|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,425.45
|
|
| Hospital Charge Code |
41607803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.09 |
| Max. Negotiated Rate |
$1,325.67 |
| Rate for Payer: Aetna Commercial |
$1,231.59
|
| Rate for Payer: Cash Price |
$883.78
|
| Rate for Payer: Cigna All Commercial |
$1,230.16
|
| Rate for Payer: CORVEL All Commercial |
$1,325.67
|
| Rate for Payer: Coventry All Commercial |
$1,254.40
|
| Rate for Payer: Encore All Commercial |
$1,312.13
|
| Rate for Payer: Frontpath All Commercial |
$1,311.41
|
| Rate for Payer: Humana ChoiceCare |
$1,231.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,282.90
|
| Rate for Payer: PHCS All Commercial |
$1,069.09
|
| Rate for Payer: PHP All Commercial |
$1,081.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,100.45
|
| Rate for Payer: Signature Care EPO |
$1,183.12
|
| Rate for Payer: Signature Care PPO |
$1,254.40
|
| Rate for Payer: United Healthcare Commercial |
$1,123.25
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$237.30
|
|
| Hospital Charge Code |
41607809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.31 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.14
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Centivo All Commercial |
$121.02
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Humana Medicare |
$121.02
|
| Rate for Payer: Lucent All Commercial |
$121.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$177.98
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.55
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.70
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
| Rate for Payer: United Healthcare Medicare |
$78.31
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,512.50
|
|
| Hospital Charge Code |
41607812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,406.62 |
| Rate for Payer: Aetna Commercial |
$1,276.55
|
| Rate for Payer: Aetna Medicare |
$499.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$499.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$868.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$945.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$573.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.04
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Centivo All Commercial |
$771.38
|
| Rate for Payer: Cigna All Commercial |
$1,305.29
|
| Rate for Payer: CORVEL All Commercial |
$1,406.62
|
| Rate for Payer: Coventry All Commercial |
$1,331.00
|
| Rate for Payer: Encore All Commercial |
$1,392.26
|
| Rate for Payer: Frontpath All Commercial |
$1,391.50
|
| Rate for Payer: Humana ChoiceCare |
$1,306.35
|
| Rate for Payer: Humana Medicare |
$771.38
|
| Rate for Payer: Lucent All Commercial |
$771.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,361.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,134.38
|
| Rate for Payer: PHP All Commercial |
$1,147.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$589.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,167.65
|
| Rate for Payer: Signature Care EPO |
$1,255.38
|
| Rate for Payer: Signature Care PPO |
$1,331.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,285.62
|
| Rate for Payer: United Healthcare Commercial |
$1,191.85
|
| Rate for Payer: United Healthcare Medicare |
$499.12
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$2,521.76
|
|
| Hospital Charge Code |
41607804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,891.32 |
| Max. Negotiated Rate |
$2,345.24 |
| Rate for Payer: Aetna Commercial |
$2,178.80
|
| Rate for Payer: Cash Price |
$1,563.49
|
| Rate for Payer: Cigna All Commercial |
$2,176.28
|
| Rate for Payer: CORVEL All Commercial |
$2,345.24
|
| Rate for Payer: Coventry All Commercial |
$2,219.15
|
| Rate for Payer: Encore All Commercial |
$2,321.28
|
| Rate for Payer: Frontpath All Commercial |
$2,320.02
|
| Rate for Payer: Humana ChoiceCare |
$2,178.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,269.58
|
| Rate for Payer: PHCS All Commercial |
$1,891.32
|
| Rate for Payer: PHP All Commercial |
$1,912.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,946.80
|
| Rate for Payer: Signature Care EPO |
$2,093.06
|
| Rate for Payer: Signature Care PPO |
$2,219.15
|
| Rate for Payer: United Healthcare Commercial |
$1,987.15
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,232.00
|
|
| Hospital Charge Code |
41607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,064.45
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Cigna All Commercial |
$1,063.22
|
| Rate for Payer: CORVEL All Commercial |
$1,145.76
|
| Rate for Payer: Coventry All Commercial |
$1,084.16
|
| Rate for Payer: Encore All Commercial |
$1,134.06
|
| Rate for Payer: Frontpath All Commercial |
$1,133.44
|
| Rate for Payer: Humana ChoiceCare |
$1,064.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Sagamore Health Network All Products |
$951.10
|
| Rate for Payer: Signature Care EPO |
$1,022.56
|
| Rate for Payer: Signature Care PPO |
$1,084.16
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
41607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
