|
MUSTANG 12*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 12*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 12*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 12*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
|
|
|
MUSTANG 12*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 12*40*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 12*40*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 12*40*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 12*40*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 12*40*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 12*40*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 12*60*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 12*60*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 12*60*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 12*60*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 12*60*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 12*60*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 12*80*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 12*80*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 12*80*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 12*80*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 12*80*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 12*80*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 4*100*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 4*100*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
|
|
