|
HEAR-AID BIN DIG ITE STD SP
|
Professional
|
Both
|
$3,400.00
|
|
| Hospital Charge Code |
47000095
|
|
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 DIG MON BTE ADVANCED
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
HEAR-AID DIG MON BTE ADVANCED
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
HEAR-AID DIG MON BTE ADV SP
|
Professional
|
Both
|
$2,700.00
|
|
| Hospital Charge Code |
47000092
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
|
|
HEAR-AID DIG MON BTE ESSENTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
HEAR-AID DIG MON BTE ESSENTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
HEAR-AID DIG MON BTE ESS SP
|
Professional
|
Both
|
$1,200.00
|
|
| Hospital Charge Code |
47000090
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
HEAR-AID DIG MON BTE PREMIUM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem Medicaid |
$1,341.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Humana KY Medicaid |
$1,341.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
|
HEAR-AID DIG MON BTE PREMIUM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
|
HEAR-AID DIG MON BTE PRM SP
|
Professional
|
Both
|
$3,900.00
|
|
| Hospital Charge Code |
47000093
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,900.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Multiplan PHCS |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,730.00
|
| Rate for Payer: UHCCP Medicaid |
$1,365.00
|
|
|
HEAR-AID DIG MON BTE STANDARD
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
HEAR-AID DIG MON BTE STANDARD
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
47000077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
HEAR-AID DIG MON BTE STD SP
|
Professional
|
Both
|
$1,700.00
|
|
| Hospital Charge Code |
47000091
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
|
|
HEAR-AID DIG MON ITE ADVANCED
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
HEAR-AID DIG MON ITE ADVANCED
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
HEAR-AID DIG MON ITE ADV SP
|
Professional
|
Both
|
$2,700.00
|
|
| Hospital Charge Code |
47000088
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
|
|
HEAR-AID DIG MON ITE ESSENTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
HEAR-AID DIG MON ITE ESSENTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
HEAR-AID DIG MON ITE ESS SP
|
Professional
|
Both
|
$1,200.00
|
|
| Hospital Charge Code |
47000086
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
HEAR-AID DIG MON ITE PREMIUM
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
|
HEAR-AID DIG MON ITE PREMIUM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem Medicaid |
$1,341.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Humana KY Medicaid |
$1,341.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
|
HEAR-AID DIG MON ITE PRM SP
|
Professional
|
Both
|
$3,900.00
|
|
| Hospital Charge Code |
47000089
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,900.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Multiplan PHCS |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,730.00
|
| Rate for Payer: UHCCP Medicaid |
$1,365.00
|
|
|
HEAR-AID DIG MON ITE STANDARD
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
HEAR-AID DIG MON ITE STANDARD
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
47000074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
HEAR-AID DIG MON ITE STD SP
|
Professional
|
Both
|
$1,700.00
|
|
| Hospital Charge Code |
47000087
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
|
