|
HEALIX ANCHOR 6.5 BIO ABS
|
Facility
|
IP
|
$3,855.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.22 |
| Max. Negotiated Rate |
$3,701.28 |
| Rate for Payer: Aetna Commercial |
$2,968.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.29
|
| Rate for Payer: Cash Price |
$1,927.75
|
| Rate for Payer: Cigna Commercial |
$3,200.06
|
| Rate for Payer: First Health Commercial |
$3,662.72
|
| Rate for Payer: Humana Commercial |
$3,277.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.20
|
| Rate for Payer: PHCS Commercial |
$3,701.28
|
| Rate for Payer: United Healthcare All Payer |
$3,392.84
|
|
|
HEALIX ANCHOR 6.5 BIO ABS
|
Facility
|
OP
|
$3,855.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.22 |
| Max. Negotiated Rate |
$3,701.28 |
| Rate for Payer: Aetna Commercial |
$2,968.74
|
| Rate for Payer: Anthem Medicaid |
$1,325.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.29
|
| Rate for Payer: Cash Price |
$1,927.75
|
| Rate for Payer: Cigna Commercial |
$3,200.06
|
| Rate for Payer: First Health Commercial |
$3,662.72
|
| Rate for Payer: Humana Commercial |
$3,277.18
|
| Rate for Payer: Humana KY Medicaid |
$1,325.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.20
|
| Rate for Payer: PHCS Commercial |
$3,701.28
|
| Rate for Payer: United Healthcare All Payer |
$3,392.84
|
|
|
HEAR-AID BIN DIG BTE ADVANCED
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,212.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna Commercial |
$4,482.00
|
| Rate for Payer: First Health Commercial |
$5,130.00
|
| Rate for Payer: Humana Commercial |
$4,590.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,428.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,985.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,752.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,674.00
|
| Rate for Payer: PHCS Commercial |
$5,184.00
|
| Rate for Payer: United Healthcare All Payer |
$4,752.00
|
|
|
HEAR-AID BIN DIG BTE ADVANCED
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Anthem Medicaid |
$1,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,212.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna Commercial |
$4,482.00
|
| Rate for Payer: First Health Commercial |
$5,130.00
|
| Rate for Payer: Humana Commercial |
$4,590.00
|
| Rate for Payer: Humana KY Medicaid |
$1,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,428.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,985.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,894.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,752.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,674.00
|
| Rate for Payer: PHCS Commercial |
$5,184.00
|
| Rate for Payer: United Healthcare All Payer |
$4,752.00
|
|
|
HEAR-AID BIN DIG BTE ADV SP
|
Professional
|
Both
|
$5,400.00
|
|
| Hospital Charge Code |
47000100
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$5,400.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Multiplan PHCS |
$3,240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,780.00
|
| Rate for Payer: UHCCP Medicaid |
$1,890.00
|
|
|
HEAR-AID BIN DIG BTE ESSENTIAL
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
HEAR-AID BIN DIG BTE ESSENTIAL
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
HEAR-AID BIN DIG BTE ESS SP
|
Professional
|
Both
|
$2,400.00
|
|
| Hospital Charge Code |
47000098
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
|
|
HEAR-AID BIN DIG BTE PREMIUM
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$6,006.00
|
| Rate for Payer: Anthem Medicaid |
$2,682.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Cigna Commercial |
$6,474.00
|
| Rate for Payer: First Health Commercial |
$7,410.00
|
| Rate for Payer: Humana Commercial |
$6,630.00
|
| Rate for Payer: Humana KY Medicaid |
$2,682.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,736.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.00
|
| Rate for Payer: PHCS Commercial |
$7,488.00
|
| Rate for Payer: United Healthcare All Payer |
$6,864.00
|
|
|
HEAR-AID BIN DIG BTE PREMIUM
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$6,006.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Cigna Commercial |
$6,474.00
|
| Rate for Payer: First Health Commercial |
$7,410.00
|
| Rate for Payer: Humana Commercial |
$6,630.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.00
|
| Rate for Payer: PHCS Commercial |
$7,488.00
|
| Rate for Payer: United Healthcare All Payer |
$6,864.00
|
|
|
HEAR-AID BIN DIG BTE PRM SP
|
Professional
|
Both
|
$7,800.00
|
|
| Hospital Charge Code |
47000101
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$2,730.00 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$7,800.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Multiplan PHCS |
$4,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,460.00
|
| Rate for Payer: UHCCP Medicaid |
$2,730.00
|
|
|
HEAR-AID BIN DIG BTE STANDARD
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
HEAR-AID BIN DIG BTE STANDARD
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Humana KY Medicaid |
$1,169.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
HEAR-AID BIN DIG BTE STD SP
|
Professional
|
Both
|
$3,400.00
|
|
| Hospital Charge Code |
47000099
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,190.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,400.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Multiplan PHCS |
$2,040.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,380.00
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
|
|
HEAR-AID BIN DIG ITE ADVANCED
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,212.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna Commercial |
$4,482.00
|
| Rate for Payer: First Health Commercial |
$5,130.00
|
| Rate for Payer: Humana Commercial |
$4,590.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,428.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,985.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,752.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,674.00
|
| Rate for Payer: PHCS Commercial |
$5,184.00
|
| Rate for Payer: United Healthcare All Payer |
$4,752.00
|
|
|
HEAR-AID BIN DIG ITE ADVANCED
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$4,158.00
|
| Rate for Payer: Anthem Medicaid |
$1,857.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,212.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna Commercial |
$4,482.00
|
| Rate for Payer: First Health Commercial |
$5,130.00
|
| Rate for Payer: Humana Commercial |
$4,590.00
|
| Rate for Payer: Humana KY Medicaid |
$1,857.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,428.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,985.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,620.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,894.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,752.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,674.00
|
| Rate for Payer: PHCS Commercial |
$5,184.00
|
| Rate for Payer: United Healthcare All Payer |
$4,752.00
|
|
|
HEAR-AID BIN DIG ITE ADV SP
|
Professional
|
Both
|
$5,400.00
|
|
| Hospital Charge Code |
47000096
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$5,400.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Multiplan PHCS |
$3,240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,780.00
|
| Rate for Payer: UHCCP Medicaid |
$1,890.00
|
|
|
HEAR-AID BIN DIG ITE ESSENTIAL
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
HEAR-AID BIN DIG ITE ESSENTIAL
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
HEAR-AID BIN DIG ITE ESS SP
|
Professional
|
Both
|
$2,400.00
|
|
| Hospital Charge Code |
47000094
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
|
|
HEAR-AID BIN DIG ITE PREMIUM
|
Facility
|
IP
|
$7,800.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$6,006.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Cigna Commercial |
$6,474.00
|
| Rate for Payer: First Health Commercial |
$7,410.00
|
| Rate for Payer: Humana Commercial |
$6,630.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.00
|
| Rate for Payer: PHCS Commercial |
$7,488.00
|
| Rate for Payer: United Healthcare All Payer |
$6,864.00
|
|
|
HEAR-AID BIN DIG ITE PREMIUM
|
Facility
|
OP
|
$7,800.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$6,006.00
|
| Rate for Payer: Anthem Medicaid |
$2,682.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,084.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Cigna Commercial |
$6,474.00
|
| Rate for Payer: First Health Commercial |
$7,410.00
|
| Rate for Payer: Humana Commercial |
$6,630.00
|
| Rate for Payer: Humana KY Medicaid |
$2,682.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,396.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,340.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,736.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,864.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.00
|
| Rate for Payer: PHCS Commercial |
$7,488.00
|
| Rate for Payer: United Healthcare All Payer |
$6,864.00
|
|
|
HEAR-AID BIN DIG ITE PRM SP
|
Professional
|
Both
|
$7,800.00
|
|
| Hospital Charge Code |
47000097
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$2,730.00 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$7,800.00
|
| Rate for Payer: Cash Price |
$3,900.00
|
| Rate for Payer: Multiplan PHCS |
$4,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,460.00
|
| Rate for Payer: UHCCP Medicaid |
$2,730.00
|
|
|
HEAR-AID BIN DIG ITE STANDARD
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
HEAR-AID BIN DIG ITE STANDARD
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Humana KY Medicaid |
$1,169.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
