Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCULAR CZ70BD 21.5

Facility

$750.00

Hospital Charge Code	270661720
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR CZ70BD 22.5

Facility

$750.00

Hospital Charge Code	270662074
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR CZ70BD 22.5

Facility

$750.00

Hospital Charge Code	270662074
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 CZ7OBD 17.0D

Facility

$750.00

Hospital Charge Code	270661261
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR CZ7OBD 17.0D

Facility

$750.00

Hospital Charge Code	270661261
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 INTRA OCULAR D 8.50

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270678597
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 INTRA OCULAR D 8.50

Facility

$750.00

Service Code	HCPCS V2632
Hospital Charge Code	270678597
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 DIOPTER 19.5

Facility

$720.40

Service Code	HCPCS V2787
Hospital Charge Code	270655372
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 DIOPTER 19.5

Facility

$720.40

Service Code	HCPCS V2787
Hospital Charge Code	270655372
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 INTRAOCULAR LI61AO 22.0

Facility

$895.00

Hospital Charge Code	270637478
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$268.50
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR LI61AO 22.0

Facility

$895.00

Hospital Charge Code	270637478
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR LI61AO 22.0

Facility

$895.00

Hospital Charge Code	270637477
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR LI61AO 22.0

Facility

$895.00

Hospital Charge Code	270637477
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$268.50
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR LI61AO 25.5

Facility

$895.00

Hospital Charge Code	270637479
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR LI61AO 25.5

Facility

$895.00

Hospital Charge Code	270637479
Hospital Revenue Code	276
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$268.50
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

LENS INTRAOCULAR MA60MA 5.0

Facility

$744.00

Hospital Charge Code	270633633
Hospital Revenue Code	276
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$180.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS INTRAOCULAR MA60MA 5.0

Facility

$744.00

Hospital Charge Code	270633633
Hospital Revenue Code	276
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS INTRAOCULAR MC60CM 11.5

Facility

$750.00

Hospital Charge Code	270618948
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR MC60CM 11.5

Facility

$750.00

Hospital Charge Code	270618948
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 MTA2UO 10.5

Facility

$744.00

Hospital Charge Code	270626590
Hospital Revenue Code	276
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$223.20
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS INTRAOCULAR MTA2UO 10.5

Facility

$744.00

Hospital Charge Code	270626590
Hospital Revenue Code	276
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$180.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS INTRAOCULAR MTA2UO 11.0

Facility

$750.00

Hospital Charge Code	270616712
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

LENS INTRAOCULAR MTA2UO 11.0

Facility

$750.00

Hospital Charge Code	270616712
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 MTA2UO 23.0

Facility

$750.00

Hospital Charge Code	270637660
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 MTA2UO 23.0

Facility

$750.00

Hospital Charge Code	270637660
Hospital Revenue Code	276
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
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	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges