|
LENS SV25T2 DIOPTR 16.5 RESTOR
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 17.5 (P)
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 17.5 (P)
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 26.5 (P)
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 26.5 (P)
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 8.5 (P)
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T3 DIOPTER 8.5 (P)
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T4 DIOPTER 20.5 (P)
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS SV25T4 DIOPTER 20.5 (P)
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
LENS TORIC CNA0T6+11.0
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS TORIC CNA0T6+11.0
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS TORIC CNW0T6
|
Facility
|
IP
|
$3,893.75
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,168.12 |
| Max. Negotiated Rate |
$3,738.00 |
| Rate for Payer: Aetna Commercial |
$2,998.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,037.12
|
| Rate for Payer: Cash Price |
$1,946.88
|
| Rate for Payer: Cigna Commercial |
$3,231.81
|
| Rate for Payer: First Health Commercial |
$3,699.06
|
| Rate for Payer: Humana Commercial |
$3,309.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,168.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,426.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,920.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,387.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.69
|
| Rate for Payer: PHCS Commercial |
$3,738.00
|
| Rate for Payer: United Healthcare All Payer |
$3,426.50
|
|
|
LENS TORIC CNW0T6
|
Facility
|
OP
|
$3,893.75
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,168.12 |
| Max. Negotiated Rate |
$3,738.00 |
| Rate for Payer: Aetna Commercial |
$2,998.19
|
| Rate for Payer: Anthem Medicaid |
$1,339.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,037.12
|
| Rate for Payer: Cash Price |
$1,946.88
|
| Rate for Payer: Cigna Commercial |
$3,231.81
|
| Rate for Payer: First Health Commercial |
$3,699.06
|
| Rate for Payer: Humana Commercial |
$3,309.69
|
| Rate for Payer: Humana KY Medicaid |
$1,339.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,168.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,365.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,426.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,920.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,387.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.69
|
| Rate for Payer: PHCS Commercial |
$3,738.00
|
| Rate for Payer: United Healthcare All Payer |
$3,426.50
|
|
|
LENS TORIC SN6AT5 +13.0
|
Facility
|
IP
|
$3,856.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
LENS TORIC SN6AT5 +13.0
|
Facility
|
OP
|
$3,856.25
|
|
|
Service Code
|
HCPCS V2787
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
LENS VIVITY CNWET0+19.0
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+19.0
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+20.5
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+20.5
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+21.0
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+21.0
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LENS VIVITY CNWET0+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 VIVITY CNWET0+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 VIVITY CNWET0+6.0
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
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 VIVITY CNWET0+6.0
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
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
|
|
