Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON MTA5UO 23.5

Facility

$1,572.00

Hospital Charge Code	270602810
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 23.5

Facility

$1,572.00

Hospital Charge Code	270602810
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 24.0

Facility

$1,572.00

Hospital Charge Code	270602811
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 24.0

Facility

$1,572.00

Hospital Charge Code	270602811
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 24.5

Facility

$1,572.00

Hospital Charge Code	270602812
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 24.5

Facility

$1,572.00

Hospital Charge Code	270602812
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 26.0

Facility

$1,572.00

Hospital Charge Code	270602813
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 26.0

Facility

$1,572.00

Hospital Charge Code	270602813
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 26.5

Facility

$1,572.00

Hospital Charge Code	270602814
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 26.5

Facility

$1,572.00

Hospital Charge Code	270602814
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 5.0

Facility

$2,267.25

Hospital Charge Code	270602786
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 MTA5UO 5.0

Facility

$2,267.25

Hospital Charge Code	270602786
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 MTA5UO 8.0

Facility

$2,267.25

Hospital Charge Code	270602788
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 MTA5UO 8.0

Facility

$2,267.25

Hospital Charge Code	270602788
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 MTA5UO 8.5

Facility

$1,572.00

Hospital Charge Code	270602787
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 8.5

Facility

$1,572.00

Hospital Charge Code	270602787
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA5UO 9.5

Facility

$2,267.25

Hospital Charge Code	270602789
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 MTA5UO 9.5

Facility

$2,267.25

Hospital Charge Code	270602789
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 MTA6UO 10.0

Facility

$1,572.00

Hospital Charge Code	270602824
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA6UO 10.0

Facility

$1,572.00

Hospital Charge Code	270602824
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$380.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

LENS IO ALCON MTA6UO 12.0

Facility

$750.00

Hospital Charge Code	270602825
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 IO ALCON MTA6UO 12.0

Facility

$750.00

Hospital Charge Code	270602825
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 IO ALCON MTA6UO 12.5

Facility

$750.00

Service Code	HCPCS C1780
Hospital Charge Code	270602827
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 IO ALCON MTA6UO 12.5

Facility

$750.00

Service Code	HCPCS C1780
Hospital Charge Code	270602827
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 IO ALCON MTA6UO 13.0

Facility

$1,572.00

Hospital Charge Code	270602299
Hospital Revenue Code	276
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$786.00
Rate for Payer: Aetna Commercial	$471.60
Rate for Payer: Aetna Medicare Advantage	$471.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$400.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$400.86
Rate for Payer: Cigna Commercial	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.42
Rate for Payer: Qualcare PPO/HMO/WC	$235.80

Know your out-of-pocket cost for care.

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