PATIENT FINANCING
Fees and Financing

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.

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Payment Options
We accept all major credit cards.
24-month special financing with approved credit.
FLEXIBLE SPENDING ACCOUNTS
Save up to approximately $978 of pre-tax dollars by using your Flexible Spending Plan

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
Ambulatory Surgical Center
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.

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