|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608453
|
|
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 |
41608381
|
|
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
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608469
|
|
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 |
41608440
|
|
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
|
IP
|
$1,625.00
|
|
| Hospital Charge Code |
41608312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
|
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
|
IP
|
$5,920.20
|
|
| Hospital Charge Code |
41607813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,440.15 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$5,115.05
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
|
|
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 |
41608439
|
|
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
|
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
|
$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
|
$6,624.00
|
|
| Hospital Charge Code |
41607600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| 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 |
$121.68
|
| 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 |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
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 |
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
|
$49.65
|
|
| Hospital Charge Code |
41607598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$46.17 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cigna All Commercial |
$42.85
|
| Rate for Payer: CORVEL All Commercial |
$46.17
|
| Rate for Payer: Coventry All Commercial |
$43.69
|
| Rate for Payer: Encore All Commercial |
$45.70
|
| Rate for Payer: Frontpath All Commercial |
$45.68
|
| Rate for Payer: Humana ChoiceCare |
$42.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.68
|
| Rate for Payer: PHCS All Commercial |
$37.24
|
| Rate for Payer: PHP All Commercial |
$37.65
|
| Rate for Payer: Sagamore Health Network All Products |
$38.33
|
| Rate for Payer: Signature Care EPO |
$41.21
|
| Rate for Payer: Signature Care PPO |
$43.69
|
| Rate for Payer: United Healthcare Commercial |
$39.12
|
|
|
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
|
IP
|
$6,624.00
|
|
| Hospital Charge Code |
41607600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,723.14
|
| Rate for Payer: Cash Price |
$4,106.88
|
| 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: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: PHCS All Commercial |
$4,968.00
|
| Rate for Payer: PHP All Commercial |
$5,023.64
|
| 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: United Healthcare Commercial |
$5,219.71
|
|
|
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 |
41608401
|
|
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 |
41608512
|
|
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 |
41608476
|
|
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 |
41608413
|
|
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
|
|
