|
OS SEROTYPES 20
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001062
|
|
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 21
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001048
|
|
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 21
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001048
|
|
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 22
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001063
|
|
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 22
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001063
|
|
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 23
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001053
|
|
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 23
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001053
|
|
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 3
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001043
|
|
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 3
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001043
|
|
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 33
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001051
|
|
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 33
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001051
|
|
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 4
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001046
|
|
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 4
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001046
|
|
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 5
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001055
|
|
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 5
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001055
|
|
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 6
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001047
|
|
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 6
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001047
|
|
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 7
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001044
|
|
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 7
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001044
|
|
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 8
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001050
|
|
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 8
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001050
|
|
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 9
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001064
|
|
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 9
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
30001064
|
|
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 SERPINA1 GENE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 81332
|
| Hospital Charge Code |
30000196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$43.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$61.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.65
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$43.65
|
| Rate for Payer: Humana Medicare Advantage |
$43.65
|
| Rate for Payer: Kentucky WC Medicaid |
$44.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
OS SERPINA1 GENE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 81332
|
| Hospital Charge Code |
30000196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.26
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.74
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
