Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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	$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 ITE PREMIUM

Facility

$7,800.00

Service Code	HCPCS V5260
Hospital Charge Code	47000082
Hospital Revenue Code	270
Min. Negotiated Rate	$2,340.00
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	$6,240.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,786.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,382.00
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

$7,800.00

Service Code	HCPCS V5260
Hospital Charge Code	47000082
Hospital Revenue Code	270
Min. Negotiated Rate	$2,340.00
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	$6,240.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,786.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,382.00
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	$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 ITE STANDARD

Facility

$3,400.00

Service Code	HCPCS V5260
Hospital Charge Code	47000080
Hospital Revenue Code	270
Min. Negotiated Rate	$1,020.00
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	$2,720.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,958.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,346.00
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

$3,400.00

Service Code	HCPCS V5260
Hospital Charge Code	47000080
Hospital Revenue Code	270
Min. Negotiated Rate	$1,020.00
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	$2,720.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,958.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,346.00
Rate for Payer: PHCS Commercial	$3,264.00
Rate for Payer: United Healthcare All Payer	$2,992.00

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	$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 DIG MON BTE ADVANCED

Facility

$2,700.00

Service Code	HCPCS V5257
Hospital Charge Code	47000078
Hospital Revenue Code	270
Min. Negotiated Rate	$810.00
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	$2,160.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,349.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,863.00
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

$2,700.00

Service Code	HCPCS V5257
Hospital Charge Code	47000078
Hospital Revenue Code	270
Min. Negotiated Rate	$810.00
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	$2,160.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,349.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,863.00
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	$1,890.00
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

$1,235.00

Service Code	HCPCS V5257
Hospital Charge Code	47000032
Hospital Revenue Code	270
Min. Negotiated Rate	$370.50
Max. Negotiated Rate	$1,185.60
Rate for Payer: Aetna Commercial	$950.95
Rate for Payer: Anthem Medicaid	$424.72
Rate for Payer: Anthem POS/PPO/Traditional	$963.30
Rate for Payer: Cash Price	$617.50
Rate for Payer: Cigna Commercial	$1,025.05
Rate for Payer: First Health Commercial	$1,173.25
Rate for Payer: Humana Commercial	$1,049.75
Rate for Payer: Humana KY Medicaid	$424.72
Rate for Payer: Kentucky WC Medicaid	$429.04
Rate for Payer: Medical Mutual Of Ohio HMO	$1,012.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$911.43
Rate for Payer: Molina Healthcare Benefit Exchange	$370.50
Rate for Payer: Molina Healthcare Medicaid	$433.24
Rate for Payer: Ohio Health Choice Commercial	$1,086.80
Rate for Payer: Ohio Health Group HMO	$926.25
Rate for Payer: Ohio Health Group PPO Differential	$988.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,074.45
Rate for Payer: Ohio Health Group PPO SOMC Employees	$852.15
Rate for Payer: PHCS Commercial	$1,185.60
Rate for Payer: United Healthcare All Payer	$1,086.80

HEAR-AID DIG MON BTE ESSENTIAL

Facility

$1,235.00

Service Code	HCPCS V5257
Hospital Charge Code	47000032
Hospital Revenue Code	270
Min. Negotiated Rate	$370.50
Max. Negotiated Rate	$1,185.60
Rate for Payer: Aetna Commercial	$950.95
Rate for Payer: Anthem POS/PPO/Traditional	$963.30
Rate for Payer: Cash Price	$617.50
Rate for Payer: Cigna Commercial	$1,025.05
Rate for Payer: First Health Commercial	$1,173.25
Rate for Payer: Humana Commercial	$1,049.75
Rate for Payer: Medical Mutual Of Ohio HMO	$1,012.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$911.43
Rate for Payer: Molina Healthcare Benefit Exchange	$370.50
Rate for Payer: Ohio Health Choice Commercial	$1,086.80
Rate for Payer: Ohio Health Group HMO	$926.25
Rate for Payer: Ohio Health Group PPO Differential	$988.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,074.45
Rate for Payer: Ohio Health Group PPO SOMC Employees	$852.15
Rate for Payer: PHCS Commercial	$1,185.60
Rate for Payer: United Healthcare All Payer	$1,086.80

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	$840.00
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

$3,900.00

Service Code	HCPCS V5257
Hospital Charge Code	47000079
Hospital Revenue Code	270
Min. Negotiated Rate	$1,170.00
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	$3,120.00
Rate for Payer: Ohio Health Group PPO No Differential	$3,393.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,691.00
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

$3,900.00

Service Code	HCPCS V5257
Hospital Charge Code	47000079
Hospital Revenue Code	270
Min. Negotiated Rate	$1,170.00
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	$3,120.00
Rate for Payer: Ohio Health Group PPO No Differential	$3,393.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,691.00
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	$2,730.00
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

$1,749.00

Service Code	HCPCS V5257
Hospital Charge Code	47000077
Hospital Revenue Code	270
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$1,679.04
Rate for Payer: Aetna Commercial	$1,346.73
Rate for Payer: Anthem POS/PPO/Traditional	$1,364.22
Rate for Payer: Cash Price	$874.50
Rate for Payer: Cigna Commercial	$1,451.67
Rate for Payer: First Health Commercial	$1,661.55
Rate for Payer: Humana Commercial	$1,486.65
Rate for Payer: Medical Mutual Of Ohio HMO	$1,434.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,290.76
Rate for Payer: Molina Healthcare Benefit Exchange	$524.70
Rate for Payer: Ohio Health Choice Commercial	$1,539.12
Rate for Payer: Ohio Health Group HMO	$1,311.75
Rate for Payer: Ohio Health Group PPO Differential	$1,399.20
Rate for Payer: Ohio Health Group PPO No Differential	$1,521.63
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,206.81
Rate for Payer: PHCS Commercial	$1,679.04
Rate for Payer: United Healthcare All Payer	$1,539.12

HEAR-AID DIG MON BTE STANDARD

Facility

$1,749.00

Service Code	HCPCS V5257
Hospital Charge Code	47000077
Hospital Revenue Code	270
Min. Negotiated Rate	$524.70
Max. Negotiated Rate	$1,679.04
Rate for Payer: Aetna Commercial	$1,346.73
Rate for Payer: Anthem Medicaid	$601.48
Rate for Payer: Anthem POS/PPO/Traditional	$1,364.22
Rate for Payer: Cash Price	$874.50
Rate for Payer: Cigna Commercial	$1,451.67
Rate for Payer: First Health Commercial	$1,661.55
Rate for Payer: Humana Commercial	$1,486.65
Rate for Payer: Humana KY Medicaid	$601.48
Rate for Payer: Kentucky WC Medicaid	$607.60
Rate for Payer: Medical Mutual Of Ohio HMO	$1,434.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,290.76
Rate for Payer: Molina Healthcare Benefit Exchange	$524.70
Rate for Payer: Molina Healthcare Medicaid	$613.55
Rate for Payer: Ohio Health Choice Commercial	$1,539.12
Rate for Payer: Ohio Health Group HMO	$1,311.75
Rate for Payer: Ohio Health Group PPO Differential	$1,399.20
Rate for Payer: Ohio Health Group PPO No Differential	$1,521.63
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,206.81
Rate for Payer: PHCS Commercial	$1,679.04
Rate for Payer: United Healthcare All Payer	$1,539.12

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	$1,190.00
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

$2,700.00

Service Code	HCPCS V5256
Hospital Charge Code	47000075
Hospital Revenue Code	270
Min. Negotiated Rate	$810.00
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	$2,160.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,349.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,863.00
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

$2,700.00

Service Code	HCPCS V5256
Hospital Charge Code	47000075
Hospital Revenue Code	270
Min. Negotiated Rate	$810.00
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	$2,160.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,349.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,863.00
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	$1,890.00
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

$1,200.00

Service Code	HCPCS V5256
Hospital Charge Code	47000031
Hospital Revenue Code	270
Min. Negotiated Rate	$360.00
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	$960.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,044.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$828.00
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

$1,200.00

Service Code	HCPCS V5256
Hospital Charge Code	47000031
Hospital Revenue Code	270
Min. Negotiated Rate	$360.00
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	$960.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,044.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$828.00
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	$840.00
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

Know your out-of-pocket cost for care.

All Charges