Mutual Medical Plans: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Mutual Medical Plans appears in disclosed negotiated rates across 1 hospital and 174 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

174 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
00187-4303-05 - amobarbital 0.5 gm Inj Inpatient	Springfield Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$1,333 – $3,332	—
00187-4303-05 - amobarbital 0.5 gm Inj Outpatient	Springfield Memorial Hospital	J0300 HCPCS	$3,332	$3,332	$750 – $3,332	—
13533-0800-20 - immune globulin intravenous and su Inpatient	Springfield Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$1,535 – $3,839	—
13533-0800-20 - immune globulin intravenous and su Outpatient	Springfield Memorial Hospital	J1561 HCPCS	$3,839	$3,839	$864 – $3,839	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Inpatient	Springfield Memorial Hospital	J2597 HCPCS	$195	$195	$78.05 – $195	—
55566-2300-00 - desmopressin 4 mcg/mL Inj Outpatient	Springfield Memorial Hospital	J2597 HCPCS	$195	$195	$43.90 – $195	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Inpatient	Springfield Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$507 – $1,267	—
61364-0181-03 - peramivir 10 mg/mL 20mL vial Outpatient	Springfield Memorial Hospital	J2547 HCPCS	$1,267	$1,267	$285 – $1,267	—
63323-0593-03 - glucagon 1 mg Inj Inpatient	Springfield Memorial Hospital	J1611 HCPCS	$451	$451	$180 – $451	—
63323-0593-03 - glucagon 1 mg Inj Outpatient	Springfield Memorial Hospital	J1611 HCPCS	$451	$451	$101 – $451	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Inpatient	Springfield Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$1,620 – $4,051	—
66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Outpatient	Springfield Memorial Hospital	C9488 HCPCS	$4,051	$4,051	$911 – $4,051	—
67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Inpatient	Springfield Memorial Hospital	J0695 HCPCS	$638	$638	$255 – $638	—
67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Outpatient	Springfield Memorial Hospital	J0695 HCPCS	$638	$638	$143 – $638	—
BASEPLATE HA ADAPTER 25MM Inpatient	Springfield Memorial Hospital	C1776 HCPCS	$12,938	$12,938	$4,438 – $12,938	—
BASEPLATE HA ADAPTER 25MM Outpatient	Springfield Memorial Hospital	C1776 HCPCS	$12,938	$12,938	$2,911 – $12,938	—
BEARING HUMRL XL 44-36 STD Inpatient	Springfield Memorial Hospital	C1776 HCPCS	$6,300	$6,300	$2,161 – $6,300	—
BEARING HUMRL XL 44-36 STD Outpatient	Springfield Memorial Hospital	C1776 HCPCS	$6,300	$6,300	$1,418 – $6,300	—
Bill Only Opiates Serum /Plasma Inpatient	Springfield Memorial Hospital	80361 CPT	$246	$246	$98.40 – $246	—
Bill Only Opiates Serum /Plasma Outpatient	Springfield Memorial Hospital	80361 CPT	$246	$246	$78.72 – $246	—
BONE CORPECTOMY FIB 50MM Inpatient	Springfield Memorial Hospital	C1713 HCPCS	$8,607	$8,607	$2,952 – $8,607	—
BONE CORPECTOMY FIB 50MM Outpatient	Springfield Memorial Hospital	C1713 HCPCS	$8,607	$8,607	$1,937 – $8,607	—
FMS-Amniocentesis Dx Inpatient	Springfield Memorial Hospital	59000 CPT	$1,813	$1,813	$725 – $1,813	—
FMS-Amniocentesis Dx Outpatient	Springfield Memorial Hospital	59000 CPT	$1,813	$1,813	$294 – $6,866	—
FMS-EST PT Visit Only Lvl I Inpatient	Springfield Memorial Hospital	99211 CPT	$249	$249	$99.60 – $249	—