MARCUS A. EAST, M.D.
ADAM T. SHUPE, O.D.
RYAN W. LAPOUR, M.D.
PATRICK KWONG, O.D.
Glasses Estimate
MIKE
ROSE
STEPHANIE
MARIAH
DIEGO
No Insurance
Patient Has Insurance
20% Discount
Insurance:
VSP Signature Plan
VSP Choice Plan
VSP Advantage Plan
Spectera
Eyemed
Superior Vision
Providence
Blue Cross / Blue Shield
United Health Care
Medicare
Atrio
Regence
Health Net
Cigna
Pacific Source
Regence Med Advantage
Regence BCBS
AARP
WVCH
DMAP
Moda
Providence PEBB
Tricare
Kaiser Choice
Ameritas
EBMS
--OPTION NOT IN LIST--
Insurance Benefit:
Additional % Off:
LENS INFORMATION
Lens Style
Retail Cost
Out Of Pocket
Single Vision Distance
Single Vision Computer
Single Vision Near
MySV
Bifocal
Trifocal
Hoya Summit CD IQ BKS
Hoya Summit ECP IQ BKS
Array 2 Progressive
LifeStyle 3 Progressive
MyStyle 2 Progressive
Office Lens
Fillable
Material
Lens Options
FRAME INFORMATION
Manufacturer
Line
Model
Color
Eye
Bridge
Temple
Frame Type
Retail
OOP
TOTALS
Insurance Co-Pay
Total Retail
Total Out of Pocket
NOTES
655 Medical Center Dr NE
|
Salem, Oregon 97301
|
503.399.9250
|
Fax 503.370.7935
|
mceyeclinic.com
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