Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LENS IOL MTA3UO 29.00

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270668271
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 IOL MTA3UO 29.00

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270668271
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 MT6PW 12.5******

Facility

$410.00

Service Code	HCPCS C1780
Hospital Charge Code	2707602827
Hospital Revenue Code	276
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare Advantage	$123.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.55
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$90.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Community & State	$9.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.87

LENS IO MT6PW 12.5******

Facility

$410.00

Service Code	HCPCS C1780
Hospital Charge Code	2707602827
Hospital Revenue Code	276
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$90.20
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

LENS IO MZ20BD 15.5

Facility

$750.00

Hospital Charge Code	270627531
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 MZ20BD 15.5

Facility

$750.00

Hospital Charge Code	270627531
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 STAAR 9.5 AA4204VL

Facility

$1,342.45

Hospital Charge Code	270620913
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 STAAR 9.5 AA4204VL

Facility

$1,342.45

Hospital Charge Code	270620913
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 STAAR AA4203VF 21.0

Facility

$1,344.00

Hospital Charge Code	270614334
Hospital Revenue Code	276
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$325.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.68
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

LENS IO STAAR AA4203VF 21.0

Facility

$1,344.00

Hospital Charge Code	270614334
Hospital Revenue Code	276
Min. Negotiated Rate	$32.39
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$510.72
Rate for Payer: Aetna Medicare Advantage	$403.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.72
Rate for Payer: Cigna Commercial	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.68
Rate for Payer: Qualcare PPO/HMO/WC	$201.60
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$35.62

LENS IO STAAR AQ2010V 13.5

Facility

$1,612.85

Hospital Charge Code	270612883
Hospital Revenue Code	276
Min. Negotiated Rate	$241.93
Max. Negotiated Rate	$390.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.83
Rate for Payer: Qualcare PPO/HMO/WC	$241.93

LENS IO STAAR AQ2010V 13.5

Facility

$1,612.85

Hospital Charge Code	270612883
Hospital Revenue Code	276
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$806.42
Rate for Payer: Aetna Commercial	$612.88
Rate for Payer: Aetna Medicare Advantage	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.28
Rate for Payer: Cigna Commercial	$806.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.83
Rate for Payer: Qualcare PPO/HMO/WC	$241.93
Rate for Payer: UnitedHealthcare Community & State	$38.87
Rate for Payer: Wellpoint Medicaid Managed Care	$42.74

LENS MEDI-FLOW THERAPEUTIC

Facility

$127.21

Hospital Charge Code	270651786
Hospital Revenue Code	272
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.60
Rate for Payer: Aetna Commercial	$48.34
Rate for Payer: Aetna Medicare Advantage	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.44
Rate for Payer: Cigna Commercial	$63.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.16
Rate for Payer: Oxford Commercial	$25.44
Rate for Payer: Qualcare PPO/HMO/WC	$19.08
Rate for Payer: UnitedHealthcare Commercial	$25.44
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

LENS MEDI-FLOW THERAPEUTIC

Facility

$127.21

Hospital Charge Code	270651786
Hospital Revenue Code	272
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$19.08
Rate for Payer: Qualcare PPO/HMO/WC	$19.08

LENS MORGAN MEDI-FLOW

Facility

$208.15

Hospital Charge Code	270644315
Hospital Revenue Code	272
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$79.10
Rate for Payer: Aetna Medicare Advantage	$62.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.08
Rate for Payer: Cigna Commercial	$104.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.45
Rate for Payer: Oxford Commercial	$41.63
Rate for Payer: Qualcare PPO/HMO/WC	$31.22
Rate for Payer: UnitedHealthcare Commercial	$41.63
Rate for Payer: UnitedHealthcare Community & State	$5.02
Rate for Payer: Wellpoint Medicaid Managed Care	$5.52

LENS MORGAN MEDI-FLOW

Facility

$208.15

Hospital Charge Code	270644315
Hospital Revenue Code	272
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$31.22
Rate for Payer: Qualcare PPO/HMO/WC	$31.22

LENS MULTIFLEXII W/O FT. PLATE

Facility

$1,475.00

Hospital Charge Code	270650895
Hospital Revenue Code	276
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

LENS MULTIFLEXII W/O FT. PLATE

Facility

$1,475.00

Hospital Charge Code	270650895
Hospital Revenue Code	276
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

LENS MULTIFLEXII W/O FT. PLATE

Facility

$425.00

Hospital Charge Code	270655292
Hospital Revenue Code	276
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

LENS MULTIFLEXII W/O FT. PLATE

Facility

$425.00

Hospital Charge Code	270655292
Hospital Revenue Code	276
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

LENS PANOPTIX 23.5 DIOPTER

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697250
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PANOPTIX 23.5 DIOPTER

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697250
Hospital Revenue Code	276
Min. Negotiated Rate	$113.87
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,795.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75
Rate for Payer: UnitedHealthcare Community & State	$113.87
Rate for Payer: Wellpoint Medicaid Managed Care	$125.21

LENS PANOPTIX TRIFOC 24.5 DIOP

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697072
Hospital Revenue Code	276
Min. Negotiated Rate	$113.87
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,795.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75
Rate for Payer: UnitedHealthcare Community & State	$113.87
Rate for Payer: Wellpoint Medicaid Managed Care	$125.21

LENS PANOPTIX TRIFOC 24.5 DIOP

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697072
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PAPER CLEANING TISSUE

Facility

$1.35

Hospital Charge Code	270665600
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

Know your out-of-pocket cost for care.

All Charges