Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON MTA3UO 19.5

Facility

$2,267.25

Hospital Charge Code	270602468
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 20.0

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270602471
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 20.0

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270602471
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 20.5

Facility

$2,267.25

Hospital Charge Code	270602600
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 20.5

Facility

$2,267.25

Hospital Charge Code	270602600
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 21.0

Facility

$1,572.00

Hospital Charge Code	270602601
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 21.0

Facility

$1,572.00

Hospital Charge Code	270602601
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 21.5

Facility

$2,267.25

Hospital Charge Code	270602602
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 21.5

Facility

$2,267.25

Hospital Charge Code	270602602
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 22.5

Facility

$750.00

Hospital Charge Code	270602604
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 22.5

Facility

$750.00

Hospital Charge Code	270602604
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 23.5

Facility

$2,267.25

Hospital Charge Code	270602605
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 23.5

Facility

$2,267.25

Hospital Charge Code	270602605
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 24.0

Facility

$2,267.25

Hospital Charge Code	270602606
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 24.0

Facility

$2,267.25

Hospital Charge Code	270602606
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 26.0

Facility

$2,267.25

Hospital Charge Code	270602607
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 26.0

Facility

$2,267.25

Hospital Charge Code	270602607
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 26.5

Facility

$2,267.25

Hospital Charge Code	270602608
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 26.5

Facility

$2,267.25

Hospital Charge Code	270602608
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 5.0

Facility

$2,267.25

Hospital Charge Code	270602448
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 5.0

Facility

$2,267.25

Hospital Charge Code	270602448
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 8.5

Facility

$2,267.25

Hospital Charge Code	270602449
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 8.5

Facility

$2,267.25

Hospital Charge Code	270602449
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 9.5

Facility

$750.00

Hospital Charge Code	270602450
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 9.5

Facility

$750.00

Hospital Charge Code	270602450
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

Know your out-of-pocket cost for care.

All Charges