|
LENS INTRAOCULAR MZ30BD 14.0
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270646212
|
|
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 INTRAOCULAR MZ30BD 14.0
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270646212
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 14.5
|
Facility
|
OP
|
$744.00
|
|
| Hospital Charge Code |
278636775
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Medicare Advantage |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.72
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 14.5
|
Facility
|
OP
|
$744.00
|
|
| Hospital Charge Code |
270636775
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Medicare Advantage |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.72
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 14.5
|
Facility
|
IP
|
$744.00
|
|
| Hospital Charge Code |
278636775
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 14.5
|
Facility
|
IP
|
$744.00
|
|
| Hospital Charge Code |
270636775
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 15.0
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270640128
|
|
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 INTRAOCULAR MZ30BD 15.0
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270640128
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 15.5
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270639578
|
|
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 INTRAOCULAR MZ30BD 15.5
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270639578
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 21.5
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270621297
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 21.5
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270621297
|
|
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 INTRAOCULAR MZ30BD 22.0
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270619948
|
|
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 INTRAOCULAR MZ30BD 22.0
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270619948
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 22.5
|
Facility
|
OP
|
$744.00
|
|
| Hospital Charge Code |
276636776
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Medicare Advantage |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.72
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 22.5
|
Facility
|
IP
|
$744.00
|
|
| Hospital Charge Code |
276636776
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 25.0
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270646214
|
|
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 INTRAOCULAR MZ30BD 25.0
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270646214
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 25.5
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270646215
|
|
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 INTRAOCULAR MZ30BD 25.5
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270646215
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 26.5
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
270641344
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$375.00 |
| 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 |
$375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$181.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$112.50
|
|
|
LENS INTRAOCULAR MZ30BD 26.5
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
270641344
|
|
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 INTRAOCULAR MZ30BD 28.0
|
Facility
|
IP
|
$744.00
|
|
| Hospital Charge Code |
270634909
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ30BD 28.0
|
Facility
|
OP
|
$744.00
|
|
| Hospital Charge Code |
270634909
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Medicare Advantage |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.72
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|
|
LENS INTRAOCULAR MZ60BD 10.0
|
Facility
|
OP
|
$744.00
|
|
| Hospital Charge Code |
270617657
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Medicare Advantage |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$189.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$189.72
|
| Rate for Payer: Cigna Commercial |
$372.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$180.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$111.60
|
|