|
LENS INTRAOCCULAR 13.0 DIOPTER
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655347
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Aetna Commercial |
$223.50
|
| Rate for Payer: Aetna Medicare Advantage |
$223.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.97
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.29
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.75
|
|
|
LENS INTRAOCCULAR+13.0 DIOPTER
|
Facility
|
IP
|
$887.00
|
|
| Hospital Charge Code |
270671559
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$214.65 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
|
LENS INTRAOCCULAR+13.0 DIOPTER
|
Facility
|
OP
|
$887.00
|
|
| Hospital Charge Code |
270671559
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$443.50 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: Aetna Medicare Advantage |
$266.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.19
|
| Rate for Payer: Cigna Commercial |
$443.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
|
LENS INTRAOCCULAR 13.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270664997
|
|
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 INTRAOCCULAR 13.5 DIOPTER
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655345
|
|
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 INTRAOCCULAR 13.5 DIOPTER
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655345
|
|
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 INTRAOCCULAR 13.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270664997
|
|
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 INTRAOCCULAR+13.5 DIOPTER
|
Facility
|
OP
|
$887.00
|
|
| Hospital Charge Code |
270650712
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$443.50 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: Aetna Medicare Advantage |
$266.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.19
|
| Rate for Payer: Cigna Commercial |
$443.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
|
LENS INTRAOCCULAR+13.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653278
|
|
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
|
|
|
LENS INTRAOCCULAR+13.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653278
|
|
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 INTRAOCCULAR+13.5 DIOPTER
|
Facility
|
IP
|
$887.00
|
|
| Hospital Charge Code |
270650712
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$214.65 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
|
LENS INTRAOCCULAR 14.0
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
270653250
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
LENS INTRAOCCULAR 14.0
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
270653250
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
LENS INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653295
|
|
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 INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653295
|
|
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 INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270653261
|
|
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 INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270653261
|
|
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 INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655288
|
|
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 INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655288
|
|
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
|
|
|
LENS INTRAOCCULAR 14.5 DIOPTER
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653296
|
|
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 INTRAOCCULAR 14.5 DIOPTER
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653296
|
|
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 INTRAOCCULAR 14.5 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270653256
|
|
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 INTRAOCCULAR 14.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270653256
|
|
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 INTRAOCCULAR+14.5 DIOPTER
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650886
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.05 |
| Max. Negotiated Rate |
$214.65 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
|
LENS INTRAOCCULAR+14.5 DIOPTER
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650886
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$266.10 |
| Rate for Payer: Aetna Commercial |
$266.10
|
| Rate for Payer: Aetna Medicare Advantage |
$266.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.19
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.05
|
|
