|
RANGER GLOBAL DCB OTW5*120*150
|
Facility
|
IP
|
$7,891.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
RANGER GLOBAL DCB OTW5*120*150
|
Facility
|
OP
|
$7,891.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem Medicaid |
$2,713.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Humana KY Medicaid |
$2,713.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
RANGER GLOBAL DCB OTW5*150*150
|
Facility
|
IP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
RANGER GLOBAL DCB OTW5*150*150
|
Facility
|
OP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Anthem Medicaid |
$3,285.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Humana KY Medicaid |
$3,285.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,351.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
RANGER GLOBAL DCB OTW 5*150*90
|
Facility
|
IP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.83 |
| Max. Negotiated Rate |
$8,276.88 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
| Rate for Payer: United Healthcare All Payer |
$7,587.14
|
|
|
RANGER GLOBAL DCB OTW 5*150*90
|
Facility
|
OP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.83 |
| Max. Negotiated Rate |
$8,276.88 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem Medicaid |
$2,965.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Humana KY Medicaid |
$2,965.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
| Rate for Payer: United Healthcare All Payer |
$7,587.14
|
|
|
RANGER GLOBAL DCB OTW5*200*150
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
RANGER GLOBAL DCB OTW5*200*150
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
RANGER GLOBAL DCB OTW 5*200*90
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
RANGER GLOBAL DCB OTW 5*200*90
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
RANGER GLOBAL DCB OTW 5*40*135
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW 5*40*135
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW 5*40*80
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*40*80
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*60*135
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW 5*60*135
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW 5*60*80
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*60*80
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*80*135
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*80*135
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*80*80
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW 5*80*80
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
RANGER GLOBAL DCB OTW6*100*135
|
Facility
|
IP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW6*100*135
|
Facility
|
OP
|
$9,005.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,170.65 |
| Max. Negotiated Rate |
$8,644.80 |
| Rate for Payer: Aetna Commercial |
$6,933.85
|
| Rate for Payer: Anthem Medicaid |
$3,096.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,023.90
|
| Rate for Payer: Cash Price |
$4,502.50
|
| Rate for Payer: Cigna Commercial |
$7,474.15
|
| Rate for Payer: First Health Commercial |
$8,554.75
|
| Rate for Payer: Humana Commercial |
$7,654.25
|
| Rate for Payer: Humana KY Medicaid |
$3,096.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,128.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,384.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,645.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,924.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,801.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,791.55
|
| Rate for Payer: PHCS Commercial |
$8,644.80
|
| Rate for Payer: United Healthcare All Payer |
$7,924.40
|
|
|
RANGER GLOBAL DCB OTW 6*100*80
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
