LENS INTRAOCULAR SN60AT 28.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901081
|
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 28.5D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901083
|
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 SN60WF 16.5
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64903948
|
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 SN60WF 17.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64904724
|
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 SN60WF 18.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901008
|
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 SN60WF 18.5D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901013
|
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 SN60WF 19.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901011
|
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 SN60WF 20.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901006
|
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 SN60WF 20.5D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901010
|
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 SN60WF 21.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901015
|
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 SN60WF 21.5D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901016
|
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 SN60WF 22.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901018
|
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 SN60WF 23.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901019
|
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 SN60WF 23.5D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901005
|
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 SN60WF 24.0D
|
Facility
|
OP
|
$437.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901705
|
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 ZCBOO 21.0D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901047
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 21.5D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901041
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 23.0D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901043
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 23.5D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901036
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 24.0D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901038
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 24.5D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901040
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS INTRAOCULAR ZCBOO 27.0D
|
Facility
|
OP
|
$412.50
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64901045
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$433.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$247.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
Rate for Payer: EmblemHealth Commercial |
$206.25
|
Rate for Payer: Fidelis Medicare Advantage |
$433.12
|
Rate for Payer: Group Health Inc Commercial |
$206.25
|
Rate for Payer: Group Health Inc Medicare |
$144.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
LENS ITEC PLOAD MONO 22.0D
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64906336
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$136.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$78.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
Rate for Payer: EmblemHealth Commercial |
$65.00
|
Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
Rate for Payer: Group Health Inc Commercial |
$65.00
|
Rate for Payer: Group Health Inc Medicare |
$45.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
LENS ITEC PLOAD MONO 30.5D
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64906337
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$136.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$78.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
Rate for Payer: EmblemHealth Commercial |
$65.00
|
Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
Rate for Payer: Group Health Inc Commercial |
$65.00
|
Rate for Payer: Group Health Inc Medicare |
$45.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
LENS ITEC PLOAD MONO 5.0D
|
Facility
|
OP
|
$130.00
|
|
Service Code
|
HCPCS C1780
|
Hospital Charge Code |
64906285
|
Hospital Revenue Code
|
276
|
Min. Negotiated Rate |
$2.26 |
Max. Negotiated Rate |
$136.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
Rate for Payer: Aetna Government |
$2.26
|
Rate for Payer: Brighton Health Commercial |
$78.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
Rate for Payer: EmblemHealth Commercial |
$65.00
|
Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
Rate for Payer: Group Health Inc Commercial |
$65.00
|
Rate for Payer: Group Health Inc Medicare |
$45.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|