|
HC CMCH NEW SUPPLY
|
Facility
IP
|
$4,865.47
|
|
| Hospital Charge Code |
41607601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,649.10 |
| Max. Negotiated Rate |
$4,524.89 |
| Rate for Payer: Aetna Commercial |
$4,203.77
|
| Rate for Payer: Cash Price |
$3,016.59
|
| 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: Lutheran Preferred All Commercial |
$4,378.92
|
| Rate for Payer: PHCS All Commercial |
$3,649.10
|
| Rate for Payer: PHP All Commercial |
$3,689.97
|
| 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: United Healthcare Commercial |
$3,833.99
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$49.65
|
|
| Hospital Charge Code |
41607598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$41.90
|
| Rate for Payer: Aetna Medicare |
$16.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.02
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Cash Price |
$30.78
|
| Rate for Payer: Centivo All Commercial |
$25.32
|
| 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: Humana Medicare |
$25.32
|
| Rate for Payer: Lucent All Commercial |
$25.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$37.24
|
| Rate for Payer: PHP All Commercial |
$37.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.36
|
| 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: Three Rivers Preferred All Commercial |
$42.20
|
| Rate for Payer: United Healthcare Commercial |
$39.12
|
| Rate for Payer: United Healthcare Medicare |
$16.38
|
|
|
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 |
41608356
|
|
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
|
$2,520.00
|
|
| 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
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
IP
|
$1,841.40
|
|
| Hospital Charge Code |
41607814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,381.05 |
| Max. Negotiated Rate |
$1,712.50 |
| Rate for Payer: Aetna Commercial |
$1,590.97
|
| Rate for Payer: Cash Price |
$1,141.67
|
| 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: Lutheran Preferred All Commercial |
$1,657.26
|
| Rate for Payer: PHCS All Commercial |
$1,381.05
|
| Rate for Payer: PHP All Commercial |
$1,396.52
|
| 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: United Healthcare Commercial |
$1,451.02
|
|
|
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
|
$2,649.60
|
|
| Hospital Charge Code |
41607599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,464.13 |
| Rate for Payer: Aetna Commercial |
$2,236.26
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$874.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,521.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,656.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,005.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$961.80
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Cash Price |
$1,642.75
|
| Rate for Payer: Centivo All Commercial |
$1,351.30
|
| 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: Humana Medicare |
$1,351.30
|
| Rate for Payer: Lucent All Commercial |
$1,351.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,384.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,987.20
|
| Rate for Payer: PHP All Commercial |
$2,009.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,033.34
|
| 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: Three Rivers Preferred All Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare Commercial |
$2,087.88
|
| Rate for Payer: United Healthcare Medicare |
$874.37
|
|
|
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
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
IP
|
$2,250.00
|
|
| Hospital Charge Code |
41607805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608365
|
|
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 |
41608432
|
|
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 |
41608504
|
|
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
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608474
|
|
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 |
41608475
|
|
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 |
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
|
$121.68
|
|
| Hospital Charge Code |
41608391
|
|
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 |
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 |
41608466
|
|
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 |
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 |
41608405
|
|
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
|
|
