|
MUSTANG 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 9*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 BALLOON 5*20*135
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
MUSTANG BALLOON 5*20*135
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
MUTAMYCIN 5 MG [ 20MG/40ML]
|
Facility
|
IP
|
$3,444.29
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
25002659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,033.29 |
| Max. Negotiated Rate |
$3,306.52 |
| Rate for Payer: Aetna Commercial |
$2,652.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,686.55
|
| Rate for Payer: Cash Price |
$1,722.14
|
| Rate for Payer: Cigna Commercial |
$2,858.76
|
| Rate for Payer: First Health Commercial |
$3,272.08
|
| Rate for Payer: Humana Commercial |
$2,927.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,824.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,583.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,755.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.56
|
| Rate for Payer: PHCS Commercial |
$3,306.52
|
| Rate for Payer: United Healthcare All Payer |
$3,030.98
|
|
|
MUTAMYCIN 5 MG [ 20MG/40ML]
|
Facility
|
OP
|
$3,444.29
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
25002659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$3,306.52 |
| Rate for Payer: Aetna Commercial |
$2,652.10
|
| Rate for Payer: Anthem Medicaid |
$1,184.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,686.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.16
|
| Rate for Payer: Cash Price |
$1,722.14
|
| Rate for Payer: Cash Price |
$1,722.14
|
| Rate for Payer: Cigna Commercial |
$2,858.76
|
| Rate for Payer: First Health Commercial |
$3,272.08
|
| Rate for Payer: Humana Commercial |
$2,927.65
|
| Rate for Payer: Humana KY Medicaid |
$1,184.49
|
| Rate for Payer: Humana Medicare Advantage |
$28.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,196.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,824.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,208.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,583.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,755.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.56
|
| Rate for Payer: PHCS Commercial |
$3,306.52
|
| Rate for Payer: United Healthcare All Payer |
$3,030.98
|
|
|
MUTAMYCIN (MITOMYCIN) 5MG/10ML
|
Facility
|
IP
|
$1,325.82
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
25002658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$397.75 |
| Max. Negotiated Rate |
$1,272.79 |
| Rate for Payer: Aetna Commercial |
$1,020.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,034.14
|
| Rate for Payer: Cash Price |
$662.91
|
| Rate for Payer: Cigna Commercial |
$1,100.43
|
| Rate for Payer: First Health Commercial |
$1,259.53
|
| Rate for Payer: Humana Commercial |
$1,126.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,087.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$978.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.72
|
| Rate for Payer: Ohio Health Group HMO |
$994.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.82
|
| Rate for Payer: PHCS Commercial |
$1,272.79
|
| Rate for Payer: United Healthcare All Payer |
$1,166.72
|
|
|
MUTAMYCIN (MITOMYCIN) 5MG/10ML
|
Facility
|
OP
|
$1,325.82
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
25002658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$1,272.79 |
| Rate for Payer: Aetna Commercial |
$1,020.88
|
| Rate for Payer: Anthem Medicaid |
$455.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,034.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.16
|
| Rate for Payer: Cash Price |
$662.91
|
| Rate for Payer: Cash Price |
$662.91
|
| Rate for Payer: Cigna Commercial |
$1,100.43
|
| Rate for Payer: First Health Commercial |
$1,259.53
|
| Rate for Payer: Humana Commercial |
$1,126.95
|
| Rate for Payer: Humana KY Medicaid |
$455.95
|
| Rate for Payer: Humana Medicare Advantage |
$28.27
|
| Rate for Payer: Kentucky WC Medicaid |
$460.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,087.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$978.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$465.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.72
|
| Rate for Payer: Ohio Health Group HMO |
$994.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.82
|
| Rate for Payer: PHCS Commercial |
$1,272.79
|
| Rate for Payer: United Healthcare All Payer |
$1,166.72
|
|
|
M V I W/VITIMIN K
|
Facility
|
OP
|
$122.38
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
25000936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$117.48 |
| Rate for Payer: Aetna Commercial |
$94.23
|
| Rate for Payer: Anthem Medicaid |
$42.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.46
|
| Rate for Payer: Cash Price |
$61.19
|
| Rate for Payer: Cigna Commercial |
$101.58
|
| Rate for Payer: First Health Commercial |
$116.26
|
| Rate for Payer: Humana Commercial |
$104.02
|
| Rate for Payer: Humana KY Medicaid |
$42.09
|
| Rate for Payer: Kentucky WC Medicaid |
$42.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.69
|
| Rate for Payer: Ohio Health Group HMO |
$91.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.44
|
| Rate for Payer: PHCS Commercial |
$117.48
|
| Rate for Payer: United Healthcare All Payer |
$107.69
|
|
|
M V I W/VITIMIN K
|
Facility
|
IP
|
$122.38
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
25000936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$117.48 |
| Rate for Payer: Aetna Commercial |
$94.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.46
|
| Rate for Payer: Cash Price |
$61.19
|
| Rate for Payer: Cigna Commercial |
$101.58
|
| Rate for Payer: First Health Commercial |
$116.26
|
| Rate for Payer: Humana Commercial |
$104.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.69
|
| Rate for Payer: Ohio Health Group HMO |
$91.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.44
|
| Rate for Payer: PHCS Commercial |
$117.48
|
| Rate for Payer: United Healthcare All Payer |
$107.69
|
|
