|
LENS CNA0T0 PL DIOPTER 6.5
|
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 7.0
|
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 7.0
|
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 7.5
|
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 7.5
|
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 8.0
|
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 8.0
|
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 8.5
|
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 8.5
|
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 9.0
|
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 9.0
|
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 9.5
|
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 9.5
|
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 - DIOPTER (S) V2630
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
LENS - DIOPTER (S) V2630
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
LENS - DIOPTER (S) V2632
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
LENS - DIOPTER (S) V2632
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
LENS - DIOPTER (T) V2787
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem Medicaid |
$187.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Humana KY Medicaid |
$187.43
|
| Rate for Payer: Kentucky WC Medicaid |
$189.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.95
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
LENS - DIOPTER (T) V2787
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.95
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
LENS GLIDE
|
Facility
|
IP
|
$45.25
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$37.56
|
| Rate for Payer: First Health Commercial |
$42.99
|
| Rate for Payer: Humana Commercial |
$38.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.82
|
| Rate for Payer: Ohio Health Group HMO |
$33.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.03
|
| Rate for Payer: PHCS Commercial |
$43.44
|
| Rate for Payer: United Healthcare All Payer |
$39.82
|
|
|
LENS GLIDE
|
Facility
|
OP
|
$45.25
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Aetna Commercial |
$34.84
|
| Rate for Payer: Anthem Medicaid |
$15.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$37.56
|
| Rate for Payer: First Health Commercial |
$42.99
|
| Rate for Payer: Humana Commercial |
$38.46
|
| Rate for Payer: Humana KY Medicaid |
$15.56
|
| Rate for Payer: Kentucky WC Medicaid |
$15.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.82
|
| Rate for Payer: Ohio Health Group HMO |
$33.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.03
|
| Rate for Payer: PHCS Commercial |
$43.44
|
| Rate for Payer: United Healthcare All Payer |
$39.82
|
|
|
LENS MA60AC DIOPTER 10.0 (S)
|
Facility
|
IP
|
$1,784.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$1,712.64 |
| Rate for Payer: Aetna Commercial |
$1,373.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.52
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cigna Commercial |
$1,480.72
|
| Rate for Payer: First Health Commercial |
$1,694.80
|
| Rate for Payer: Humana Commercial |
$1,516.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.04
|
| Rate for Payer: PHCS Commercial |
$1,712.64
|
| Rate for Payer: United Healthcare All Payer |
$1,569.92
|
|
|
LENS MA60AC DIOPTER 10.0 (S)
|
Facility
|
OP
|
$1,784.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$1,712.64 |
| Rate for Payer: Aetna Commercial |
$1,373.68
|
| Rate for Payer: Anthem Medicaid |
$613.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.52
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cigna Commercial |
$1,480.72
|
| Rate for Payer: First Health Commercial |
$1,694.80
|
| Rate for Payer: Humana Commercial |
$1,516.40
|
| Rate for Payer: Humana KY Medicaid |
$613.52
|
| Rate for Payer: Kentucky WC Medicaid |
$619.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.04
|
| Rate for Payer: PHCS Commercial |
$1,712.64
|
| Rate for Payer: United Healthcare All Payer |
$1,569.92
|
|
|
LENS MA60AC DIOPTER 10.5 (S)
|
Facility
|
OP
|
$1,784.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$1,712.64 |
| Rate for Payer: Aetna Commercial |
$1,373.68
|
| Rate for Payer: Anthem Medicaid |
$613.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.52
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cigna Commercial |
$1,480.72
|
| Rate for Payer: First Health Commercial |
$1,694.80
|
| Rate for Payer: Humana Commercial |
$1,516.40
|
| Rate for Payer: Humana KY Medicaid |
$613.52
|
| Rate for Payer: Kentucky WC Medicaid |
$619.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.04
|
| Rate for Payer: PHCS Commercial |
$1,712.64
|
| Rate for Payer: United Healthcare All Payer |
$1,569.92
|
|
|
LENS MA60AC DIOPTER 10.5 (S)
|
Facility
|
IP
|
$1,784.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$1,712.64 |
| Rate for Payer: Aetna Commercial |
$1,373.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.52
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cigna Commercial |
$1,480.72
|
| Rate for Payer: First Health Commercial |
$1,694.80
|
| Rate for Payer: Humana Commercial |
$1,516.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.04
|
| Rate for Payer: PHCS Commercial |
$1,712.64
|
| Rate for Payer: United Healthcare All Payer |
$1,569.92
|
|
