|
LENS SN6CWS DIOPTER 15.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 15.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 15.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 16.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 16.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 16.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 16.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 17.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 17.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 17.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 17.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 18.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 18.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 18.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 18.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 19.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 19.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 19.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 19.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 20.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 20.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 20.5 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 20.5 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 21.0 (S)
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
LENS SN6CWS DIOPTER 21.0 (S)
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS V2630
|
| Hospital Charge Code |
27000069
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
