|
PREVENT VISIT - 1-4 YR(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
510P0104
|
|
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 - 18-39 YR
|
Facility
|
OP
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.08 |
| Max. Negotiated Rate |
$362.40 |
| Rate for Payer: Aetna Commercial |
$290.68
|
| Rate for Payer: Anthem Medicaid |
$129.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.45
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cigna Commercial |
$313.32
|
| Rate for Payer: First Health Commercial |
$358.62
|
| Rate for Payer: Humana Commercial |
$320.88
|
| Rate for Payer: Humana KY Medicaid |
$129.82
|
| Rate for Payer: Kentucky WC Medicaid |
$131.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.20
|
| Rate for Payer: Ohio Health Group HMO |
$283.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.02
|
| Rate for Payer: PHCS Commercial |
$362.40
|
| Rate for Payer: United Healthcare All Payer |
$332.20
|
|
|
PREVENT VISIT - 18-39 YR
|
Facility
|
IP
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.08 |
| Max. Negotiated Rate |
$362.40 |
| Rate for Payer: Aetna Commercial |
$290.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.45
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cigna Commercial |
$313.32
|
| Rate for Payer: First Health Commercial |
$358.62
|
| Rate for Payer: Humana Commercial |
$320.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.20
|
| Rate for Payer: Ohio Health Group HMO |
$283.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.02
|
| Rate for Payer: PHCS Commercial |
$362.40
|
| Rate for Payer: United Healthcare All Payer |
$332.20
|
|
|
PREVENT VISIT - 18-39 YR
|
Professional
|
Both
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$377.50 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.13
|
| Rate for Payer: Anthem Medicaid |
$70.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.50
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cigna Commercial |
$135.52
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$70.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.62
|
| Rate for Payer: Molina Healthcare Passport |
$70.22
|
| Rate for Payer: Multiplan PHCS |
$226.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.25
|
| Rate for Payer: UHCCP Medicaid |
$46.34
|
| Rate for Payer: United Healthcare Non-Options |
$73.86
|
| Rate for Payer: United Healthcare Options |
$60.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.92
|
|
|
PREVENT VISIT - 18-39 YR(P
|
Professional
|
Both
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
510P0107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$377.50 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.13
|
| Rate for Payer: Anthem Medicaid |
$70.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.50
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cigna Commercial |
$135.52
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$70.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.62
|
| Rate for Payer: Molina Healthcare Passport |
$70.22
|
| Rate for Payer: Multiplan PHCS |
$226.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.25
|
| Rate for Payer: UHCCP Medicaid |
$46.34
|
| Rate for Payer: United Healthcare Non-Options |
$73.86
|
| Rate for Payer: United Healthcare Options |
$60.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.92
|
|
|
PREVENT VISIT 40-64
|
Professional
|
Both
|
$457.50
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$457.50 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.29
|
| Rate for Payer: Anthem Medicaid |
$93.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.50
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cigna Commercial |
$191.42
|
| Rate for Payer: Healthspan PPO |
$147.58
|
| Rate for Payer: Humana Medicaid |
$93.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.87
|
| Rate for Payer: Molina Healthcare Passport |
$93.99
|
| Rate for Payer: Multiplan PHCS |
$274.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$320.25
|
| Rate for Payer: UHCCP Medicaid |
$65.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.93
|
|
|
PREVENT VISIT 40-64
|
Facility
|
OP
|
$457.50
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna Commercial |
$352.28
|
| Rate for Payer: Anthem Medicaid |
$157.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.85
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cigna Commercial |
$379.72
|
| Rate for Payer: First Health Commercial |
$434.62
|
| Rate for Payer: Humana Commercial |
$388.88
|
| Rate for Payer: Humana KY Medicaid |
$157.33
|
| Rate for Payer: Kentucky WC Medicaid |
$158.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.60
|
| Rate for Payer: Ohio Health Group HMO |
$343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.82
|
| Rate for Payer: PHCS Commercial |
$439.20
|
| Rate for Payer: United Healthcare All Payer |
$402.60
|
|
|
PREVENT VISIT 40-64
|
Facility
|
IP
|
$457.50
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna Commercial |
$352.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.85
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cigna Commercial |
$379.72
|
| Rate for Payer: First Health Commercial |
$434.62
|
| Rate for Payer: Humana Commercial |
$388.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.60
|
| Rate for Payer: Ohio Health Group HMO |
$343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.82
|
| Rate for Payer: PHCS Commercial |
$439.20
|
| Rate for Payer: United Healthcare All Payer |
$402.60
|
|
|
PREVENT VISIT 40-64(P
|
Professional
|
Both
|
$457.50
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
510P0101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$457.50 |
| Rate for Payer: Aetna Commercial |
$148.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.29
|
| Rate for Payer: Anthem Medicaid |
$93.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.50
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cigna Commercial |
$191.42
|
| Rate for Payer: Healthspan PPO |
$147.58
|
| Rate for Payer: Humana Medicaid |
$93.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.87
|
| Rate for Payer: Molina Healthcare Passport |
$93.99
|
| Rate for Payer: Multiplan PHCS |
$274.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$320.25
|
| Rate for Payer: UHCCP Medicaid |
$65.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.93
|
|
|
PREVENT VISIT - 40-64 YR
|
Facility
|
OP
|
$398.38
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$382.44 |
| Rate for Payer: Aetna Commercial |
$306.75
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.74
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cigna Commercial |
$330.66
|
| Rate for Payer: First Health Commercial |
$378.46
|
| Rate for Payer: Humana Commercial |
$338.62
|
| Rate for Payer: Humana KY Medicaid |
$137.00
|
| Rate for Payer: Kentucky WC Medicaid |
$138.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.57
|
| Rate for Payer: Ohio Health Group HMO |
$298.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.50
|
| Rate for Payer: PHCS Commercial |
$382.44
|
| Rate for Payer: United Healthcare All Payer |
$350.57
|
|
|
PREVENT VISIT - 40-64 YR
|
Facility
|
IP
|
$398.38
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$382.44 |
| Rate for Payer: Aetna Commercial |
$306.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.74
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cigna Commercial |
$330.66
|
| Rate for Payer: First Health Commercial |
$378.46
|
| Rate for Payer: Humana Commercial |
$338.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.57
|
| Rate for Payer: Ohio Health Group HMO |
$298.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.50
|
| Rate for Payer: PHCS Commercial |
$382.44
|
| Rate for Payer: United Healthcare All Payer |
$350.57
|
|
|
PREVENT VISIT - 40-64 YR
|
Professional
|
Both
|
$398.38
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$398.38 |
| Rate for Payer: Aetna Commercial |
$120.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.45
|
| Rate for Payer: Anthem Medicaid |
$76.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.38
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cigna Commercial |
$149.95
|
| Rate for Payer: Healthspan PPO |
$122.46
|
| Rate for Payer: Humana Medicaid |
$76.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.07
|
| Rate for Payer: Molina Healthcare Passport |
$76.54
|
| Rate for Payer: Multiplan PHCS |
$239.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.87
|
| Rate for Payer: UHCCP Medicaid |
$50.87
|
| Rate for Payer: United Healthcare Non-Options |
$83.32
|
| Rate for Payer: United Healthcare Options |
$68.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.31
|
|
|
PREVENT VISIT - 40-64 YR(P
|
Professional
|
Both
|
$398.38
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
510P0108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$398.38 |
| Rate for Payer: Aetna Commercial |
$120.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.45
|
| Rate for Payer: Anthem Medicaid |
$76.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.38
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cigna Commercial |
$149.95
|
| Rate for Payer: Healthspan PPO |
$122.46
|
| Rate for Payer: Humana Medicaid |
$76.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.07
|
| Rate for Payer: Molina Healthcare Passport |
$76.54
|
| Rate for Payer: Multiplan PHCS |
$239.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.87
|
| Rate for Payer: UHCCP Medicaid |
$50.87
|
| Rate for Payer: United Healthcare Non-Options |
$83.32
|
| Rate for Payer: United Healthcare Options |
$68.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.31
|
|
|
PREVENT VISIT - 5-11 YR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
51000105
|
|
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
|
|
|
PREVENT VISIT - 5-11 YR
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
51000105
|
|
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 |
$122.23
|
| Rate for Payer: Healthspan PPO |
$101.56
|
| 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 - 5-11 YR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
51000105
|
|
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 - 5-11 YR(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
510P0105
|
|
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 |
$122.23
|
| Rate for Payer: Healthspan PPO |
$101.56
|
| 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 - NEW AGE18-39
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
51000326
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna Commercial |
$120.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.97
|
| Rate for Payer: Anthem Medicaid |
$77.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$163.72
|
| Rate for Payer: Healthspan PPO |
$126.64
|
| Rate for Payer: Humana Medicaid |
$77.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.15
|
| Rate for Payer: Molina Healthcare Passport |
$77.60
|
| Rate for Payer: Multiplan PHCS |
$268.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$51.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.38
|
|
|
PREVENT VISIT - NEW AGE18-39
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
51000326
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$429.12 |
| Rate for Payer: Aetna Commercial |
$344.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.66
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$371.01
|
| Rate for Payer: First Health Commercial |
$424.65
|
| Rate for Payer: Humana Commercial |
$379.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$393.36
|
| Rate for Payer: Ohio Health Group HMO |
$335.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.57
|
| Rate for Payer: PHCS Commercial |
$429.12
|
| Rate for Payer: United Healthcare All Payer |
$393.36
|
|
|
PREVENT VISIT - NEW AGE18-39
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
51000326
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$429.12 |
| Rate for Payer: Aetna Commercial |
$344.19
|
| Rate for Payer: Anthem Medicaid |
$153.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$348.66
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$371.01
|
| Rate for Payer: First Health Commercial |
$424.65
|
| Rate for Payer: Humana Commercial |
$379.95
|
| Rate for Payer: Humana KY Medicaid |
$153.72
|
| Rate for Payer: Kentucky WC Medicaid |
$155.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$366.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$393.36
|
| Rate for Payer: Ohio Health Group HMO |
$335.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.57
|
| Rate for Payer: PHCS Commercial |
$429.12
|
| Rate for Payer: United Healthcare All Payer |
$393.36
|
|
|
PREVENT VISIT - NEW AGE18-39(P
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 99385
|
| Hospital Charge Code |
510P0326
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna Commercial |
$120.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.97
|
| Rate for Payer: Anthem Medicaid |
$77.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.00
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$163.72
|
| Rate for Payer: Healthspan PPO |
$126.64
|
| Rate for Payer: Humana Medicaid |
$77.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.15
|
| Rate for Payer: Molina Healthcare Passport |
$77.60
|
| Rate for Payer: Multiplan PHCS |
$268.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.90
|
| Rate for Payer: UHCCP Medicaid |
$51.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.38
|
|
|
PREVENT VISIT - NEW AGE5-11 (P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 99383
|
| Hospital Charge Code |
510P0098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.31
|
| Rate for Payer: Anthem Medicaid |
$68.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$150.41
|
| Rate for Payer: Healthspan PPO |
$115.91
|
| 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 |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$44.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.94
|
|
|
PREVENT VISIT - NEW AGE5-11 Y
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 99383
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
PREVENT VISIT - NEW AGE5-11 Y
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 99383
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
PREVENT VISIT - NEW AGE5-11 Y
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 99383
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.31
|
| Rate for Payer: Anthem Medicaid |
$68.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$150.41
|
| Rate for Payer: Healthspan PPO |
$115.91
|
| 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 |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$44.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.94
|
|
