|
LENS SV25T4 DIOPTER 20.5 (P)
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
LENS SV25T4 DIOPTER 20.5 (P)
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
LENS TORIC CNA0T6+11.0
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LENS TORIC CNA0T6+11.0
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LENS TORIC CNW0T6
|
Facility
|
IP
|
$3,967.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$515.78 |
| Max. Negotiated Rate |
$3,808.80 |
| Rate for Payer: Aetna Commercial |
$3,054.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,094.65
|
| Rate for Payer: Cash Price |
$1,983.75
|
| Rate for Payer: Cigna Commercial |
$3,293.02
|
| Rate for Payer: First Health Commercial |
$3,769.12
|
| Rate for Payer: Humana Commercial |
$3,372.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,975.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.92
|
| Rate for Payer: PHCS Commercial |
$3,808.80
|
| Rate for Payer: United Healthcare All Payer |
$3,491.40
|
|
|
LENS TORIC CNW0T6
|
Facility
|
OP
|
$3,967.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$515.78 |
| Max. Negotiated Rate |
$3,808.80 |
| Rate for Payer: Aetna Commercial |
$3,054.98
|
| Rate for Payer: Anthem Medicaid |
$1,364.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,094.65
|
| Rate for Payer: Cash Price |
$1,983.75
|
| Rate for Payer: Cigna Commercial |
$3,293.02
|
| Rate for Payer: First Health Commercial |
$3,769.12
|
| Rate for Payer: Humana Commercial |
$3,372.38
|
| Rate for Payer: Humana KY Medicaid |
$1,364.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,391.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,975.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.92
|
| Rate for Payer: PHCS Commercial |
$3,808.80
|
| Rate for Payer: United Healthcare All Payer |
$3,491.40
|
|
|
LENS TORIC SN6AT5 +13.0
|
Facility
|
IP
|
$3,932.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
LENS TORIC SN6AT5 +13.0
|
Facility
|
OP
|
$3,932.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
LENS VIVITY CNWET0+19.0
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LENS VIVITY CNWET0+19.0
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LENS VIVITY CNWET0+22.0
|
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 VIVITY CNWET0+22.0
|
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 VIVITY CNWET3 11.50
|
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 VIVITY CNWET3 11.50
|
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 VIVITY CNWET3+20.0
|
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 VIVITY CNWET3+20.0
|
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 VIVITY CNWET3 23.0
|
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 VIVITY CNWET3 23.0
|
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 VIVITY CNWET4+13.0
|
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 VIVITY CNWET4+13.0
|
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 VIVITY CNWET4+14.5
|
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 VIVITY CNWET4+14.5
|
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 VIVITY CNWETE 22.0
|
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 VIVITY CNWETE 22.0
|
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 VIVITY DFT 015*13.5
|
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
|
|
