|
HC SUTURE VICRYL PLUS 2-0 VCP917H
|
Facility
|
OP
|
$14.95
|
|
| Hospital Charge Code |
41601471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.26
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Centivo All Commercial |
$8.13
|
| Rate for Payer: Cigna All Commercial |
$12.90
|
| Rate for Payer: CORVEL All Commercial |
$13.90
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Encore All Commercial |
$13.76
|
| Rate for Payer: Frontpath All Commercial |
$13.75
|
| Rate for Payer: Humana ChoiceCare |
$12.91
|
| Rate for Payer: Humana Medicare |
$4.78
|
| Rate for Payer: Lucent All Commercial |
$8.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.21
|
| Rate for Payer: PHP All Commercial |
$11.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.83
|
| Rate for Payer: Sagamore Health Network All Products |
$11.54
|
| Rate for Payer: Signature Care EPO |
$12.41
|
| Rate for Payer: Signature Care PPO |
$13.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.71
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
| Rate for Payer: United Healthcare Medicare |
$4.78
|
|
|
HC SUTURE VICRYL PLUS 2-0 VCP917H
|
Facility
|
IP
|
$14.95
|
|
| Hospital Charge Code |
41601471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cigna All Commercial |
$12.90
|
| Rate for Payer: CORVEL All Commercial |
$13.90
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Encore All Commercial |
$13.76
|
| Rate for Payer: Frontpath All Commercial |
$13.75
|
| Rate for Payer: Humana ChoiceCare |
$12.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: PHCS All Commercial |
$11.21
|
| Rate for Payer: PHP All Commercial |
$11.34
|
| Rate for Payer: Sagamore Health Network All Products |
$11.54
|
| Rate for Payer: Signature Care EPO |
$12.41
|
| Rate for Payer: Signature Care PPO |
$13.16
|
| Rate for Payer: United Healthcare Commercial |
$11.78
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH-1
|
Facility
|
IP
|
$19.01
|
|
| Hospital Charge Code |
41602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Cigna All Commercial |
$16.41
|
| Rate for Payer: CORVEL All Commercial |
$17.68
|
| Rate for Payer: Coventry All Commercial |
$16.73
|
| Rate for Payer: Encore All Commercial |
$17.50
|
| Rate for Payer: Frontpath All Commercial |
$17.49
|
| Rate for Payer: Humana ChoiceCare |
$16.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.11
|
| Rate for Payer: PHCS All Commercial |
$14.26
|
| Rate for Payer: PHP All Commercial |
$14.42
|
| Rate for Payer: Sagamore Health Network All Products |
$14.68
|
| Rate for Payer: Signature Care EPO |
$15.78
|
| Rate for Payer: Signature Care PPO |
$16.73
|
| Rate for Payer: United Healthcare Commercial |
$14.98
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH-1
|
Facility
|
OP
|
$19.01
|
|
| Hospital Charge Code |
41602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.69
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Cash Price |
$11.41
|
| Rate for Payer: Centivo All Commercial |
$10.34
|
| Rate for Payer: Cigna All Commercial |
$16.41
|
| Rate for Payer: CORVEL All Commercial |
$17.68
|
| Rate for Payer: Coventry All Commercial |
$16.73
|
| Rate for Payer: Encore All Commercial |
$17.50
|
| Rate for Payer: Frontpath All Commercial |
$17.49
|
| Rate for Payer: Humana ChoiceCare |
$16.42
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Lucent All Commercial |
$10.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$14.26
|
| Rate for Payer: PHP All Commercial |
$14.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.41
|
| Rate for Payer: Sagamore Health Network All Products |
$14.68
|
| Rate for Payer: Signature Care EPO |
$15.78
|
| Rate for Payer: Signature Care PPO |
$16.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.16
|
| Rate for Payer: United Healthcare Commercial |
$14.98
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
|
|
HC SUTURE VICRYL PLUS 3-0 VCP427H
|
Facility
|
OP
|
$20.12
|
|
| Hospital Charge Code |
41601614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.08
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Centivo All Commercial |
$10.95
|
| Rate for Payer: Cigna All Commercial |
$17.36
|
| Rate for Payer: CORVEL All Commercial |
$18.71
|
| Rate for Payer: Coventry All Commercial |
$17.71
|
| Rate for Payer: Encore All Commercial |
$18.52
|
| Rate for Payer: Frontpath All Commercial |
$18.51
|
| Rate for Payer: Humana ChoiceCare |
$17.38
|
| Rate for Payer: Humana Medicare |
$6.44
|
| Rate for Payer: Lucent All Commercial |
$10.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.09
|
| Rate for Payer: PHP All Commercial |
$15.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.85
|
| Rate for Payer: Sagamore Health Network All Products |
$15.53
|
| Rate for Payer: Signature Care EPO |
$16.70
|
| Rate for Payer: Signature Care PPO |
$17.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
| Rate for Payer: United Healthcare Medicare |
$6.44
|
|
|
HC SUTURE VICRYL PLUS 3-0 VCP427H
|
Facility
|
IP
|
$20.12
|
|
| Hospital Charge Code |
41601614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cigna All Commercial |
$17.36
|
| Rate for Payer: CORVEL All Commercial |
$18.71
|
| Rate for Payer: Coventry All Commercial |
$17.71
|
| Rate for Payer: Encore All Commercial |
$18.52
|
| Rate for Payer: Frontpath All Commercial |
$18.51
|
| Rate for Payer: Humana ChoiceCare |
$17.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.11
|
| Rate for Payer: PHCS All Commercial |
$15.09
|
| Rate for Payer: PHP All Commercial |
$15.26
|
| Rate for Payer: Sagamore Health Network All Products |
$15.53
|
| Rate for Payer: Signature Care EPO |
$16.70
|
| Rate for Payer: Signature Care PPO |
$17.71
|
| Rate for Payer: United Healthcare Commercial |
$15.85
|
|
|
HC SUTURE VICRYL PLUS 4-0 PS-4
|
Facility
|
OP
|
$24.70
|
|
| Hospital Charge Code |
41602407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$20.85
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$14.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.69
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Centivo All Commercial |
$13.44
|
| Rate for Payer: Cigna All Commercial |
$21.32
|
| Rate for Payer: CORVEL All Commercial |
$22.97
|
| Rate for Payer: Coventry All Commercial |
$21.74
|
| Rate for Payer: Encore All Commercial |
$22.74
|
| Rate for Payer: Frontpath All Commercial |
$22.72
|
| Rate for Payer: Humana ChoiceCare |
$21.33
|
| Rate for Payer: Humana Medicare |
$7.90
|
| Rate for Payer: Lucent All Commercial |
$13.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$18.52
|
| Rate for Payer: PHP All Commercial |
$18.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.63
|
| Rate for Payer: Sagamore Health Network All Products |
$19.07
|
| Rate for Payer: Signature Care EPO |
$20.50
|
| Rate for Payer: Signature Care PPO |
$21.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
| Rate for Payer: United Healthcare Medicare |
$7.90
|
|
|
HC SUTURE VICRYL PLUS 4-0 PS-4
|
Facility
|
IP
|
$24.70
|
|
| Hospital Charge Code |
41602407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cigna All Commercial |
$21.32
|
| Rate for Payer: CORVEL All Commercial |
$22.97
|
| Rate for Payer: Coventry All Commercial |
$21.74
|
| Rate for Payer: Encore All Commercial |
$22.74
|
| Rate for Payer: Frontpath All Commercial |
$22.72
|
| Rate for Payer: Humana ChoiceCare |
$21.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.23
|
| Rate for Payer: PHCS All Commercial |
$18.52
|
| Rate for Payer: PHP All Commercial |
$18.73
|
| Rate for Payer: Sagamore Health Network All Products |
$19.07
|
| Rate for Payer: Signature Care EPO |
$20.50
|
| Rate for Payer: Signature Care PPO |
$21.74
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
|
|
HC SUTURE VICRYL RAPIDE 3-0 VR935
|
Facility
|
OP
|
$48.10
|
|
| Hospital Charge Code |
41601172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$15.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$27.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.93
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Centivo All Commercial |
$26.17
|
| Rate for Payer: Cigna All Commercial |
$41.51
|
| Rate for Payer: CORVEL All Commercial |
$44.73
|
| Rate for Payer: Coventry All Commercial |
$42.33
|
| Rate for Payer: Encore All Commercial |
$44.28
|
| Rate for Payer: Frontpath All Commercial |
$44.25
|
| Rate for Payer: Humana ChoiceCare |
$41.54
|
| Rate for Payer: Humana Medicare |
$15.39
|
| Rate for Payer: Lucent All Commercial |
$26.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.29
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$36.08
|
| Rate for Payer: PHP All Commercial |
$36.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.76
|
| Rate for Payer: Sagamore Health Network All Products |
$37.13
|
| Rate for Payer: Signature Care EPO |
$39.92
|
| Rate for Payer: Signature Care PPO |
$42.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.88
|
| Rate for Payer: United Healthcare Commercial |
$37.90
|
| Rate for Payer: United Healthcare Medicare |
$15.39
|
|
|
HC SUTURE VICRYL RAPIDE 3-0 VR935
|
Facility
|
IP
|
$48.10
|
|
| Hospital Charge Code |
41601172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$44.73 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna All Commercial |
$41.51
|
| Rate for Payer: CORVEL All Commercial |
$44.73
|
| Rate for Payer: Coventry All Commercial |
$42.33
|
| Rate for Payer: Encore All Commercial |
$44.28
|
| Rate for Payer: Frontpath All Commercial |
$44.25
|
| Rate for Payer: Humana ChoiceCare |
$41.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.29
|
| Rate for Payer: PHCS All Commercial |
$36.08
|
| Rate for Payer: PHP All Commercial |
$36.48
|
| Rate for Payer: Sagamore Health Network All Products |
$37.13
|
| Rate for Payer: Signature Care EPO |
$39.92
|
| Rate for Payer: Signature Care PPO |
$42.33
|
| Rate for Payer: United Healthcare Commercial |
$37.90
|
|
|
HC SUTURE VICRYL RAPIDE 4-0 VR845
|
Facility
|
OP
|
$37.61
|
|
| Hospital Charge Code |
41601486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$34.98 |
| Rate for Payer: Aetna Commercial |
$31.74
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.24
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Centivo All Commercial |
$20.46
|
| Rate for Payer: Cigna All Commercial |
$32.46
|
| Rate for Payer: CORVEL All Commercial |
$34.98
|
| Rate for Payer: Coventry All Commercial |
$33.10
|
| Rate for Payer: Encore All Commercial |
$34.62
|
| Rate for Payer: Frontpath All Commercial |
$34.60
|
| Rate for Payer: Humana ChoiceCare |
$32.48
|
| Rate for Payer: Humana Medicare |
$12.04
|
| Rate for Payer: Lucent All Commercial |
$20.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.85
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.21
|
| Rate for Payer: PHP All Commercial |
$28.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.67
|
| Rate for Payer: Sagamore Health Network All Products |
$29.03
|
| Rate for Payer: Signature Care EPO |
$31.22
|
| Rate for Payer: Signature Care PPO |
$33.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.97
|
| Rate for Payer: United Healthcare Commercial |
$29.64
|
| Rate for Payer: United Healthcare Medicare |
$12.04
|
|
|
HC SUTURE VICRYL RAPIDE 4-0 VR845
|
Facility
|
IP
|
$37.61
|
|
| Hospital Charge Code |
41601486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$34.98 |
| Rate for Payer: Aetna Commercial |
$32.50
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cigna All Commercial |
$32.46
|
| Rate for Payer: CORVEL All Commercial |
$34.98
|
| Rate for Payer: Coventry All Commercial |
$33.10
|
| Rate for Payer: Encore All Commercial |
$34.62
|
| Rate for Payer: Frontpath All Commercial |
$34.60
|
| Rate for Payer: Humana ChoiceCare |
$32.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.85
|
| Rate for Payer: PHCS All Commercial |
$28.21
|
| Rate for Payer: PHP All Commercial |
$28.52
|
| Rate for Payer: Sagamore Health Network All Products |
$29.03
|
| Rate for Payer: Signature Care EPO |
$31.22
|
| Rate for Payer: Signature Care PPO |
$33.10
|
| Rate for Payer: United Healthcare Commercial |
$29.64
|
|
|
HC SUTURE VICRYL RAPIDE 5-0 VR834
|
Facility
|
OP
|
$38.24
|
|
| Hospital Charge Code |
41601487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$32.27
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.46
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Centivo All Commercial |
$20.80
|
| Rate for Payer: Cigna All Commercial |
$33.00
|
| Rate for Payer: CORVEL All Commercial |
$35.56
|
| Rate for Payer: Coventry All Commercial |
$33.65
|
| Rate for Payer: Encore All Commercial |
$35.20
|
| Rate for Payer: Frontpath All Commercial |
$35.18
|
| Rate for Payer: Humana ChoiceCare |
$33.03
|
| Rate for Payer: Humana Medicare |
$12.24
|
| Rate for Payer: Lucent All Commercial |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.68
|
| Rate for Payer: PHP All Commercial |
$29.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.91
|
| Rate for Payer: Sagamore Health Network All Products |
$29.52
|
| Rate for Payer: Signature Care EPO |
$31.74
|
| Rate for Payer: Signature Care PPO |
$33.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.50
|
| Rate for Payer: United Healthcare Commercial |
$30.13
|
| Rate for Payer: United Healthcare Medicare |
$12.24
|
|
|
HC SUTURE VICRYL RAPIDE 5-0 VR834
|
Facility
|
IP
|
$38.24
|
|
| Hospital Charge Code |
41601487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.04
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cigna All Commercial |
$33.00
|
| Rate for Payer: CORVEL All Commercial |
$35.56
|
| Rate for Payer: Coventry All Commercial |
$33.65
|
| Rate for Payer: Encore All Commercial |
$35.20
|
| Rate for Payer: Frontpath All Commercial |
$35.18
|
| Rate for Payer: Humana ChoiceCare |
$33.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.42
|
| Rate for Payer: PHCS All Commercial |
$28.68
|
| Rate for Payer: PHP All Commercial |
$29.00
|
| Rate for Payer: Sagamore Health Network All Products |
$29.52
|
| Rate for Payer: Signature Care EPO |
$31.74
|
| Rate for Payer: Signature Care PPO |
$33.65
|
| Rate for Payer: United Healthcare Commercial |
$30.13
|
|
|
HC SUT VICRYL+ 0 54" VCP287G
|
Facility
|
IP
|
$12.83
|
|
| Hospital Charge Code |
41607980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cigna All Commercial |
$11.07
|
| Rate for Payer: CORVEL All Commercial |
$11.93
|
| Rate for Payer: Coventry All Commercial |
$11.29
|
| Rate for Payer: Encore All Commercial |
$11.81
|
| Rate for Payer: Frontpath All Commercial |
$11.80
|
| Rate for Payer: Humana ChoiceCare |
$11.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.55
|
| Rate for Payer: PHCS All Commercial |
$9.62
|
| Rate for Payer: PHP All Commercial |
$9.73
|
| Rate for Payer: Sagamore Health Network All Products |
$9.90
|
| Rate for Payer: Signature Care EPO |
$10.65
|
| Rate for Payer: Signature Care PPO |
$11.29
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
|
|
HC SUT VICRYL+ 0 54" VCP287G
|
Facility
|
OP
|
$12.83
|
|
| Hospital Charge Code |
41607980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.83
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.52
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Centivo All Commercial |
$6.98
|
| Rate for Payer: Cigna All Commercial |
$11.07
|
| Rate for Payer: CORVEL All Commercial |
$11.93
|
| Rate for Payer: Coventry All Commercial |
$11.29
|
| Rate for Payer: Encore All Commercial |
$11.81
|
| Rate for Payer: Frontpath All Commercial |
$11.80
|
| Rate for Payer: Humana ChoiceCare |
$11.08
|
| Rate for Payer: Humana Medicare |
$4.11
|
| Rate for Payer: Lucent All Commercial |
$6.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.55
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.62
|
| Rate for Payer: PHP All Commercial |
$9.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.00
|
| Rate for Payer: Sagamore Health Network All Products |
$9.90
|
| Rate for Payer: Signature Care EPO |
$10.65
|
| Rate for Payer: Signature Care PPO |
$11.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.91
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
| Rate for Payer: United Healthcare Medicare |
$4.11
|
|
|
HC SUT VICRYL+ 0 CT-1 36" VCP946H
|
Facility
|
IP
|
$9.67
|
|
| Hospital Charge Code |
41607982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$8.35
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cigna All Commercial |
$8.35
|
| Rate for Payer: CORVEL All Commercial |
$8.99
|
| Rate for Payer: Coventry All Commercial |
$8.51
|
| Rate for Payer: Encore All Commercial |
$8.90
|
| Rate for Payer: Frontpath All Commercial |
$8.90
|
| Rate for Payer: Humana ChoiceCare |
$8.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.70
|
| Rate for Payer: PHCS All Commercial |
$7.25
|
| Rate for Payer: PHP All Commercial |
$7.33
|
| Rate for Payer: Sagamore Health Network All Products |
$7.47
|
| Rate for Payer: Signature Care EPO |
$8.03
|
| Rate for Payer: Signature Care PPO |
$8.51
|
| Rate for Payer: United Healthcare Commercial |
$7.62
|
|
|
HC SUT VICRYL+ 0 CT-1 36" VCP946H
|
Facility
|
OP
|
$9.67
|
|
| Hospital Charge Code |
41607982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.40
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Cash Price |
$5.80
|
| Rate for Payer: Centivo All Commercial |
$5.26
|
| Rate for Payer: Cigna All Commercial |
$8.35
|
| Rate for Payer: CORVEL All Commercial |
$8.99
|
| Rate for Payer: Coventry All Commercial |
$8.51
|
| Rate for Payer: Encore All Commercial |
$8.90
|
| Rate for Payer: Frontpath All Commercial |
$8.90
|
| Rate for Payer: Humana ChoiceCare |
$8.35
|
| Rate for Payer: Humana Medicare |
$3.09
|
| Rate for Payer: Lucent All Commercial |
$5.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.70
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.25
|
| Rate for Payer: PHP All Commercial |
$7.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.77
|
| Rate for Payer: Sagamore Health Network All Products |
$7.47
|
| Rate for Payer: Signature Care EPO |
$8.03
|
| Rate for Payer: Signature Care PPO |
$8.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.22
|
| Rate for Payer: United Healthcare Commercial |
$7.62
|
| Rate for Payer: United Healthcare Medicare |
$3.09
|
|
|
HC SUT VICRYL+ 0 CT-1 CR VCPP41D
|
Facility
|
OP
|
$71.62
|
|
| Hospital Charge Code |
41607981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$66.61 |
| Rate for Payer: Aetna Commercial |
$60.45
|
| Rate for Payer: Aetna Medicare |
$22.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.21
|
| Rate for Payer: Cash Price |
$42.97
|
| Rate for Payer: Cash Price |
$42.97
|
| Rate for Payer: Centivo All Commercial |
$38.96
|
| Rate for Payer: Cigna All Commercial |
$61.81
|
| Rate for Payer: CORVEL All Commercial |
$66.61
|
| Rate for Payer: Coventry All Commercial |
$63.03
|
| Rate for Payer: Encore All Commercial |
$65.93
|
| Rate for Payer: Frontpath All Commercial |
$65.89
|
| Rate for Payer: Humana ChoiceCare |
$61.86
|
| Rate for Payer: Humana Medicare |
$22.92
|
| Rate for Payer: Lucent All Commercial |
$38.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$53.72
|
| Rate for Payer: PHP All Commercial |
$54.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.93
|
| Rate for Payer: Sagamore Health Network All Products |
$55.29
|
| Rate for Payer: Signature Care EPO |
$59.44
|
| Rate for Payer: Signature Care PPO |
$63.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.88
|
| Rate for Payer: United Healthcare Commercial |
$56.44
|
| Rate for Payer: United Healthcare Medicare |
$22.92
|
|
|
HC SUT VICRYL+ 0 CT-1 CR VCPP41D
|
Facility
|
IP
|
$71.62
|
|
| Hospital Charge Code |
41607981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$66.61 |
| Rate for Payer: Aetna Commercial |
$61.88
|
| Rate for Payer: Cash Price |
$42.97
|
| Rate for Payer: Cigna All Commercial |
$61.81
|
| Rate for Payer: CORVEL All Commercial |
$66.61
|
| Rate for Payer: Coventry All Commercial |
$63.03
|
| Rate for Payer: Encore All Commercial |
$65.93
|
| Rate for Payer: Frontpath All Commercial |
$65.89
|
| Rate for Payer: Humana ChoiceCare |
$61.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$64.46
|
| Rate for Payer: PHCS All Commercial |
$53.72
|
| Rate for Payer: PHP All Commercial |
$54.32
|
| Rate for Payer: Sagamore Health Network All Products |
$55.29
|
| Rate for Payer: Signature Care EPO |
$59.44
|
| Rate for Payer: Signature Care PPO |
$63.03
|
| Rate for Payer: United Healthcare Commercial |
$56.44
|
|
|
HC SUT VICRYL+ 0 CT-2 CR VCP727D
|
Facility
|
IP
|
$90.21
|
|
| Hospital Charge Code |
41607983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.66 |
| Max. Negotiated Rate |
$83.90 |
| Rate for Payer: Aetna Commercial |
$77.94
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Cigna All Commercial |
$77.85
|
| Rate for Payer: CORVEL All Commercial |
$83.90
|
| Rate for Payer: Coventry All Commercial |
$79.38
|
| Rate for Payer: Encore All Commercial |
$83.04
|
| Rate for Payer: Frontpath All Commercial |
$82.99
|
| Rate for Payer: Humana ChoiceCare |
$77.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.19
|
| Rate for Payer: PHCS All Commercial |
$67.66
|
| Rate for Payer: PHP All Commercial |
$68.42
|
| Rate for Payer: Sagamore Health Network All Products |
$69.64
|
| Rate for Payer: Signature Care EPO |
$74.87
|
| Rate for Payer: Signature Care PPO |
$79.38
|
| Rate for Payer: United Healthcare Commercial |
$71.09
|
|
|
HC SUT VICRYL+ 0 CT-2 CR VCP727D
|
Facility
|
OP
|
$90.21
|
|
| Hospital Charge Code |
41607983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$83.90 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$28.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.75
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Cash Price |
$54.13
|
| Rate for Payer: Centivo All Commercial |
$49.07
|
| Rate for Payer: Cigna All Commercial |
$77.85
|
| Rate for Payer: CORVEL All Commercial |
$83.90
|
| Rate for Payer: Coventry All Commercial |
$79.38
|
| Rate for Payer: Encore All Commercial |
$83.04
|
| Rate for Payer: Frontpath All Commercial |
$82.99
|
| Rate for Payer: Humana ChoiceCare |
$77.91
|
| Rate for Payer: Humana Medicare |
$28.87
|
| Rate for Payer: Lucent All Commercial |
$49.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.19
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$67.66
|
| Rate for Payer: PHP All Commercial |
$68.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.18
|
| Rate for Payer: Sagamore Health Network All Products |
$69.64
|
| Rate for Payer: Signature Care EPO |
$74.87
|
| Rate for Payer: Signature Care PPO |
$79.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$76.68
|
| Rate for Payer: United Healthcare Commercial |
$71.09
|
| Rate for Payer: United Healthcare Medicare |
$28.87
|
|
|
HC SUT VICRYL+ 0 CTX 36" VCP370H
|
Facility
|
IP
|
$10.12
|
|
| Hospital Charge Code |
41607985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cigna All Commercial |
$8.73
|
| Rate for Payer: CORVEL All Commercial |
$9.41
|
| Rate for Payer: Coventry All Commercial |
$8.91
|
| Rate for Payer: Encore All Commercial |
$9.32
|
| Rate for Payer: Frontpath All Commercial |
$9.31
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.11
|
| Rate for Payer: PHCS All Commercial |
$7.59
|
| Rate for Payer: PHP All Commercial |
$7.68
|
| Rate for Payer: Sagamore Health Network All Products |
$7.81
|
| Rate for Payer: Signature Care EPO |
$8.40
|
| Rate for Payer: Signature Care PPO |
$8.91
|
| Rate for Payer: United Healthcare Commercial |
$7.97
|
|
|
HC SUT VICRYL+ 0 CTX 36" VCP370H
|
Facility
|
OP
|
$10.12
|
|
| Hospital Charge Code |
41607985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.54
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.56
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Cash Price |
$6.07
|
| Rate for Payer: Centivo All Commercial |
$5.51
|
| Rate for Payer: Cigna All Commercial |
$8.73
|
| Rate for Payer: CORVEL All Commercial |
$9.41
|
| Rate for Payer: Coventry All Commercial |
$8.91
|
| Rate for Payer: Encore All Commercial |
$9.32
|
| Rate for Payer: Frontpath All Commercial |
$9.31
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare |
$3.24
|
| Rate for Payer: Lucent All Commercial |
$5.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.59
|
| Rate for Payer: PHP All Commercial |
$7.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.95
|
| Rate for Payer: Sagamore Health Network All Products |
$7.81
|
| Rate for Payer: Signature Care EPO |
$8.40
|
| Rate for Payer: Signature Care PPO |
$8.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.60
|
| Rate for Payer: United Healthcare Commercial |
$7.97
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
|
|
HC SUT VICRYL+ 0 UR-5 27" VCP376H
|
Facility
|
IP
|
$11.52
|
|
| Hospital Charge Code |
41607986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Cigna All Commercial |
$9.94
|
| Rate for Payer: CORVEL All Commercial |
$10.71
|
| Rate for Payer: Coventry All Commercial |
$10.14
|
| Rate for Payer: Encore All Commercial |
$10.60
|
| Rate for Payer: Frontpath All Commercial |
$10.60
|
| Rate for Payer: Humana ChoiceCare |
$9.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.37
|
| Rate for Payer: PHCS All Commercial |
$8.64
|
| Rate for Payer: PHP All Commercial |
$8.74
|
| Rate for Payer: Sagamore Health Network All Products |
$8.89
|
| Rate for Payer: Signature Care EPO |
$9.56
|
| Rate for Payer: Signature Care PPO |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$9.08
|
|
