|
HC SUT VICRYL+ 3-0 SH 27" VCP416H
|
Facility
|
OP
|
$11.89
|
|
| Hospital Charge Code |
41607998
|
|
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 CR VCP864D
|
Facility
|
IP
|
$85.51
|
|
| Hospital Charge Code |
41607996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.13 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna Commercial |
$73.88
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cigna All Commercial |
$73.80
|
| Rate for Payer: CORVEL All Commercial |
$79.52
|
| Rate for Payer: Coventry All Commercial |
$75.25
|
| Rate for Payer: Encore All Commercial |
$78.71
|
| Rate for Payer: Frontpath All Commercial |
$78.67
|
| Rate for Payer: Humana ChoiceCare |
$73.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.96
|
| Rate for Payer: PHCS All Commercial |
$64.13
|
| Rate for Payer: PHP All Commercial |
$64.85
|
| Rate for Payer: Sagamore Health Network All Products |
$66.01
|
| Rate for Payer: Signature Care EPO |
$70.97
|
| Rate for Payer: Signature Care PPO |
$75.25
|
| Rate for Payer: United Healthcare Commercial |
$67.38
|
|
|
HC SUT VICRYL+ 3-0 SH CR VCP864D
|
Facility
|
OP
|
$85.51
|
|
| Hospital Charge Code |
41607996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$72.17
|
| Rate for Payer: Aetna Medicare |
$28.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.04
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Cash Price |
$53.02
|
| Rate for Payer: Centivo All Commercial |
$43.61
|
| Rate for Payer: Cigna All Commercial |
$73.80
|
| Rate for Payer: CORVEL All Commercial |
$79.52
|
| Rate for Payer: Coventry All Commercial |
$75.25
|
| Rate for Payer: Encore All Commercial |
$78.71
|
| Rate for Payer: Frontpath All Commercial |
$78.67
|
| Rate for Payer: Humana ChoiceCare |
$73.85
|
| Rate for Payer: Humana Medicare |
$43.61
|
| Rate for Payer: Lucent All Commercial |
$43.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$64.13
|
| Rate for Payer: PHP All Commercial |
$64.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.35
|
| Rate for Payer: Sagamore Health Network All Products |
$66.01
|
| Rate for Payer: Signature Care EPO |
$70.97
|
| Rate for Payer: Signature Care PPO |
$75.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.68
|
| Rate for Payer: United Healthcare Commercial |
$67.38
|
| Rate for Payer: United Healthcare Medicare |
$28.22
|
|
|
HC SUT VICRYL+ 4-0 FS-1 VCP441H
|
Facility
|
IP
|
$17.01
|
|
| Hospital Charge Code |
41607999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Cigna All Commercial |
$14.68
|
| Rate for Payer: CORVEL All Commercial |
$15.82
|
| Rate for Payer: Coventry All Commercial |
$14.97
|
| Rate for Payer: Encore All Commercial |
$15.66
|
| Rate for Payer: Frontpath All Commercial |
$15.65
|
| Rate for Payer: Humana ChoiceCare |
$14.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.31
|
| Rate for Payer: PHCS All Commercial |
$12.76
|
| Rate for Payer: PHP All Commercial |
$12.90
|
| Rate for Payer: Sagamore Health Network All Products |
$13.13
|
| Rate for Payer: Signature Care EPO |
$14.12
|
| Rate for Payer: Signature Care PPO |
$14.97
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
|
|
HC SUT VICRYL+ 4-0 FS-1 VCP441H
|
Facility
|
OP
|
$17.01
|
|
| Hospital Charge Code |
41607999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Medicare |
$5.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.17
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Centivo All Commercial |
$8.68
|
| Rate for Payer: Cigna All Commercial |
$14.68
|
| Rate for Payer: CORVEL All Commercial |
$15.82
|
| Rate for Payer: Coventry All Commercial |
$14.97
|
| Rate for Payer: Encore All Commercial |
$15.66
|
| Rate for Payer: Frontpath All Commercial |
$15.65
|
| Rate for Payer: Humana ChoiceCare |
$14.69
|
| Rate for Payer: Humana Medicare |
$8.68
|
| Rate for Payer: Lucent All Commercial |
$8.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.76
|
| Rate for Payer: PHP All Commercial |
$12.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.63
|
| Rate for Payer: Sagamore Health Network All Products |
$13.13
|
| Rate for Payer: Signature Care EPO |
$14.12
|
| Rate for Payer: Signature Care PPO |
$14.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.46
|
| Rate for Payer: United Healthcare Commercial |
$13.40
|
| Rate for Payer: United Healthcare Medicare |
$5.61
|
|
|
HC SUT VICRYL+ 4-0 PS-2 VCP496H
|
Facility
|
OP
|
$31.40
|
|
| Hospital Charge Code |
41608000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.50
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.40
|
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Centivo All Commercial |
$16.01
|
| Rate for Payer: Cigna All Commercial |
$27.10
|
| Rate for Payer: CORVEL All Commercial |
$29.20
|
| Rate for Payer: Coventry All Commercial |
$27.63
|
| Rate for Payer: Encore All Commercial |
$28.90
|
| Rate for Payer: Frontpath All Commercial |
$28.89
|
| Rate for Payer: Humana ChoiceCare |
$27.12
|
| Rate for Payer: Humana Medicare |
$16.01
|
| Rate for Payer: Lucent All Commercial |
$16.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.55
|
| Rate for Payer: PHP All Commercial |
$23.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.25
|
| Rate for Payer: Sagamore Health Network All Products |
$24.24
|
| Rate for Payer: Signature Care EPO |
$26.06
|
| Rate for Payer: Signature Care PPO |
$27.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.69
|
| Rate for Payer: United Healthcare Commercial |
$24.74
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
|
|
HC SUT VICRYL+ 4-0 PS-2 VCP496H
|
Facility
|
IP
|
$31.40
|
|
| Hospital Charge Code |
41608000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$29.20 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Cigna All Commercial |
$27.10
|
| Rate for Payer: CORVEL All Commercial |
$29.20
|
| Rate for Payer: Coventry All Commercial |
$27.63
|
| Rate for Payer: Encore All Commercial |
$28.90
|
| Rate for Payer: Frontpath All Commercial |
$28.89
|
| Rate for Payer: Humana ChoiceCare |
$27.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.26
|
| Rate for Payer: PHCS All Commercial |
$23.55
|
| Rate for Payer: PHP All Commercial |
$23.81
|
| Rate for Payer: Sagamore Health Network All Products |
$24.24
|
| Rate for Payer: Signature Care EPO |
$26.06
|
| Rate for Payer: Signature Care PPO |
$27.63
|
| Rate for Payer: United Healthcare Commercial |
$24.74
|
|
|
HC SUT VICRYL+ 4-0 RB-1 VCP714D
|
Facility
|
IP
|
$98.79
|
|
| Hospital Charge Code |
41608001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.09 |
| Max. Negotiated Rate |
$91.87 |
| Rate for Payer: Aetna Commercial |
$85.35
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Cigna All Commercial |
$85.26
|
| Rate for Payer: CORVEL All Commercial |
$91.87
|
| Rate for Payer: Coventry All Commercial |
$86.94
|
| Rate for Payer: Encore All Commercial |
$90.94
|
| Rate for Payer: Frontpath All Commercial |
$90.89
|
| Rate for Payer: Humana ChoiceCare |
$85.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.91
|
| Rate for Payer: PHCS All Commercial |
$74.09
|
| Rate for Payer: PHP All Commercial |
$74.92
|
| Rate for Payer: Sagamore Health Network All Products |
$76.27
|
| Rate for Payer: Signature Care EPO |
$82.00
|
| Rate for Payer: Signature Care PPO |
$86.94
|
| Rate for Payer: United Healthcare Commercial |
$77.85
|
|
|
HC SUT VICRYL+ 4-0 RB-1 VCP714D
|
Facility
|
OP
|
$98.79
|
|
| Hospital Charge Code |
41608001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$83.38
|
| Rate for Payer: Aetna Medicare |
$32.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: Centivo All Commercial |
$50.38
|
| Rate for Payer: Cigna All Commercial |
$85.26
|
| Rate for Payer: CORVEL All Commercial |
$91.87
|
| Rate for Payer: Coventry All Commercial |
$86.94
|
| Rate for Payer: Encore All Commercial |
$90.94
|
| Rate for Payer: Frontpath All Commercial |
$90.89
|
| Rate for Payer: Humana ChoiceCare |
$85.32
|
| Rate for Payer: Humana Medicare |
$50.38
|
| Rate for Payer: Lucent All Commercial |
$50.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$74.09
|
| Rate for Payer: PHP All Commercial |
$74.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.53
|
| Rate for Payer: Sagamore Health Network All Products |
$76.27
|
| Rate for Payer: Signature Care EPO |
$82.00
|
| Rate for Payer: Signature Care PPO |
$86.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.97
|
| Rate for Payer: United Healthcare Commercial |
$77.85
|
| Rate for Payer: United Healthcare Medicare |
$32.60
|
|
|
HC SUT VICRYL+ 4-0 SH-1 VCP218H
|
Facility
|
IP
|
$12.12
|
|
| Hospital Charge Code |
41608003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$11.27 |
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cigna All Commercial |
$10.46
|
| Rate for Payer: CORVEL All Commercial |
$11.27
|
| Rate for Payer: Coventry All Commercial |
$10.67
|
| Rate for Payer: Encore All Commercial |
$11.16
|
| Rate for Payer: Frontpath All Commercial |
$11.15
|
| Rate for Payer: Humana ChoiceCare |
$10.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.91
|
| Rate for Payer: PHCS All Commercial |
$9.09
|
| Rate for Payer: PHP All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$9.36
|
| Rate for Payer: Signature Care EPO |
$10.06
|
| Rate for Payer: Signature Care PPO |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$9.55
|
|
|
HC SUT VICRYL+ 4-0 SH-1 VCP218H
|
Facility
|
OP
|
$12.12
|
|
| Hospital Charge Code |
41608003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.23
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Centivo All Commercial |
$6.18
|
| Rate for Payer: Cigna All Commercial |
$10.46
|
| Rate for Payer: CORVEL All Commercial |
$11.27
|
| Rate for Payer: Coventry All Commercial |
$10.67
|
| Rate for Payer: Encore All Commercial |
$11.16
|
| Rate for Payer: Frontpath All Commercial |
$11.15
|
| Rate for Payer: Humana ChoiceCare |
$10.47
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Lucent All Commercial |
$6.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.09
|
| Rate for Payer: PHP All Commercial |
$9.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.73
|
| Rate for Payer: Sagamore Health Network All Products |
$9.36
|
| Rate for Payer: Signature Care EPO |
$10.06
|
| Rate for Payer: Signature Care PPO |
$10.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$9.55
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
|
|
HC SUT VICRYL+ 4-0 SH 27" VCP315H
|
Facility
|
OP
|
$11.63
|
|
| Hospital Charge Code |
41608002
|
|
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 |
$7.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.22
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Centivo All Commercial |
$5.93
|
| Rate for Payer: Cigna All Commercial |
$10.04
|
| Rate for Payer: CORVEL All Commercial |
$10.82
|
| Rate for Payer: Coventry All Commercial |
$10.23
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.70
|
| Rate for Payer: Humana ChoiceCare |
$10.04
|
| Rate for Payer: Humana Medicare |
$5.93
|
| Rate for Payer: Lucent All Commercial |
$5.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.72
|
| Rate for Payer: PHP All Commercial |
$8.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.54
|
| Rate for Payer: Sagamore Health Network All Products |
$8.98
|
| Rate for Payer: Signature Care EPO |
$9.65
|
| Rate for Payer: Signature Care PPO |
$10.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.89
|
| Rate for Payer: United Healthcare Commercial |
$9.16
|
| Rate for Payer: United Healthcare Medicare |
$3.84
|
|
|
HC SUT VICRYL+ 4-0 SH 27" VCP315H
|
Facility
|
IP
|
$11.63
|
|
| Hospital Charge Code |
41608002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$10.82 |
| Rate for Payer: Aetna Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Cigna All Commercial |
$10.04
|
| Rate for Payer: CORVEL All Commercial |
$10.82
|
| Rate for Payer: Coventry All Commercial |
$10.23
|
| Rate for Payer: Encore All Commercial |
$10.71
|
| Rate for Payer: Frontpath All Commercial |
$10.70
|
| Rate for Payer: Humana ChoiceCare |
$10.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.47
|
| Rate for Payer: PHCS All Commercial |
$8.72
|
| Rate for Payer: PHP All Commercial |
$8.82
|
| Rate for Payer: Sagamore Health Network All Products |
$8.98
|
| Rate for Payer: Signature Care EPO |
$9.65
|
| Rate for Payer: Signature Care PPO |
$10.23
|
| Rate for Payer: United Healthcare Commercial |
$9.16
|
|
|
HC SUT VICRYL+ 5-0 P-3 VCP493G
|
Facility
|
OP
|
$34.81
|
|
| Hospital Charge Code |
41608004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.64
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Centivo All Commercial |
$17.75
|
| Rate for Payer: Cigna All Commercial |
$30.04
|
| Rate for Payer: CORVEL All Commercial |
$32.37
|
| Rate for Payer: Coventry All Commercial |
$30.63
|
| Rate for Payer: Encore All Commercial |
$32.04
|
| Rate for Payer: Frontpath All Commercial |
$32.03
|
| Rate for Payer: Humana ChoiceCare |
$30.07
|
| Rate for Payer: Humana Medicare |
$17.75
|
| Rate for Payer: Lucent All Commercial |
$17.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$26.11
|
| Rate for Payer: PHP All Commercial |
$26.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.58
|
| Rate for Payer: Sagamore Health Network All Products |
$26.87
|
| Rate for Payer: Signature Care EPO |
$28.89
|
| Rate for Payer: Signature Care PPO |
$30.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.59
|
| Rate for Payer: United Healthcare Commercial |
$27.43
|
| Rate for Payer: United Healthcare Medicare |
$11.49
|
|
|
HC SUT VICRYL+ 5-0 P-3 VCP493G
|
Facility
|
IP
|
$34.81
|
|
| Hospital Charge Code |
41608004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.11 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cigna All Commercial |
$30.04
|
| Rate for Payer: CORVEL All Commercial |
$32.37
|
| Rate for Payer: Coventry All Commercial |
$30.63
|
| Rate for Payer: Encore All Commercial |
$32.04
|
| Rate for Payer: Frontpath All Commercial |
$32.03
|
| Rate for Payer: Humana ChoiceCare |
$30.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.33
|
| Rate for Payer: PHCS All Commercial |
$26.11
|
| Rate for Payer: PHP All Commercial |
$26.40
|
| Rate for Payer: Sagamore Health Network All Products |
$26.87
|
| Rate for Payer: Signature Care EPO |
$28.89
|
| Rate for Payer: Signature Care PPO |
$30.63
|
| Rate for Payer: United Healthcare Commercial |
$27.43
|
|
|
HC SYNOVASURE AD LF TEST
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
41607696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,601.25 |
| Max. Negotiated Rate |
$1,985.55 |
| Rate for Payer: Aetna Commercial |
$1,844.64
|
| Rate for Payer: Cash Price |
$1,323.70
|
| Rate for Payer: Cigna All Commercial |
$1,842.50
|
| Rate for Payer: CORVEL All Commercial |
$1,985.55
|
| Rate for Payer: Coventry All Commercial |
$1,878.80
|
| Rate for Payer: Encore All Commercial |
$1,965.27
|
| Rate for Payer: Frontpath All Commercial |
$1,964.20
|
| Rate for Payer: Humana ChoiceCare |
$1,844.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,921.50
|
| Rate for Payer: PHCS All Commercial |
$1,601.25
|
| Rate for Payer: PHP All Commercial |
$1,619.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1,648.22
|
| Rate for Payer: Signature Care EPO |
$1,772.05
|
| Rate for Payer: Signature Care PPO |
$1,878.80
|
| Rate for Payer: United Healthcare Commercial |
$1,682.38
|
|
|
HC SYNOVASURE AD LF TEST
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
41607696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,985.55 |
| Rate for Payer: Aetna Commercial |
$1,801.94
|
| Rate for Payer: Aetna Medicare |
$704.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$704.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,226.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,334.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$810.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$775.00
|
| Rate for Payer: Cash Price |
$1,323.70
|
| Rate for Payer: Cash Price |
$1,323.70
|
| Rate for Payer: Centivo All Commercial |
$1,088.85
|
| Rate for Payer: Cigna All Commercial |
$1,842.50
|
| Rate for Payer: CORVEL All Commercial |
$1,985.55
|
| Rate for Payer: Coventry All Commercial |
$1,878.80
|
| Rate for Payer: Encore All Commercial |
$1,965.27
|
| Rate for Payer: Frontpath All Commercial |
$1,964.20
|
| Rate for Payer: Humana ChoiceCare |
$1,844.00
|
| Rate for Payer: Humana Medicare |
$1,088.85
|
| Rate for Payer: Lucent All Commercial |
$1,088.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,921.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,601.25
|
| Rate for Payer: PHP All Commercial |
$1,619.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$832.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,648.22
|
| Rate for Payer: Signature Care EPO |
$1,772.05
|
| Rate for Payer: Signature Care PPO |
$1,878.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,814.75
|
| Rate for Payer: United Healthcare Commercial |
$1,682.38
|
| Rate for Payer: United Healthcare Medicare |
$704.55
|
|
|
HC SYNTHETIC CANNABINOID - K2 SPICE CHARGE
|
Facility
|
IP
|
$77.34
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$71.92 |
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cigna All Commercial |
$66.74
|
| Rate for Payer: CORVEL All Commercial |
$71.92
|
| Rate for Payer: Coventry All Commercial |
$68.06
|
| Rate for Payer: Encore All Commercial |
$71.19
|
| Rate for Payer: Frontpath All Commercial |
$71.15
|
| Rate for Payer: Humana ChoiceCare |
$66.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.60
|
| Rate for Payer: PHCS All Commercial |
$58.00
|
| Rate for Payer: PHP All Commercial |
$58.65
|
| Rate for Payer: Sagamore Health Network All Products |
$59.70
|
| Rate for Payer: Signature Care EPO |
$64.19
|
| Rate for Payer: Signature Care PPO |
$68.06
|
| Rate for Payer: United Healthcare Commercial |
$60.94
|
|
|
HC SYNTHETIC CANNABINOID - K2 SPICE CHARGE
|
Facility
|
OP
|
$77.34
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
63001400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$71.92 |
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.07
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Centivo All Commercial |
$39.44
|
| Rate for Payer: Cigna All Commercial |
$66.74
|
| Rate for Payer: CORVEL All Commercial |
$71.92
|
| Rate for Payer: Coventry All Commercial |
$68.06
|
| Rate for Payer: Encore All Commercial |
$71.19
|
| Rate for Payer: Frontpath All Commercial |
$71.15
|
| Rate for Payer: Humana ChoiceCare |
$66.80
|
| Rate for Payer: Humana Medicare |
$39.44
|
| Rate for Payer: Lucent All Commercial |
$39.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.60
|
| Rate for Payer: Managed Health Services Medicaid |
$62.14
|
| Rate for Payer: MDWise Medicaid |
$62.14
|
| Rate for Payer: PHCS All Commercial |
$58.00
|
| Rate for Payer: PHP All Commercial |
$58.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.16
|
| Rate for Payer: Sagamore Health Network All Products |
$59.70
|
| Rate for Payer: Signature Care EPO |
$64.19
|
| Rate for Payer: Signature Care PPO |
$68.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.74
|
| Rate for Payer: United Healthcare Commercial |
$60.94
|
| Rate for Payer: United Healthcare Medicare |
$25.52
|
|
|
HC SYNTHETIC CANNABINOID - K2 SPICE W/CONF
|
Facility
|
OP
|
$128.52
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001417
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: Aetna Medicare |
$42.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$77.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.65
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Centivo All Commercial |
$65.55
|
| Rate for Payer: Cigna All Commercial |
$110.91
|
| Rate for Payer: CORVEL All Commercial |
$119.52
|
| Rate for Payer: Coventry All Commercial |
$113.10
|
| Rate for Payer: Encore All Commercial |
$118.30
|
| Rate for Payer: Frontpath All Commercial |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$111.00
|
| Rate for Payer: Humana Medicare |
$65.55
|
| Rate for Payer: Lucent All Commercial |
$65.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.67
|
| Rate for Payer: Managed Health Services Medicaid |
$77.12
|
| Rate for Payer: MDWise Medicaid |
$77.12
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$97.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.12
|
| Rate for Payer: Sagamore Health Network All Products |
$99.22
|
| Rate for Payer: Signature Care EPO |
$106.67
|
| Rate for Payer: Signature Care PPO |
$113.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.24
|
| Rate for Payer: United Healthcare Commercial |
$101.27
|
| Rate for Payer: United Healthcare Medicare |
$42.41
|
|
|
HC SYNTHETIC CANNABINOID - K2 SPICE W/CONF
|
Facility
|
IP
|
$128.52
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
63001417
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$119.52 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cigna All Commercial |
$110.91
|
| Rate for Payer: CORVEL All Commercial |
$119.52
|
| Rate for Payer: Coventry All Commercial |
$113.10
|
| Rate for Payer: Encore All Commercial |
$118.30
|
| Rate for Payer: Frontpath All Commercial |
$118.24
|
| Rate for Payer: Humana ChoiceCare |
$111.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.67
|
| Rate for Payer: PHCS All Commercial |
$96.39
|
| Rate for Payer: PHP All Commercial |
$97.47
|
| Rate for Payer: Sagamore Health Network All Products |
$99.22
|
| Rate for Payer: Signature Care EPO |
$106.67
|
| Rate for Payer: Signature Care PPO |
$113.10
|
| Rate for Payer: United Healthcare Commercial |
$101.27
|
|
|
HC SYSTEM FIXATION PERMANENT CAPSURE
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
41602188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
|
|
HC SYSTEM FIXATION PERMANENT CAPSURE
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
41602188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna Commercial |
$1,181.60
|
| Rate for Payer: Aetna Medicare |
$462.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$462.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$804.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$875.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$531.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$508.20
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Centivo All Commercial |
$714.00
|
| Rate for Payer: Cigna All Commercial |
$1,208.20
|
| Rate for Payer: CORVEL All Commercial |
$1,302.00
|
| Rate for Payer: Coventry All Commercial |
$1,232.00
|
| Rate for Payer: Encore All Commercial |
$1,288.70
|
| Rate for Payer: Frontpath All Commercial |
$1,288.00
|
| Rate for Payer: Humana ChoiceCare |
$1,209.18
|
| Rate for Payer: Humana Medicare |
$714.00
|
| Rate for Payer: Lucent All Commercial |
$714.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,260.00
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$1,050.00
|
| Rate for Payer: PHP All Commercial |
$1,061.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$546.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,080.80
|
| Rate for Payer: Signature Care EPO |
$1,162.00
|
| Rate for Payer: Signature Care PPO |
$1,232.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,190.00
|
| Rate for Payer: United Healthcare Commercial |
$1,103.20
|
| Rate for Payer: United Healthcare Medicare |
$462.00
|
|
|
HC SYSTEM LYNX SUPRAPUBIC SLING
|
Facility
|
OP
|
$4,500.00
|
|
| Hospital Charge Code |
41602408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,185.00 |
| Rate for Payer: Aetna Commercial |
$3,798.00
|
| Rate for Payer: Aetna Medicare |
$1,485.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,485.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,584.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,812.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,707.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,633.50
|
| Rate for Payer: Cash Price |
$2,790.00
|
| Rate for Payer: Cash Price |
$2,790.00
|
| Rate for Payer: Centivo All Commercial |
$2,295.00
|
| Rate for Payer: Cigna All Commercial |
$3,883.50
|
| Rate for Payer: CORVEL All Commercial |
$4,185.00
|
| Rate for Payer: Coventry All Commercial |
$3,960.00
|
| Rate for Payer: Encore All Commercial |
$4,142.25
|
| Rate for Payer: Frontpath All Commercial |
$4,140.00
|
| Rate for Payer: Humana ChoiceCare |
$3,886.65
|
| Rate for Payer: Humana Medicare |
$2,295.00
|
| Rate for Payer: Lucent All Commercial |
$2,295.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,050.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,375.00
|
| Rate for Payer: PHP All Commercial |
$3,412.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,755.00
|
| Rate for Payer: Sagamore Health Network All Products |
$3,474.00
|
| Rate for Payer: Signature Care EPO |
$3,735.00
|
| Rate for Payer: Signature Care PPO |
$3,960.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,825.00
|
| Rate for Payer: United Healthcare Commercial |
$3,546.00
|
| Rate for Payer: United Healthcare Medicare |
$1,485.00
|
|
|
HC SYSTEM LYNX SUPRAPUBIC SLING
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
41602408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,375.00 |
| Max. Negotiated Rate |
$4,185.00 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Cash Price |
$2,790.00
|
| Rate for Payer: Cigna All Commercial |
$3,883.50
|
| Rate for Payer: CORVEL All Commercial |
$4,185.00
|
| Rate for Payer: Coventry All Commercial |
$3,960.00
|
| Rate for Payer: Encore All Commercial |
$4,142.25
|
| Rate for Payer: Frontpath All Commercial |
$4,140.00
|
| Rate for Payer: Humana ChoiceCare |
$3,886.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,050.00
|
| Rate for Payer: PHCS All Commercial |
$3,375.00
|
| Rate for Payer: PHP All Commercial |
$3,412.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3,474.00
|
| Rate for Payer: Signature Care EPO |
$3,735.00
|
| Rate for Payer: Signature Care PPO |
$3,960.00
|
| Rate for Payer: United Healthcare Commercial |
$3,546.00
|
|
