Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO CHIROFLEX 20.0******

Facility

$600.00

Service Code	HCPCS C1780
Hospital Charge Code	27060296
Hospital Revenue Code	276
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

LENS IO CHIROFLEX 20.0******

Facility

$600.00

Service Code	HCPCS C1780
Hospital Charge Code	27060296
Hospital Revenue Code	276
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

LENS IO CHIRON 68UV 14.0

Facility

$445.65

Hospital Charge Code	270624444
Hospital Revenue Code	276
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$107.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.85

LENS IO CHIRON 68UV 14.0

Facility

$445.65

Hospital Charge Code	270624444
Hospital Revenue Code	276
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$222.82
Rate for Payer: Aetna Commercial	$169.35
Rate for Payer: Aetna Medicare Advantage	$133.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.64
Rate for Payer: Cigna Commercial	$222.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.85
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.81

LENS IO CHIRON 8191B 16.0

Facility

$690.45

Hospital Charge Code	270621593
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 16.0

Facility

$690.45

Hospital Charge Code	270621593
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 18.0

Facility

$690.45

Hospital Charge Code	270621256
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 18.0

Facility

$690.45

Hospital Charge Code	270621256
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 19.0

Facility

$445.65

Hospital Charge Code	270624731
Hospital Revenue Code	276
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$107.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.85

LENS IO CHIRON 8191B 19.0

Facility

$445.65

Hospital Charge Code	270624731
Hospital Revenue Code	276
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$222.82
Rate for Payer: Aetna Commercial	$169.35
Rate for Payer: Aetna Medicare Advantage	$133.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.64
Rate for Payer: Cigna Commercial	$222.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.85
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.81

LENS IO CHIRON 8191B 21.0

Facility

$690.45

Hospital Charge Code	270621257
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 21.0

Facility

$690.45

Hospital Charge Code	270621257
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 22.0

Facility

$690.45

Hospital Charge Code	270621594
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 22.0

Facility

$690.45

Hospital Charge Code	270621594
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 22.5

Facility

$690.45

Hospital Charge Code	270621595
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 22.5

Facility

$690.45

Hospital Charge Code	270621595
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 23.0

Facility

$472.85

Hospital Charge Code	270621886
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 CHIRON 8191B 23.0

Facility

$472.85

Hospital Charge Code	270621886
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 CHIRON 8191B 24.0

Facility

$690.45

Hospital Charge Code	270621596
Hospital Revenue Code	276
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

LENS IO CHIRON 8191B 24.0

Facility

$690.45

Hospital Charge Code	270621596
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 24.5D

Facility

$472.85

Hospital Charge Code	270621821
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 CHIRON 8191B 24.5D

Facility

$472.85

Hospital Charge Code	270621821
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 CHIRON 8191B 27.0D

Facility

$472.85

Hospital Charge Code	270622552
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 CHIRON 8191B 27.0D

Facility

$472.85

Hospital Charge Code	270622552
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 CHIRON CIIVB 14.0

Facility

$1,659.25

Hospital Charge Code	270602009
Hospital Revenue Code	276
Min. Negotiated Rate	$248.89
Max. Negotiated Rate	$401.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$365.04
Rate for Payer: Qualcare PPO/HMO/WC	$248.89

Know your out-of-pocket cost for care.

All Charges