|
HEAD V40 TPR LFIT ANA 44MM +4
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TPR LFIT ANA 44MM +4
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TPR LFIT ANA 44MM -4
|
Facility
|
OP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem Medicaid |
$3,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Humana KY Medicaid |
$3,158.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEAD V40 TPR LFIT ANA 44MM -4
|
Facility
|
IP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEALIX ANCHOR 5.5 BIO ABS.
|
Facility
|
IP
|
$3,897.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.25 |
| Max. Negotiated Rate |
$3,741.60 |
| Rate for Payer: Aetna Commercial |
$3,001.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.05
|
| Rate for Payer: Cash Price |
$1,948.75
|
| Rate for Payer: Cigna Commercial |
$3,234.93
|
| Rate for Payer: First Health Commercial |
$3,702.62
|
| Rate for Payer: Humana Commercial |
$3,312.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,195.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,429.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,390.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,689.28
|
| Rate for Payer: PHCS Commercial |
$3,741.60
|
| Rate for Payer: United Healthcare All Payer |
$3,429.80
|
|
|
HEALIX ANCHOR 5.5 BIO ABS.
|
Facility
|
OP
|
$3,897.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.25 |
| Max. Negotiated Rate |
$3,741.60 |
| Rate for Payer: Aetna Commercial |
$3,001.07
|
| Rate for Payer: Anthem Medicaid |
$1,340.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.05
|
| Rate for Payer: Cash Price |
$1,948.75
|
| Rate for Payer: Cigna Commercial |
$3,234.93
|
| Rate for Payer: First Health Commercial |
$3,702.62
|
| Rate for Payer: Humana Commercial |
$3,312.88
|
| Rate for Payer: Humana KY Medicaid |
$1,340.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,353.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,195.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,429.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,390.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,689.28
|
| Rate for Payer: PHCS Commercial |
$3,741.60
|
| Rate for Payer: United Healthcare All Payer |
$3,429.80
|
|
|
HEALIX ANCHOR 6.5 BIO ABS
|
Facility
|
IP
|
$3,773.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.12 |
| Max. Negotiated Rate |
$3,622.80 |
| Rate for Payer: Aetna Commercial |
$2,905.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,943.53
|
| Rate for Payer: Cash Price |
$1,886.88
|
| Rate for Payer: Cigna Commercial |
$3,132.21
|
| Rate for Payer: First Health Commercial |
$3,585.06
|
| Rate for Payer: Humana Commercial |
$3,207.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,320.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,019.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,283.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,603.89
|
| Rate for Payer: PHCS Commercial |
$3,622.80
|
| Rate for Payer: United Healthcare All Payer |
$3,320.90
|
|
|
HEALIX ANCHOR 6.5 BIO ABS
|
Facility
|
OP
|
$3,773.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.12 |
| Max. Negotiated Rate |
$3,622.80 |
| Rate for Payer: Aetna Commercial |
$2,905.79
|
| Rate for Payer: Anthem Medicaid |
$1,297.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,943.53
|
| Rate for Payer: Cash Price |
$1,886.88
|
| Rate for Payer: Cigna Commercial |
$3,132.21
|
| Rate for Payer: First Health Commercial |
$3,585.06
|
| Rate for Payer: Humana Commercial |
$3,207.69
|
| Rate for Payer: Humana KY Medicaid |
$1,297.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,320.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,019.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,283.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,603.89
|
| Rate for Payer: PHCS Commercial |
$3,622.80
|
| Rate for Payer: United Healthcare All Payer |
$3,320.90
|
|
|
HEAR-AID BIN DIG BTE ADVANCED
|
Facility
|
IP
|
$5,557.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,667.10 |
| Max. Negotiated Rate |
$5,334.72 |
| Rate for Payer: Aetna Commercial |
$4,278.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,334.46
|
| Rate for Payer: Cash Price |
$2,778.50
|
| Rate for Payer: Cigna Commercial |
$4,612.31
|
| Rate for Payer: First Health Commercial |
$5,279.15
|
| Rate for Payer: Humana Commercial |
$4,723.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,556.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,890.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,167.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,445.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,834.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.33
|
| Rate for Payer: PHCS Commercial |
$5,334.72
|
| Rate for Payer: United Healthcare All Payer |
$4,890.16
|
|
|
HEAR-AID BIN DIG BTE ADVANCED
|
Facility
|
OP
|
$5,557.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,667.10 |
| Max. Negotiated Rate |
$5,334.72 |
| Rate for Payer: Aetna Commercial |
$4,278.89
|
| Rate for Payer: Anthem Medicaid |
$1,911.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,334.46
|
| Rate for Payer: Cash Price |
$2,778.50
|
| Rate for Payer: Cigna Commercial |
$4,612.31
|
| Rate for Payer: First Health Commercial |
$5,279.15
|
| Rate for Payer: Humana Commercial |
$4,723.45
|
| Rate for Payer: Humana KY Medicaid |
$1,911.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,930.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,556.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,949.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,890.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,167.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,445.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,834.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.33
|
| Rate for Payer: PHCS Commercial |
$5,334.72
|
| Rate for Payer: United Healthcare All Payer |
$4,890.16
|
|
|
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 |
$3,780.00 |
| 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
|
$2,470.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Anthem Medicaid |
$849.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,235.00
|
| Rate for Payer: Cigna Commercial |
$2,050.10
|
| Rate for Payer: First Health Commercial |
$2,346.50
|
| Rate for Payer: Humana Commercial |
$2,099.50
|
| Rate for Payer: Humana KY Medicaid |
$849.43
|
| Rate for Payer: Kentucky WC Medicaid |
$858.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,025.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,822.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$866.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,173.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,852.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.30
|
| Rate for Payer: PHCS Commercial |
$2,371.20
|
| Rate for Payer: United Healthcare All Payer |
$2,173.60
|
|
|
HEAR-AID BIN DIG BTE ESSENTIAL
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,235.00
|
| Rate for Payer: Cigna Commercial |
$2,050.10
|
| Rate for Payer: First Health Commercial |
$2,346.50
|
| Rate for Payer: Humana Commercial |
$2,099.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,025.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,822.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,173.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,852.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.30
|
| Rate for Payer: PHCS Commercial |
$2,371.20
|
| Rate for Payer: United Healthcare All Payer |
$2,173.60
|
|
|
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 |
$1,680.00 |
| 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
|
$8,026.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,407.80 |
| Max. Negotiated Rate |
$7,704.96 |
| Rate for Payer: Aetna Commercial |
$6,180.02
|
| Rate for Payer: Anthem Medicaid |
$2,760.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.28
|
| Rate for Payer: Cash Price |
$4,013.00
|
| Rate for Payer: Cigna Commercial |
$6,661.58
|
| Rate for Payer: First Health Commercial |
$7,624.70
|
| Rate for Payer: Humana Commercial |
$6,822.10
|
| Rate for Payer: Humana KY Medicaid |
$2,760.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,788.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,815.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.94
|
| Rate for Payer: PHCS Commercial |
$7,704.96
|
| Rate for Payer: United Healthcare All Payer |
$7,062.88
|
|
|
HEAR-AID BIN DIG BTE PREMIUM
|
Facility
|
IP
|
$8,026.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,407.80 |
| Max. Negotiated Rate |
$7,704.96 |
| Rate for Payer: Aetna Commercial |
$6,180.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.28
|
| Rate for Payer: Cash Price |
$4,013.00
|
| Rate for Payer: Cigna Commercial |
$6,661.58
|
| Rate for Payer: First Health Commercial |
$7,624.70
|
| Rate for Payer: Humana Commercial |
$6,822.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.94
|
| Rate for Payer: PHCS Commercial |
$7,704.96
|
| Rate for Payer: United Healthcare All Payer |
$7,062.88
|
|
|
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 |
$5,460.00 |
| 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
|
$3,499.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,049.70 |
| Max. Negotiated Rate |
$3,359.04 |
| Rate for Payer: Aetna Commercial |
$2,694.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,729.22
|
| Rate for Payer: Cash Price |
$1,749.50
|
| Rate for Payer: Cigna Commercial |
$2,904.17
|
| Rate for Payer: First Health Commercial |
$3,324.05
|
| Rate for Payer: Humana Commercial |
$2,974.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,869.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,079.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,624.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,044.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.31
|
| Rate for Payer: PHCS Commercial |
$3,359.04
|
| Rate for Payer: United Healthcare All Payer |
$3,079.12
|
|
|
HEAR-AID BIN DIG BTE STANDARD
|
Facility
|
OP
|
$3,499.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
47000083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,049.70 |
| Max. Negotiated Rate |
$3,359.04 |
| Rate for Payer: Aetna Commercial |
$2,694.23
|
| Rate for Payer: Anthem Medicaid |
$1,203.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,729.22
|
| Rate for Payer: Cash Price |
$1,749.50
|
| Rate for Payer: Cigna Commercial |
$2,904.17
|
| Rate for Payer: First Health Commercial |
$3,324.05
|
| Rate for Payer: Humana Commercial |
$2,974.15
|
| Rate for Payer: Humana KY Medicaid |
$1,203.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,869.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,079.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,624.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,044.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.31
|
| Rate for Payer: PHCS Commercial |
$3,359.04
|
| Rate for Payer: United Healthcare All Payer |
$3,079.12
|
|
|
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 |
$2,380.00 |
| 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
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,620.00 |
| 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 |
$4,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,698.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,726.00
|
| 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
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,620.00 |
| 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 |
$4,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,698.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,726.00
|
| 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 |
$3,780.00 |
| 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
|
$2,470.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,235.00
|
| Rate for Payer: Cigna Commercial |
$2,050.10
|
| Rate for Payer: First Health Commercial |
$2,346.50
|
| Rate for Payer: Humana Commercial |
$2,099.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,025.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,822.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,173.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,852.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.30
|
| Rate for Payer: PHCS Commercial |
$2,371.20
|
| Rate for Payer: United Healthcare All Payer |
$2,173.60
|
|
|
HEAR-AID BIN DIG ITE ESSENTIAL
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
47000033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,371.20 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Anthem Medicaid |
$849.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,235.00
|
| Rate for Payer: Cigna Commercial |
$2,050.10
|
| Rate for Payer: First Health Commercial |
$2,346.50
|
| Rate for Payer: Humana Commercial |
$2,099.50
|
| Rate for Payer: Humana KY Medicaid |
$849.43
|
| Rate for Payer: Kentucky WC Medicaid |
$858.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,025.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,822.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$741.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$866.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,173.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,852.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,148.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,704.30
|
| Rate for Payer: PHCS Commercial |
$2,371.20
|
| Rate for Payer: United Healthcare All Payer |
$2,173.60
|
|
