|
MUSCLE TEST CRAN NERVE BILAT(T
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 95868
|
| Hospital Charge Code |
922T0020
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Facility
|
OP
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,248.07 |
| Max. Negotiated Rate |
$6,275.52 |
| Rate for Payer: Aetna Commercial |
$5,033.49
|
| Rate for Payer: Anthem Medicaid |
$2,248.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,098.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$5,425.71
|
| Rate for Payer: First Health Commercial |
$6,210.15
|
| Rate for Payer: Humana Commercial |
$5,556.45
|
| Rate for Payer: Humana KY Medicaid |
$2,248.07
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,360.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,824.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,293.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,687.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,510.53
|
| Rate for Payer: PHCS Commercial |
$6,275.52
|
| Rate for Payer: United Healthcare All Payer |
$5,752.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Facility
|
IP
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,961.10 |
| Max. Negotiated Rate |
$6,275.52 |
| Rate for Payer: Aetna Commercial |
$5,033.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,098.86
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$5,425.71
|
| Rate for Payer: First Health Commercial |
$6,210.15
|
| Rate for Payer: Humana Commercial |
$5,556.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,360.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,824.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,961.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,687.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,510.53
|
| Rate for Payer: PHCS Commercial |
$6,275.52
|
| Rate for Payer: United Healthcare All Payer |
$5,752.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
Professional
|
Both
|
$6,537.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
76100204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.58 |
| Max. Negotiated Rate |
$3,922.20 |
| Rate for Payer: Ambetter Exchange |
$969.62
|
| Rate for Payer: Anthem Medicaid |
$827.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$969.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$969.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,163.54
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cash Price |
$3,268.50
|
| Rate for Payer: Cigna Commercial |
$1,723.35
|
| Rate for Payer: Humana Medicaid |
$827.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,354.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$969.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.13
|
| Rate for Payer: Molina Healthcare Passport |
$827.58
|
| Rate for Payer: Multiplan PHCS |
$3,922.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.51
|
| Rate for Payer: UHCCP Medicaid |
$2,287.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$835.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$969.62
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761P0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,723.35 |
| Rate for Payer: Ambetter Exchange |
$969.62
|
| Rate for Payer: Anthem Medicaid |
$827.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$969.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$969.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,163.54
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,723.35
|
| Rate for Payer: Humana Medicaid |
$827.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,354.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$969.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.13
|
| Rate for Payer: Molina Healthcare Passport |
$827.58
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.51
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$835.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$969.62
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(T
|
Facility
|
IP
|
$5,287.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761T0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,586.10 |
| Max. Negotiated Rate |
$5,075.52 |
| Rate for Payer: Aetna Commercial |
$4,070.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.86
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cigna Commercial |
$4,388.21
|
| Rate for Payer: First Health Commercial |
$5,022.65
|
| Rate for Payer: Humana Commercial |
$4,493.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,335.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,586.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,652.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,599.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,648.03
|
| Rate for Payer: PHCS Commercial |
$5,075.52
|
| Rate for Payer: United Healthcare All Payer |
$4,652.56
|
|
|
MUSC MYOQ/FSCQ FLP H&N PEDC(T
|
Facility
|
OP
|
$5,287.00
|
|
|
Service Code
|
HCPCS 15733
|
| Hospital Charge Code |
761T0204
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,818.20 |
| Max. Negotiated Rate |
$5,075.52 |
| Rate for Payer: Aetna Commercial |
$4,070.99
|
| Rate for Payer: Anthem Medicaid |
$1,818.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cash Price |
$2,643.50
|
| Rate for Payer: Cigna Commercial |
$4,388.21
|
| Rate for Payer: First Health Commercial |
$5,022.65
|
| Rate for Payer: Humana Commercial |
$4,493.95
|
| Rate for Payer: Humana KY Medicaid |
$1,818.20
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,335.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,854.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,652.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,965.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,599.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,648.03
|
| Rate for Payer: PHCS Commercial |
$5,075.52
|
| Rate for Payer: United Healthcare All Payer |
$4,652.56
|
|
|
MUSC TST DONE W/N TST NONEX(P
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510P0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$132.44 |
| Rate for Payer: Ambetter Exchange |
$74.06
|
| Rate for Payer: Anthem Medicaid |
$61.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.87
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$132.44
|
| Rate for Payer: Healthspan PPO |
$75.97
|
| Rate for Payer: Humana Medicaid |
$61.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.46
|
| Rate for Payer: Molina Healthcare Passport |
$61.24
|
| Rate for Payer: Multiplan PHCS |
$66.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.28
|
| Rate for Payer: UHCCP Medicaid |
$38.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.06
|
|
|
MUSC TST DONE W/N TST NONEX(T
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510T0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
MUSC TST DONE W/N TST NONEX(T
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
510T0037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$213.00 |
| Rate for Payer: Ambetter Exchange |
$74.06
|
| Rate for Payer: Anthem Medicaid |
$61.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.87
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$132.44
|
| Rate for Payer: Healthspan PPO |
$75.97
|
| Rate for Payer: Humana Medicaid |
$61.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.46
|
| Rate for Payer: Molina Healthcare Passport |
$61.24
|
| Rate for Payer: Multiplan PHCS |
$213.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.28
|
| Rate for Payer: UHCCP Medicaid |
$124.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.06
|
|
|
MUSC TST DONE W/N TST NONEXT
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 95887
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.95
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
MUSTANG 10*20*135
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*20*135
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*20*40
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*20*40
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*20*75
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*20*75
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*135
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*135
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*40
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*40
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*75
|
Facility
|
IP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
|
MUSTANG 10*30*75
|
Facility
|
OP
|
$1,953.60
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.08 |
| Max. Negotiated Rate |
$1,875.46 |
| Rate for Payer: Aetna Commercial |
$1,504.27
|
| Rate for Payer: Anthem Medicaid |
$671.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.81
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cigna Commercial |
$1,621.49
|
| Rate for Payer: First Health Commercial |
$1,855.92
|
| Rate for Payer: Humana Commercial |
$1,660.56
|
| Rate for Payer: Humana KY Medicaid |
$671.84
|
| Rate for Payer: Kentucky WC Medicaid |
$678.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,562.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.98
|
| Rate for Payer: PHCS Commercial |
$1,875.46
|
| Rate for Payer: United Healthcare All Payer |
$1,719.17
|
|
