Completed children's preventive screening form (EPSDT)

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR COMPLETED EPSDT

Payers reporting HCPCS S0302

Payer pricing summary

Low

Average

$103

Median

$73

High

$748

Payer rate distribution

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#
1	Tricare percent of total billed charges · bothfrom % of charges · +2 other terms	2	$26	$26	—	—	2–20	$26 – $26
2	Aetna fee schedule · outpatient · +9 other terms	21	$47	$113	$118	104%	—	$9 – $466
3	Anthem facility · case rate · outpatient · +6 other terms	15	$10	$11	$2	23%	—	$7 – $16
4	Caresource facility · case rate · outpatient · +1 other terms	15	$10	$11	$2	23%	—	$7 – $17
5	Molina facility · case rate · outpatient · +1 other terms	15	$10	$11	$2	23%	—	$7 – $16
6	UnitedHealthcare facility · case rate · outpatient · +8 other terms	15	$10	$11	$3	24%	—	$7 – $17
7	Cigna facility · fee schedule · outpatient · +6 other terms	13	$5	$21	$62	290%	—	$5 – $290
8	Wellmark fee schedule · both · +1 other terms	13	$33	$40	$43	107%	—	$33 – $300
9	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$63	$48	$27	55%	—	$21 – $79
10	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	12	$23	$141	$301	214%	—	$0 – $1.1k
11	Medcost professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms	11	$124	$119	$14	12%	—	$73 – $124
12	Medical Mutual professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms	11	$124	$112	$20	18%	—	$73 – $124
13	Optum facility · case rate · outpatient · +4 other terms	11	$9	$10	$2	22%	—	$8 – $15
14	Oscar professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms	11	$124	$119	$14	12%	—	$73 – $124
15	Highmark fee schedule · outpatient · +3 other terms	10	$120	$120	$2	2%	—	$113 – $121
16	Medica fee schedule · both · +7 other terms	10	$87	$84	$9	11%	—	$54 – $87
17	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$48	$48	—	—	—	$48 – $48
18	Humana fee schedule · outpatient · +5 other terms	6	$47	$33	$21	63%	—	$0 – $47
19	First Health professional · fee schedule · both · +4 other terms	3	$64	$64	$13	20%	—	$51 – $76
20	Amerihealth Caritas professional · fee schedule · outpatient	2	$13	$13	$0	3%	—	$13 – $14
21	Bcbs Il professional · fee schedule · both	1	$300	$300	—	—	—	$300 – $300
22	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
23	Bcbs Nc facility · fee schedule · outpatient	1	$37	$37	—	—	—	$37 – $37
24	Bcbs Nv fee schedule · outpatient	1	$35	$35	$8	23%	—	$27 – $44
25	Bcbs Vt professional · fee schedule · outpatient	1	$12	$12	—	—	—	$12 – $12

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