|
LENS INTRAOC 3 PIECE ASP PAL-16.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903459
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-17.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903461
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-17.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903463
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-18.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903465
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-18.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903467
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-19.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903469
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-19.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903471
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-20.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903473
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-20.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903475
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-21.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903477
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-21.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903479
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-22.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903481
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-22.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903483
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASPPAL-23.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903485
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-23.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903487
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-24.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903489
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-24.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903491
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-25.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903493
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-25.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903494
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-26.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903496
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-26.5
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903498
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC 3 PIECE ASP PAL-27.0
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903499
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
LENS INTRAOC SOFTTEC-HD-10.00
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1840
|
| Hospital Charge Code |
64903348
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$648.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.95
|
| Rate for Payer: Aetna Government |
$648.95
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LENS INTRAOC SOFTTEC-HD-10.50
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903349
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LENS INTRAOC SOFTTEC-HD-11.00
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64903351
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
