Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

HEAR-AID REPAIR $225 MINOR SP

Professional

Both

$225.00

Hospital Charge Code	47000111
Hospital Revenue Code	222
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$225.00
Rate for Payer: Buckeye Medicare Advantage	$225.00
Rate for Payer: Cash Price	$112.50
Rate for Payer: Multiplan PHCS	$135.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$157.50
Rate for Payer: UHCCP Medicaid	$78.75

HEAR-AID REPAIR $250 MINOR SP

Professional

Both

$250.00

Hospital Charge Code	47000112
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

HEAR-AID REPAIR $300 MINOR SP

Professional

Both

$300.00

Hospital Charge Code	47000113
Hospital Revenue Code	222
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$300.00
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Multiplan PHCS	$180.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$210.00
Rate for Payer: UHCCP Medicaid	$105.00

HEAR-AID REPAIR $350 MINOR SP

Professional

Both

$350.00

Hospital Charge Code	47000108
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$350.00
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$122.50

HEAR-AID RPR OFFICE MINOR SP

Professional

Both

$25.00

Hospital Charge Code	47000109
Hospital Revenue Code	222
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$25.00
Rate for Payer: Buckeye Medicare Advantage	$25.00
Rate for Payer: Cash Price	$12.50
Rate for Payer: Multiplan PHCS	$15.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$17.50
Rate for Payer: UHCCP Medicaid	$8.75

HEAR-AID RPR PARTS MINOR SP

Professional

Both

$75.00

Hospital Charge Code	47000110
Hospital Revenue Code	222
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$75.00
Rate for Payer: Buckeye Medicare Advantage	$75.00
Rate for Payer: Cash Price	$37.50
Rate for Payer: Multiplan PHCS	$45.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$52.50
Rate for Payer: UHCCP Medicaid	$26.25

HEARING AID ACCESSORIES

Facility

$250.00

Service Code	HCPCS V5267
Hospital Charge Code	47000049
Hospital Revenue Code	290
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$192.50
Rate for Payer: Anthem POS/PPO/Traditional	$195.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: First Health Commercial	$237.50
Rate for Payer: Humana Commercial	$212.50
Rate for Payer: Medical Mutual Of Ohio HMO	$205.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$184.50
Rate for Payer: Molina Healthcare Benefit Exchange	$75.00
Rate for Payer: Ohio Health Choice Commercial	$220.00
Rate for Payer: Ohio Health Group HMO	$187.50
Rate for Payer: Ohio Health Group PPO Differential	$50.00
Rate for Payer: Ohio Health Group PPO No Differential	$32.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$77.50
Rate for Payer: PHCS Commercial	$240.00
Rate for Payer: United Healthcare All Payer	$220.00

HEARING AID ACCESSORIES

Facility

$250.00

Service Code	HCPCS V5267
Hospital Charge Code	47000049
Hospital Revenue Code	290
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$192.50
Rate for Payer: Anthem Medicaid	$85.98
Rate for Payer: Anthem POS/PPO/Traditional	$195.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: First Health Commercial	$237.50
Rate for Payer: Humana Commercial	$212.50
Rate for Payer: Humana KY Medicaid	$85.98
Rate for Payer: Kentucky WC Medicaid	$86.85
Rate for Payer: Medical Mutual Of Ohio HMO	$205.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$184.50
Rate for Payer: Molina Healthcare Benefit Exchange	$75.00
Rate for Payer: Molina Healthcare Medicaid	$87.70
Rate for Payer: Ohio Health Choice Commercial	$220.00
Rate for Payer: Ohio Health Group HMO	$187.50
Rate for Payer: Ohio Health Group PPO Differential	$50.00
Rate for Payer: Ohio Health Group PPO No Differential	$32.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$77.50
Rate for Payer: PHCS Commercial	$240.00
Rate for Payer: United Healthcare All Payer	$220.00

HEARING AID ACCESSORIES SP

Professional

Both

$250.00

Hospital Charge Code	47000104
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

HEARING AID/CANAL

Facility

$1,100.00

Hospital Charge Code	47000028
Hospital Revenue Code	292
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$1,056.00
Rate for Payer: Aetna Commercial	$847.00
Rate for Payer: Anthem Medicaid	$378.29
Rate for Payer: Anthem POS/PPO/Traditional	$858.00
Rate for Payer: Cash Price	$550.00
Rate for Payer: Cigna Commercial	$913.00
Rate for Payer: First Health Commercial	$1,045.00
Rate for Payer: Humana Commercial	$935.00
Rate for Payer: Humana KY Medicaid	$378.29
Rate for Payer: Kentucky WC Medicaid	$382.14
Rate for Payer: Medical Mutual Of Ohio HMO	$902.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$811.80
Rate for Payer: Molina Healthcare Benefit Exchange	$330.00
Rate for Payer: Molina Healthcare Medicaid	$385.88
Rate for Payer: Ohio Health Choice Commercial	$968.00
Rate for Payer: Ohio Health Group HMO	$825.00
Rate for Payer: Ohio Health Group PPO Differential	$220.00
Rate for Payer: Ohio Health Group PPO No Differential	$143.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$341.00
Rate for Payer: PHCS Commercial	$1,056.00
Rate for Payer: United Healthcare All Payer	$968.00

HEARING AID/CANAL

Facility

$1,100.00

Hospital Charge Code	47000028
Hospital Revenue Code	292
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$1,056.00
Rate for Payer: Aetna Commercial	$847.00
Rate for Payer: Anthem POS/PPO/Traditional	$858.00
Rate for Payer: Cash Price	$550.00
Rate for Payer: Cigna Commercial	$913.00
Rate for Payer: First Health Commercial	$1,045.00
Rate for Payer: Humana Commercial	$935.00
Rate for Payer: Medical Mutual Of Ohio HMO	$902.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$811.80
Rate for Payer: Molina Healthcare Benefit Exchange	$330.00
Rate for Payer: Ohio Health Choice Commercial	$968.00
Rate for Payer: Ohio Health Group HMO	$825.00
Rate for Payer: Ohio Health Group PPO Differential	$220.00
Rate for Payer: Ohio Health Group PPO No Differential	$143.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$341.00
Rate for Payer: PHCS Commercial	$1,056.00
Rate for Payer: United Healthcare All Payer	$968.00

HEARING AID CONSULTATION

Facility

$62.00

Service Code	HCPCS 92594
Hospital Charge Code	47000020
Hospital Revenue Code	470
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$59.52
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Anthem Medicaid	$21.32
Rate for Payer: Anthem POS/PPO/Traditional	$48.36
Rate for Payer: Cash Price	$31.00
Rate for Payer: Cigna Commercial	$51.46
Rate for Payer: First Health Commercial	$58.90
Rate for Payer: Humana Commercial	$52.70
Rate for Payer: Humana KY Medicaid	$21.32
Rate for Payer: Kentucky WC Medicaid	$21.54
Rate for Payer: Medical Mutual Of Ohio HMO	$50.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$45.76
Rate for Payer: Molina Healthcare Benefit Exchange	$18.60
Rate for Payer: Molina Healthcare Medicaid	$21.75
Rate for Payer: Ohio Health Choice Commercial	$54.56
Rate for Payer: Ohio Health Group HMO	$46.50
Rate for Payer: Ohio Health Group PPO Differential	$12.40
Rate for Payer: Ohio Health Group PPO No Differential	$8.06
Rate for Payer: Ohio Health Group PPO SOMC Employees	$19.22
Rate for Payer: PHCS Commercial	$59.52
Rate for Payer: United Healthcare All Payer	$54.56

HEARING AID CONSULTATION

Facility

$62.00

Service Code	HCPCS 92594
Hospital Charge Code	47000020
Hospital Revenue Code	470
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$59.52
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Anthem POS/PPO/Traditional	$48.36
Rate for Payer: Cash Price	$31.00
Rate for Payer: Cigna Commercial	$51.46
Rate for Payer: First Health Commercial	$58.90
Rate for Payer: Humana Commercial	$52.70
Rate for Payer: Medical Mutual Of Ohio HMO	$50.84
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$45.76
Rate for Payer: Molina Healthcare Benefit Exchange	$18.60
Rate for Payer: Ohio Health Choice Commercial	$54.56
Rate for Payer: Ohio Health Group HMO	$46.50
Rate for Payer: Ohio Health Group PPO Differential	$12.40
Rate for Payer: Ohio Health Group PPO No Differential	$8.06
Rate for Payer: Ohio Health Group PPO SOMC Employees	$19.22
Rate for Payer: PHCS Commercial	$59.52
Rate for Payer: United Healthcare All Payer	$54.56

HEARING AID REPAIR/MAJOR

Facility

$149.00

Service Code	HCPCS V5014
Hospital Charge Code	47000023
Hospital Revenue Code	292
Min. Negotiated Rate	$19.37
Max. Negotiated Rate	$143.04
Rate for Payer: Aetna Commercial	$114.73
Rate for Payer: Anthem POS/PPO/Traditional	$116.22
Rate for Payer: Cash Price	$74.50
Rate for Payer: Cigna Commercial	$123.67
Rate for Payer: First Health Commercial	$141.55
Rate for Payer: Humana Commercial	$126.65
Rate for Payer: Medical Mutual Of Ohio HMO	$122.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$109.96
Rate for Payer: Molina Healthcare Benefit Exchange	$44.70
Rate for Payer: Ohio Health Choice Commercial	$131.12
Rate for Payer: Ohio Health Group HMO	$111.75
Rate for Payer: Ohio Health Group PPO Differential	$29.80
Rate for Payer: Ohio Health Group PPO No Differential	$19.37
Rate for Payer: Ohio Health Group PPO SOMC Employees	$46.19
Rate for Payer: PHCS Commercial	$143.04
Rate for Payer: United Healthcare All Payer	$131.12

HEARING AID REPAIR/MAJOR

Facility

$149.00

Service Code	HCPCS V5014
Hospital Charge Code	47000023
Hospital Revenue Code	292
Min. Negotiated Rate	$19.37
Max. Negotiated Rate	$143.04
Rate for Payer: Aetna Commercial	$114.73
Rate for Payer: Anthem Medicaid	$51.24
Rate for Payer: Anthem POS/PPO/Traditional	$116.22
Rate for Payer: Cash Price	$74.50
Rate for Payer: Cigna Commercial	$123.67
Rate for Payer: First Health Commercial	$141.55
Rate for Payer: Humana Commercial	$126.65
Rate for Payer: Humana KY Medicaid	$51.24
Rate for Payer: Kentucky WC Medicaid	$51.76
Rate for Payer: Medical Mutual Of Ohio HMO	$122.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$109.96
Rate for Payer: Molina Healthcare Benefit Exchange	$44.70
Rate for Payer: Molina Healthcare Medicaid	$52.27
Rate for Payer: Ohio Health Choice Commercial	$131.12
Rate for Payer: Ohio Health Group HMO	$111.75
Rate for Payer: Ohio Health Group PPO Differential	$29.80
Rate for Payer: Ohio Health Group PPO No Differential	$19.37
Rate for Payer: Ohio Health Group PPO SOMC Employees	$46.19
Rate for Payer: PHCS Commercial	$143.04
Rate for Payer: United Healthcare All Payer	$131.12

HEARING AID REPAIR MAJOR SP

Professional

Both

$250.00

Hospital Charge Code	47000115
Hospital Revenue Code	222
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$250.00
Rate for Payer: Buckeye Medicare Advantage	$250.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Multiplan PHCS	$150.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$175.00
Rate for Payer: UHCCP Medicaid	$87.50

HEARING AID REPAIR MINOR

Facility

$300.00

Hospital Charge Code	47000054
Hospital Revenue Code	470
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem Medicaid	$103.17
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Humana KY Medicaid	$103.17
Rate for Payer: Kentucky WC Medicaid	$104.22
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$90.00
Rate for Payer: Molina Healthcare Medicaid	$105.24
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$60.00
Rate for Payer: Ohio Health Group PPO No Differential	$39.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$93.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

HEARING AID REPAIR MINOR

Facility

$350.00

Hospital Charge Code	47000039
Hospital Revenue Code	470
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$269.50
Rate for Payer: Anthem Medicaid	$120.36
Rate for Payer: Anthem POS/PPO/Traditional	$273.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$290.50
Rate for Payer: First Health Commercial	$332.50
Rate for Payer: Humana Commercial	$297.50
Rate for Payer: Humana KY Medicaid	$120.36
Rate for Payer: Kentucky WC Medicaid	$121.59
Rate for Payer: Medical Mutual Of Ohio HMO	$287.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$258.30
Rate for Payer: Molina Healthcare Benefit Exchange	$105.00
Rate for Payer: Molina Healthcare Medicaid	$122.78
Rate for Payer: Ohio Health Choice Commercial	$308.00
Rate for Payer: Ohio Health Group HMO	$262.50
Rate for Payer: Ohio Health Group PPO Differential	$70.00
Rate for Payer: Ohio Health Group PPO No Differential	$45.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$108.50
Rate for Payer: PHCS Commercial	$336.00
Rate for Payer: United Healthcare All Payer	$308.00

HEARING AID REPAIR MINOR

Facility

$75.00

Hospital Charge Code	47000051
Hospital Revenue Code	470
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$57.75
Rate for Payer: Anthem POS/PPO/Traditional	$58.50
Rate for Payer: Cash Price	$37.50
Rate for Payer: Cigna Commercial	$62.25
Rate for Payer: First Health Commercial	$71.25
Rate for Payer: Humana Commercial	$63.75
Rate for Payer: Medical Mutual Of Ohio HMO	$61.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$55.35
Rate for Payer: Molina Healthcare Benefit Exchange	$22.50
Rate for Payer: Ohio Health Choice Commercial	$66.00
Rate for Payer: Ohio Health Group HMO	$56.25
Rate for Payer: Ohio Health Group PPO Differential	$15.00
Rate for Payer: Ohio Health Group PPO No Differential	$9.75
Rate for Payer: Ohio Health Group PPO SOMC Employees	$23.25
Rate for Payer: PHCS Commercial	$72.00
Rate for Payer: United Healthcare All Payer	$66.00

HEARING AID REPAIR MINOR

Facility

$250.00

Hospital Charge Code	47000053
Hospital Revenue Code	470
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$192.50
Rate for Payer: Anthem Medicaid	$85.98
Rate for Payer: Anthem POS/PPO/Traditional	$195.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: First Health Commercial	$237.50
Rate for Payer: Humana Commercial	$212.50
Rate for Payer: Humana KY Medicaid	$85.98
Rate for Payer: Kentucky WC Medicaid	$86.85
Rate for Payer: Medical Mutual Of Ohio HMO	$205.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$184.50
Rate for Payer: Molina Healthcare Benefit Exchange	$75.00
Rate for Payer: Molina Healthcare Medicaid	$87.70
Rate for Payer: Ohio Health Choice Commercial	$220.00
Rate for Payer: Ohio Health Group HMO	$187.50
Rate for Payer: Ohio Health Group PPO Differential	$50.00
Rate for Payer: Ohio Health Group PPO No Differential	$32.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$77.50
Rate for Payer: PHCS Commercial	$240.00
Rate for Payer: United Healthcare All Payer	$220.00

HEARING AID REPAIR MINOR

Facility

$225.00

Hospital Charge Code	47000052
Hospital Revenue Code	470
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$173.25
Rate for Payer: Anthem Medicaid	$77.38
Rate for Payer: Anthem POS/PPO/Traditional	$175.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$186.75
Rate for Payer: First Health Commercial	$213.75
Rate for Payer: Humana Commercial	$191.25
Rate for Payer: Humana KY Medicaid	$77.38
Rate for Payer: Kentucky WC Medicaid	$78.16
Rate for Payer: Medical Mutual Of Ohio HMO	$184.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$166.05
Rate for Payer: Molina Healthcare Benefit Exchange	$67.50
Rate for Payer: Molina Healthcare Medicaid	$78.93
Rate for Payer: Ohio Health Choice Commercial	$198.00
Rate for Payer: Ohio Health Group HMO	$168.75
Rate for Payer: Ohio Health Group PPO Differential	$45.00
Rate for Payer: Ohio Health Group PPO No Differential	$29.25
Rate for Payer: Ohio Health Group PPO SOMC Employees	$69.75
Rate for Payer: PHCS Commercial	$216.00
Rate for Payer: United Healthcare All Payer	$198.00

HEARING AID REPAIR MINOR

Facility

$300.00

Hospital Charge Code	47000054
Hospital Revenue Code	470
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$90.00
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$60.00
Rate for Payer: Ohio Health Group PPO No Differential	$39.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$93.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

HEARING AID REPAIR MINOR

Facility

$350.00

Hospital Charge Code	47000039
Hospital Revenue Code	470
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Commercial	$269.50
Rate for Payer: Anthem POS/PPO/Traditional	$273.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Cigna Commercial	$290.50
Rate for Payer: First Health Commercial	$332.50
Rate for Payer: Humana Commercial	$297.50
Rate for Payer: Medical Mutual Of Ohio HMO	$287.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$258.30
Rate for Payer: Molina Healthcare Benefit Exchange	$105.00
Rate for Payer: Ohio Health Choice Commercial	$308.00
Rate for Payer: Ohio Health Group HMO	$262.50
Rate for Payer: Ohio Health Group PPO Differential	$70.00
Rate for Payer: Ohio Health Group PPO No Differential	$45.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$108.50
Rate for Payer: PHCS Commercial	$336.00
Rate for Payer: United Healthcare All Payer	$308.00

HEARING AID REPAIR MINOR

Facility

$250.00

Hospital Charge Code	47000053
Hospital Revenue Code	470
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$192.50
Rate for Payer: Anthem POS/PPO/Traditional	$195.00
Rate for Payer: Cash Price	$125.00
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: First Health Commercial	$237.50
Rate for Payer: Humana Commercial	$212.50
Rate for Payer: Medical Mutual Of Ohio HMO	$205.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$184.50
Rate for Payer: Molina Healthcare Benefit Exchange	$75.00
Rate for Payer: Ohio Health Choice Commercial	$220.00
Rate for Payer: Ohio Health Group HMO	$187.50
Rate for Payer: Ohio Health Group PPO Differential	$50.00
Rate for Payer: Ohio Health Group PPO No Differential	$32.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$77.50
Rate for Payer: PHCS Commercial	$240.00
Rate for Payer: United Healthcare All Payer	$220.00

HEARING AID REPAIR MINOR

Facility

$225.00

Hospital Charge Code	47000052
Hospital Revenue Code	470
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$173.25
Rate for Payer: Anthem POS/PPO/Traditional	$175.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial	$186.75
Rate for Payer: First Health Commercial	$213.75
Rate for Payer: Humana Commercial	$191.25
Rate for Payer: Medical Mutual Of Ohio HMO	$184.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$166.05
Rate for Payer: Molina Healthcare Benefit Exchange	$67.50
Rate for Payer: Ohio Health Choice Commercial	$198.00
Rate for Payer: Ohio Health Group HMO	$168.75
Rate for Payer: Ohio Health Group PPO Differential	$45.00
Rate for Payer: Ohio Health Group PPO No Differential	$29.25
Rate for Payer: Ohio Health Group PPO SOMC Employees	$69.75
Rate for Payer: PHCS Commercial	$216.00
Rate for Payer: United Healthcare All Payer	$198.00

Know your out-of-pocket cost for care.

All Charges