|
HC SUT VICRYL+ 0 CTX 36" VCP370H
|
Facility
|
OP
|
$13.13
|
|
| Hospital Charge Code |
41607985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.08
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.77
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Centivo All Commercial |
$6.70
|
| Rate for Payer: Cigna All Commercial |
$11.33
|
| Rate for Payer: CORVEL All Commercial |
$12.21
|
| Rate for Payer: Coventry All Commercial |
$11.55
|
| Rate for Payer: Encore All Commercial |
$12.09
|
| Rate for Payer: Frontpath All Commercial |
$12.08
|
| Rate for Payer: Humana ChoiceCare |
$11.34
|
| Rate for Payer: Humana Medicare |
$6.70
|
| Rate for Payer: Lucent All Commercial |
$6.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.85
|
| Rate for Payer: PHP All Commercial |
$9.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.12
|
| Rate for Payer: Sagamore Health Network All Products |
$10.14
|
| Rate for Payer: Signature Care EPO |
$10.90
|
| Rate for Payer: Signature Care PPO |
$11.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
|
|
HC SUT VICRYL+ 0 CTX 36" VCP370H
|
Facility
|
IP
|
$13.13
|
|
| Hospital Charge Code |
41607985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Aetna Commercial |
$11.34
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cigna All Commercial |
$11.33
|
| Rate for Payer: CORVEL All Commercial |
$12.21
|
| Rate for Payer: Coventry All Commercial |
$11.55
|
| Rate for Payer: Encore All Commercial |
$12.09
|
| Rate for Payer: Frontpath All Commercial |
$12.08
|
| Rate for Payer: Humana ChoiceCare |
$11.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.82
|
| Rate for Payer: PHCS All Commercial |
$9.85
|
| Rate for Payer: PHP All Commercial |
$9.96
|
| Rate for Payer: Sagamore Health Network All Products |
$10.14
|
| Rate for Payer: Signature Care EPO |
$10.90
|
| Rate for Payer: Signature Care PPO |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$10.35
|
|
|
HC SUT VICRYL+ 0 UR-5 27" VCP376H
|
Facility
|
IP
|
$14.95
|
|
| Hospital Charge Code |
41607986
|
|
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 |
$9.27
|
| 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 SUT VICRYL+ 0 UR-5 27" VCP376H
|
Facility
|
OP
|
$14.95
|
|
| Hospital Charge Code |
41607986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.43
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Centivo All Commercial |
$7.62
|
| 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 |
$7.62
|
| Rate for Payer: Lucent All Commercial |
$7.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$4.93
|
|
|
HC SUT VICRYL+ 1 CT-1 36" VCP347H
|
Facility
|
OP
|
$12.23
|
|
| Hospital Charge Code |
41607987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.44
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Centivo All Commercial |
$6.24
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Humana Medicare |
$6.24
|
| Rate for Payer: Lucent All Commercial |
$6.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.77
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
| Rate for Payer: United Healthcare Medicare |
$4.04
|
|
|
HC SUT VICRYL+ 1 CT-1 36" VCP347H
|
Facility
|
IP
|
$12.23
|
|
| Hospital Charge Code |
41607987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
|
|
HC SUT VICRYL+ 1 CT-2 27" VCP335H
|
Facility
|
OP
|
$11.64
|
|
| Hospital Charge Code |
41607988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$3.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Centivo All Commercial |
$5.94
|
| Rate for Payer: Cigna All Commercial |
$10.05
|
| Rate for Payer: CORVEL All Commercial |
$10.83
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Lucent All Commercial |
$5.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8.99
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
| Rate for Payer: United Healthcare Medicare |
$3.84
|
|
|
HC SUT VICRYL+ 1 CT-2 27" VCP335H
|
Facility
|
IP
|
$11.64
|
|
| Hospital Charge Code |
41607988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$10.83 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna All Commercial |
$10.05
|
| Rate for Payer: CORVEL All Commercial |
$10.83
|
| Rate for Payer: Coventry All Commercial |
$10.24
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.71
|
| Rate for Payer: Humana ChoiceCare |
$10.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.48
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$8.83
|
| Rate for Payer: Sagamore Health Network All Products |
$8.99
|
| Rate for Payer: Signature Care EPO |
$9.66
|
| Rate for Payer: Signature Care PPO |
$10.24
|
| Rate for Payer: United Healthcare Commercial |
$9.17
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP259H
|
Facility
|
OP
|
$11.17
|
|
| Hospital Charge Code |
41607990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.43
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.05
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Centivo All Commercial |
$5.70
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Humana Medicare |
$5.70
|
| Rate for Payer: Lucent All Commercial |
$5.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.36
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$3.69
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP259H
|
Facility
|
IP
|
$11.17
|
|
| Hospital Charge Code |
41607990
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP339H
|
Facility
|
IP
|
$11.87
|
|
| Hospital Charge Code |
41607991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cigna All Commercial |
$10.24
|
| Rate for Payer: CORVEL All Commercial |
$11.04
|
| Rate for Payer: Coventry All Commercial |
$10.45
|
| Rate for Payer: Encore All Commercial |
$10.93
|
| Rate for Payer: Frontpath All Commercial |
$10.92
|
| Rate for Payer: Humana ChoiceCare |
$10.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.68
|
| Rate for Payer: PHCS All Commercial |
$8.90
|
| Rate for Payer: PHP All Commercial |
$9.00
|
| Rate for Payer: Sagamore Health Network All Products |
$9.16
|
| Rate for Payer: Signature Care EPO |
$9.85
|
| Rate for Payer: Signature Care PPO |
$10.45
|
| Rate for Payer: United Healthcare Commercial |
$9.35
|
|
|
HC SUT VICRYL+ 2-0 CT-1 VCP339H
|
Facility
|
OP
|
$11.87
|
|
| Hospital Charge Code |
41607991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.02
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Centivo All Commercial |
$6.05
|
| Rate for Payer: Cigna All Commercial |
$10.24
|
| Rate for Payer: CORVEL All Commercial |
$11.04
|
| Rate for Payer: Coventry All Commercial |
$10.45
|
| Rate for Payer: Encore All Commercial |
$10.93
|
| Rate for Payer: Frontpath All Commercial |
$10.92
|
| Rate for Payer: Humana ChoiceCare |
$10.25
|
| Rate for Payer: Humana Medicare |
$6.05
|
| Rate for Payer: Lucent All Commercial |
$6.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.90
|
| Rate for Payer: PHP All Commercial |
$9.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.63
|
| Rate for Payer: Sagamore Health Network All Products |
$9.16
|
| Rate for Payer: Signature Care EPO |
$9.85
|
| Rate for Payer: Signature Care PPO |
$10.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.09
|
| Rate for Payer: United Healthcare Commercial |
$9.35
|
| Rate for Payer: United Healthcare Medicare |
$3.92
|
|
|
HC SUT VICRYL+ 2-0 TIE VCP105G
|
Facility
|
OP
|
$67.32
|
|
| Hospital Charge Code |
41607989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$56.82
|
| Rate for Payer: Aetna Medicare |
$22.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$42.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.44
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Centivo All Commercial |
$34.33
|
| Rate for Payer: Cigna All Commercial |
$58.10
|
| Rate for Payer: CORVEL All Commercial |
$62.61
|
| Rate for Payer: Coventry All Commercial |
$59.24
|
| Rate for Payer: Encore All Commercial |
$61.97
|
| Rate for Payer: Frontpath All Commercial |
$61.93
|
| Rate for Payer: Humana ChoiceCare |
$58.14
|
| Rate for Payer: Humana Medicare |
$34.33
|
| Rate for Payer: Lucent All Commercial |
$34.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$50.49
|
| Rate for Payer: PHP All Commercial |
$51.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.25
|
| Rate for Payer: Sagamore Health Network All Products |
$51.97
|
| Rate for Payer: Signature Care EPO |
$55.88
|
| Rate for Payer: Signature Care PPO |
$59.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$57.22
|
| Rate for Payer: United Healthcare Commercial |
$53.05
|
| Rate for Payer: United Healthcare Medicare |
$22.22
|
|
|
HC SUT VICRYL+ 2-0 TIE VCP105G
|
Facility
|
IP
|
$67.32
|
|
| Hospital Charge Code |
41607989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Aetna Commercial |
$58.16
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cigna All Commercial |
$58.10
|
| Rate for Payer: CORVEL All Commercial |
$62.61
|
| Rate for Payer: Coventry All Commercial |
$59.24
|
| Rate for Payer: Encore All Commercial |
$61.97
|
| Rate for Payer: Frontpath All Commercial |
$61.93
|
| Rate for Payer: Humana ChoiceCare |
$58.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.59
|
| Rate for Payer: PHCS All Commercial |
$50.49
|
| Rate for Payer: PHP All Commercial |
$51.06
|
| Rate for Payer: Sagamore Health Network All Products |
$51.97
|
| Rate for Payer: Signature Care EPO |
$55.88
|
| Rate for Payer: Signature Care PPO |
$59.24
|
| Rate for Payer: United Healthcare Commercial |
$53.05
|
|
|
HC SUT VICRYL+ 2-0 UR-4 VCP375H
|
Facility
|
OP
|
$14.95
|
|
| Hospital Charge Code |
41607992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.43
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Centivo All Commercial |
$7.62
|
| 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 |
$7.62
|
| Rate for Payer: Lucent All Commercial |
$7.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$4.93
|
|
|
HC SUT VICRYL+ 2-0 UR-4 VCP375H
|
Facility
|
IP
|
$14.95
|
|
| Hospital Charge Code |
41607992
|
|
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 |
$9.27
|
| 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 SUT VICRYL+ 3-0 54" VCP205G
|
Facility
|
IP
|
$15.85
|
|
| Hospital Charge Code |
41607993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cigna All Commercial |
$13.68
|
| Rate for Payer: CORVEL All Commercial |
$14.74
|
| Rate for Payer: Coventry All Commercial |
$13.95
|
| Rate for Payer: Encore All Commercial |
$14.59
|
| Rate for Payer: Frontpath All Commercial |
$14.58
|
| Rate for Payer: Humana ChoiceCare |
$13.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHP All Commercial |
$12.02
|
| Rate for Payer: Sagamore Health Network All Products |
$12.24
|
| Rate for Payer: Signature Care EPO |
$13.16
|
| Rate for Payer: Signature Care PPO |
$13.95
|
| Rate for Payer: United Healthcare Commercial |
$12.49
|
|
|
HC SUT VICRYL+ 3-0 54" VCP205G
|
Facility
|
OP
|
$15.85
|
|
| Hospital Charge Code |
41607993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.38
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Centivo All Commercial |
$8.08
|
| Rate for Payer: Cigna All Commercial |
$13.68
|
| Rate for Payer: CORVEL All Commercial |
$14.74
|
| Rate for Payer: Coventry All Commercial |
$13.95
|
| Rate for Payer: Encore All Commercial |
$14.59
|
| Rate for Payer: Frontpath All Commercial |
$14.58
|
| Rate for Payer: Humana ChoiceCare |
$13.69
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Lucent All Commercial |
$8.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.89
|
| Rate for Payer: PHP All Commercial |
$12.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.18
|
| Rate for Payer: Sagamore Health Network All Products |
$12.24
|
| Rate for Payer: Signature Care EPO |
$13.16
|
| Rate for Payer: Signature Care PPO |
$13.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$12.49
|
| Rate for Payer: United Healthcare Medicare |
$5.23
|
|
|
HC SUT VICRYL+ 3-0 54" VCP285G
|
Facility
|
IP
|
$16.68
|
|
| Hospital Charge Code |
41607994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$15.51 |
| Rate for Payer: Aetna Commercial |
$14.41
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cigna All Commercial |
$14.39
|
| Rate for Payer: CORVEL All Commercial |
$15.51
|
| Rate for Payer: Coventry All Commercial |
$14.68
|
| Rate for Payer: Encore All Commercial |
$15.35
|
| Rate for Payer: Frontpath All Commercial |
$15.35
|
| Rate for Payer: Humana ChoiceCare |
$14.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.01
|
| Rate for Payer: PHCS All Commercial |
$12.51
|
| Rate for Payer: PHP All Commercial |
$12.65
|
| Rate for Payer: Sagamore Health Network All Products |
$12.88
|
| Rate for Payer: Signature Care EPO |
$13.84
|
| Rate for Payer: Signature Care PPO |
$14.68
|
| Rate for Payer: United Healthcare Commercial |
$13.14
|
|
|
HC SUT VICRYL+ 3-0 54" VCP285G
|
Facility
|
OP
|
$16.68
|
|
| Hospital Charge Code |
41607994
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.05
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Centivo All Commercial |
$8.51
|
| Rate for Payer: Cigna All Commercial |
$14.39
|
| Rate for Payer: CORVEL All Commercial |
$15.51
|
| Rate for Payer: Coventry All Commercial |
$14.68
|
| Rate for Payer: Encore All Commercial |
$15.35
|
| Rate for Payer: Frontpath All Commercial |
$15.35
|
| Rate for Payer: Humana ChoiceCare |
$14.41
|
| Rate for Payer: Humana Medicare |
$8.51
|
| Rate for Payer: Lucent All Commercial |
$8.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.51
|
| Rate for Payer: PHP All Commercial |
$12.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.51
|
| Rate for Payer: Sagamore Health Network All Products |
$12.88
|
| Rate for Payer: Signature Care EPO |
$13.84
|
| Rate for Payer: Signature Care PPO |
$14.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$13.14
|
| Rate for Payer: United Healthcare Medicare |
$5.50
|
|
|
HC SUT VICRYL+ 3-0 PS-2 VCP497H
|
Facility
|
OP
|
$31.18
|
|
| Hospital Charge Code |
41607995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.32
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.32
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Centivo All Commercial |
$15.90
|
| Rate for Payer: Cigna All Commercial |
$26.91
|
| Rate for Payer: CORVEL All Commercial |
$29.00
|
| Rate for Payer: Coventry All Commercial |
$27.44
|
| Rate for Payer: Encore All Commercial |
$28.70
|
| Rate for Payer: Frontpath All Commercial |
$28.69
|
| Rate for Payer: Humana ChoiceCare |
$26.93
|
| Rate for Payer: Humana Medicare |
$15.90
|
| Rate for Payer: Lucent All Commercial |
$15.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.38
|
| Rate for Payer: PHP All Commercial |
$23.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.16
|
| Rate for Payer: Sagamore Health Network All Products |
$24.07
|
| Rate for Payer: Signature Care EPO |
$25.88
|
| Rate for Payer: Signature Care PPO |
$27.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.50
|
| Rate for Payer: United Healthcare Commercial |
$24.57
|
| Rate for Payer: United Healthcare Medicare |
$10.29
|
|
|
HC SUT VICRYL+ 3-0 PS-2 VCP497H
|
Facility
|
IP
|
$31.18
|
|
| Hospital Charge Code |
41607995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$26.94
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Cigna All Commercial |
$26.91
|
| Rate for Payer: CORVEL All Commercial |
$29.00
|
| Rate for Payer: Coventry All Commercial |
$27.44
|
| Rate for Payer: Encore All Commercial |
$28.70
|
| Rate for Payer: Frontpath All Commercial |
$28.69
|
| Rate for Payer: Humana ChoiceCare |
$26.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.06
|
| Rate for Payer: PHCS All Commercial |
$23.38
|
| Rate for Payer: PHP All Commercial |
$23.65
|
| Rate for Payer: Sagamore Health Network All Products |
$24.07
|
| Rate for Payer: Signature Care EPO |
$25.88
|
| Rate for Payer: Signature Care PPO |
$27.44
|
| Rate for Payer: United Healthcare Commercial |
$24.57
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP316H
|
Facility
|
IP
|
$11.89
|
|
| Hospital Charge Code |
41607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$10.27
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna All Commercial |
$10.26
|
| Rate for Payer: CORVEL All Commercial |
$11.06
|
| Rate for Payer: Coventry All Commercial |
$10.46
|
| Rate for Payer: Encore All Commercial |
$10.94
|
| Rate for Payer: Frontpath All Commercial |
$10.94
|
| Rate for Payer: Humana ChoiceCare |
$10.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.70
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Sagamore Health Network All Products |
$9.18
|
| Rate for Payer: Signature Care EPO |
$9.87
|
| Rate for Payer: Signature Care PPO |
$10.46
|
| Rate for Payer: United Healthcare Commercial |
$9.37
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP316H
|
Facility
|
OP
|
$11.89
|
|
| Hospital Charge Code |
41607997
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.32
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Centivo All Commercial |
$6.06
|
| Rate for Payer: Cigna All Commercial |
$10.26
|
| Rate for Payer: CORVEL All Commercial |
$11.06
|
| Rate for Payer: Coventry All Commercial |
$10.46
|
| Rate for Payer: Encore All Commercial |
$10.94
|
| Rate for Payer: Frontpath All Commercial |
$10.94
|
| Rate for Payer: Humana ChoiceCare |
$10.27
|
| Rate for Payer: Humana Medicare |
$6.06
|
| Rate for Payer: Lucent All Commercial |
$6.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.64
|
| Rate for Payer: Sagamore Health Network All Products |
$9.18
|
| Rate for Payer: Signature Care EPO |
$9.87
|
| Rate for Payer: Signature Care PPO |
$10.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$9.37
|
| Rate for Payer: United Healthcare Medicare |
$3.92
|
|
|
HC SUT VICRYL+ 3-0 SH 27" VCP416H
|
Facility
|
IP
|
$11.89
|
|
| Hospital Charge Code |
41607998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$10.27
|
| Rate for Payer: Cash Price |
$7.37
|
| Rate for Payer: Cigna All Commercial |
$10.26
|
| Rate for Payer: CORVEL All Commercial |
$11.06
|
| Rate for Payer: Coventry All Commercial |
$10.46
|
| Rate for Payer: Encore All Commercial |
$10.94
|
| Rate for Payer: Frontpath All Commercial |
$10.94
|
| Rate for Payer: Humana ChoiceCare |
$10.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.70
|
| Rate for Payer: PHCS All Commercial |
$8.92
|
| Rate for Payer: PHP All Commercial |
$9.02
|
| Rate for Payer: Sagamore Health Network All Products |
$9.18
|
| Rate for Payer: Signature Care EPO |
$9.87
|
| Rate for Payer: Signature Care PPO |
$10.46
|
| Rate for Payer: United Healthcare Commercial |
$9.37
|
|
