Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON MTA3UO 13.5

Facility

$2,267.25

Hospital Charge Code	270602455
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 13.5

Facility

$2,267.25

Hospital Charge Code	270602455
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 14.0

Facility

$2,267.25

Hospital Charge Code	270602456
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 14.0

Facility

$2,267.25

Hospital Charge Code	270602456
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 14.5

Facility

$1,572.00

Hospital Charge Code	270602457
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA3UO 14.5

Facility

$1,572.00

Hospital Charge Code	270602457
Hospital Revenue Code	276
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$597.36
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80
Rate for Payer: UnitedHealthcare Community & State	$37.89
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

LENS IO ALCON MTA3UO 15.0

Facility

$725.00

Service Code	HCPCS V2630
Hospital Charge Code	270602458
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 IO ALCON MTA3UO 15.0

Facility

$725.00

Service Code	HCPCS V2630
Hospital Charge Code	270602458
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 IO ALCON MTA3UO 15.5

Facility

$2,267.25

Hospital Charge Code	270602460
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 15.5

Facility

$2,267.25

Hospital Charge Code	270602460
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 16.0

Facility

$2,267.25

Hospital Charge Code	270602461
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 16.0

Facility

$2,267.25

Hospital Charge Code	270602461
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 16.5

Facility

$1,572.00

Hospital Charge Code	270602462
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA3UO 16.5

Facility

$1,572.00

Hospital Charge Code	270602462
Hospital Revenue Code	276
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$597.36
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80
Rate for Payer: UnitedHealthcare Community & State	$37.89
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

LENS IO ALCON MTA3UO 17.0

Facility

$750.00

Hospital Charge Code	270602463
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 IO ALCON MTA3UO 17.0

Facility

$750.00

Hospital Charge Code	270602463
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 IO ALCON MTA3UO 17.5

Facility

$2,267.25

Hospital Charge Code	270602464
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 17.5

Facility

$2,267.25

Hospital Charge Code	270602464
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 18.0

Facility

$2,267.25

Hospital Charge Code	270602465
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 18.0

Facility

$2,267.25

Hospital Charge Code	270602465
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 18.5

Facility

$2,267.25

Hospital Charge Code	270602466
Hospital Revenue Code	276
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$861.55
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09
Rate for Payer: UnitedHealthcare Community & State	$54.64
Rate for Payer: Wellpoint Medicaid Managed Care	$60.08

LENS IO ALCON MTA3UO 18.5

Facility

$2,267.25

Hospital Charge Code	270602466
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON MTA3UO 19.0

Facility

$1,572.00

Hospital Charge Code	270602467
Hospital Revenue Code	276
Min. Negotiated Rate	$37.89
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$597.36
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80
Rate for Payer: UnitedHealthcare Community & State	$37.89
Rate for Payer: Wellpoint Medicaid Managed Care	$41.66

LENS IO ALCON MTA3UO 19.0

Facility

$1,572.00

Hospital Charge Code	270602467
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$345.84
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA3UO 19.5

Facility

$2,267.25

Hospital Charge Code	270602468
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$498.80
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

Know your out-of-pocket cost for care.

All Charges