Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOCULAR SN60WF

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270686279
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 SN60WF

Facility

$1,623.25

Service Code	HCPCS V2632
Hospital Charge Code	270686279
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 INTRAOCULER SN60WS 6.0D

Facility

$800.00

Hospital Charge Code	270639436
Hospital Revenue Code	276
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

LENS INTRAOCULER SN60WS 6.0D

Facility

$800.00

Hospital Charge Code	270639436
Hospital Revenue Code	276
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

LENS INTRAOCU MT4PWR18*****

Facility

$820.00

Hospital Charge Code	270625
Hospital Revenue Code	276
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$246.00
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

LENS INTRAOCU MT4PWR18*****

Facility

$820.00

Hospital Charge Code	270625
Hospital Revenue Code	276
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$198.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

LENS INTROCULAR 18.0 DIOPTER

Facility

$300.00

Hospital Charge Code	270652681
Hospital Revenue Code	276
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

LENS INTROCULAR 18.0 DIOPTER

Facility

$300.00

Hospital Charge Code	270652681
Hospital Revenue Code	276
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

LENS INTROCULAR MZ30BD 22.5

Facility

$744.00

Hospital Charge Code	270636776
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 INTROCULAR MZ30BD 22.5

Facility

$744.00

Hospital Charge Code	270636776
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 INTROCULAR SK60CM 14

Facility

$744.00

Hospital Charge Code	270636777
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 INTROCULAR SK60CM 14

Facility

$744.00

Hospital Charge Code	270636777
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 INTROCULAR SK60CM 21

Facility

$744.00

Hospital Charge Code	276636778
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 INTROCULAR SK60CM 21

Facility

$744.00

Hospital Charge Code	276636778
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 INTROCULAR SK60CM 21

Facility

$744.00

Hospital Charge Code	270636778
Hospital Revenue Code	278
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) NJ Health	$148.80
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 INTROCULAR SK60CM 21

Facility

$744.00

Hospital Charge Code	270636778
Hospital Revenue Code	278
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$180.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

LENS INTROCULAR SN60AT 29.5

Facility

$900.00

Hospital Charge Code	270631623
Hospital Revenue Code	276
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$270.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

LENS INTROCULAR SN60AT 29.5

Facility

$900.00

Hospital Charge Code	270631623
Hospital Revenue Code	276
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

LENS IO AA4203VF 14.0 FOLDABLE

Facility

$875.00

Hospital Charge Code	270624614
Hospital Revenue Code	276
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

LENS IO AA4203VF 14.0 FOLDABLE

Facility

$875.00

Hospital Charge Code	270624614
Hospital Revenue Code	276
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$262.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

LENS IO ALCON CZ70BD 20.0

Facility

$3,000.00

Hospital Charge Code	270602198
Hospital Revenue Code	276
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$900.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

LENS IO ALCON CZ70BD 20.0

Facility

$3,000.00

Hospital Charge Code	270602198
Hospital Revenue Code	276
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

LENS IO ALCON JF3LRU 10.0

Facility

$2,267.25

Hospital Charge Code	270602227
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON JF3LRU 10.0

Facility

$2,267.25

Hospital Charge Code	270602227
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$1,133.62
Rate for Payer: Aetna Commercial	$680.17
Rate for Payer: Aetna Medicare Advantage	$680.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$578.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$578.15
Rate for Payer: Cigna Commercial	$1,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

LENS IO ALCON JF3LRU 11.0

Facility

$2,267.25

Hospital Charge Code	270602228
Hospital Revenue Code	276
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$548.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$548.67
Rate for Payer: Qualcare PPO/HMO/WC	$340.09

Know your out-of-pocket cost for care.

All Charges