|
LENS INTRAOCCULAR 22.0 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653245
|
|
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 22.0 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653245
|
|
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 22.0 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653323
|
|
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 22.0 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653323
|
|
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+22.0 DIOPTER
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650865
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$162.14 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
LENS INTRAOCCULAR+22.0 DIOPTER
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650865
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.03
|
|
|
LENS INTRAOCCULAR+22.5
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650866
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.03
|
|
|
LENS INTRAOCCULAR+22.5
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650866
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$162.14 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
LENS INTRAOCCULAR 22.5 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653312
|
|
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 22.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270660635
|
|
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 22.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661238
|
|
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 22.5 DIOPTER
|
Facility
|
OP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661238
|
|
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 22.5 DIOPTER
|
Facility
|
IP
|
$720.40
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270660635
|
|
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 22.5 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653312
|
|
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 23.0 DIOPTER
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661734
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.03
|
|
|
LENS INTRAOCCULAR 23.0 DIOPTER
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270661734
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$162.14 |
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
LENS INTRAOCCULAR 23.0 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653246
|
|
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 23.0 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653325
|
|
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 23.0 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653246
|
|
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 23.0 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270653325
|
|
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 23.5 DIOPTER
|
Facility
|
IP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270664944
|
|
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 23.5 DIOPTER
|
Facility
|
OP
|
$1,623.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270664944
|
|
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+23.5 DIOPTER
|
Facility
|
IP
|
$1,548.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650867
|
|
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+23.5 DIOPTER
|
Facility
|
OP
|
$1,548.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
270650867
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$774.12 |
| Rate for Payer: Aetna Commercial |
$588.34
|
| 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 |
$774.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$374.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$232.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.97
|
|
|
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 |
$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
|
|
