|
LENS IO ALCON MC71CM 16.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270605947
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 16.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270605947
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 16.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602267
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 16.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602267
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 17.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602268
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 17.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602268
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 17.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602269
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 17.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602269
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 18.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602270
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 18.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602270
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 18.5
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602271
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 18.5
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602271
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 19.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270605203
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 19.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270605203
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 20.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602272
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 20.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602272
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 21.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602273
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 21.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602273
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 22.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602274
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 22.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602274
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 23.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602275
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 23.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602275
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 24.0
|
Facility
|
IP
|
$2,267.25
|
|
| Hospital Charge Code |
270602276
|
|
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
|
|
LENS IO ALCON MC71CM 24.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602276
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|
|
LENS IO ALCON MC71CM 26.0
|
Facility
|
OP
|
$2,267.25
|
|
| Hospital Charge Code |
270602277
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$1,133.62 |
| Rate for Payer: Aetna Commercial |
$861.55
|
| 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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$498.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$340.09
|
| Rate for Payer: UnitedHealthcare Community & State |
$54.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$60.08
|
|