Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCCULAR 20.5 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270660120
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$216.12
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR+20.5 DIOPTER

Facility

$887.00

Service Code	HCPCS C1780
Hospital Charge Code	270650862
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR+20.5 DIOPTER

Facility

$887.00

Service Code	HCPCS C1780
Hospital Charge Code	270650862
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$266.10
Rate for Payer: Aetna Medicare Advantage	$266.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR+20.5 DIOPTER

Facility

$887.00

Hospital Charge Code	270650764
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR+20.5 DIOPTER

Facility

$887.00

Hospital Charge Code	270650764
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$266.10
Rate for Payer: Aetna Medicare Advantage	$266.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR 20DIO FOLD

Facility

$720.40

Hospital Charge Code	270650614
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$360.20
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$360.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR 20DIO FOLD

Facility

$720.40

Hospital Charge Code	270650614
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$174.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR 21.0

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653300
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$486.98
Rate for Payer: Aetna Commercial	$486.98
Rate for Payer: Aetna Medicare Advantage	$486.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.93
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR 21.0

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653300
Hospital Revenue Code	276
Min. Negotiated Rate	$243.49
Max. Negotiated Rate	$392.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR +21.00

Facility

$720.00

Hospital Charge Code	270668387
Hospital Revenue Code	276
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$216.00
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

LENS INTRAOCCULAR +21.00

Facility

$720.00

Hospital Charge Code	270668387
Hospital Revenue Code	276
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$174.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

LENS INTRAOCCULAR 21.0 DIOPTER

Facility

$675.00

Hospital Charge Code	270650622
Hospital Revenue Code	276
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

LENS INTRAOCCULAR 21.0 DIOPTER

Facility

$675.00

Hospital Charge Code	270650622
Hospital Revenue Code	276
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

LENS INTRAOCCULAR+21.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270650863
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$486.98
Rate for Payer: Aetna Commercial	$486.98
Rate for Payer: Aetna Medicare Advantage	$486.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.93
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR+21.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270650863
Hospital Revenue Code	276
Min. Negotiated Rate	$243.49
Max. Negotiated Rate	$392.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR21.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270650893
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$174.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR21.0 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270650893
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$216.12
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR +21.5DIOPTER

Facility

$887.00

Hospital Charge Code	270653233
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR +21.5DIOPTER

Facility

$887.00

Hospital Charge Code	270653233
Hospital Revenue Code	276
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$443.50
Rate for Payer: Aetna Commercial	$266.10
Rate for Payer: Aetna Medicare Advantage	$266.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.65
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653322
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$486.98
Rate for Payer: Aetna Commercial	$486.98
Rate for Payer: Aetna Medicare Advantage	$486.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.93
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$720.40

Service Code	HCPCS C1780
Hospital Charge Code	270660119
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$360.20
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$360.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653244
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$216.12
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$216.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.70
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653322
Hospital Revenue Code	276
Min. Negotiated Rate	$243.49
Max. Negotiated Rate	$392.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270653244
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$174.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

LENS INTRAOCCULAR 21.5 DIOPTER

Facility

$720.40

Service Code	HCPCS C1780
Hospital Charge Code	270660119
Hospital Revenue Code	276
Min. Negotiated Rate	$108.06
Max. Negotiated Rate	$174.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.34
Rate for Payer: Qualcare PPO/HMO/WC	$108.06

Know your out-of-pocket cost for care.

All Charges