|
LENS INTRAOCULAR MN60AC 22.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901023
|
|
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 MTA3UO 13.0
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901139
|
|
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 MTA3UO 15.0
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901141
|
|
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 MTA3UO 16.0
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901142
|
|
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 MTA3UO 17.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901034
|
|
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 MTA3UO 18.0D
|
Facility
|
OP
|
$237.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901171
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.50
|
| Rate for Payer: EmblemHealth Commercial |
$118.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.38
|
| Rate for Payer: Group Health Inc Commercial |
$118.75
|
| Rate for Payer: Group Health Inc Medicare |
$83.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.38
|
|
|
LENS INTRAOCULAR SN60AT 12.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901049
|
|
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 SN60AT 14.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901050
|
|
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 SN60AT 17.5
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901052
|
|
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 SN60AT 18.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901054
|
|
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 SN60AT 19.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901056
|
|
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 SN60AT 19.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901058
|
|
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 SN60AT 20.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901059
|
|
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 SN60AT 20.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901061
|
|
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 SN60AT 21.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901063
|
|
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 SN60AT 21.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901064
|
|
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 SN60AT 22.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901066
|
|
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 SN60AT 22.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901068
|
|
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 SN60AT 23.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901069
|
|
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 SN60AT 23.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901071
|
|
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 SN60AT 24.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901073
|
|
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 SN60AT 24.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901075
|
|
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 SN60AT 25.0D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901076
|
|
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 SN60AT 25.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901078
|
|
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 SN60AT 27.5D
|
Facility
|
OP
|
$437.50
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64901080
|
|
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
|
|
