|
MUSTANG 10*80*75
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*20*135
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*20*135
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*20*40
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*20*40
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*20*75
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
|
|
MUSTANG 12*20*75
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*135
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*135
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*40
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*40
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*75
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*30*75
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*135
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*135
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*40
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*40
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*75
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*40*75
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*135
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*135
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*40
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*40
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*75
|
Facility
|
IP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Aetna Commercial |
$1,503.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
|
|
MUSTANG 12*60*75
|
Facility
|
OP
|
$1,952.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,873.92 |
| Rate for Payer: Anthem Medicaid |
$671.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,522.56
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cigna Commercial |
$1,620.16
|
| Rate for Payer: First Health Commercial |
$1,854.40
|
| Rate for Payer: Humana Commercial |
$1,659.20
|
| Rate for Payer: Humana KY Medicaid |
$671.29
|
| Rate for Payer: Kentucky WC Medicaid |
$678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,600.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,440.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.12
|
| Rate for Payer: PHCS Commercial |
$1,873.92
|
| Rate for Payer: United Healthcare All Payer |
$1,717.76
|
| Rate for Payer: Aetna Commercial |
$1,503.04
|
|
