Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO ALCON SK61CM 21.0

Facility

$1,521.65

Hospital Charge Code	270602182
Hospital Revenue Code	276
Min. Negotiated Rate	$228.25
Max. Negotiated Rate	$760.83
Rate for Payer: Aetna Commercial	$456.50
Rate for Payer: Aetna Medicare Advantage	$456.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.02
Rate for Payer: Cigna Commercial	$760.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$368.24
Rate for Payer: Qualcare PPO/HMO/WC	$228.25

LENS IO ALCON SK61CM 21.5

Facility

$1,149.65

Hospital Charge Code	270616101
Hospital Revenue Code	276
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

LENS IO ALCON SK61CM 21.5

Facility

$1,149.65

Hospital Charge Code	270616101
Hospital Revenue Code	276
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$344.89
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

LENS IO ALCON SK61CM 22.5

Facility

$786.45

Hospital Charge Code	270616093
Hospital Revenue Code	276
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$190.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: Qualcare PPO/HMO/WC	$117.97

LENS IO ALCON SK61CM 22.5

Facility

$786.45

Hospital Charge Code	270616093
Hospital Revenue Code	276
Min. Negotiated Rate	$117.97
Max. Negotiated Rate	$393.23
Rate for Payer: Aetna Commercial	$235.94
Rate for Payer: Aetna Medicare Advantage	$235.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.54
Rate for Payer: Cigna Commercial	$393.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.32
Rate for Payer: Qualcare PPO/HMO/WC	$117.97

LENS IO ALLERGAN AC21B 8.5

Facility

$1,342.45

Hospital Charge Code	270619576
Hospital Revenue Code	276
Min. Negotiated Rate	$201.37
Max. Negotiated Rate	$324.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: Qualcare PPO/HMO/WC	$201.37

LENS IO ALLERGAN AC21B 8.5

Facility

$1,342.45

Hospital Charge Code	270619576
Hospital Revenue Code	276
Min. Negotiated Rate	$201.37
Max. Negotiated Rate	$671.23
Rate for Payer: Aetna Commercial	$402.74
Rate for Payer: Aetna Medicare Advantage	$402.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.32
Rate for Payer: Cigna Commercial	$671.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: Qualcare PPO/HMO/WC	$201.37

LENS IO B LOMB 0.30 P574UV

Facility

$472.00

Hospital Charge Code	270623399
Hospital Revenue Code	276
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$114.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.22
Rate for Payer: Qualcare PPO/HMO/WC	$70.80

LENS IO B LOMB 0.30 P574UV

Facility

$472.00

Hospital Charge Code	270623399
Hospital Revenue Code	276
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$236.00
Rate for Payer: Aetna Commercial	$141.60
Rate for Payer: Aetna Medicare Advantage	$141.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.36
Rate for Payer: Cigna Commercial	$236.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.22
Rate for Payer: Qualcare PPO/HMO/WC	$70.80

LENS IO B LOMB 6ML625 12.5

Facility

$472.85

Hospital Charge Code	270622916
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$141.85
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 6ML625 12.5

Facility

$472.85

Hospital Charge Code	270622916
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 19.5

Facility

$472.85

Hospital Charge Code	270622922
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 19.5

Facility

$472.85

Hospital Charge Code	270622922
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$141.85
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 20.0

Facility

$472.85

Hospital Charge Code	270622176
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$114.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB 8191B 20.0

Facility

$472.85

Hospital Charge Code	270622176
Hospital Revenue Code	276
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$236.43
Rate for Payer: Aetna Commercial	$141.85
Rate for Payer: Aetna Medicare Advantage	$141.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.58
Rate for Payer: Cigna Commercial	$236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.43
Rate for Payer: Qualcare PPO/HMO/WC	$70.93

LENS IO B LOMB LI16U 21.0

Facility

$912.85

Hospital Charge Code	270620975
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$456.43
Rate for Payer: Aetna Commercial	$273.86
Rate for Payer: Aetna Medicare Advantage	$273.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.78
Rate for Payer: Cigna Commercial	$456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

LENS IO B LOMB LI16U 21.0

Facility

$912.85

Hospital Charge Code	270620975
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$220.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

LENS IO B LOMB LI61U 15.5

Facility

$912.85

Hospital Charge Code	270620973
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$456.43
Rate for Payer: Aetna Commercial	$273.86
Rate for Payer: Aetna Medicare Advantage	$273.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.78
Rate for Payer: Cigna Commercial	$456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

LENS IO B LOMB LI61U 15.5

Facility

$912.85

Hospital Charge Code	270620973
Hospital Revenue Code	276
Min. Negotiated Rate	$136.93
Max. Negotiated Rate	$220.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.91
Rate for Payer: Qualcare PPO/HMO/WC	$136.93

LENS IO CHIROFLEX 20.0******

Facility

$600.00

Service Code	HCPCS C1780
Hospital Charge Code	27060296
Hospital Revenue Code	276
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

LENS IO CHIROFLEX 20.0******

Facility

$600.00

Service Code	HCPCS C1780
Hospital Charge Code	27060296
Hospital Revenue Code	276
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

LENS IO CHIRON 68UV 14.0

Facility

$445.65

Hospital Charge Code	270624444
Hospital Revenue Code	276
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$107.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$66.85

LENS IO CHIRON 68UV 14.0

Facility

$445.65

Hospital Charge Code	270624444
Hospital Revenue Code	276
Min. Negotiated Rate	$66.85
Max. Negotiated Rate	$222.82
Rate for Payer: Aetna Commercial	$133.69
Rate for Payer: Aetna Medicare Advantage	$133.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.64
Rate for Payer: Cigna Commercial	$222.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.85
Rate for Payer: Qualcare PPO/HMO/WC	$66.85

LENS IO CHIRON 8191B 16.0

Facility

$690.45

Hospital Charge Code	270621593
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

LENS IO CHIRON 8191B 16.0

Facility

$690.45

Hospital Charge Code	270621593
Hospital Revenue Code	276
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

Know your out-of-pocket cost for care.

All Charges