|
CORNEA FOR TRANSPLANT
|
Facility
|
OP
|
$11,632.00
|
|
| Hospital Charge Code |
270616072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,512.16 |
| Max. Negotiated Rate |
$5,816.00 |
| Rate for Payer: Aetna Commercial |
$3,489.60
|
| Rate for Payer: Aetna Medicare Advantage |
$3,489.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,966.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,966.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,966.16
|
| Rate for Payer: Cigna Commercial |
$5,816.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,512.16
|
| Rate for Payer: Oxford Commercial |
$5,816.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,744.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,816.00
|
|
|
CORNEA FOR TRANSPLANT
|
Facility
|
IP
|
$7,257.65
|
|
| Hospital Charge Code |
270605752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.65 |
| Max. Negotiated Rate |
$1,756.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,451.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,756.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,088.65
|
|
|
CORNEA FOR TRANSPLANT
|
Facility
|
OP
|
$7,257.65
|
|
| Hospital Charge Code |
270605752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.65 |
| Max. Negotiated Rate |
$3,628.82 |
| Rate for Payer: Aetna Commercial |
$2,177.30
|
| Rate for Payer: Aetna Medicare Advantage |
$2,177.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,850.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,850.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,451.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,850.70
|
| Rate for Payer: Cigna Commercial |
$3,628.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,756.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,088.65
|
|
|
CORNEA FULL THICKNES
|
Facility
|
IP
|
$16,750.00
|
|
| Hospital Charge Code |
270678916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.50 |
| Max. Negotiated Rate |
$4,053.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,053.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,512.50
|
|
|
CORNEA FULL THICKNES
|
Facility
|
OP
|
$16,750.00
|
|
| Hospital Charge Code |
270678916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.50 |
| Max. Negotiated Rate |
$8,375.00 |
| Rate for Payer: Aetna Commercial |
$5,025.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,025.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,271.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,271.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,271.25
|
| Rate for Payer: Cigna Commercial |
$8,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,053.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,512.50
|
|
|
CORNEA GRAFT DSEK K002-DS
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS V2785
|
| Hospital Charge Code |
270687298
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,795.00 |
| Max. Negotiated Rate |
$10,750.00 |
| Rate for Payer: Aetna Commercial |
$6,450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$6,450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$5,482.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$5,482.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$10,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,795.00
|
| Rate for Payer: Oxford Commercial |
$10,750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,225.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$10,750.00
|
|
|
CORNEA GRAFT DSEK K002-DS
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS V2785
|
| Hospital Charge Code |
270687298
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$3,225.00 |
| Max. Negotiated Rate |
$3,225.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,225.00
|
|
|
CORNEA HUMAN TISSUE
|
Facility
|
OP
|
$19,000.00
|
|
| Hospital Charge Code |
270662061
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,845.00
|
| Rate for Payer: Cigna Commercial |
$9,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$9,500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,500.00
|
|
|
CORNEA HUMAN TISSUE
|
Facility
|
IP
|
$19,000.00
|
|
| Hospital Charge Code |
270662061
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
|
|
CORNEA HUMAN TISSUE
|
Facility
|
IP
|
$19,000.00
|
|
|
Service Code
|
HCPCS V2785
|
| Hospital Charge Code |
270670868
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,850.00 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
|
|
CORNEA HUMAN TISSUE
|
Facility
|
OP
|
$19,000.00
|
|
|
Service Code
|
HCPCS V2785
|
| Hospital Charge Code |
270670868
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,845.00
|
| Rate for Payer: Cigna Commercial |
$9,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$9,500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,500.00
|
|
|
CORNEAL COLLAGEN SHIELD 24HR
|
Facility
|
OP
|
$180.35
|
|
| Hospital Charge Code |
270650815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$90.17 |
| Rate for Payer: Aetna Commercial |
$54.10
|
| Rate for Payer: Aetna Medicare Advantage |
$54.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$45.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$45.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$45.99
|
| Rate for Payer: Cigna Commercial |
$90.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$23.45
|
| Rate for Payer: Oxford Commercial |
$90.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$90.17
|
|
|
CORNEAL COLLAGEN SHIELD 24HR
|
Facility
|
IP
|
$180.35
|
|
| Hospital Charge Code |
270650815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$27.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$27.05
|
|
|
CORNEAL COLLAGEN SHIELD OASIS
|
Facility
|
OP
|
$16.25
|
|
| Hospital Charge Code |
270655273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna Medicare Advantage |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.14
|
| Rate for Payer: Cigna Commercial |
$8.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.11
|
| Rate for Payer: Oxford Commercial |
$8.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.12
|
|
|
CORNEAL COLLAGEN SHIELD OASIS
|
Facility
|
IP
|
$16.25
|
|
| Hospital Charge Code |
270655273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.44
|
|
|
CORNEAL PROTECTORS
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
270335129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Medicare Advantage |
$19.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.83
|
| Rate for Payer: Cigna Commercial |
$33.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$8.58
|
| Rate for Payer: Oxford Commercial |
$33.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.00
|
|
|
CORNEAL PROTECTORS
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
270335129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|
|
CORNEAL SHIELDS ADULT
|
Facility
|
OP
|
$35.80
|
|
| Hospital Charge Code |
270620339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$17.90 |
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$9.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$9.13
|
| Rate for Payer: Cigna Commercial |
$17.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.65
|
| Rate for Payer: Oxford Commercial |
$17.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.90
|
|
|
CORNEAL SHIELDS ADULT
|
Facility
|
IP
|
$35.80
|
|
| Hospital Charge Code |
270620339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.37
|
|
|
CORNEA Sclera, Quarter
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
270682018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$382.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$382.50
|
| Rate for Payer: Cigna Commercial |
$750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
CORNEA Sclera, Quarter
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
270682018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$300.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$363.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$225.00
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$19,000.00
|
|
| Hospital Charge Code |
270663595
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$9,500.00 |
| Rate for Payer: Aetna Commercial |
$5,700.00
|
| Rate for Payer: Aetna Medicare Advantage |
$5,700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,845.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,845.00
|
| Rate for Payer: Cigna Commercial |
$9,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,470.00
|
| Rate for Payer: Oxford Commercial |
$9,500.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$9,500.00
|
|
|
CORNEA TISSUE
|
Facility
|
OP
|
$15,500.00
|
|
| Hospital Charge Code |
270661154
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,015.00 |
| Max. Negotiated Rate |
$7,750.00 |
| Rate for Payer: Aetna Commercial |
$4,650.00
|
| Rate for Payer: Aetna Medicare Advantage |
$4,650.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,952.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,952.50
|
| Rate for Payer: Cigna Commercial |
$7,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,015.00
|
| Rate for Payer: Oxford Commercial |
$7,750.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$7,750.00
|
|
|
CORNEA TISSUE
|
Facility
|
IP
|
$15,500.00
|
|
| Hospital Charge Code |
270661154
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,325.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
|
|
CORNEA TISSUE
|
Facility
|
IP
|
$15,500.00
|
|
| Hospital Charge Code |
270661141
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$2,325.00 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,325.00
|
|