|
PRESSURE WIRE X GUIDE WIRE
|
Facility
|
IP
|
$4,411.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,323.38 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$3,396.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.78
|
| Rate for Payer: Cash Price |
$2,205.62
|
| Rate for Payer: Cigna Commercial |
$3,661.34
|
| Rate for Payer: First Health Commercial |
$4,190.69
|
| Rate for Payer: Humana Commercial |
$3,749.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,837.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.76
|
| Rate for Payer: PHCS Commercial |
$4,234.80
|
| Rate for Payer: United Healthcare All Payer |
$3,881.90
|
|
|
PRETREAT RBC INC W CHEM AG
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 86970
|
| Hospital Charge Code |
30001242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.59
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
PRETREAT RBC INC W CHEM AG
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 86970
|
| Hospital Charge Code |
30001242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem Medicaid |
$54.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.88
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Humana KY Medicaid |
$54.88
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$55.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.59
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
PRETREAT RBC W ENZYMES EACH
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 86971
|
| Hospital Charge Code |
30001243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.04 |
| Max. Negotiated Rate |
$221.66 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
PRETREAT RBC W ENZYMES EACH
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 86971
|
| Hospital Charge Code |
30001243
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.45
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
PREVACID (LANSOPRAZO 15MG/1CAP
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 68001011104
|
| Hospital Charge Code |
25001224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PREVACID (LANSOPRAZO 15MG/1CAP
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 68001011104
|
| Hospital Charge Code |
25001224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
PREVACID (LANSOPRAZO 30MG/1TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 16571069803
|
| Hospital Charge Code |
25001225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
PREVACID (LANSOPRAZO 30MG/1TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 16571069803
|
| Hospital Charge Code |
25001225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
PREVENA PEEL & PLACE SYSTEM
|
Facility
|
IP
|
$3,728.19
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.46 |
| Max. Negotiated Rate |
$3,579.06 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,907.99
|
| Rate for Payer: Cash Price |
$1,864.09
|
| Rate for Payer: Cigna Commercial |
$3,094.40
|
| Rate for Payer: First Health Commercial |
$3,541.78
|
| Rate for Payer: Humana Commercial |
$3,168.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,982.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,243.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.45
|
| Rate for Payer: PHCS Commercial |
$3,579.06
|
| Rate for Payer: United Healthcare All Payer |
$3,280.81
|
|
|
PREVENA PEEL & PLACE SYSTEM
|
Facility
|
OP
|
$3,728.19
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.46 |
| Max. Negotiated Rate |
$3,579.06 |
| Rate for Payer: Aetna Commercial |
$2,870.71
|
| Rate for Payer: Anthem Medicaid |
$1,282.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,907.99
|
| Rate for Payer: Cash Price |
$1,864.09
|
| Rate for Payer: Cigna Commercial |
$3,094.40
|
| Rate for Payer: First Health Commercial |
$3,541.78
|
| Rate for Payer: Humana Commercial |
$3,168.96
|
| Rate for Payer: Humana KY Medicaid |
$1,282.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,982.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,243.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.45
|
| Rate for Payer: PHCS Commercial |
$3,579.06
|
| Rate for Payer: United Healthcare All Payer |
$3,280.81
|
|
|
Preventive Conseling Indiv 15
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
Preventive Conseling Indiv 15
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$79.10 |
| 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: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| 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 |
$67.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.10
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.90
|
|
|
Preventive Conseling Indiv 15
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 99401
|
| Hospital Charge Code |
94200005
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
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 |
$45.50 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| 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 |
76102636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| 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 |
$19.50 |
| 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 |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| 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 |
$19.50 |
| 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 |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
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 |
$114.10 |
| 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: 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
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 99402
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.90 |
| 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 |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
Preventive Counseling Indiv 30
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 99402
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.90 |
| 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 |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
Preventive Counseling Indiv 45
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 99403
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.80 |
| 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 |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| 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 |
$158.20 |
| 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: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$132.55
|
| Rate for Payer: Healthspan PPO |
$98.67
|
| 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
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 99403
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$67.80 |
| 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 |
$180.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.94
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
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 |
$232.40 |
| 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: 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
|
|
