|
PREVENA PEEL & PLACE SYSTEM
|
Facility
|
OP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
Preventive Conseling Indiv 15
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Aetna Commercial |
$37.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.75
|
| Rate for Payer: Anthem Medicaid |
$25.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.00
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$56.82
|
| Rate for Payer: Healthspan PPO |
$40.59
|
| Rate for Payer: Humana Medicaid |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.15
|
| Rate for Payer: Molina Healthcare Passport |
$25.64
|
| Rate for Payer: Multiplan PHCS |
$65.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.30
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
|
|
Preventive Conseling Indiv 15
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
Preventive Conseling Indiv 15
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
PREVENTIVE COUNSELING GROUP
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99412
|
| Hospital Charge Code |
76102636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$27.33
|
| Rate for Payer: Healthspan PPO |
$23.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
PREVENTIVE COUNSELING GROUP
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99412
|
| Hospital Charge Code |
761P2636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$27.33
|
| Rate for Payer: Healthspan PPO |
$23.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.12
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
|
|
PREVENTIVE COUNSELING GROUP
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 99412
|
| Hospital Charge Code |
76102636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
PREVENTIVE COUNSELING GROUP
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 99412
|
| Hospital Charge Code |
76102636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
Preventive Counseling Indiv 30
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 99402
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
Preventive Counseling Indiv 30
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99402
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna Commercial |
$76.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.60
|
| Rate for Payer: Anthem Medicaid |
$44.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.00
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$95.55
|
| Rate for Payer: Healthspan PPO |
$70.36
|
| Rate for Payer: Humana Medicaid |
$44.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.37
|
| Rate for Payer: Molina Healthcare Passport |
$44.48
|
| Rate for Payer: Multiplan PHCS |
$97.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.10
|
| Rate for Payer: UHCCP Medicaid |
$32.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.92
|
|
|
Preventive Counseling Indiv 30
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 99402
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
Preventive Counseling Indiv 45
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 99403
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.06
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
Preventive Counseling Indiv 45
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 99403
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.46
|
| Rate for Payer: Anthem Medicaid |
$62.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$226.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$132.55
|
| Rate for Payer: Healthspan PPO |
$98.68
|
| Rate for Payer: Humana Medicaid |
$62.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.59
|
| Rate for Payer: Molina Healthcare Passport |
$62.34
|
| Rate for Payer: Multiplan PHCS |
$135.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.20
|
| Rate for Payer: UHCCP Medicaid |
$47.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.96
|
|
|
Preventive Counseling Indiv 45
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 99403
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem Medicaid |
$77.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Humana KY Medicaid |
$77.72
|
| Rate for Payer: Kentucky WC Medicaid |
$78.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.06
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
Preventive Counseling Indiv 60
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 99404
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
Preventive Counseling Indiv 60
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 99404
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
Preventive Counseling Indiv 60
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 99404
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$152.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.52
|
| Rate for Payer: Anthem Medicaid |
$80.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$170.67
|
| Rate for Payer: Healthspan PPO |
$129.55
|
| Rate for Payer: Humana Medicaid |
$80.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.90
|
| Rate for Payer: Molina Healthcare Passport |
$80.29
|
| Rate for Payer: Multiplan PHCS |
$199.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.40
|
| Rate for Payer: UHCCP Medicaid |
$65.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.09
|
|
|
PREVENT VIS 65 YRS AND OLDER(P
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 99387
|
| Hospital Charge Code |
510P0102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna Commercial |
$162.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.93
|
| Rate for Payer: Anthem Medicaid |
$101.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$509.00
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$208.03
|
| Rate for Payer: Healthspan PPO |
$162.38
|
| Rate for Payer: Humana Medicaid |
$101.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.43
|
| Rate for Payer: Molina Healthcare Passport |
$101.40
|
| Rate for Payer: Multiplan PHCS |
$305.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$356.30
|
| Rate for Payer: UHCCP Medicaid |
$70.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.41
|
|
|
PREVENT VISIT - 12-17 YR
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$68.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$134.42
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$68.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.63
|
| Rate for Payer: Molina Healthcare Passport |
$68.26
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.94
|
|
|
PREVENT VISIT - 12-17 YR
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
PREVENT VISIT - 12-17 YR
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
PREVENT VISIT - 12-17 YR(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
510P0106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$68.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$134.42
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$68.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.63
|
| Rate for Payer: Molina Healthcare Passport |
$68.26
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.94
|
|
|
PREVENT VISIT - 1-4 YR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
PREVENT VISIT - 1-4 YR
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.90
|
| Rate for Payer: Anthem Medicaid |
$60.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$123.36
|
| Rate for Payer: Healthspan PPO |
$101.98
|
| Rate for Payer: Humana Medicaid |
$60.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.64
|
| Rate for Payer: Molina Healthcare Passport |
$60.43
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$39.80
|
| Rate for Payer: United Healthcare Non-Options |
$64.88
|
| Rate for Payer: United Healthcare Options |
$53.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.03
|
|
|
PREVENT VISIT - 1-4 YR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.20
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
