Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCULAR 15.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695617
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 15.5 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653297
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
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	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR 15.5 DIOPTER

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270653297
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: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR 16.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695584
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 16.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695584
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 16.5 DIOPTER

Facility

$425.00

Service Code	HCPCS V2632
Hospital Charge Code	270688895
Hospital Revenue Code	276
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$145.73
Rate for Payer: Aetna Commercial	$127.50
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	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

LENS INTRAOCULAR 16.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695575
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 16.5 DIOPTER

Facility

$425.00

Service Code	HCPCS V2632
Hospital Charge Code	270688895
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: Qualcare PPO/HMO/WC	$63.75

LENS INTRAOCULAR 16.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695575
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 17.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695580
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 17.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695580
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 17.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695571
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 17.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695571
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 18.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653316
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 INTRAOCULAR 18.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695581
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 18.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695581
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 18.0 DIOPTER

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270653316
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 INTRAOCULAR 18.0 DIOPTER

Facility

$2,250.00

Service Code	HCPCS V2632
Hospital Charge Code	270698114
Hospital Revenue Code	276
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

LENS INTRAOCULAR 18.0 DIOPTER

Facility

$2,250.00

Service Code	HCPCS V2632
Hospital Charge Code	270698114
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

LENS INTRAOCULAR 18.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695572
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 18.5 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695572
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 19.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695569
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR 19.0 DIOPTER

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270695569
Hospital Revenue Code	276
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$223.50
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$145.73
Rate for Payer: Cigna Medicare Advantage	$87.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

LENS INTRAOCULAR+19.0DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270650859
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 INTRAOCULAR+19.0DIOPTER

Facility

$720.40

Service Code	HCPCS V2632
Hospital Charge Code	270650859
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

Know your out-of-pocket cost for care.

All Charges