|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608497
|
|
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 |
41608430
|
|
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 |
41608429
|
|
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 |
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 |
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 |
41608372
|
|
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
OP
|
$121.68
|
|
| Hospital Charge Code |
41608445
|
|
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 |
41608371
|
|
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
|
$1,232.00
|
|
| Hospital Charge Code |
41607808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,145.76 |
| Rate for Payer: Aetna Commercial |
$1,039.81
|
| Rate for Payer: Aetna Medicare |
$406.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$406.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$707.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$770.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$467.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$447.22
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Cash Price |
$763.84
|
| Rate for Payer: Centivo All Commercial |
$628.32
|
| 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: Humana Medicare |
$628.32
|
| Rate for Payer: Lucent All Commercial |
$628.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,108.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$924.00
|
| Rate for Payer: PHP All Commercial |
$934.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$480.48
|
| 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: Three Rivers Preferred All Commercial |
$1,047.20
|
| Rate for Payer: United Healthcare Commercial |
$970.82
|
| Rate for Payer: United Healthcare Medicare |
$406.56
|
|
|
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 |
41608366
|
|
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 |
41608433
|
|
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 |
41608484
|
|
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
|
$1,375.00
|
|
| Hospital Charge Code |
41607816
|
|
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
|
|
|
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
OP
|
$121.68
|
|
| Hospital Charge Code |
41608462
|
|
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 |
41608480
|
|
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
|
$2,521.76
|
|
| Hospital Charge Code |
41607804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,345.24 |
| Rate for Payer: Aetna Commercial |
$2,128.37
|
| Rate for Payer: Aetna Medicare |
$832.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$832.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,448.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,576.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$957.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$915.40
|
| Rate for Payer: Cash Price |
$1,563.49
|
| Rate for Payer: Cash Price |
$1,563.49
|
| Rate for Payer: Centivo All Commercial |
$1,286.10
|
| 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: Humana Medicare |
$1,286.10
|
| Rate for Payer: Lucent All Commercial |
$1,286.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,269.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,891.32
|
| Rate for Payer: PHP All Commercial |
$1,912.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$983.49
|
| 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: Three Rivers Preferred All Commercial |
$2,143.50
|
| Rate for Payer: United Healthcare Commercial |
$1,987.15
|
| Rate for Payer: United Healthcare Medicare |
$832.18
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608406
|
|
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 |
41608501
|
|
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 |
41608367
|
|
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
|
$1,530.00
|
|
| Hospital Charge Code |
41608308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,147.50 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,321.92
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna All Commercial |
$1,320.39
|
| Rate for Payer: CORVEL All Commercial |
$1,422.90
|
| Rate for Payer: Coventry All Commercial |
$1,346.40
|
| Rate for Payer: Encore All Commercial |
$1,408.36
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,181.16
|
| Rate for Payer: Signature Care EPO |
$1,269.90
|
| Rate for Payer: Signature Care PPO |
$1,346.40
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
|
|
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
OP
|
$121.68
|
|
| Hospital Charge Code |
41608500
|
|
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
|
|
