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCULAR 25.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270656075
Hospital Revenue Code	276
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$811.62
Rate for Payer: Aetna Commercial	$616.84
Rate for Payer: Aetna Medicare Advantage	$486.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.93
Rate for Payer: Cigna Commercial	$811.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.12
Rate for Payer: Qualcare PPO/HMO/WC	$243.49
Rate for Payer: UnitedHealthcare Community & State	$39.12
Rate for Payer: Wellpoint Medicaid Managed Care	$43.02

LENS INTRAOCULAR 25.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270656075
Hospital Revenue Code	276
Min. Negotiated Rate	$243.49
Max. Negotiated Rate	$392.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.12
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCULAR 25.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695621
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 INTRAOCULAR 25.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695621
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 INTRAOCULAR 26 0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695622
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 INTRAOCULAR 26 0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695622
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 INTRAOCULAR 26.5 CZ70BD

Facility

$744.00

Hospital Charge Code	270634375
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 INTRAOCULAR 26.5 CZ70BD

Facility

$744.00

Hospital Charge Code	270634375
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 INTRAOCULAR 26 5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695623
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 INTRAOCULAR 26 5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695623
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 INTRAOCULAR 26.5 DIPOLTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270678584
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 INTRAOCULAR 26.5 DIPOLTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270678584
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 INTRAOCULAR 27.0 DIOPTER

Facility

$670.00

Service Code	HCPCS V2632
Hospital Charge Code	270653274
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 INTRAOCULAR 27.0 DIOPTER

Facility

$670.00

Service Code	HCPCS V2632
Hospital Charge Code	270653274
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 INTRAOCULAR 27.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695624
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 INTRAOCULAR 27.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695624
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 INTRAOCULAR 27.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695625
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 INTRAOCULAR 27.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695625
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 INTRAOCULAR 28.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695626
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 INTRAOCULAR 28.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653308
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 INTRAOCULAR 28.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695626
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 INTRAOCULAR 28.0 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653308
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 INTRAOCULAR 28.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270662312
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 INTRAOCULAR 28.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695627
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 INTRAOCULAR 28.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695627
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

Know your out-of-pocket cost for care.

All Charges