|
Preventive Counseling Indiv 60
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 99404
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$99.60 |
| 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 |
$265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.08
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
Preventive Counseling Indiv 60
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 99404
|
| Hospital Charge Code |
94200008
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$99.60 |
| 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 |
$265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.08
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
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 |
$356.30 |
| 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 |
$127.74
|
| 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 |
$127.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.29
|
| Rate for Payer: Molina Healthcare Passport |
$127.74
|
| 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 |
$129.02
|
|
|
PREVENT VISIT - 12-17 YR
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.50 |
| 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 |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
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 |
$164.50 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$89.90
|
| 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 |
$89.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.70
|
| Rate for Payer: Molina Healthcare Passport |
$89.90
|
| 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 |
$90.80
|
|
|
PREVENT VISIT - 12-17 YR
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.50 |
| 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 |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| 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 |
$164.50 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$89.90
|
| 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 |
$89.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.70
|
| Rate for Payer: Molina Healthcare Passport |
$89.90
|
| 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 |
$90.80
|
|
|
PREVENT VISIT - 1-4 YR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| 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 |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
PREVENT VISIT - 1-4 YR
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 99392
|
| Hospital Charge Code |
51000104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| 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 |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| 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 |
$154.00 |
| 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 |
$78.58
|
| 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 |
$101.97
|
| Rate for Payer: Humana Medicaid |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| 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 |
$79.37
|
|
|
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 |
$154.00 |
| 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 |
$78.58
|
| 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 |
$101.97
|
| Rate for Payer: Humana Medicaid |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| 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 |
$79.37
|
|
|
PREVENT VISIT - 18-39 YR
|
Facility
|
IP
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.25 |
| 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 |
$302.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.48
|
| 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 |
$264.25 |
| 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 |
$84.80
|
| 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 |
$84.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.50
|
| Rate for Payer: Molina Healthcare Passport |
$84.80
|
| 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 |
$85.65
|
|
|
PREVENT VISIT - 18-39 YR
|
Facility
|
OP
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.25 |
| 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 |
$302.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$328.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.48
|
| Rate for Payer: PHCS Commercial |
$362.40
|
| Rate for Payer: United Healthcare All Payer |
$332.20
|
|
|
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 |
$264.25 |
| 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 |
$84.80
|
| 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 |
$84.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.50
|
| Rate for Payer: Molina Healthcare Passport |
$84.80
|
| 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 |
$85.65
|
|
|
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 |
$320.25 |
| 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 |
$116.70
|
| 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 |
$147.57
|
| Rate for Payer: Humana Medicaid |
$116.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.03
|
| Rate for Payer: Molina Healthcare Passport |
$116.70
|
| 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 |
$117.87
|
|
|
PREVENT VISIT 40-64
|
Facility
|
OP
|
$457.50
|
|
|
Service Code
|
HCPCS 99386
|
| Hospital Charge Code |
51000101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna Commercial |
$352.27
|
| 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 |
$379.73
|
| 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 |
$337.63
|
| 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 |
$366.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.68
|
| 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 |
$137.25 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna Commercial |
$352.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.85
|
| Rate for Payer: Cash Price |
$228.75
|
| Rate for Payer: Cigna Commercial |
$379.73
|
| 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 |
$337.63
|
| 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 |
$366.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.68
|
| 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 |
$320.25 |
| 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 |
$116.70
|
| 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 |
$147.57
|
| Rate for Payer: Humana Medicaid |
$116.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.03
|
| Rate for Payer: Molina Healthcare Passport |
$116.70
|
| 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 |
$117.87
|
|
|
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 |
$278.87 |
| 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 |
$100.83
|
| 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 |
$100.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.85
|
| Rate for Payer: Molina Healthcare Passport |
$100.83
|
| 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 |
$101.84
|
|
|
PREVENT VISIT - 40-64 YR
|
Facility
|
OP
|
$398.38
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.51 |
| 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 |
$298.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.88
|
| 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 |
$119.51 |
| 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 |
$298.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.88
|
| Rate for Payer: PHCS Commercial |
$382.44
|
| Rate for Payer: United Healthcare All Payer |
$350.57
|
|
|
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 |
$278.87 |
| 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 |
$100.83
|
| 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 |
$100.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.85
|
| Rate for Payer: Molina Healthcare Passport |
$100.83
|
| 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 |
$101.84
|
|
|
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 |
$154.00 |
| 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 |
$78.58
|
| 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 |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| 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 |
$79.37
|
|
|
PREVENT VISIT - 5-11 YR
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99393
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| 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 |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
