Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON SK61CM 19.0

Facility

$1,521.65

Hospital Charge Code	270602181
Hospital Revenue Code	276
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$760.83
Rate for Payer: Aetna Commercial	$578.23
Rate for Payer: Aetna Medicare Advantage	$456.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.02
Rate for Payer: Cigna Commercial	$760.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$334.76
Rate for Payer: Qualcare PPO/HMO/WC	$228.25
Rate for Payer: UnitedHealthcare Community & State	$36.67
Rate for Payer: Wellpoint Medicaid Managed Care	$40.32

LENS IO ALCON SK61CM 20.0

Facility

$786.45

Hospital Charge Code	270615649
Hospital Revenue Code	276
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$190.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.02
Rate for Payer: Qualcare PPO/HMO/WC	$117.97

LENS IO ALCON SK61CM 20.0

Facility

$786.45

Hospital Charge Code	270615649
Hospital Revenue Code	276
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$393.23
Rate for Payer: Aetna Commercial	$298.85
Rate for Payer: Aetna Medicare Advantage	$235.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.54
Rate for Payer: Cigna Commercial	$393.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.02
Rate for Payer: Qualcare PPO/HMO/WC	$117.97
Rate for Payer: UnitedHealthcare Community & State	$18.95
Rate for Payer: Wellpoint Medicaid Managed Care	$20.84

LENS IO ALCON SK61CM 20.5

Facility

$750.00

Hospital Charge Code	270602183
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 SK61CM 20.5

Facility

$750.00

Hospital Charge Code	270602183
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 SK61CM 21.0

Facility

$1,521.65

Hospital Charge Code	270602182
Hospital Revenue Code	276
Min. Negotiated Rate	$228.25
Max. Negotiated Rate	$368.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$334.76
Rate for Payer: Qualcare PPO/HMO/WC	$228.25

LENS IO ALCON SK61CM 21.0

Facility

$1,521.65

Hospital Charge Code	270602182
Hospital Revenue Code	276
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$760.83
Rate for Payer: Aetna Commercial	$578.23
Rate for Payer: Aetna Medicare Advantage	$456.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.02
Rate for Payer: Cigna Commercial	$760.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$334.76
Rate for Payer: Qualcare PPO/HMO/WC	$228.25
Rate for Payer: UnitedHealthcare Community & State	$36.67
Rate for Payer: Wellpoint Medicaid Managed Care	$40.32

LENS IO ALCON SK61CM 21.5

Facility

$1,149.65

Hospital Charge Code	270616101
Hospital Revenue Code	276
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

LENS IO ALCON SK61CM 21.5

Facility

$1,149.65

Hospital Charge Code	270616101
Hospital Revenue Code	276
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$252.92
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.47

LENS IO ALCON SK61CM 22.5

Facility

$786.45

Hospital Charge Code	270616093
Hospital Revenue Code	276
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$190.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.02
Rate for Payer: Qualcare PPO/HMO/WC	$117.97

LENS IO ALCON SK61CM 22.5

Facility

$786.45

Hospital Charge Code	270616093
Hospital Revenue Code	276
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$393.23
Rate for Payer: Aetna Commercial	$298.85
Rate for Payer: Aetna Medicare Advantage	$235.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.54
Rate for Payer: Cigna Commercial	$393.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.02
Rate for Payer: Qualcare PPO/HMO/WC	$117.97
Rate for Payer: UnitedHealthcare Community & State	$18.95
Rate for Payer: Wellpoint Medicaid Managed Care	$20.84

LENS IO ALLERGAN AC21B 8.5

Facility

$1,342.45

Hospital Charge Code	270619576
Hospital Revenue Code	276
Min. Negotiated Rate	$201.37
Max. Negotiated Rate	$324.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.34
Rate for Payer: Qualcare PPO/HMO/WC	$201.37

LENS IO ALLERGAN AC21B 8.5

Facility

$1,342.45

Hospital Charge Code	270619576
Hospital Revenue Code	276
Min. Negotiated Rate	$32.35
Max. Negotiated Rate	$671.23
Rate for Payer: Aetna Commercial	$510.13
Rate for Payer: Aetna Medicare Advantage	$402.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.32
Rate for Payer: Cigna Commercial	$671.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.34
Rate for Payer: Qualcare PPO/HMO/WC	$201.37
Rate for Payer: UnitedHealthcare Community & State	$32.35
Rate for Payer: Wellpoint Medicaid Managed Care	$35.57

LENS IO B LOMB 0.30 P574UV

Facility

$472.00

Hospital Charge Code	270623399
Hospital Revenue Code	276
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$114.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.84
Rate for Payer: Qualcare PPO/HMO/WC	$70.80

LENS IO B LOMB 0.30 P574UV

Facility

$472.00

Hospital Charge Code	270623399
Hospital Revenue Code	276
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna Commercial	$179.36
Rate for Payer: Aetna Medicare Advantage	$141.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.36
Rate for Payer: Cigna Commercial	$236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.84
Rate for Payer: Qualcare PPO/HMO/WC	$70.80
Rate for Payer: UnitedHealthcare Community & State	$11.38
Rate for Payer: Wellpoint Medicaid Managed Care	$12.51

LENS IO B LOMB 6ML625 12.5

Facility

$472.85

Hospital Charge Code	270622916
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 6ML625 12.5

Facility

$472.85

Hospital Charge Code	270622916
Hospital Revenue Code	276
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$179.68
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93
Rate for Payer: UnitedHealthcare Community & State	$11.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.53

LENS IO B LOMB 8191B 19.5

Facility

$472.85

Hospital Charge Code	270622922
Hospital Revenue Code	276
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$179.68
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93
Rate for Payer: UnitedHealthcare Community & State	$11.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.53

LENS IO B LOMB 8191B 19.5

Facility

$472.85

Hospital Charge Code	270622922
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 20.0

Facility

$472.85

Hospital Charge Code	270622176
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 20.0

Facility

$472.85

Hospital Charge Code	270622176
Hospital Revenue Code	276
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$179.68
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.03
Rate for Payer: Qualcare PPO/HMO/WC	$70.93
Rate for Payer: UnitedHealthcare Community & State	$11.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.53

LENS IO B LOMB LI16U 21.0

Facility

$912.85

Hospital Charge Code	270620975
Hospital Revenue Code	276
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$456.43
Rate for Payer: Aetna Commercial	$346.88
Rate for Payer: Aetna Medicare Advantage	$273.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.78
Rate for Payer: Cigna Commercial	$456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.83
Rate for Payer: Qualcare PPO/HMO/WC	$136.93
Rate for Payer: UnitedHealthcare Community & State	$22.00
Rate for Payer: Wellpoint Medicaid Managed Care	$24.19

LENS IO B LOMB LI16U 21.0

Facility

$912.85

Hospital Charge Code	270620975
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$220.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.83
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

LENS IO B LOMB LI61U 15.5

Facility

$912.85

Hospital Charge Code	270620973
Hospital Revenue Code	276
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$456.43
Rate for Payer: Aetna Commercial	$346.88
Rate for Payer: Aetna Medicare Advantage	$273.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.78
Rate for Payer: Cigna Commercial	$456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.83
Rate for Payer: Qualcare PPO/HMO/WC	$136.93
Rate for Payer: UnitedHealthcare Community & State	$22.00
Rate for Payer: Wellpoint Medicaid Managed Care	$24.19

LENS IO B LOMB LI61U 15.5

Facility

$912.85

Hospital Charge Code	270620973
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$220.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.83
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

Know your out-of-pocket cost for care.

All Charges