|
OS SEROTONIN RELEASE ASSAY, UF
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30002027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$511.68 |
| Rate for Payer: Aetna Commercial |
$410.41
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cigna Commercial |
$442.39
|
| Rate for Payer: First Health Commercial |
$506.35
|
| Rate for Payer: Humana Commercial |
$453.05
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.04
|
| Rate for Payer: Ohio Health Group HMO |
$399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.23
|
| Rate for Payer: PHCS Commercial |
$511.68
|
| Rate for Payer: United Healthcare All Payer |
$469.04
|
|
|
OS SEROTONIN RELEASE ASSAY, UF
|
Facility
|
IP
|
$533.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30002027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$511.68 |
| Rate for Payer: Aetna Commercial |
$410.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$428.00
|
| Rate for Payer: Cash Price |
$266.50
|
| Rate for Payer: Cigna Commercial |
$442.39
|
| Rate for Payer: First Health Commercial |
$506.35
|
| Rate for Payer: Humana Commercial |
$453.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.04
|
| Rate for Payer: Ohio Health Group HMO |
$399.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.23
|
| Rate for Payer: PHCS Commercial |
$511.68
|
| Rate for Payer: United Healthcare All Payer |
$469.04
|
|
|
OS SEROTYPES 1
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 1
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 10
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 10
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 11
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 11
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 12
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 12
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 14
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 14
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 15
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 15
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 16
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 16
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 17
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 17
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 18
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 18
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001045
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 19
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 19
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 2
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem Medicaid |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.99
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Humana KY Medicaid |
$14.99
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Kentucky WC Medicaid |
$15.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 2
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
|
OS SEROTYPES 20
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna Commercial |
$10.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna Commercial |
$11.62
|
| Rate for Payer: First Health Commercial |
$13.30
|
| Rate for Payer: Humana Commercial |
$11.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.32
|
| Rate for Payer: Ohio Health Group HMO |
$10.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.34
|
| Rate for Payer: PHCS Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Payer |
$12.32
|
|
