|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41608312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.88
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Centivo All Commercial |
$828.75
|
| 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: Humana Medicare |
$828.75
|
| Rate for Payer: Lucent All Commercial |
$828.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| 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: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$536.25
|
|
|
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 |
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
|
IP
|
$1,512.50
|
|
| Hospital Charge Code |
41607812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$1,406.62 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Cash Price |
$937.75
|
| 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: Lutheran Preferred All Commercial |
$1,361.25
|
| Rate for Payer: PHCS All Commercial |
$1,134.38
|
| Rate for Payer: PHP All Commercial |
$1,147.08
|
| 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: United Healthcare Commercial |
$1,191.85
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,841.40
|
|
| Hospital Charge Code |
41607814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,712.50 |
| Rate for Payer: Aetna Commercial |
$1,554.14
|
| Rate for Payer: Aetna Medicare |
$607.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$607.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,057.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,151.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$698.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$668.43
|
| Rate for Payer: Cash Price |
$1,141.67
|
| Rate for Payer: Cash Price |
$1,141.67
|
| Rate for Payer: Centivo All Commercial |
$939.11
|
| Rate for Payer: Cigna All Commercial |
$1,589.13
|
| Rate for Payer: CORVEL All Commercial |
$1,712.50
|
| Rate for Payer: Coventry All Commercial |
$1,620.43
|
| Rate for Payer: Encore All Commercial |
$1,695.01
|
| Rate for Payer: Frontpath All Commercial |
$1,694.09
|
| Rate for Payer: Humana ChoiceCare |
$1,590.42
|
| Rate for Payer: Humana Medicare |
$939.11
|
| Rate for Payer: Lucent All Commercial |
$939.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,657.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,381.05
|
| Rate for Payer: PHP All Commercial |
$1,396.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$718.15
|
| Rate for Payer: Sagamore Health Network All Products |
$1,421.56
|
| Rate for Payer: Signature Care EPO |
$1,528.36
|
| Rate for Payer: Signature Care PPO |
$1,620.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,565.19
|
| Rate for Payer: United Healthcare Commercial |
$1,451.02
|
| Rate for Payer: United Healthcare Medicare |
$607.66
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608415
|
|
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 |
41608419
|
|
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 |
41608450
|
|
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 |
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 |
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
|
$99.89
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.96 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$84.31
|
| Rate for Payer: Aetna Medicare |
$32.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.26
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Centivo All Commercial |
$50.94
|
| 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: Humana Medicare |
$50.94
|
| Rate for Payer: Lucent All Commercial |
$50.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$74.92
|
| Rate for Payer: PHP All Commercial |
$75.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.96
|
| 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: Three Rivers Preferred All Commercial |
$84.91
|
| Rate for Payer: United Healthcare Commercial |
$78.71
|
| Rate for Payer: United Healthcare Medicare |
$32.96
|
|
|
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 |
41608506
|
|
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 |
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 |
41608495
|
|
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 |
41608511
|
|
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
|
$945.00
|
|
| Hospital Charge Code |
41607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
|
|
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
|
$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
|
|
|
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 |
41608389
|
|
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
|
$237.30
|
|
| Hospital Charge Code |
41607809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.98 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$205.03
|
| Rate for Payer: Cash Price |
$147.13
|
| 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: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: PHCS All Commercial |
$177.98
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| 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: United Healthcare Commercial |
$186.99
|
|
|
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
|
$121.68
|
|
| Hospital Charge Code |
41608427
|
|
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 |
41608509
|
|
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
|
|
