|
LENS INTRAOCCULAR 24.0 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653328
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$486.98 |
| Rate for Payer: Aetna Commercial |
$486.98
|
| Rate for Payer: Aetna Medicare Advantage |
$486.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$413.93
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$392.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.49
|
|
|
LENS INTRAOCCULAR 24.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270653252
|
|
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 24.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
| Hospital Charge Code |
270653252
|
|
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 24.0 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653328
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$392.83 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$392.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.49
|
|
|
LENS INTRAOCCULAR+24.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650869
|
|
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+24.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650869
|
|
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 INTRAOCCULAR24.5 DIO FOLD
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650644
|
|
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 INTRAOCCULAR24.5 DIO FOLD
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650644
|
|
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 24.5 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653302
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$243.49 |
| Max. Negotiated Rate |
$392.83 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$392.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.49
|
|
|
LENS INTRAOCCULAR 24.5 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653302
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$486.98 |
| Rate for Payer: Aetna Commercial |
$486.98
|
| Rate for Payer: Aetna Medicare Advantage |
$486.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$413.93
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$392.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.49
|
|
|
LENS INTRAOCCULAR 24.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
| Hospital Charge Code |
661735
|
|
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 24.5 DIOPTER
|
Facility
|
OP
|
$1,548.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661735
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$464.48 |
| Rate for Payer: Aetna Commercial |
$464.48
|
| Rate for Payer: Aetna Medicare Advantage |
$464.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$394.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$394.80
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$374.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.24
|
|
|
LENS INTRAOCCULAR 24.5 DIOPTER
|
Facility
|
IP
|
$1,548.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661735
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$232.24 |
| Max. Negotiated Rate |
$374.68 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$374.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.24
|
|
|
LENS INTRAOCCULAR 24.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
| Hospital Charge Code |
661735
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$360.20 |
| 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 |
$360.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.06
|
|
|
LENS INTRAOCCULAR +25
|
Facility
|
IP
|
$887.00
|
|
| Hospital Charge Code |
270650616
|
|
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 +25
|
Facility
|
OP
|
$887.00
|
|
| Hospital Charge Code |
270650616
|
|
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 25.0 DIOPTER
|
Facility
|
IP
|
$1,748.70
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653306
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$423.19 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.31
|
|
|
LENS INTRAOCCULAR 25.0 DIOPTER
|
Facility
|
OP
|
$1,748.70
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653306
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$524.61 |
| Rate for Payer: Aetna Commercial |
$524.61
|
| Rate for Payer: Aetna Medicare Advantage |
$524.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$445.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$445.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$445.92
|
| Rate for Payer: Cigna Commercial |
$145.73
|
| Rate for Payer: Cigna Medicare Advantage |
$87.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.31
|
|
|
LENS INTRAOCCULAR 25.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661736
|
|
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 25.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
| Hospital Charge Code |
270650619
|
|
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 25.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661736
|
|
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 25.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
| Hospital Charge Code |
270650619
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$360.20 |
| 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 |
$360.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.06
|
|
|
LENS INTRAOCCULAR 25.5DIO FOLD
|
Facility
|
IP
|
$720.40
|
|
| Hospital Charge Code |
270650617
|
|
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 25.5DIO FOLD
|
Facility
|
OP
|
$720.40
|
|
| Hospital Charge Code |
270650617
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$360.20 |
| 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 |
$360.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.06
|
|
|
LENS INTRAOCCULAR 25.5 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
| Hospital Charge Code |
270653253
|
|
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
|
|
