Heights University Hospital

All Charges

Charge

Type

Setting

Price

LENS IO STAAR 9.5 AA4204VL

Facility

$1,342.45

Hospital Charge Code	270620913
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 STAAR 9.5 AA4204VL

Facility

$1,342.45

Hospital Charge Code	270620913
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 STAAR AA4203VF 21.0

Facility

$1,344.00

Hospital Charge Code	270614334
Hospital Revenue Code	276
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$325.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

LENS IO STAAR AA4203VF 21.0

Facility

$1,344.00

Hospital Charge Code	270614334
Hospital Revenue Code	276
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$403.20
Rate for Payer: Aetna Medicare Advantage	$403.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.72
Rate for Payer: Cigna Commercial	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.25
Rate for Payer: Qualcare PPO/HMO/WC	$201.60

LENS IO STAAR AQ2010V 13.5

Facility

$1,612.85

Hospital Charge Code	270612883
Hospital Revenue Code	276
Min. Negotiated Rate	$241.93
Max. Negotiated Rate	$806.42
Rate for Payer: Aetna Medicare Advantage	$483.86
Rate for Payer: Aetna Commercial	$483.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.28
Rate for Payer: Cigna Commercial	$806.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.31
Rate for Payer: Qualcare PPO/HMO/WC	$241.93

LENS IO STAAR AQ2010V 13.5

Facility

$1,612.85

Hospital Charge Code	270612883
Hospital Revenue Code	276
Min. Negotiated Rate	$241.93
Max. Negotiated Rate	$390.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.31
Rate for Payer: Qualcare PPO/HMO/WC	$241.93

LENS MEDI-FLOW THERAPEUTIC

Facility

$127.21

Hospital Charge Code	270651786
Hospital Revenue Code	272
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$19.08
Rate for Payer: Qualcare PPO/HMO/WC	$19.08

LENS MEDI-FLOW THERAPEUTIC

Facility

$127.21

Hospital Charge Code	270651786
Hospital Revenue Code	272
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$63.60
Rate for Payer: Aetna Commercial	$38.16
Rate for Payer: Aetna Medicare Advantage	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.44
Rate for Payer: Cigna Commercial	$63.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.54
Rate for Payer: Oxford Commercial	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.08
Rate for Payer: UnitedHealthcare Commercial	$63.60

LENS MORGAN MEDI-FLOW

Facility

$208.15

Hospital Charge Code	270644315
Hospital Revenue Code	272
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$31.22
Rate for Payer: Qualcare PPO/HMO/WC	$31.22

LENS MORGAN MEDI-FLOW

Facility

$208.15

Hospital Charge Code	270644315
Hospital Revenue Code	272
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$104.08
Rate for Payer: Aetna Commercial	$62.45
Rate for Payer: Aetna Medicare Advantage	$62.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.08
Rate for Payer: Cigna Commercial	$104.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.06
Rate for Payer: Oxford Commercial	$104.08
Rate for Payer: Qualcare PPO/HMO/WC	$31.22
Rate for Payer: UnitedHealthcare Commercial	$104.08

LENS MULTIFLEXII W/O FT. PLATE

Facility

$425.00

Hospital Charge Code	270655292
Hospital Revenue Code	276
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

LENS MULTIFLEXII W/O FT. PLATE

Facility

$1,475.00

Hospital Charge Code	270650895
Hospital Revenue Code	276
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

LENS MULTIFLEXII W/O FT. PLATE

Facility

$1,475.00

Hospital Charge Code	270650895
Hospital Revenue Code	276
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$442.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

LENS MULTIFLEXII W/O FT. PLATE

Facility

$425.00

Hospital Charge Code	270655292
Hospital Revenue Code	276
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

LENS PANOPTIX 23.5 DIOPTER

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697250
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,417.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PANOPTIX 23.5 DIOPTER

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697250
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PANOPTIX TRIFOC 24.5 DIOP

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697072
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,417.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PANOPTIX TRIFOC 24.5 DIOP

Facility

$4,725.00

Service Code	HCPCS V2788
Hospital Charge Code	270697072
Hospital Revenue Code	276
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LENS PAPER CLEANING TISSUE

Facility

$1.35

Hospital Charge Code	270665600
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

LENS PAPER CLEANING TISSUE

Facility

$1.35

Hospital Charge Code	270665600
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna Commercial	$0.41
Rate for Payer: Aetna Medicare Advantage	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.34
Rate for Payer: Cigna Commercial	$0.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.18
Rate for Payer: Oxford Commercial	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.20
Rate for Payer: UnitedHealthcare Commercial	$0.68

LENS RESTORE

Facility

$4,475.00

Service Code	HCPCS V2788
Hospital Charge Code	270663818
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS RESTORE

Facility

$4,475.00

Hospital Charge Code	270663737
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS RESTORE

Facility

$4,475.00

Hospital Charge Code	270663817
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS RESTORE

Facility

$4,475.00

Hospital Charge Code	270663666
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

LENS RESTORE

Facility

$4,475.00

Hospital Charge Code	270663737
Hospital Revenue Code	276
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,342.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

Know your out-of-pocket cost for care.

All Charges