|
LENS PANOPTIX CNWTT0 18.5
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
LENS PANOPTIX CNWTT0 19.0
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT0 19.0
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT0+20.5
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT0+20.5
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT0+22.0
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT0+22.0
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT0+23.5
|
Facility
|
OP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem Medicaid |
$1,342.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Humana KY Medicaid |
$1,342.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,369.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT0+23.5
|
Facility
|
IP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT3+15.0
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LENS PANOPTIX CNWTT3+15.0
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LENS PANOPTIX CNWTT3+19.5
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT3+19.5
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT3+20.5
|
Facility
|
OP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem Medicaid |
$1,342.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Humana KY Medicaid |
$1,342.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,369.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT3+20.5
|
Facility
|
IP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT3+21.50
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT3+21.50
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LENS PANOPTIX CNWTT3+22.0
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
LENS PANOPTIX CNWTT3+22.0
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
LENS PANOPTIX CNWTT3+24.5
|
Facility
|
IP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT3+24.5
|
Facility
|
OP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem Medicaid |
$1,342.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Humana KY Medicaid |
$1,342.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,369.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT3+26.0
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT3+26.0
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
LENS PANOPTIX CNWTT5+16.5
|
Facility
|
OP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem Medicaid |
$1,342.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Humana KY Medicaid |
$1,342.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,369.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
|
LENS PANOPTIX CNWTT5+16.5
|
Facility
|
IP
|
$3,903.12
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,170.94 |
| Max. Negotiated Rate |
$3,747.00 |
| Rate for Payer: Aetna Commercial |
$3,005.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,044.43
|
| Rate for Payer: Cash Price |
$1,951.56
|
| Rate for Payer: Cigna Commercial |
$3,239.59
|
| Rate for Payer: First Health Commercial |
$3,707.96
|
| Rate for Payer: Humana Commercial |
$3,317.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,200.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,880.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,927.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,122.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,395.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.15
|
| Rate for Payer: PHCS Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Payer |
$3,434.75
|
|
