|
LENS INTRAOCCULAR 14.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270655288
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$360.20 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.46
|
|
|
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
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653296
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
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 |
$25.19 |
| Max. Negotiated Rate |
$443.50 |
| Rate for Payer: Aetna Commercial |
$337.06
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.19
|
|
|
LENS INTRAOCCULAR 15.0 DIO
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653330
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
LENS INTRAOCCULAR 15.0 DIO
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653330
|
|
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 15.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661729
|
|
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 15.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661729
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$360.20 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.46
|
|
|
LENS INTRAOCCULAR 15.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661730
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$360.20 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.46
|
|
|
LENS INTRAOCCULAR 15.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661730
|
|
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 16.0 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653299
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$46.10 |
| Max. Negotiated Rate |
$811.62 |
| Rate for Payer: Aetna Commercial |
$616.84
|
| 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 |
$811.62
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$392.83
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.49
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.10
|
|
|
LENS INTRAOCCULAR 16.0 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653299
|
|
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+16.0 DIOPTER
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653279
|
|
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+16.0 DIOPTER
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653279
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$443.50 |
| Rate for Payer: Aetna Commercial |
$337.06
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.19
|
|
|
LENS INTRAOCCULAR 16.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653240
|
|
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 16.5 DIOPTER
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653311
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$23.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.30
|
|
|
LENS INTRAOCCULAR 16.5 DIOPTER
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653311
|
|
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 16.5 DIOPTER
|
Facility
|
IP
|
$887.20
|
|
| Hospital Charge Code |
270655268
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.08
|
|
|
LENS INTRAOCCULAR 16.5 DIOPTER
|
Facility
|
OP
|
$887.20
|
|
| Hospital Charge Code |
270655268
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$443.60 |
| Rate for Payer: Aetna Commercial |
$337.14
|
| Rate for Payer: Aetna Medicare Advantage |
$266.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$226.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$226.24
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$226.24
|
| Rate for Payer: Cigna Commercial |
$443.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$214.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$133.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.20
|
|
|
LENS INTRAOCCULAR 16.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653240
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$360.20 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.46
|
|
|
LENS INTRAOCCULAR+16.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653280
|
|
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+16.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653280
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$360.20 |
| Rate for Payer: Aetna Commercial |
$273.75
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.46
|
|
|
LENS INTRAOCCULAR 17.0 DIOPTER
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270664998
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| 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
|
| Rate for Payer: UnitedHealthcare Community & State |
$13.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$12.07
|
|
|
LENS INTRAOCCULAR 17.0 DIOPTER
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270664998
|
|
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
|
|
