|
LENS CNA0T0 PL DIOPTER 18.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 19.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 19.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 19.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 19.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 20.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 20.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 20.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 20.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 21.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 21.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 21.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 21.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 22.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 22.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 22.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 22.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 23.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 23.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 23.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 23.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 24.0
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 24.0
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 24.5
|
Facility
|
IP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
|
LENS CNA0T0 PL DIOPTER 24.5
|
Facility
|
OP
|
$1,892.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,816.80 |
| Rate for Payer: Aetna Commercial |
$1,457.22
|
| Rate for Payer: Anthem Medicaid |
$650.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.15
|
| Rate for Payer: Cash Price |
$946.25
|
| Rate for Payer: Cigna Commercial |
$1,570.78
|
| Rate for Payer: First Health Commercial |
$1,797.88
|
| Rate for Payer: Humana Commercial |
$1,608.62
|
| Rate for Payer: Humana KY Medicaid |
$650.83
|
| Rate for Payer: Kentucky WC Medicaid |
$657.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.68
|
| Rate for Payer: PHCS Commercial |
$1,816.80
|
| Rate for Payer: United Healthcare All Payer |
$1,665.40
|
|
