St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LENS INTRAOC SOFTTEC-HD-26.50

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903432
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-27.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903434
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-27.50

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903436
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-28.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903438
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-28.50

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903440
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-29.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903441
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-30.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903443
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-31.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903445
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-32.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903446
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-33.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903448
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-34.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903449
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-35.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903450
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-36.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903452
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-5.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903341
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-6.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903342
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-7.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903344
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-8.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903345
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-9.00

Facility

$210.00

Service Code	HCPCS C1780
Hospital Charge Code	64903346
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 INTRAOCULAR MA60AC 18.0D

Facility

$350.00

Service Code	HCPCS C1780
Hospital Charge Code	64901025
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

LENS INTRAOCULAR MA60AC 18.5D

Facility

$437.50

Service Code	HCPCS C1780
Hospital Charge Code	64901027
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$459.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.50
Rate for Payer: EmblemHealth Commercial	$218.75
Rate for Payer: Fidelis Medicare Advantage	$459.38
Rate for Payer: Group Health Inc Commercial	$218.75
Rate for Payer: Group Health Inc Medicare	$153.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$218.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.38

LENS INTRAOCULAR MA60AC 22.0D

Facility

$350.00

Service Code	HCPCS C1780
Hospital Charge Code	64901029
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

LENS INTRAOCULAR MA60AC 22.5D

Facility

$350.00

Service Code	HCPCS C1780
Hospital Charge Code	64901031
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

LENS INTRAOCULAR MA60AC 25.0D

Facility

$375.00

Service Code	HCPCS C1780
Hospital Charge Code	64901033
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$255.00
Rate for Payer: EmblemHealth Commercial	$187.50
Rate for Payer: Fidelis Medicare Advantage	$393.75
Rate for Payer: Group Health Inc Commercial	$187.50
Rate for Payer: Group Health Inc Medicare	$131.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.75

LENS INTRAOCULAR MN60AC 20.5D

Facility

$437.50

Service Code	HCPCS C1780
Hospital Charge Code	64901024
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$459.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.50
Rate for Payer: EmblemHealth Commercial	$218.75
Rate for Payer: Fidelis Medicare Advantage	$459.38
Rate for Payer: Group Health Inc Commercial	$218.75
Rate for Payer: Group Health Inc Medicare	$153.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$218.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.38

LENS INTRAOCULAR MN60AC 21.0D

Facility

$437.50

Service Code	HCPCS C1780
Hospital Charge Code	64901021
Hospital Revenue Code	276
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$459.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$240.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.26
Rate for Payer: Aetna Government	$2.26
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$297.50
Rate for Payer: EmblemHealth Commercial	$218.75
Rate for Payer: Fidelis Medicare Advantage	$459.38
Rate for Payer: Group Health Inc Commercial	$218.75
Rate for Payer: Group Health Inc Medicare	$153.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.75
Rate for Payer: Hamaspik Choice Inc Medicare	$218.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$284.38

Know your out-of-pocket cost for care.

All Charges