|
RANGER GLOBAL DCB OTW 7*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
|
|
|
RANGER GLOBAL DCB OTW 7*100*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 OTW7*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 OTW7*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 OTW7*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 OTW7*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 OTW7*200*150
|
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 OTW7*200*150
|
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 7*40*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 7*40*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 7*40*80
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
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 7*40*80
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
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 7*60*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 7*60*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 7*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 7*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 7*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 7*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 7*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 7*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
|
|
|
RAPAMUNE(SIROLIMUS) 1MG TAB
|
Facility
|
IP
|
$30.88
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
25002508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$23.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cigna Commercial |
$25.63
|
| Rate for Payer: First Health Commercial |
$29.34
|
| Rate for Payer: Humana Commercial |
$26.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.17
|
| Rate for Payer: Ohio Health Group HMO |
$23.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.57
|
| Rate for Payer: PHCS Commercial |
$29.64
|
| Rate for Payer: United Healthcare All Payer |
$27.17
|
|
|
RAPAMUNE(SIROLIMUS) 1MG TAB
|
Facility
|
OP
|
$30.88
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
25002508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$23.78
|
| Rate for Payer: Anthem Medicaid |
$10.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cigna Commercial |
$25.63
|
| Rate for Payer: First Health Commercial |
$29.34
|
| Rate for Payer: Humana Commercial |
$26.25
|
| Rate for Payer: Humana KY Medicaid |
$10.62
|
| Rate for Payer: Kentucky WC Medicaid |
$10.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.17
|
| Rate for Payer: Ohio Health Group HMO |
$23.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.57
|
| Rate for Payer: PHCS Commercial |
$29.64
|
| Rate for Payer: United Healthcare All Payer |
$27.17
|
|
|
RAPID CROSS 2*150*170
|
Facility
|
IP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 2*150*170
|
Facility
|
OP
|
$3,813.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.76 |
| Max. Negotiated Rate |
$3,660.96 |
| Rate for Payer: Aetna Commercial |
$2,936.40
|
| Rate for Payer: Anthem Medicaid |
$1,311.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,974.53
|
| Rate for Payer: Cash Price |
$1,906.75
|
| Rate for Payer: Cigna Commercial |
$3,165.20
|
| Rate for Payer: First Health Commercial |
$3,622.82
|
| Rate for Payer: Humana Commercial |
$3,241.48
|
| Rate for Payer: Humana KY Medicaid |
$1,311.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.18
|
| Rate for Payer: PHCS Commercial |
$3,660.96
|
| Rate for Payer: United Healthcare All Payer |
$3,355.88
|
|
|
RAPID CROSS 2*40*170
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
