|
RANGER GLOBAL DCB OTW7*150*150
|
Facility
|
IP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,925.75 |
| Max. Negotiated Rate |
$9,362.40 |
| Rate for Payer: Aetna Commercial |
$7,509.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,606.95
|
| Rate for Payer: Cash Price |
$4,876.25
|
| Rate for Payer: Cigna Commercial |
$8,094.57
|
| Rate for Payer: First Health Commercial |
$9,264.88
|
| Rate for Payer: Humana Commercial |
$8,289.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,484.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,729.23
|
| Rate for Payer: PHCS Commercial |
$9,362.40
|
| Rate for Payer: United Healthcare All Payer |
$8,582.20
|
|
|
RANGER GLOBAL DCB OTW7*150*150
|
Facility
|
OP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,925.75 |
| Max. Negotiated Rate |
$9,362.40 |
| Rate for Payer: Aetna Commercial |
$7,509.43
|
| Rate for Payer: Anthem Medicaid |
$3,353.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,606.95
|
| Rate for Payer: Cash Price |
$4,876.25
|
| Rate for Payer: Cigna Commercial |
$8,094.57
|
| Rate for Payer: First Health Commercial |
$9,264.88
|
| Rate for Payer: Humana Commercial |
$8,289.62
|
| Rate for Payer: Humana KY Medicaid |
$3,353.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,484.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,729.23
|
| Rate for Payer: PHCS Commercial |
$9,362.40
|
| Rate for Payer: United Healthcare All Payer |
$8,582.20
|
|
|
RANGER GLOBAL DCB OTW7*200*150
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
RANGER GLOBAL DCB OTW7*200*150
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
RANGER GLOBAL DCB OTW 7*40*135
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*40*135
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*40*80
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*40*80
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*60*135
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*60*135
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*60*80
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*60*80
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*80*135
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*80*135
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*80*80
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RANGER GLOBAL DCB OTW 7*80*80
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
RAPAMUNE(SIROLIMUS) 1MG TAB
|
Facility
|
IP
|
$30.88
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
25002508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.26 |
| 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 |
$24.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.31
|
| 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 |
$9.26 |
| 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 |
$24.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.31
|
| Rate for Payer: PHCS Commercial |
$29.64
|
| Rate for Payer: United Healthcare All Payer |
$27.17
|
|
|
RAPID COMPRESSION IMPLANT
|
Facility
|
OP
|
$18,271.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,481.39 |
| Max. Negotiated Rate |
$17,540.45 |
| Rate for Payer: Aetna Commercial |
$14,068.90
|
| Rate for Payer: Anthem Medicaid |
$6,283.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,251.61
|
| Rate for Payer: Cash Price |
$9,135.65
|
| Rate for Payer: Cigna Commercial |
$15,165.18
|
| Rate for Payer: First Health Commercial |
$17,357.74
|
| Rate for Payer: Humana Commercial |
$15,530.60
|
| Rate for Payer: Humana KY Medicaid |
$6,283.50
|
| Rate for Payer: Kentucky WC Medicaid |
$6,347.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,982.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,484.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,481.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,409.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,078.74
|
| Rate for Payer: Ohio Health Group HMO |
$13,703.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,896.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,607.20
|
| Rate for Payer: PHCS Commercial |
$17,540.45
|
| Rate for Payer: United Healthcare All Payer |
$16,078.74
|
|
|
RAPID COMPRESSION IMPLANT
|
Facility
|
IP
|
$18,271.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,481.39 |
| Max. Negotiated Rate |
$17,540.45 |
| Rate for Payer: Aetna Commercial |
$14,068.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,251.61
|
| Rate for Payer: Cash Price |
$9,135.65
|
| Rate for Payer: Cigna Commercial |
$15,165.18
|
| Rate for Payer: First Health Commercial |
$17,357.74
|
| Rate for Payer: Humana Commercial |
$15,530.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,982.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,484.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,481.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,078.74
|
| Rate for Payer: Ohio Health Group HMO |
$13,703.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,896.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,607.20
|
| Rate for Payer: PHCS Commercial |
$17,540.45
|
| Rate for Payer: United Healthcare All Payer |
$16,078.74
|
|
|
RAPID CROSS 2*150*170
|
Facility
|
OP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem Medicaid |
$1,282.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Humana KY Medicaid |
$1,282.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 2*150*170
|
Facility
|
IP
|
$3,728.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.62 |
| Max. Negotiated Rate |
$3,579.60 |
| Rate for Payer: Aetna Commercial |
$2,871.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.43
|
| Rate for Payer: Cash Price |
$1,864.38
|
| Rate for Payer: Cigna Commercial |
$3,094.86
|
| Rate for Payer: First Health Commercial |
$3,542.31
|
| Rate for Payer: Humana Commercial |
$3,169.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,281.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.84
|
| Rate for Payer: PHCS Commercial |
$3,579.60
|
| Rate for Payer: United Healthcare All Payer |
$3,281.30
|
|
|
RAPID CROSS 2*40*170
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
RAPID CROSS 2*40*170
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
RAPID CROSS 2*80*170
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
