|
LENS IO CHIRON CIIVB 21.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602128
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 21.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602128
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 22.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602099
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 22.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602099
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 22.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602100
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 22.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602100
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 23.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602007
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 23.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602007
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 23.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602006
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 23.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602006
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 24.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602101
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 24.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602101
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 24.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270611019
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 24.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270611019
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 25.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602102
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 25.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602102
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 25.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602103
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 25.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602103
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 26.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602104
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 26.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602104
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 26.5
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602105
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 26.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602105
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 27.0
|
Facility
|
IP
|
$1,659.25
|
|
| Hospital Charge Code |
270602106
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$401.54 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 27.0
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602106
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|
|
LENS IO CHIRON CIIVB 27.5
|
Facility
|
OP
|
$1,659.25
|
|
| Hospital Charge Code |
270602107
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$248.89 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: Aetna Commercial |
$497.77
|
| Rate for Payer: Aetna Medicare Advantage |
$497.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$423.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$423.11
|
| Rate for Payer: Cigna Commercial |
$829.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$401.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$248.89
|
|