|
LENGTHENER HII MICRO
|
Facility
|
OP
|
$23,714.15
|
|
| Hospital Charge Code |
270688786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,082.84 |
| Max. Negotiated Rate |
$11,857.08 |
| Rate for Payer: Aetna Commercial |
$7,114.24
|
| Rate for Payer: Aetna Medicare Advantage |
$7,114.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6,047.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6,047.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6,047.11
|
| Rate for Payer: Cigna Commercial |
$11,857.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,082.84
|
| Rate for Payer: Oxford Commercial |
$11,857.08
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3,557.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$11,857.08
|
|
|
LENGTH/RELS ABD HALLUCIS MSCL
|
Facility
|
IP
|
$12,289.60
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
16000721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,843.44 |
| Max. Negotiated Rate |
$1,843.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,843.44
|
|
|
LENGTH/RELS ABD HALLUCIS MSCL
|
Facility
|
OP
|
$12,289.60
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
16000721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,597.65 |
| Max. Negotiated Rate |
$7,791.93 |
| Rate for Payer: Aetna Commercial |
$3,686.88
|
| Rate for Payer: Aetna Medicare Advantage |
$3,686.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,133.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,133.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,133.85
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,597.65
|
| Rate for Payer: Oxford Commercial |
$4,871.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,843.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$5,529.00
|
|
|
LENGTH/SHORT TNDNLEG/ANKLE,SGL
|
Facility
|
OP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
16000351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,864.00 |
| Max. Negotiated Rate |
$9,178.50 |
| Rate for Payer: Aetna Better Health Medicaid |
$8,649.28
|
| Rate for Payer: Aetna Commercial |
$9,178.50
|
| Rate for Payer: Aetna Medicare Advantage |
$9,178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,801.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,801.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,801.73
|
| Rate for Payer: Cigna Commercial |
$7,791.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,977.35
|
| Rate for Payer: Oxford Commercial |
$6,055.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$6,873.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$8,822.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8,649.28
|
|
|
LENGTH/SHORT TNDNLEG/ANKLE,SGL
|
Facility
|
IP
|
$30,595.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
16000351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,589.25 |
| Max. Negotiated Rate |
$4,589.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4,589.25
|
|
|
LEN INTRAOCCUAR 14.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270675795
|
|
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
|
|
|
LEN INTRAOCCUAR 14.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270675795
|
|
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
|
|
|
LEN INTRAOCCUAR 16.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270675796
|
|
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
|
|
|
LEN INTRAOCCUAR 16.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270675796
|
|
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
|
|
|
LEN INTRAOCCUAR 19.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675797
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$145.73 |
| 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 |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
LEN INTRAOCCUAR 19.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675797
|
|
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
|
|
|
LEN INTRAOCCUAR 26.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270675798
|
|
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
|
|
|
LEN INTRAOCCUAR 26.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270675798
|
|
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
|
|
|
LEN INTRAOCCUAR 27.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270675799
|
|
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
|
|
|
LEN INTRAOCCUAR 27.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270675799
|
|
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
|
|
|
LEN INTRAOCCUAR 30.0 DIOPTER
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675800
|
|
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
|
|
|
LEN INTRAOCCUAR 30.0 DIOPTER
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675800
|
|
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
|
|
|
LEN INTRAOCCUAR 7.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675792
|
|
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
|
|
|
LEN INTRAOCCUAR 7.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675792
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$145.73 |
| 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 |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
LEN INTRAOCCUAR 7.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270675793
|
|
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
|
|
|
LEN INTRAOCCUAR 7.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270675793
|
|
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
|
|
|
LEN INTRAOCCUAR 8.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675794
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$145.73 |
| 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 |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$102.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.75
|
|
|
LEN INTRAOCCUAR 8.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270675794
|
|
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
|
|
|
LEN INTRAOCCULAR 11.5 DIOPTOR
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270687405
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$216.12 |
| 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 |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.06
|
|
|
LEN INTRAOCCULAR 11.5 DIOPTOR
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270687405
|
|
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
|
|