|
LENS PANOPTIX CNWTT0+22.0
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
LENS PANOPTIX CNWTT0+22.0
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
LENS PANOPTIX CNWTT0+23.5
|
Facility
|
IP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT0+23.5
|
Facility
|
OP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem Medicaid |
$1,367.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Humana KY Medicaid |
$1,367.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT3+19.5
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTT3+19.5
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTT3+20.5
|
Facility
|
OP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem Medicaid |
$1,367.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Humana KY Medicaid |
$1,367.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT3+20.5
|
Facility
|
IP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT3+22.0
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
LENS PANOPTIX CNWTT3+22.0
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
LENS PANOPTIX CNWTT3+24.5
|
Facility
|
OP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem Medicaid |
$1,367.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Humana KY Medicaid |
$1,367.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT3+24.5
|
Facility
|
IP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT3+26.0
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
LENS PANOPTIX CNWTT3+26.0
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
LENS PANOPTIX CNWTT5+16.5
|
Facility
|
IP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT5+16.5
|
Facility
|
OP
|
$3,976.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$3,817.20 |
| Rate for Payer: Aetna Commercial |
$3,061.71
|
| Rate for Payer: Anthem Medicaid |
$1,367.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,101.48
|
| Rate for Payer: Cash Price |
$1,988.12
|
| Rate for Payer: Cigna Commercial |
$3,300.29
|
| Rate for Payer: First Health Commercial |
$3,777.44
|
| Rate for Payer: Humana Commercial |
$3,379.81
|
| Rate for Payer: Humana KY Medicaid |
$1,367.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,381.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,260.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,934.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,499.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,982.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.64
|
| Rate for Payer: PHCS Commercial |
$3,817.20
|
| Rate for Payer: United Healthcare All Payer |
$3,499.10
|
|
|
LENS PANOPTIX CNWTT5+18.50
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTT5+18.50
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTT5+21.00
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTT5+21.00
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTTO+20.5
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX CNWTTO+20.5
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LENS PANOPTIX DIOPTER 23.0 (T)
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
LENS PANOPTIX DIOPTER 23.0 (T)
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
LENS PANOPTIX TFNT00+15.0
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
