|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$7,491.74
|
|
| Hospital Charge Code |
41608311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,618.81 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,495.04
|
| 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: 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: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| 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: United Healthcare Commercial |
$5,903.49
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,878.00
|
|
| Hospital Charge Code |
41608540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,746.54 |
| Rate for Payer: Aetna Commercial |
$1,585.03
|
| Rate for Payer: Aetna Medicare |
$600.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$582.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,078.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,173.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$691.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$661.06
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Centivo All Commercial |
$1,021.63
|
| Rate for Payer: Cigna All Commercial |
$1,620.71
|
| Rate for Payer: CORVEL All Commercial |
$1,746.54
|
| Rate for Payer: Coventry All Commercial |
$1,652.64
|
| Rate for Payer: Encore All Commercial |
$1,728.70
|
| Rate for Payer: Frontpath All Commercial |
$1,727.76
|
| Rate for Payer: Humana ChoiceCare |
$1,622.03
|
| Rate for Payer: Humana Medicare |
$600.96
|
| Rate for Payer: Lucent All Commercial |
$1,021.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,690.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,408.50
|
| Rate for Payer: PHP All Commercial |
$1,424.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$732.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,449.82
|
| Rate for Payer: Signature Care EPO |
$1,558.74
|
| Rate for Payer: Signature Care PPO |
$1,652.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,596.30
|
| Rate for Payer: United Healthcare Commercial |
$1,479.86
|
| Rate for Payer: United Healthcare Medicare |
$600.96
|
|
|
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 |
$3,974.40
|
| 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
|
IP
|
$1,425.45
|
|
| Hospital Charge Code |
41607803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.09 |
| Max. Negotiated Rate |
$1,325.67 |
| Rate for Payer: Aetna Commercial |
$1,231.59
|
| Rate for Payer: Cash Price |
$855.27
|
| Rate for Payer: Cigna All Commercial |
$1,230.16
|
| Rate for Payer: CORVEL All Commercial |
$1,325.67
|
| Rate for Payer: Coventry All Commercial |
$1,254.40
|
| Rate for Payer: Encore All Commercial |
$1,312.13
|
| Rate for Payer: Frontpath All Commercial |
$1,311.41
|
| Rate for Payer: Humana ChoiceCare |
$1,231.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,282.90
|
| Rate for Payer: PHCS All Commercial |
$1,069.09
|
| Rate for Payer: PHP All Commercial |
$1,081.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,100.45
|
| Rate for Payer: Signature Care EPO |
$1,183.12
|
| Rate for Payer: Signature Care PPO |
$1,254.40
|
| Rate for Payer: United Healthcare Commercial |
$1,123.25
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$129.57
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$109.36
|
| Rate for Payer: Aetna Medicare |
$41.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.61
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Centivo All Commercial |
$70.49
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Humana Medicare |
$41.46
|
| Rate for Payer: Lucent All Commercial |
$70.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.53
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.13
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
| Rate for Payer: United Healthcare Medicare |
$41.46
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,625.00
|
|
| Hospital Charge Code |
41608312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$520.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$503.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$598.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$572.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Centivo All Commercial |
$884.00
|
| 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 |
$520.00
|
| Rate for Payer: Lucent All Commercial |
$884.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$520.00
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,327.50
|
|
| Hospital Charge Code |
41608309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,234.58 |
| Rate for Payer: Aetna Commercial |
$1,120.41
|
| Rate for Payer: Aetna Medicare |
$424.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$411.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$762.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$829.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$488.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$467.28
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Centivo All Commercial |
$722.16
|
| Rate for Payer: Cigna All Commercial |
$1,145.63
|
| Rate for Payer: CORVEL All Commercial |
$1,234.58
|
| Rate for Payer: Coventry All Commercial |
$1,168.20
|
| Rate for Payer: Encore All Commercial |
$1,221.96
|
| Rate for Payer: Frontpath All Commercial |
$1,221.30
|
| Rate for Payer: Humana ChoiceCare |
$1,146.56
|
| Rate for Payer: Humana Medicare |
$424.80
|
| Rate for Payer: Lucent All Commercial |
$722.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,194.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$995.62
|
| Rate for Payer: PHP All Commercial |
$1,006.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$517.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1,024.83
|
| Rate for Payer: Signature Care EPO |
$1,101.83
|
| Rate for Payer: Signature Care PPO |
$1,168.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,128.38
|
| Rate for Payer: United Healthcare Commercial |
$1,046.07
|
| Rate for Payer: United Healthcare Medicare |
$424.80
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$735.00
|
|
| Hospital Charge Code |
41608539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$683.55 |
| Rate for Payer: Aetna Commercial |
$620.34
|
| Rate for Payer: Aetna Medicare |
$235.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$422.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$258.72
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Centivo All Commercial |
$399.84
|
| Rate for Payer: Cigna All Commercial |
$634.30
|
| Rate for Payer: CORVEL All Commercial |
$683.55
|
| Rate for Payer: Coventry All Commercial |
$646.80
|
| Rate for Payer: Encore All Commercial |
$676.57
|
| Rate for Payer: Frontpath All Commercial |
$676.20
|
| Rate for Payer: Humana ChoiceCare |
$634.82
|
| Rate for Payer: Humana Medicare |
$235.20
|
| Rate for Payer: Lucent All Commercial |
$399.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$551.25
|
| Rate for Payer: PHP All Commercial |
$557.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.65
|
| Rate for Payer: Sagamore Health Network All Products |
$567.42
|
| Rate for Payer: Signature Care EPO |
$610.05
|
| Rate for Payer: Signature Care PPO |
$646.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.75
|
| Rate for Payer: United Healthcare Commercial |
$579.18
|
| Rate for Payer: United Healthcare Medicare |
$235.20
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$129.57
|
|
| Hospital Charge Code |
41607817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Aetna Commercial |
$111.95
|
| Rate for Payer: Cash Price |
$77.74
|
| Rate for Payer: Cigna All Commercial |
$111.82
|
| Rate for Payer: CORVEL All Commercial |
$120.50
|
| Rate for Payer: Coventry All Commercial |
$114.02
|
| Rate for Payer: Encore All Commercial |
$119.27
|
| Rate for Payer: Frontpath All Commercial |
$119.20
|
| Rate for Payer: Humana ChoiceCare |
$111.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.61
|
| Rate for Payer: PHCS All Commercial |
$97.18
|
| Rate for Payer: PHP All Commercial |
$98.27
|
| Rate for Payer: Sagamore Health Network All Products |
$100.03
|
| Rate for Payer: Signature Care EPO |
$107.54
|
| Rate for Payer: Signature Care PPO |
$114.02
|
| Rate for Payer: United Healthcare Commercial |
$102.10
|
|
|
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 |
$975.00
|
| 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
|
$74.62
|
|
| Hospital Charge Code |
41608538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.27
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Cash Price |
$44.77
|
| Rate for Payer: Centivo All Commercial |
$40.59
|
| Rate for Payer: Cigna All Commercial |
$64.40
|
| Rate for Payer: CORVEL All Commercial |
$69.40
|
| Rate for Payer: Coventry All Commercial |
$65.67
|
| Rate for Payer: Encore All Commercial |
$68.69
|
| Rate for Payer: Frontpath All Commercial |
$68.65
|
| Rate for Payer: Humana ChoiceCare |
$64.45
|
| Rate for Payer: Humana Medicare |
$23.88
|
| Rate for Payer: Lucent All Commercial |
$40.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$55.97
|
| Rate for Payer: PHP All Commercial |
$56.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.10
|
| Rate for Payer: Sagamore Health Network All Products |
$57.61
|
| Rate for Payer: Signature Care EPO |
$61.93
|
| Rate for Payer: Signature Care PPO |
$65.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.43
|
| Rate for Payer: United Healthcare Commercial |
$58.80
|
| Rate for Payer: United Healthcare Medicare |
$23.88
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$237.30
|
|
| Hospital Charge Code |
41607809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$75.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.53
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Centivo All Commercial |
$129.09
|
| 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: Humana Medicare |
$75.94
|
| Rate for Payer: Lucent All Commercial |
$129.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$177.97
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.55
|
| 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: Three Rivers Preferred All Commercial |
$201.71
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
| Rate for Payer: United Healthcare Medicare |
$75.94
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$7,491.74
|
|
| Hospital Charge Code |
41608311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$2,397.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,322.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,302.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,683.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,756.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,637.09
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Cash Price |
$4,495.04
|
| Rate for Payer: Centivo All Commercial |
$4,075.51
|
| 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: 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 |
$2,397.36
|
| Rate for Payer: Lucent All Commercial |
$4,075.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$5,618.81
|
| 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 |
$2,397.36
|
|
|
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 |
$918.00
|
| 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 |
$1,408.37
|
| 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
|
$1,530.00
|
|
| Hospital Charge Code |
41608308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Aetna Commercial |
$1,291.32
|
| Rate for Payer: Aetna Medicare |
$489.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$474.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$878.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$956.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$563.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$538.56
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Centivo All Commercial |
$832.32
|
| 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 |
$1,408.37
|
| Rate for Payer: Frontpath All Commercial |
$1,407.60
|
| Rate for Payer: Humana ChoiceCare |
$1,321.46
|
| Rate for Payer: Humana Medicare |
$489.60
|
| Rate for Payer: Lucent All Commercial |
$832.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,377.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,147.50
|
| Rate for Payer: PHP All Commercial |
$1,160.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$596.70
|
| 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: Three Rivers Preferred All Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare Commercial |
$1,205.64
|
| Rate for Payer: United Healthcare Medicare |
$489.60
|
|
|
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 |
$2,384.64
|
| 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
|
$3,974.40
|
|
| Hospital Charge Code |
41608310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$3,696.19 |
| Rate for Payer: Aetna Commercial |
$3,354.39
|
| Rate for Payer: Aetna Medicare |
$1,271.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,232.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,282.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,484.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,462.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,398.99
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Cash Price |
$2,384.64
|
| Rate for Payer: Centivo All Commercial |
$2,162.07
|
| 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: Humana Medicare |
$1,271.81
|
| Rate for Payer: Lucent All Commercial |
$2,162.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,576.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$2,980.80
|
| Rate for Payer: PHP All Commercial |
$3,014.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,550.02
|
| 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: Three Rivers Preferred All Commercial |
$3,378.24
|
| Rate for Payer: United Healthcare Commercial |
$3,131.83
|
| Rate for Payer: United Healthcare Medicare |
$1,271.81
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$1,425.45
|
|
| Hospital Charge Code |
41607803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$1,325.67 |
| Rate for Payer: Aetna Commercial |
$1,203.08
|
| Rate for Payer: Aetna Medicare |
$456.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$441.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$818.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$891.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$524.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$501.76
|
| Rate for Payer: Cash Price |
$855.27
|
| Rate for Payer: Cash Price |
$855.27
|
| Rate for Payer: Centivo All Commercial |
$775.44
|
| Rate for Payer: Cigna All Commercial |
$1,230.16
|
| Rate for Payer: CORVEL All Commercial |
$1,325.67
|
| Rate for Payer: Coventry All Commercial |
$1,254.40
|
| Rate for Payer: Encore All Commercial |
$1,312.13
|
| Rate for Payer: Frontpath All Commercial |
$1,311.41
|
| Rate for Payer: Humana ChoiceCare |
$1,231.16
|
| Rate for Payer: Humana Medicare |
$456.14
|
| Rate for Payer: Lucent All Commercial |
$775.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,282.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,069.09
|
| Rate for Payer: PHP All Commercial |
$1,081.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$555.93
|
| Rate for Payer: Sagamore Health Network All Products |
$1,100.45
|
| Rate for Payer: Signature Care EPO |
$1,183.12
|
| Rate for Payer: Signature Care PPO |
$1,254.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,211.63
|
| Rate for Payer: United Healthcare Commercial |
$1,123.25
|
| Rate for Payer: United Healthcare Medicare |
$456.14
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$6,624.00
|
|
| Hospital Charge Code |
41607600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$6,160.32 |
| Rate for Payer: Aetna Commercial |
$5,590.66
|
| Rate for Payer: Aetna Medicare |
$2,119.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,053.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3,804.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,140.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,437.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,331.65
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Cash Price |
$3,974.40
|
| Rate for Payer: Centivo All Commercial |
$3,603.46
|
| 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 |
$2,119.68
|
| Rate for Payer: Lucent All Commercial |
$3,603.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,961.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$2,119.68
|
|
|
HC COBALT SERUM
|
Facility
|
IP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.03 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$201.64
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
|
|
HC COBALT SERUM
|
Facility
|
OP
|
$233.38
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
63001567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$217.04 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$74.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.15
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Cash Price |
$140.03
|
| Rate for Payer: Centivo All Commercial |
$126.96
|
| Rate for Payer: Cigna All Commercial |
$201.41
|
| Rate for Payer: CORVEL All Commercial |
$217.04
|
| Rate for Payer: Coventry All Commercial |
$205.37
|
| Rate for Payer: Encore All Commercial |
$214.83
|
| Rate for Payer: Frontpath All Commercial |
$214.71
|
| Rate for Payer: Humana ChoiceCare |
$201.57
|
| Rate for Payer: Humana Medicare |
$74.68
|
| Rate for Payer: Lucent All Commercial |
$126.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$210.04
|
| Rate for Payer: Managed Health Services Medicaid |
$21.96
|
| Rate for Payer: MDWise Medicaid |
$21.96
|
| Rate for Payer: PHCS All Commercial |
$175.03
|
| Rate for Payer: PHP All Commercial |
$177.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.02
|
| Rate for Payer: Sagamore Health Network All Products |
$180.17
|
| Rate for Payer: Signature Care EPO |
$193.71
|
| Rate for Payer: Signature Care PPO |
$205.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$198.37
|
| Rate for Payer: United Healthcare Commercial |
$183.90
|
| Rate for Payer: United Healthcare Medicare |
$74.68
|
|
|
HC COCAINE QTMS
|
Facility
|
IP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC COCAINE QTMS
|
Facility
|
OP
|
$156.37
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Centivo All Commercial |
$85.07
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$85.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$50.04
|
|
|
HC COCAINE QTMS
|
Facility
|
IP
|
$156.37
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$135.10
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
|
|
HC COCAINE QTMS
|
Facility
|
OP
|
$156.37
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$145.42 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Cash Price |
$93.82
|
| Rate for Payer: Centivo All Commercial |
$85.07
|
| Rate for Payer: Cigna All Commercial |
$134.95
|
| Rate for Payer: CORVEL All Commercial |
$145.42
|
| Rate for Payer: Coventry All Commercial |
$137.61
|
| Rate for Payer: Encore All Commercial |
$143.94
|
| Rate for Payer: Frontpath All Commercial |
$143.86
|
| Rate for Payer: Humana ChoiceCare |
$135.06
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$85.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$140.73
|
| Rate for Payer: Managed Health Services Medicaid |
$114.43
|
| Rate for Payer: MDWise Medicaid |
$114.43
|
| Rate for Payer: PHCS All Commercial |
$117.28
|
| Rate for Payer: PHP All Commercial |
$118.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.98
|
| Rate for Payer: Sagamore Health Network All Products |
$120.72
|
| Rate for Payer: Signature Care EPO |
$129.79
|
| Rate for Payer: Signature Care PPO |
$137.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.91
|
| Rate for Payer: United Healthcare Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare |
$50.04
|
|
