Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO IOLAB 2192S 16.0

Facility

$959.25

Hospital Charge Code	270602005
Hospital Revenue Code	276
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$232.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.14
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

LENS IO IOLAB 2192S 22.5

Facility

$959.25

Hospital Charge Code	270602124
Hospital Revenue Code	276
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$232.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.14
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

LENS IO IOLAB 2192S 22.5

Facility

$959.25

Hospital Charge Code	270602124
Hospital Revenue Code	276
Min. Negotiated Rate	$143.89
Max. Negotiated Rate	$479.62
Rate for Payer: Aetna Commercial	$287.77
Rate for Payer: Aetna Medicare Advantage	$287.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.61
Rate for Payer: Cigna Commercial	$479.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.14
Rate for Payer: Qualcare PPO/HMO/WC	$143.89

LENS IO L122UV 09.0

Facility

$472.85

Hospital Charge Code	270621823
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 L122UV 09.0

Facility

$472.85

Hospital Charge Code	270621823
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 IOL CHIRON 68UV 21.0

Facility

$445.65

Hospital Charge Code	270623887
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 IOL CHIRON 68UV 21.0

Facility

$445.65

Hospital Charge Code	270623887
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 IOL MA60AC 10.0

Facility

$720.40

Hospital Charge Code	270669805
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 IOL MA60AC 10.0

Facility

$720.40

Hospital Charge Code	270669805
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 IOL MA60AC 15.5

Facility

$720.40

Hospital Charge Code	270669804
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 IOL MA60AC 15.5

Facility

$720.40

Hospital Charge Code	270669804
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 IOL MA60AC 20.5

Facility

$720.40

Hospital Charge Code	270669803
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 IOL MA60AC 20.5

Facility

$720.40

Hospital Charge Code	270669803
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 IOL MA60AC 6.0

Facility

$720.40

Hospital Charge Code	270669800
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 IOL MA60AC 6.0

Facility

$720.40

Hospital Charge Code	270669800
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 IOL MA60AC 6.5

Facility

$720.40

Hospital Charge Code	270669801
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 IOL MA60AC 6.5

Facility

$720.40

Hospital Charge Code	270669801
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 IOL MA60AC 8.5

Facility

$720.40

Hospital Charge Code	270669802
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 IOL MA60AC 8.5

Facility

$720.40

Hospital Charge Code	270669802
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 IOL MTA3UO 29.00

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270668271
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 IOL MTA3UO 29.00

Facility

$750.00

Service Code	HCPCS V2630
Hospital Charge Code	270668271
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 MT6PW 12.5******

Facility

$410.00

Service Code	HCPCS C1780
Hospital Charge Code	2707602827
Hospital Revenue Code	276
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$123.00
Rate for Payer: Aetna Medicare Advantage	$123.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.55
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.22
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

LENS IO MT6PW 12.5******

Facility

$410.00

Service Code	HCPCS C1780
Hospital Charge Code	2707602827
Hospital Revenue Code	276
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.22
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

LENS IO MZ20BD 15.5

Facility

$750.00

Hospital Charge Code	270627531
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 MZ20BD 15.5

Facility

$750.00

Hospital Charge Code	270627531
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