We make every effort to maintain fees as fair as possible for the services rendered. By paying at the time of service, you can help us limit unnecessary expenses.
Insurance coverage is seldom designed to pay the entire cost of your medical and surgical care, and patients are responsible for any unpaid balance. Each patient with an open account will receive a monthly statement. If you have surgery, we will (at no extra cost) assist you in securing payment from your insurance companies. Payment is not required for 60 days to allow time for a claim to be processed.
Many companies offer their employees flexible spending plans to use towards health care expenses. If you have this option, you can save up to $978 by allocating the expense of your Laser Vision Correction to your flexible spending account. The applied money is not taxed by the IRS, which increases your spendable income. Take a look at the chart to the left for an illustration of how much money you can save by utilizing your FSA account.
| Employee Income and costs | Without FSA | With FSA | |
|---|---|---|---|
| Annual Income | $50,000 | $50,000 | |
| Health Care Account | $0 | $3490 | |
| Adjusted Taxable Income | $50000 | $46510 | |
| Taxes Paid (28%) | $14000 | $13022 | |
| After-Tax Income | $33488 | $36000 | |
| Healh Care Account Costs | $3490 | $0 | |
| Spendable Income | $32510 | $33488 | |
Price Transparency
| CPT CODE |
Description | Standard Charge |
Medicare Allowed |
Indiana Medicaid Allowed |
Self-Pay *Uninsured |
|---|---|---|---|---|---|
| 67228 | Panretinal Photocoagulation (PRP) | 500.00 | 173.45 | 329.12 | 173.45 |
| 65855 | Trabeculoplasty by Laser (ALT/SLT) | 500.00 | 131.46 | 329.12 | 131.46 |
| 66762 | Iridoplasty by Photocoagulation (ALIR) | 600.00 | 273.25 | 218.54 | 273.25 |
| 67145 | Retinal Tear Laser (ALR) | 600.00 | 146.31 | 443.28 | 146.31 |
| 67210 | Retinal Laser (IMD) | 600.00 | 270.11 | 318.54 | 270.11 |
| 66821 | Yag Capsulotomy Laser | 856.00 | 297.42 | 443.28 | 297.42 |
| 66761 | Yag Iridotomy (YLI) | 1000.00 | 183.78 | 800.42 | 183.78 |
| 67031 | Vitreolysis | 1000.00 | 297.42 | 443.28 | 297.42 |
| 66984 | Cataract Extraction w/lens | 1879.00 | 1167.60 | 1106.60 | 1167.60 |
| 66982 | Cataract Extraction w/lens Extended | 1879.00 | 1167.60 | 1106.60 | 1167.60 |
| 68760 | Punctal Closure | 200.00 | 149.05 | 267.91 | 149.05 |
| J1096 | Injectable Steroid | 2000.00 | 494.04 | 443.28 | 494.04 |
| 0191T | IStent w/cataract surgery | 3300.00 | 2708.97 | 2226.60 | 2708.97 |
| 65820 | Goniotomy | 2200.00 | 2017.38 | 582.98 | 2017.38 |
| 67908 | Ptosis Repair | 1478.00 | 965.20 | 582.98 | 965.20 |
| 15823 | Blepharoplasty | 2000.00 | 933.10 | 582.98 | 933.10 |
| 66170 | Trabeculectomy | 1478.00 | 1167.60 | 582.98 | 1167.60 |
| 68130 | Conjunctival Cyst Excision | 1300.00 | 965.20 | 443.28 | 965.20 |
| 66030 | Injection Anterior Chamber (Durysta) | 1800.00 | 1167.60 | 318.54 | 1167.60 |
| 65400 | Superficial Keratectomy | 750.00 | 518.04 | 318.54 | 518.04 |
| 66680 | Iridodialysis | 1225.00 | 1167.60 | 488.57 | 1167.60 |
| 67924 | Entropion Repair | 1478.00 | 965.20 | 582.98 | 965.20 |
| 67917 | Ectropion Repair | 1478.00 | 965.20 | 582.98 | 965.20 |
| 67875 | Tarsorrhaphy | 500.00 | 518.04 | 267.91 | 518.04 |
| 67036 | Pars Plana Vitrectomy (PPMV) | 2200.00 | 2017.22 | 582.98 | 2017.22 |
| 66625 | Peripheral Iridectomy | 1300.00 | 1167.60 | 488.57 | 1167.60 |
| 66825 | Reposition of Intraocular Lens | 1200.00 | 1167.60 | 582.98 | 1167.60 |
| 67850 | Destruction of Lesion | 310.00 | 147.60 | 97.93 | 148.80 |
| 67840 | Excision of Lesion | 310.00 | 197.35 | 267.91 | 197.35 |
| 67005 | Vitrectomy | 1478.00 | Bundled | 582.98 | 582.98 |
Revised 01/30/2024
Listed are the procedure codes and descriptions of procedures for The Eye Surgical Center of Fort Wayne. Included is the standard charge, Medicare allowed, Medicaid allowed and pricing for uninsured.
Private insurances will vary depending on the agreements that are put in place with the company or group that has that insurance. You may be required by these plans to pay a copay, co-insurance or deductible.
All private insurance allowed charges are based on if the provider is in network with them. Please call our office if you have questions about our network status with your insurance. We can also provide at your request a good faith estimate of services to be provided.