Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON MTA6UO 10.0

Facility

$1,572.00

Hospital Charge Code	270602824
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 MTA6UO 12.0

Facility

$750.00

Hospital Charge Code	270602825
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 MTA6UO 12.0

Facility

$750.00

Hospital Charge Code	270602825
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 MTA6UO 12.5

Facility

$750.00

Service Code	HCPCS C1780
Hospital Charge Code	270602827
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 MTA6UO 12.5

Facility

$750.00

Service Code	HCPCS C1780
Hospital Charge Code	270602827
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 MTA6UO 13.0

Facility

$1,572.00

Hospital Charge Code	270602299
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 MTA6UO 13.0

Facility

$1,572.00

Hospital Charge Code	270602299
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 MTA6UO 13.5

Facility

$1,572.00

Hospital Charge Code	270602826
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 MTA6UO 13.5

Facility

$1,572.00

Hospital Charge Code	270602826
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 MTA6UO 14.0

Facility

$1,572.00

Hospital Charge Code	270602828
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 MTA6UO 14.0

Facility

$1,572.00

Hospital Charge Code	270602828
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 MTA6UO 14.5

Facility

$1,572.00

Hospital Charge Code	270602829
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 MTA6UO 14.5

Facility

$1,572.00

Hospital Charge Code	270602829
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 MTA6UO 15.0

Facility

$1,572.00

Hospital Charge Code	270602830
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 MTA6UO 15.0

Facility

$1,572.00

Hospital Charge Code	270602830
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 MTA6UO 15.5

Facility

$1,572.00

Hospital Charge Code	270602874
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 MTA6UO 15.5

Facility

$1,572.00

Hospital Charge Code	270602874
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 MTA6UO 16.0

Facility

$1,572.00

Hospital Charge Code	270602875
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 MTA6UO 16.0

Facility

$1,572.00

Hospital Charge Code	270602875
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 MTA6UO 16.5

Facility

$1,572.00

Hospital Charge Code	270602876
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 MTA6UO 16.5

Facility

$1,572.00

Hospital Charge Code	270602876
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 MTA6UO 17.0

Facility

$1,572.00

Hospital Charge Code	270602877
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 MTA6UO 17.0

Facility

$1,572.00

Hospital Charge Code	270602877
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 MTA6UO 17.5

Facility

$1,572.00

Hospital Charge Code	270602878
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 MTA6UO 17.5

Facility

$1,572.00

Hospital Charge Code	270602878
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

Know your out-of-pocket cost for care.

All Charges