Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCULAR MZ30BD 25.5

Facility

$750.00

Hospital Charge Code	270646215
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 MZ30BD 26.5

Facility

$750.00

Hospital Charge Code	270641344
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 MZ30BD 26.5

Facility

$750.00

Hospital Charge Code	270641344
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 MZ30BD 28.0

Facility

$744.00

Hospital Charge Code	270634909
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 MZ30BD 28.0

Facility

$744.00

Hospital Charge Code	270634909
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 MZ60BD 10.0

Facility

$744.00

Hospital Charge Code	270617657
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 MZ60BD 10.0

Facility

$744.00

Hospital Charge Code	270617657
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 SA60AT 20.5

Facility

$892.85

Hospital Charge Code	270631866
Hospital Revenue Code	276
Min. Negotiated Rate	$133.93
Max. Negotiated Rate	$216.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93

LENS INTRAOCULAR SA60AT 20.5

Facility

$892.85

Hospital Charge Code	270631866
Hospital Revenue Code	276
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.43
Rate for Payer: Aetna Commercial	$339.28
Rate for Payer: Aetna Medicare Advantage	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$446.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

LENS INTRAOCULAR SA60AT 22.5

Facility

$892.85

Hospital Charge Code	270631867
Hospital Revenue Code	276
Min. Negotiated Rate	$133.93
Max. Negotiated Rate	$216.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93

LENS INTRAOCULAR SA60AT 22.5

Facility

$892.85

Hospital Charge Code	270631867
Hospital Revenue Code	276
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.43
Rate for Payer: Aetna Commercial	$339.28
Rate for Payer: Aetna Medicare Advantage	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$446.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

LENS INTRAOCULAR SA60AT 24.5

Facility

$892.85

Hospital Charge Code	270631868
Hospital Revenue Code	276
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.43
Rate for Payer: Aetna Commercial	$339.28
Rate for Payer: Aetna Medicare Advantage	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$446.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

LENS INTRAOCULAR SA60AT 24.5

Facility

$892.85

Hospital Charge Code	270631868
Hospital Revenue Code	276
Min. Negotiated Rate	$133.93
Max. Negotiated Rate	$216.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93

LENS INTRAOCULAR SA60AT 25.0

Facility

$892.85

Hospital Charge Code	270633024
Hospital Revenue Code	276
Min. Negotiated Rate	$133.93
Max. Negotiated Rate	$216.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93

LENS INTRAOCULAR SA60AT 25.0

Facility

$892.85

Hospital Charge Code	270633024
Hospital Revenue Code	276
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.43
Rate for Payer: Aetna Commercial	$339.28
Rate for Payer: Aetna Medicare Advantage	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$446.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

LENS INTRAOCULAR SA60AT 6.0

Facility

$892.85

Hospital Charge Code	270633631
Hospital Revenue Code	276
Min. Negotiated Rate	$133.93
Max. Negotiated Rate	$216.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93

LENS INTRAOCULAR SA60AT 6.0

Facility

$892.85

Hospital Charge Code	270633631
Hospital Revenue Code	276
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$446.43
Rate for Payer: Aetna Commercial	$339.28
Rate for Payer: Aetna Medicare Advantage	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.68
Rate for Payer: Cigna Commercial	$446.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.43
Rate for Payer: Qualcare PPO/HMO/WC	$133.93
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

LENS INTRAOCULAR SIZE 9.0 D

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270678596
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 SIZE 9.0 D

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270678596
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 SK60CM 12.5

Facility

$750.00

Hospital Charge Code	270642455
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 SK60CM 12.5

Facility

$750.00

Hospital Charge Code	270642455
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 SK60CM 13.0

Facility

$750.00

Hospital Charge Code	270640130
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 SK60CM 13.0

Facility

$750.00

Hospital Charge Code	270640130
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 SK60cm 13.5

Facility

$744.00

Hospital Charge Code	270636644
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 SK60cm 13.5

Facility

$744.00

Hospital Charge Code	270636644
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

Know your out-of-pocket cost for care.

All Charges