|
HC SUTURE VICRYL PLUS 4-0 VCP426H
|
Facility
|
OP
|
$39.31
|
|
| Hospital Charge Code |
41601613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Centivo All Commercial |
$20.05
|
| Rate for Payer: Cigna All Commercial |
$33.92
|
| Rate for Payer: CORVEL All Commercial |
$36.56
|
| Rate for Payer: Coventry All Commercial |
$34.59
|
| Rate for Payer: Encore All Commercial |
$36.18
|
| Rate for Payer: Frontpath All Commercial |
$36.17
|
| Rate for Payer: Humana ChoiceCare |
$33.95
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Lucent All Commercial |
$20.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.48
|
| Rate for Payer: PHP All Commercial |
$29.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.33
|
| Rate for Payer: Sagamore Health Network All Products |
$30.35
|
| Rate for Payer: Signature Care EPO |
$32.63
|
| Rate for Payer: Signature Care PPO |
$34.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.41
|
| Rate for Payer: United Healthcare Commercial |
$30.98
|
| Rate for Payer: United Healthcare Medicare |
$12.97
|
|
|
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 |
$29.82
|
| 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 3-0 VR935
|
Facility
|
OP
|
$48.10
|
|
| Hospital Charge Code |
41601172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.46
|
| Rate for Payer: Cash Price |
$29.82
|
| Rate for Payer: Cash Price |
$29.82
|
| Rate for Payer: Centivo All Commercial |
$24.53
|
| 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 |
$24.53
|
| Rate for Payer: Lucent All Commercial |
$24.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$15.87
|
|
|
HC SUTURE VICRYL RAPIDE 4-0 VR845
|
Facility
|
IP
|
$48.80
|
|
| Hospital Charge Code |
41601486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$45.38 |
| Rate for Payer: Aetna Commercial |
$42.16
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cigna All Commercial |
$42.11
|
| Rate for Payer: CORVEL All Commercial |
$45.38
|
| Rate for Payer: Coventry All Commercial |
$42.94
|
| Rate for Payer: Encore All Commercial |
$44.92
|
| Rate for Payer: Frontpath All Commercial |
$44.90
|
| Rate for Payer: Humana ChoiceCare |
$42.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.92
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHP All Commercial |
$37.01
|
| Rate for Payer: Sagamore Health Network All Products |
$37.67
|
| Rate for Payer: Signature Care EPO |
$40.50
|
| Rate for Payer: Signature Care PPO |
$42.94
|
| Rate for Payer: United Healthcare Commercial |
$38.45
|
|
|
HC SUTURE VICRYL RAPIDE 4-0 VR845
|
Facility
|
OP
|
$48.80
|
|
| Hospital Charge Code |
41601486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$41.19
|
| Rate for Payer: Aetna Medicare |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.71
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Centivo All Commercial |
$24.89
|
| Rate for Payer: Cigna All Commercial |
$42.11
|
| Rate for Payer: CORVEL All Commercial |
$45.38
|
| Rate for Payer: Coventry All Commercial |
$42.94
|
| Rate for Payer: Encore All Commercial |
$44.92
|
| Rate for Payer: Frontpath All Commercial |
$44.90
|
| Rate for Payer: Humana ChoiceCare |
$42.15
|
| Rate for Payer: Humana Medicare |
$24.89
|
| Rate for Payer: Lucent All Commercial |
$24.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$36.60
|
| Rate for Payer: PHP All Commercial |
$37.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.03
|
| Rate for Payer: Sagamore Health Network All Products |
$37.67
|
| Rate for Payer: Signature Care EPO |
$40.50
|
| Rate for Payer: Signature Care PPO |
$42.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.48
|
| Rate for Payer: United Healthcare Commercial |
$38.45
|
| Rate for Payer: United Healthcare Medicare |
$16.10
|
|
|
HC SUTURE VICRYL RAPIDE 5-0 VR834
|
Facility
|
OP
|
$49.62
|
|
| Hospital Charge Code |
41601487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$41.88
|
| Rate for Payer: Aetna Medicare |
$16.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.01
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Centivo All Commercial |
$25.31
|
| Rate for Payer: Cigna All Commercial |
$42.82
|
| Rate for Payer: CORVEL All Commercial |
$46.15
|
| Rate for Payer: Coventry All Commercial |
$43.67
|
| Rate for Payer: Encore All Commercial |
$45.68
|
| Rate for Payer: Frontpath All Commercial |
$45.65
|
| Rate for Payer: Humana ChoiceCare |
$42.86
|
| Rate for Payer: Humana Medicare |
$25.31
|
| Rate for Payer: Lucent All Commercial |
$25.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$37.22
|
| Rate for Payer: PHP All Commercial |
$37.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.35
|
| Rate for Payer: Sagamore Health Network All Products |
$38.31
|
| Rate for Payer: Signature Care EPO |
$41.18
|
| Rate for Payer: Signature Care PPO |
$43.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.18
|
| Rate for Payer: United Healthcare Commercial |
$39.10
|
| Rate for Payer: United Healthcare Medicare |
$16.37
|
|
|
HC SUTURE VICRYL RAPIDE 5-0 VR834
|
Facility
|
IP
|
$49.62
|
|
| Hospital Charge Code |
41601487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Cigna All Commercial |
$42.82
|
| Rate for Payer: CORVEL All Commercial |
$46.15
|
| Rate for Payer: Coventry All Commercial |
$43.67
|
| Rate for Payer: Encore All Commercial |
$45.68
|
| Rate for Payer: Frontpath All Commercial |
$45.65
|
| Rate for Payer: Humana ChoiceCare |
$42.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.66
|
| Rate for Payer: PHCS All Commercial |
$37.22
|
| Rate for Payer: PHP All Commercial |
$37.63
|
| Rate for Payer: Sagamore Health Network All Products |
$38.31
|
| Rate for Payer: Signature Care EPO |
$41.18
|
| Rate for Payer: Signature Care PPO |
$43.67
|
| Rate for Payer: United Healthcare Commercial |
$39.10
|
|
|
HC SUTURE VLOC 180 2-0
|
Facility
|
IP
|
$362.20
|
|
| Hospital Charge Code |
41601600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.65 |
| Max. Negotiated Rate |
$336.85 |
| Rate for Payer: Aetna Commercial |
$312.94
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Cigna All Commercial |
$312.58
|
| Rate for Payer: CORVEL All Commercial |
$336.85
|
| Rate for Payer: Coventry All Commercial |
$318.74
|
| Rate for Payer: Encore All Commercial |
$333.41
|
| Rate for Payer: Frontpath All Commercial |
$333.22
|
| Rate for Payer: Humana ChoiceCare |
$312.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.98
|
| Rate for Payer: PHCS All Commercial |
$271.65
|
| Rate for Payer: PHP All Commercial |
$274.69
|
| Rate for Payer: Sagamore Health Network All Products |
$279.62
|
| Rate for Payer: Signature Care EPO |
$300.63
|
| Rate for Payer: Signature Care PPO |
$318.74
|
| Rate for Payer: United Healthcare Commercial |
$285.41
|
|
|
HC SUTURE VLOC 180 2-0
|
Facility
|
OP
|
$362.20
|
|
| Hospital Charge Code |
41601600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.53 |
| Max. Negotiated Rate |
$336.85 |
| Rate for Payer: Aetna Commercial |
$305.70
|
| Rate for Payer: Aetna Medicare |
$119.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.48
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Centivo All Commercial |
$184.72
|
| Rate for Payer: Cigna All Commercial |
$312.58
|
| Rate for Payer: CORVEL All Commercial |
$336.85
|
| Rate for Payer: Coventry All Commercial |
$318.74
|
| Rate for Payer: Encore All Commercial |
$333.41
|
| Rate for Payer: Frontpath All Commercial |
$333.22
|
| Rate for Payer: Humana ChoiceCare |
$312.83
|
| Rate for Payer: Humana Medicare |
$184.72
|
| Rate for Payer: Lucent All Commercial |
$184.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.65
|
| Rate for Payer: PHP All Commercial |
$274.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.26
|
| Rate for Payer: Sagamore Health Network All Products |
$279.62
|
| Rate for Payer: Signature Care EPO |
$300.63
|
| Rate for Payer: Signature Care PPO |
$318.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.87
|
| Rate for Payer: United Healthcare Commercial |
$285.41
|
| Rate for Payer: United Healthcare Medicare |
$119.53
|
|
|
HC SUTURE VLOC 180 2-0 GS-21
|
Facility
|
OP
|
$362.20
|
|
| Hospital Charge Code |
41602381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.53 |
| Max. Negotiated Rate |
$336.85 |
| Rate for Payer: Aetna Commercial |
$305.70
|
| Rate for Payer: Aetna Medicare |
$119.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$208.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$226.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$137.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$131.48
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Centivo All Commercial |
$184.72
|
| Rate for Payer: Cigna All Commercial |
$312.58
|
| Rate for Payer: CORVEL All Commercial |
$336.85
|
| Rate for Payer: Coventry All Commercial |
$318.74
|
| Rate for Payer: Encore All Commercial |
$333.41
|
| Rate for Payer: Frontpath All Commercial |
$333.22
|
| Rate for Payer: Humana ChoiceCare |
$312.83
|
| Rate for Payer: Humana Medicare |
$184.72
|
| Rate for Payer: Lucent All Commercial |
$184.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$271.65
|
| Rate for Payer: PHP All Commercial |
$274.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.26
|
| Rate for Payer: Sagamore Health Network All Products |
$279.62
|
| Rate for Payer: Signature Care EPO |
$300.63
|
| Rate for Payer: Signature Care PPO |
$318.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$307.87
|
| Rate for Payer: United Healthcare Commercial |
$285.41
|
| Rate for Payer: United Healthcare Medicare |
$119.53
|
|
|
HC SUTURE VLOC 180 2-0 GS-21
|
Facility
|
IP
|
$362.20
|
|
| Hospital Charge Code |
41602381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.65 |
| Max. Negotiated Rate |
$336.85 |
| Rate for Payer: Aetna Commercial |
$312.94
|
| Rate for Payer: Cash Price |
$224.56
|
| Rate for Payer: Cigna All Commercial |
$312.58
|
| Rate for Payer: CORVEL All Commercial |
$336.85
|
| Rate for Payer: Coventry All Commercial |
$318.74
|
| Rate for Payer: Encore All Commercial |
$333.41
|
| Rate for Payer: Frontpath All Commercial |
$333.22
|
| Rate for Payer: Humana ChoiceCare |
$312.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$325.98
|
| Rate for Payer: PHCS All Commercial |
$271.65
|
| Rate for Payer: PHP All Commercial |
$274.69
|
| Rate for Payer: Sagamore Health Network All Products |
$279.62
|
| Rate for Payer: Signature Care EPO |
$300.63
|
| Rate for Payer: Signature Care PPO |
$318.74
|
| Rate for Payer: United Healthcare Commercial |
$285.41
|
|
|
HC SUTURE VLOC 90 2-0 VLOCM3225
|
Facility
|
IP
|
$244.74
|
|
| Hospital Charge Code |
41601622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$227.61 |
| Rate for Payer: Aetna Commercial |
$211.46
|
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Cigna All Commercial |
$211.21
|
| Rate for Payer: CORVEL All Commercial |
$227.61
|
| Rate for Payer: Coventry All Commercial |
$215.37
|
| Rate for Payer: Encore All Commercial |
$225.28
|
| Rate for Payer: Frontpath All Commercial |
$225.16
|
| Rate for Payer: Humana ChoiceCare |
$211.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.27
|
| Rate for Payer: PHCS All Commercial |
$183.56
|
| Rate for Payer: PHP All Commercial |
$185.61
|
| Rate for Payer: Sagamore Health Network All Products |
$188.94
|
| Rate for Payer: Signature Care EPO |
$203.13
|
| Rate for Payer: Signature Care PPO |
$215.37
|
| Rate for Payer: United Healthcare Commercial |
$192.86
|
|
|
HC SUTURE VLOC 90 2-0 VLOCM3225
|
Facility
|
OP
|
$244.74
|
|
| Hospital Charge Code |
41601622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$227.61 |
| Rate for Payer: Aetna Commercial |
$206.56
|
| Rate for Payer: Aetna Medicare |
$80.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$80.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$140.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$152.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.84
|
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Centivo All Commercial |
$124.82
|
| Rate for Payer: Cigna All Commercial |
$211.21
|
| Rate for Payer: CORVEL All Commercial |
$227.61
|
| Rate for Payer: Coventry All Commercial |
$215.37
|
| Rate for Payer: Encore All Commercial |
$225.28
|
| Rate for Payer: Frontpath All Commercial |
$225.16
|
| Rate for Payer: Humana ChoiceCare |
$211.38
|
| Rate for Payer: Humana Medicare |
$124.82
|
| Rate for Payer: Lucent All Commercial |
$124.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$220.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$183.56
|
| Rate for Payer: PHP All Commercial |
$185.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$95.45
|
| Rate for Payer: Sagamore Health Network All Products |
$188.94
|
| Rate for Payer: Signature Care EPO |
$203.13
|
| Rate for Payer: Signature Care PPO |
$215.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$208.03
|
| Rate for Payer: United Healthcare Commercial |
$192.86
|
| Rate for Payer: United Healthcare Medicare |
$80.76
|
|
|
HC SUT VICRY 3-0 V-34 36" VCP516H
|
Facility
|
OP
|
$19.80
|
|
| Hospital Charge Code |
41608263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.19
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Centivo All Commercial |
$10.10
|
| Rate for Payer: Cigna All Commercial |
$17.09
|
| Rate for Payer: CORVEL All Commercial |
$18.41
|
| Rate for Payer: Coventry All Commercial |
$17.42
|
| Rate for Payer: Encore All Commercial |
$18.23
|
| Rate for Payer: Frontpath All Commercial |
$18.22
|
| Rate for Payer: Humana ChoiceCare |
$17.10
|
| Rate for Payer: Humana Medicare |
$10.10
|
| Rate for Payer: Lucent All Commercial |
$10.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.85
|
| Rate for Payer: PHP All Commercial |
$15.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.72
|
| Rate for Payer: Sagamore Health Network All Products |
$15.29
|
| Rate for Payer: Signature Care EPO |
$16.43
|
| Rate for Payer: Signature Care PPO |
$17.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.83
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$6.53
|
|
|
HC SUT VICRY 3-0 V-34 36" VCP516H
|
Facility
|
IP
|
$19.80
|
|
| Hospital Charge Code |
41608263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$18.41 |
| Rate for Payer: Aetna Commercial |
$17.11
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cigna All Commercial |
$17.09
|
| Rate for Payer: CORVEL All Commercial |
$18.41
|
| Rate for Payer: Coventry All Commercial |
$17.42
|
| Rate for Payer: Encore All Commercial |
$18.23
|
| Rate for Payer: Frontpath All Commercial |
$18.22
|
| Rate for Payer: Humana ChoiceCare |
$17.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.82
|
| Rate for Payer: PHCS All Commercial |
$14.85
|
| Rate for Payer: PHP All Commercial |
$15.02
|
| Rate for Payer: Sagamore Health Network All Products |
$15.29
|
| Rate for Payer: Signature Care EPO |
$16.43
|
| Rate for Payer: Signature Care PPO |
$17.42
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
|
|
HC SUT VICRYL+ 0 54" VCP287G
|
Facility
|
IP
|
$16.65
|
|
| Hospital Charge Code |
41607980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cigna All Commercial |
$14.37
|
| Rate for Payer: CORVEL All Commercial |
$15.48
|
| Rate for Payer: Coventry All Commercial |
$14.65
|
| Rate for Payer: Encore All Commercial |
$15.33
|
| Rate for Payer: Frontpath All Commercial |
$15.32
|
| Rate for Payer: Humana ChoiceCare |
$14.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.98
|
| Rate for Payer: PHCS All Commercial |
$12.49
|
| Rate for Payer: PHP All Commercial |
$12.63
|
| Rate for Payer: Sagamore Health Network All Products |
$12.85
|
| Rate for Payer: Signature Care EPO |
$13.82
|
| Rate for Payer: Signature Care PPO |
$14.65
|
| Rate for Payer: United Healthcare Commercial |
$13.12
|
|
|
HC SUT VICRYL+ 0 54" VCP287G
|
Facility
|
OP
|
$16.65
|
|
| Hospital Charge Code |
41607980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centivo All Commercial |
$8.49
|
| Rate for Payer: Cigna All Commercial |
$14.37
|
| Rate for Payer: CORVEL All Commercial |
$15.48
|
| Rate for Payer: Coventry All Commercial |
$14.65
|
| Rate for Payer: Encore All Commercial |
$15.33
|
| Rate for Payer: Frontpath All Commercial |
$15.32
|
| Rate for Payer: Humana ChoiceCare |
$14.38
|
| Rate for Payer: Humana Medicare |
$8.49
|
| Rate for Payer: Lucent All Commercial |
$8.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.49
|
| Rate for Payer: PHP All Commercial |
$12.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.49
|
| Rate for Payer: Sagamore Health Network All Products |
$12.85
|
| Rate for Payer: Signature Care EPO |
$13.82
|
| Rate for Payer: Signature Care PPO |
$14.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.15
|
| Rate for Payer: United Healthcare Commercial |
$13.12
|
| Rate for Payer: United Healthcare Medicare |
$5.49
|
|
|
HC SUT VICRYL+ 0 CT-1 36" VCP946H
|
Facility
|
IP
|
$12.54
|
|
| Hospital Charge Code |
41607982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
|
|
HC SUT VICRYL+ 0 CT-1 36" VCP946H
|
Facility
|
OP
|
$12.54
|
|
| Hospital Charge Code |
41607982
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.55
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Centivo All Commercial |
$6.40
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Humana Medicare |
$6.40
|
| Rate for Payer: Lucent All Commercial |
$6.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.89
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
| Rate for Payer: United Healthcare Medicare |
$4.14
|
|
|
HC SUT VICRYL+ 0 CT-1 CR VCPP41D
|
Facility
|
IP
|
$92.91
|
|
| Hospital Charge Code |
41607981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$86.41 |
| Rate for Payer: Aetna Commercial |
$80.27
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna All Commercial |
$80.18
|
| Rate for Payer: CORVEL All Commercial |
$86.41
|
| Rate for Payer: Coventry All Commercial |
$81.76
|
| Rate for Payer: Encore All Commercial |
$85.52
|
| Rate for Payer: Frontpath All Commercial |
$85.48
|
| Rate for Payer: Humana ChoiceCare |
$80.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.62
|
| Rate for Payer: PHCS All Commercial |
$69.68
|
| Rate for Payer: PHP All Commercial |
$70.46
|
| Rate for Payer: Sagamore Health Network All Products |
$71.73
|
| Rate for Payer: Signature Care EPO |
$77.12
|
| Rate for Payer: Signature Care PPO |
$81.76
|
| Rate for Payer: United Healthcare Commercial |
$73.21
|
|
|
HC SUT VICRYL+ 0 CT-1 CR VCPP41D
|
Facility
|
OP
|
$92.91
|
|
| Hospital Charge Code |
41607981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$78.42
|
| Rate for Payer: Aetna Medicare |
$30.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$58.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.73
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Centivo All Commercial |
$47.38
|
| Rate for Payer: Cigna All Commercial |
$80.18
|
| Rate for Payer: CORVEL All Commercial |
$86.41
|
| Rate for Payer: Coventry All Commercial |
$81.76
|
| Rate for Payer: Encore All Commercial |
$85.52
|
| Rate for Payer: Frontpath All Commercial |
$85.48
|
| Rate for Payer: Humana ChoiceCare |
$80.25
|
| Rate for Payer: Humana Medicare |
$47.38
|
| Rate for Payer: Lucent All Commercial |
$47.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$69.68
|
| Rate for Payer: PHP All Commercial |
$70.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.23
|
| Rate for Payer: Sagamore Health Network All Products |
$71.73
|
| Rate for Payer: Signature Care EPO |
$77.12
|
| Rate for Payer: Signature Care PPO |
$81.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.97
|
| Rate for Payer: United Healthcare Commercial |
$73.21
|
| Rate for Payer: United Healthcare Medicare |
$30.66
|
|
|
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 |
$55.93
|
| 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 |
$29.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$29.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$56.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.75
|
| Rate for Payer: Cash Price |
$55.93
|
| Rate for Payer: Cash Price |
$55.93
|
| Rate for Payer: Centivo All Commercial |
$46.01
|
| 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 |
$46.01
|
| Rate for Payer: Lucent All Commercial |
$46.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$29.77
|
|
|
HC SUT VICRYL+ 0 CTB-1 VCPB946H
|
Facility
|
OP
|
$14.76
|
|
| Hospital Charge Code |
41607984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.46
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.36
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Centivo All Commercial |
$7.53
|
| Rate for Payer: Cigna All Commercial |
$12.74
|
| Rate for Payer: CORVEL All Commercial |
$13.73
|
| Rate for Payer: Coventry All Commercial |
$12.99
|
| Rate for Payer: Encore All Commercial |
$13.59
|
| Rate for Payer: Frontpath All Commercial |
$13.58
|
| Rate for Payer: Humana ChoiceCare |
$12.75
|
| Rate for Payer: Humana Medicare |
$7.53
|
| Rate for Payer: Lucent All Commercial |
$7.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.07
|
| Rate for Payer: PHP All Commercial |
$11.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.76
|
| Rate for Payer: Sagamore Health Network All Products |
$11.39
|
| Rate for Payer: Signature Care EPO |
$12.25
|
| Rate for Payer: Signature Care PPO |
$12.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.55
|
| Rate for Payer: United Healthcare Commercial |
$11.63
|
| Rate for Payer: United Healthcare Medicare |
$4.87
|
|
|
HC SUT VICRYL+ 0 CTB-1 VCPB946H
|
Facility
|
IP
|
$14.76
|
|
| Hospital Charge Code |
41607984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Aetna Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cigna All Commercial |
$12.74
|
| Rate for Payer: CORVEL All Commercial |
$13.73
|
| Rate for Payer: Coventry All Commercial |
$12.99
|
| Rate for Payer: Encore All Commercial |
$13.59
|
| Rate for Payer: Frontpath All Commercial |
$13.58
|
| Rate for Payer: Humana ChoiceCare |
$12.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.28
|
| Rate for Payer: PHCS All Commercial |
$11.07
|
| Rate for Payer: PHP All Commercial |
$11.19
|
| Rate for Payer: Sagamore Health Network All Products |
$11.39
|
| Rate for Payer: Signature Care EPO |
$12.25
|
| Rate for Payer: Signature Care PPO |
$12.99
|
| Rate for Payer: United Healthcare Commercial |
$11.63
|
|
