|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$2,520.00
|
|
| Hospital Charge Code |
41607806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,343.60 |
| Rate for Payer: Aetna Commercial |
$2,126.88
|
| Rate for Payer: Aetna Medicare |
$831.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$831.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,447.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,575.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$956.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$914.76
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Centivo All Commercial |
$1,285.20
|
| Rate for Payer: Cigna All Commercial |
$2,174.76
|
| Rate for Payer: CORVEL All Commercial |
$2,343.60
|
| Rate for Payer: Coventry All Commercial |
$2,217.60
|
| Rate for Payer: Encore All Commercial |
$2,319.66
|
| Rate for Payer: Frontpath All Commercial |
$2,318.40
|
| Rate for Payer: Humana ChoiceCare |
$2,176.52
|
| Rate for Payer: Humana Medicare |
$1,285.20
|
| Rate for Payer: Lucent All Commercial |
$1,285.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,268.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,890.00
|
| Rate for Payer: PHP All Commercial |
$1,911.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$982.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,945.44
|
| Rate for Payer: Signature Care EPO |
$2,091.60
|
| Rate for Payer: Signature Care PPO |
$2,217.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,142.00
|
| Rate for Payer: United Healthcare Commercial |
$1,985.76
|
| Rate for Payer: United Healthcare Medicare |
$831.60
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608456
|
|
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 |
41608486
|
|
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
|
$99.89
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$92.90 |
| Rate for Payer: Aetna Commercial |
$86.30
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cigna All Commercial |
$86.21
|
| Rate for Payer: CORVEL All Commercial |
$92.90
|
| Rate for Payer: Coventry All Commercial |
$87.90
|
| Rate for Payer: Encore All Commercial |
$91.95
|
| Rate for Payer: Frontpath All Commercial |
$91.90
|
| Rate for Payer: Humana ChoiceCare |
$86.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.90
|
| Rate for Payer: PHCS All Commercial |
$74.92
|
| Rate for Payer: PHP All Commercial |
$75.76
|
| Rate for Payer: Sagamore Health Network All Products |
$77.12
|
| Rate for Payer: Signature Care EPO |
$82.91
|
| Rate for Payer: Signature Care PPO |
$87.90
|
| Rate for Payer: United Healthcare Commercial |
$78.71
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608443
|
|
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 |
41608481
|
|
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
|
$1,341.50
|
|
| Hospital Charge Code |
41607811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.12 |
| Max. Negotiated Rate |
$1,247.60 |
| Rate for Payer: Aetna Commercial |
$1,159.06
|
| Rate for Payer: Cash Price |
$831.73
|
| Rate for Payer: Cigna All Commercial |
$1,157.71
|
| Rate for Payer: CORVEL All Commercial |
$1,247.60
|
| Rate for Payer: Coventry All Commercial |
$1,180.52
|
| Rate for Payer: Encore All Commercial |
$1,234.85
|
| Rate for Payer: Frontpath All Commercial |
$1,234.18
|
| Rate for Payer: Humana ChoiceCare |
$1,158.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,207.35
|
| Rate for Payer: PHCS All Commercial |
$1,006.12
|
| Rate for Payer: PHP All Commercial |
$1,017.39
|
| Rate for Payer: Sagamore Health Network All Products |
$1,035.64
|
| Rate for Payer: Signature Care EPO |
$1,113.44
|
| Rate for Payer: Signature Care PPO |
$1,180.52
|
| Rate for Payer: United Healthcare Commercial |
$1,057.10
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608412
|
|
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 |
41608507
|
|
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 |
41608458
|
|
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
|
$1,545.50
|
|
| Hospital Charge Code |
41607810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,437.32 |
| Rate for Payer: Aetna Commercial |
$1,304.40
|
| Rate for Payer: Aetna Medicare |
$510.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$510.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$887.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$966.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$586.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$561.02
|
| Rate for Payer: Cash Price |
$958.21
|
| Rate for Payer: Cash Price |
$958.21
|
| Rate for Payer: Centivo All Commercial |
$788.20
|
| Rate for Payer: Cigna All Commercial |
$1,333.77
|
| Rate for Payer: CORVEL All Commercial |
$1,437.32
|
| Rate for Payer: Coventry All Commercial |
$1,360.04
|
| Rate for Payer: Encore All Commercial |
$1,422.63
|
| Rate for Payer: Frontpath All Commercial |
$1,421.86
|
| Rate for Payer: Humana ChoiceCare |
$1,334.85
|
| Rate for Payer: Humana Medicare |
$788.20
|
| Rate for Payer: Lucent All Commercial |
$788.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,390.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,159.12
|
| Rate for Payer: PHP All Commercial |
$1,172.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$602.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,193.13
|
| Rate for Payer: Signature Care EPO |
$1,282.76
|
| Rate for Payer: Signature Care PPO |
$1,360.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,313.68
|
| Rate for Payer: United Healthcare Commercial |
$1,217.85
|
| Rate for Payer: United Healthcare Medicare |
$510.02
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$2,649.60
|
|
| Hospital Charge Code |
41607599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,987.20 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,289.25
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cigna All Commercial |
$2,286.60
|
| Rate for Payer: CORVEL All Commercial |
$2,464.13
|
| Rate for Payer: Coventry All Commercial |
$2,331.65
|
| Rate for Payer: Encore All Commercial |
$2,438.96
|
| Rate for Payer: Frontpath All Commercial |
$2,437.63
|
| Rate for Payer: Humana ChoiceCare |
$2,288.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,045.49
|
| Rate for Payer: Signature Care EPO |
$2,199.17
|
| Rate for Payer: Signature Care PPO |
$2,331.65
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608467
|
|
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
|
$6,624.00
|
|
| Hospital Charge Code |
41608056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,185.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,513.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,404.51
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Cash Price |
$4,106.88
|
| Rate for Payer: Centivo All Commercial |
$3,378.24
|
| Rate for Payer: Cigna All Commercial |
$5,716.51
|
| Rate for Payer: CORVEL All Commercial |
$6,160.32
|
| Rate for Payer: Coventry All Commercial |
$5,829.12
|
| Rate for Payer: Encore All Commercial |
$6,097.39
|
| Rate for Payer: Frontpath All Commercial |
$6,094.08
|
| Rate for Payer: Humana ChoiceCare |
$5,721.15
|
| Rate for Payer: Humana Medicare |
$3,378.24
|
| Rate for Payer: Lucent All Commercial |
$3,378.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,583.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5,113.73
|
| Rate for Payer: Signature Care EPO |
$5,497.92
|
| Rate for Payer: Signature Care PPO |
$5,829.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare Commercial |
$5,219.71
|
| Rate for Payer: United Healthcare Medicare |
$2,185.92
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608397
|
|
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
|
$7,491.74
|
|
| Hospital Charge Code |
41608311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Centivo All Commercial |
$3,820.79
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,472.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,472.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,843.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,719.50
|
| Rate for Payer: Cash Price |
$4,644.88
|
| Rate for Payer: Cash Price |
$4,644.88
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Humana Medicare |
$3,820.79
|
| Rate for Payer: Lucent All Commercial |
$3,820.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$5,618.80
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,921.78
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,367.98
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
| Rate for Payer: United Healthcare Medicare |
$2,472.27
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$4,865.47
|
|
| Hospital Charge Code |
41607601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,106.46
|
| Rate for Payer: Aetna Medicare |
$1,605.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,605.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,794.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,041.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,846.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,766.17
|
| Rate for Payer: Cash Price |
$3,016.59
|
| Rate for Payer: Cash Price |
$3,016.59
|
| Rate for Payer: Centivo All Commercial |
$2,481.39
|
| Rate for Payer: Cigna All Commercial |
$4,198.90
|
| Rate for Payer: CORVEL All Commercial |
$4,524.89
|
| Rate for Payer: Coventry All Commercial |
$4,281.61
|
| Rate for Payer: Encore All Commercial |
$4,478.67
|
| Rate for Payer: Frontpath All Commercial |
$4,476.23
|
| Rate for Payer: Humana ChoiceCare |
$4,202.31
|
| Rate for Payer: Humana Medicare |
$2,481.39
|
| Rate for Payer: Lucent All Commercial |
$2,481.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,897.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3,756.14
|
| Rate for Payer: Signature Care EPO |
$4,038.34
|
| Rate for Payer: Signature Care PPO |
$4,281.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,135.65
|
| Rate for Payer: United Healthcare Commercial |
$3,833.99
|
| Rate for Payer: United Healthcare Medicare |
$1,605.61
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608515
|
|
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 |
41608368
|
|
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 |
41608361
|
|
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
|
$3,974.40
|
|
| Hospital Charge Code |
41608310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,980.80 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,433.88
|
| Rate for Payer: Cash Price |
$2,464.13
|
| Rate for Payer: Cigna All Commercial |
$3,429.91
|
| Rate for Payer: CORVEL All Commercial |
$3,696.19
|
| Rate for Payer: Coventry All Commercial |
$3,497.47
|
| Rate for Payer: Encore All Commercial |
$3,658.44
|
| Rate for Payer: Frontpath All Commercial |
$3,656.45
|
| Rate for Payer: Humana ChoiceCare |
$3,432.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Sagamore Health Network All Products |
$3,068.24
|
| Rate for Payer: Signature Care EPO |
$3,298.75
|
| Rate for Payer: Signature Care PPO |
$3,497.47
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608369
|
|
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 |
41608375
|
|
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
|
$1,375.00
|
|
| Hospital Charge Code |
41607815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,160.50
|
| Rate for Payer: Aetna Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$789.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.12
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Centivo All Commercial |
$701.25
|
| 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: Humana Medicare |
$701.25
|
| Rate for Payer: Lucent All Commercial |
$701.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.25
|
| 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: Three Rivers Preferred All Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare Medicare |
$453.75
|
|
