|
HC SUT MCRYL+ 2-0 SH 27" MCP417H
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
41607965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$12.09 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna All Commercial |
$11.22
|
| Rate for Payer: CORVEL All Commercial |
$12.09
|
| Rate for Payer: Coventry All Commercial |
$11.44
|
| Rate for Payer: Encore All Commercial |
$11.97
|
| Rate for Payer: Frontpath All Commercial |
$11.96
|
| Rate for Payer: Humana ChoiceCare |
$11.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.70
|
| Rate for Payer: PHCS All Commercial |
$9.75
|
| Rate for Payer: PHP All Commercial |
$9.86
|
| Rate for Payer: Sagamore Health Network All Products |
$10.04
|
| Rate for Payer: Signature Care EPO |
$10.79
|
| Rate for Payer: Signature Care PPO |
$11.44
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
|
|
HC SUT MCRYL+ 3-0 PS-2 MCP427H
|
Facility
|
OP
|
$35.33
|
|
| Hospital Charge Code |
41607967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$29.82
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.44
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Centivo All Commercial |
$19.22
|
| Rate for Payer: Cigna All Commercial |
$30.49
|
| Rate for Payer: CORVEL All Commercial |
$32.86
|
| Rate for Payer: Coventry All Commercial |
$31.09
|
| Rate for Payer: Encore All Commercial |
$32.52
|
| Rate for Payer: Frontpath All Commercial |
$32.50
|
| Rate for Payer: Humana ChoiceCare |
$30.51
|
| Rate for Payer: Humana Medicare |
$11.31
|
| Rate for Payer: Lucent All Commercial |
$19.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.50
|
| Rate for Payer: PHP All Commercial |
$26.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.78
|
| Rate for Payer: Sagamore Health Network All Products |
$27.27
|
| Rate for Payer: Signature Care EPO |
$29.32
|
| Rate for Payer: Signature Care PPO |
$31.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.03
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
| Rate for Payer: United Healthcare Medicare |
$11.31
|
|
|
HC SUT MCRYL+ 3-0 PS-2 MCP427H
|
Facility
|
IP
|
$35.33
|
|
| Hospital Charge Code |
41607967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$32.86 |
| Rate for Payer: Aetna Commercial |
$30.53
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: Cigna All Commercial |
$30.49
|
| Rate for Payer: CORVEL All Commercial |
$32.86
|
| Rate for Payer: Coventry All Commercial |
$31.09
|
| Rate for Payer: Encore All Commercial |
$32.52
|
| Rate for Payer: Frontpath All Commercial |
$32.50
|
| Rate for Payer: Humana ChoiceCare |
$30.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.80
|
| Rate for Payer: PHCS All Commercial |
$26.50
|
| Rate for Payer: PHP All Commercial |
$26.79
|
| Rate for Payer: Sagamore Health Network All Products |
$27.27
|
| Rate for Payer: Signature Care EPO |
$29.32
|
| Rate for Payer: Signature Care PPO |
$31.09
|
| Rate for Payer: United Healthcare Commercial |
$27.84
|
|
|
HC SUT MCRYL+ 4-0 PS-2 MCP496G
|
Facility
|
IP
|
$34.75
|
|
| Hospital Charge Code |
41607969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$20.85
|
| Rate for Payer: Cigna All Commercial |
$29.99
|
| Rate for Payer: CORVEL All Commercial |
$32.32
|
| Rate for Payer: Coventry All Commercial |
$30.58
|
| Rate for Payer: Encore All Commercial |
$31.99
|
| Rate for Payer: Frontpath All Commercial |
$31.97
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.27
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.35
|
| Rate for Payer: Sagamore Health Network All Products |
$26.83
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.58
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
|
|
HC SUT MCRYL+ 4-0 PS-2 MCP496G
|
Facility
|
OP
|
$34.75
|
|
| Hospital Charge Code |
41607969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$32.32 |
| Rate for Payer: Aetna Commercial |
$29.33
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.23
|
| Rate for Payer: Cash Price |
$20.85
|
| Rate for Payer: Cash Price |
$20.85
|
| Rate for Payer: Centivo All Commercial |
$18.90
|
| Rate for Payer: Cigna All Commercial |
$29.99
|
| Rate for Payer: CORVEL All Commercial |
$32.32
|
| Rate for Payer: Coventry All Commercial |
$30.58
|
| Rate for Payer: Encore All Commercial |
$31.99
|
| Rate for Payer: Frontpath All Commercial |
$31.97
|
| Rate for Payer: Humana ChoiceCare |
$30.01
|
| Rate for Payer: Humana Medicare |
$11.12
|
| Rate for Payer: Lucent All Commercial |
$18.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.27
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.06
|
| Rate for Payer: PHP All Commercial |
$26.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.55
|
| Rate for Payer: Sagamore Health Network All Products |
$26.83
|
| Rate for Payer: Signature Care EPO |
$28.84
|
| Rate for Payer: Signature Care PPO |
$30.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.54
|
| Rate for Payer: United Healthcare Commercial |
$27.38
|
| Rate for Payer: United Healthcare Medicare |
$11.12
|
|
|
HC SUT PDS+ 0 CT-1 27" PDP340H
|
Facility
|
OP
|
$9.80
|
|
| Hospital Charge Code |
41607971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: Aetna Medicare |
$3.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.45
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Centivo All Commercial |
$5.33
|
| Rate for Payer: Cigna All Commercial |
$8.46
|
| Rate for Payer: CORVEL All Commercial |
$9.11
|
| Rate for Payer: Coventry All Commercial |
$8.62
|
| Rate for Payer: Encore All Commercial |
$9.02
|
| Rate for Payer: Frontpath All Commercial |
$9.02
|
| Rate for Payer: Humana ChoiceCare |
$8.46
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Lucent All Commercial |
$5.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.35
|
| Rate for Payer: PHP All Commercial |
$7.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.82
|
| Rate for Payer: Sagamore Health Network All Products |
$7.57
|
| Rate for Payer: Signature Care EPO |
$8.13
|
| Rate for Payer: Signature Care PPO |
$8.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.33
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
|
|
HC SUT PDS+ 0 CT-1 27" PDP340H
|
Facility
|
IP
|
$9.80
|
|
| Hospital Charge Code |
41607971
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$5.88
|
| Rate for Payer: Cigna All Commercial |
$8.46
|
| Rate for Payer: CORVEL All Commercial |
$9.11
|
| Rate for Payer: Coventry All Commercial |
$8.62
|
| Rate for Payer: Encore All Commercial |
$9.02
|
| Rate for Payer: Frontpath All Commercial |
$9.02
|
| Rate for Payer: Humana ChoiceCare |
$8.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.82
|
| Rate for Payer: PHCS All Commercial |
$7.35
|
| Rate for Payer: PHP All Commercial |
$7.43
|
| Rate for Payer: Sagamore Health Network All Products |
$7.57
|
| Rate for Payer: Signature Care EPO |
$8.13
|
| Rate for Payer: Signature Care PPO |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
|
|
HC SUT PDS+ 1 CT-1 27" PDP341H
|
Facility
|
IP
|
$15.91
|
|
| Hospital Charge Code |
41607975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.75
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Cigna All Commercial |
$13.73
|
| Rate for Payer: CORVEL All Commercial |
$14.80
|
| Rate for Payer: Coventry All Commercial |
$14.00
|
| Rate for Payer: Encore All Commercial |
$14.65
|
| Rate for Payer: Frontpath All Commercial |
$14.64
|
| Rate for Payer: Humana ChoiceCare |
$13.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.32
|
| Rate for Payer: PHCS All Commercial |
$11.93
|
| Rate for Payer: PHP All Commercial |
$12.07
|
| Rate for Payer: Sagamore Health Network All Products |
$12.28
|
| Rate for Payer: Signature Care EPO |
$13.21
|
| Rate for Payer: Signature Care PPO |
$14.00
|
| Rate for Payer: United Healthcare Commercial |
$12.54
|
|
|
HC SUT PDS+ 1 CT-1 27" PDP341H
|
Facility
|
OP
|
$15.91
|
|
| Hospital Charge Code |
41607975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Centivo All Commercial |
$8.66
|
| Rate for Payer: Cigna All Commercial |
$13.73
|
| Rate for Payer: CORVEL All Commercial |
$14.80
|
| Rate for Payer: Coventry All Commercial |
$14.00
|
| Rate for Payer: Encore All Commercial |
$14.65
|
| Rate for Payer: Frontpath All Commercial |
$14.64
|
| Rate for Payer: Humana ChoiceCare |
$13.74
|
| Rate for Payer: Humana Medicare |
$5.09
|
| Rate for Payer: Lucent All Commercial |
$8.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.32
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.93
|
| Rate for Payer: PHP All Commercial |
$12.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.20
|
| Rate for Payer: Sagamore Health Network All Products |
$12.28
|
| Rate for Payer: Signature Care EPO |
$13.21
|
| Rate for Payer: Signature Care PPO |
$14.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.52
|
| Rate for Payer: United Healthcare Commercial |
$12.54
|
| Rate for Payer: United Healthcare Medicare |
$5.09
|
|
|
HC SUT PDS+ 1 TP-1 96" PDP880G
|
Facility
|
OP
|
$30.86
|
|
| Hospital Charge Code |
41607977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$26.05
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.86
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Centivo All Commercial |
$16.79
|
| Rate for Payer: Cigna All Commercial |
$26.63
|
| Rate for Payer: CORVEL All Commercial |
$28.70
|
| Rate for Payer: Coventry All Commercial |
$27.16
|
| Rate for Payer: Encore All Commercial |
$28.41
|
| Rate for Payer: Frontpath All Commercial |
$28.39
|
| Rate for Payer: Humana ChoiceCare |
$26.65
|
| Rate for Payer: Humana Medicare |
$9.88
|
| Rate for Payer: Lucent All Commercial |
$16.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.77
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$23.14
|
| Rate for Payer: PHP All Commercial |
$23.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.04
|
| Rate for Payer: Sagamore Health Network All Products |
$23.82
|
| Rate for Payer: Signature Care EPO |
$25.61
|
| Rate for Payer: Signature Care PPO |
$27.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.23
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
| Rate for Payer: United Healthcare Medicare |
$9.88
|
|
|
HC SUT PDS+ 1 TP-1 96" PDP880G
|
Facility
|
IP
|
$30.86
|
|
| Hospital Charge Code |
41607977
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$26.66
|
| Rate for Payer: Cash Price |
$18.52
|
| Rate for Payer: Cigna All Commercial |
$26.63
|
| Rate for Payer: CORVEL All Commercial |
$28.70
|
| Rate for Payer: Coventry All Commercial |
$27.16
|
| Rate for Payer: Encore All Commercial |
$28.41
|
| Rate for Payer: Frontpath All Commercial |
$28.39
|
| Rate for Payer: Humana ChoiceCare |
$26.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.77
|
| Rate for Payer: PHCS All Commercial |
$23.14
|
| Rate for Payer: PHP All Commercial |
$23.40
|
| Rate for Payer: Sagamore Health Network All Products |
$23.82
|
| Rate for Payer: Signature Care EPO |
$25.61
|
| Rate for Payer: Signature Care PPO |
$27.16
|
| Rate for Payer: United Healthcare Commercial |
$24.32
|
|
|
HC SUT PDS+ 2-0 SH 27" PDP317H
|
Facility
|
IP
|
$9.92
|
|
| Hospital Charge Code |
41607978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cigna All Commercial |
$8.56
|
| Rate for Payer: CORVEL All Commercial |
$9.23
|
| Rate for Payer: Coventry All Commercial |
$8.73
|
| Rate for Payer: Encore All Commercial |
$9.13
|
| Rate for Payer: Frontpath All Commercial |
$9.13
|
| Rate for Payer: Humana ChoiceCare |
$8.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.93
|
| Rate for Payer: PHCS All Commercial |
$7.44
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Sagamore Health Network All Products |
$7.66
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.73
|
| Rate for Payer: United Healthcare Commercial |
$7.82
|
|
|
HC SUT PDS+ 2-0 SH 27" PDP317H
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
41607978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.49
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Centivo All Commercial |
$5.40
|
| Rate for Payer: Cigna All Commercial |
$8.56
|
| Rate for Payer: CORVEL All Commercial |
$9.23
|
| Rate for Payer: Coventry All Commercial |
$8.73
|
| Rate for Payer: Encore All Commercial |
$9.13
|
| Rate for Payer: Frontpath All Commercial |
$9.13
|
| Rate for Payer: Humana ChoiceCare |
$8.57
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Lucent All Commercial |
$5.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.93
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.44
|
| Rate for Payer: PHP All Commercial |
$7.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.87
|
| Rate for Payer: Sagamore Health Network All Products |
$7.66
|
| Rate for Payer: Signature Care EPO |
$8.23
|
| Rate for Payer: Signature Care PPO |
$8.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.43
|
| Rate for Payer: United Healthcare Commercial |
$7.82
|
| Rate for Payer: United Healthcare Medicare |
$3.17
|
|
|
HC SUTURE 2-0 FIBERWIRE
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41601617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC SUTURE 2-0 FIBERWIRE
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41601617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Centivo All Commercial |
$92.15
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent All Commercial |
$92.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
|
|
HC SUTURE #2 FIBERWIRE
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41601616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC SUTURE #2 FIBERWIRE
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41601616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Centivo All Commercial |
$92.15
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent All Commercial |
$92.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
|
|
HC SUTURE BONE WAX W31G
|
Facility
|
IP
|
$35.62
|
|
| Hospital Charge Code |
41601475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.71 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cigna All Commercial |
$30.74
|
| Rate for Payer: CORVEL All Commercial |
$33.13
|
| Rate for Payer: Coventry All Commercial |
$31.35
|
| Rate for Payer: Encore All Commercial |
$32.79
|
| Rate for Payer: Frontpath All Commercial |
$32.77
|
| Rate for Payer: Humana ChoiceCare |
$30.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.06
|
| Rate for Payer: PHCS All Commercial |
$26.71
|
| Rate for Payer: PHP All Commercial |
$27.01
|
| Rate for Payer: Sagamore Health Network All Products |
$27.50
|
| Rate for Payer: Signature Care EPO |
$29.56
|
| Rate for Payer: Signature Care PPO |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$28.07
|
|
|
HC SUTURE BONE WAX W31G
|
Facility
|
OP
|
$35.62
|
|
| Hospital Charge Code |
41601475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.54
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Centivo All Commercial |
$19.38
|
| Rate for Payer: Cigna All Commercial |
$30.74
|
| Rate for Payer: CORVEL All Commercial |
$33.13
|
| Rate for Payer: Coventry All Commercial |
$31.35
|
| Rate for Payer: Encore All Commercial |
$32.79
|
| Rate for Payer: Frontpath All Commercial |
$32.77
|
| Rate for Payer: Humana ChoiceCare |
$30.76
|
| Rate for Payer: Humana Medicare |
$11.40
|
| Rate for Payer: Lucent All Commercial |
$19.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.06
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.71
|
| Rate for Payer: PHP All Commercial |
$27.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.89
|
| Rate for Payer: Sagamore Health Network All Products |
$27.50
|
| Rate for Payer: Signature Care EPO |
$29.56
|
| Rate for Payer: Signature Care PPO |
$31.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.28
|
| Rate for Payer: United Healthcare Commercial |
$28.07
|
| Rate for Payer: United Healthcare Medicare |
$11.40
|
|
|
HC SUTURE CHROMIC 3-0 G122H
|
Facility
|
IP
|
$19.46
|
|
| Hospital Charge Code |
41601493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$18.10 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Cigna All Commercial |
$16.79
|
| Rate for Payer: CORVEL All Commercial |
$18.10
|
| Rate for Payer: Coventry All Commercial |
$17.12
|
| Rate for Payer: Encore All Commercial |
$17.91
|
| Rate for Payer: Frontpath All Commercial |
$17.90
|
| Rate for Payer: Humana ChoiceCare |
$16.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$14.60
|
| Rate for Payer: PHP All Commercial |
$14.76
|
| Rate for Payer: Sagamore Health Network All Products |
$15.02
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
|
|
HC SUTURE CHROMIC 3-0 G122H
|
Facility
|
OP
|
$19.46
|
|
| Hospital Charge Code |
41601493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.85
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Cash Price |
$11.68
|
| Rate for Payer: Centivo All Commercial |
$10.59
|
| Rate for Payer: Cigna All Commercial |
$16.79
|
| Rate for Payer: CORVEL All Commercial |
$18.10
|
| Rate for Payer: Coventry All Commercial |
$17.12
|
| Rate for Payer: Encore All Commercial |
$17.91
|
| Rate for Payer: Frontpath All Commercial |
$17.90
|
| Rate for Payer: Humana ChoiceCare |
$16.81
|
| Rate for Payer: Humana Medicare |
$6.23
|
| Rate for Payer: Lucent All Commercial |
$10.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.51
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$14.60
|
| Rate for Payer: PHP All Commercial |
$14.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.59
|
| Rate for Payer: Sagamore Health Network All Products |
$15.02
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$17.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.54
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare |
$6.23
|
|
|
HC SUTURE CHROMIC 4-0 18 IN
|
Facility
|
IP
|
$70.09
|
|
| Hospital Charge Code |
41602422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cigna All Commercial |
$60.49
|
| Rate for Payer: CORVEL All Commercial |
$65.18
|
| Rate for Payer: Coventry All Commercial |
$61.68
|
| Rate for Payer: Encore All Commercial |
$64.52
|
| Rate for Payer: Frontpath All Commercial |
$64.48
|
| Rate for Payer: Humana ChoiceCare |
$60.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.08
|
| Rate for Payer: PHCS All Commercial |
$52.57
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Sagamore Health Network All Products |
$54.11
|
| Rate for Payer: Signature Care EPO |
$58.17
|
| Rate for Payer: Signature Care PPO |
$61.68
|
| Rate for Payer: United Healthcare Commercial |
$55.23
|
|
|
HC SUTURE CHROMIC 4-0 18 IN
|
Facility
|
OP
|
$70.09
|
|
| Hospital Charge Code |
41602422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$59.16
|
| Rate for Payer: Aetna Medicare |
$22.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$40.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.67
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Centivo All Commercial |
$38.13
|
| Rate for Payer: Cigna All Commercial |
$60.49
|
| Rate for Payer: CORVEL All Commercial |
$65.18
|
| Rate for Payer: Coventry All Commercial |
$61.68
|
| Rate for Payer: Encore All Commercial |
$64.52
|
| Rate for Payer: Frontpath All Commercial |
$64.48
|
| Rate for Payer: Humana ChoiceCare |
$60.54
|
| Rate for Payer: Humana Medicare |
$22.43
|
| Rate for Payer: Lucent All Commercial |
$38.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$52.57
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.34
|
| Rate for Payer: Sagamore Health Network All Products |
$54.11
|
| Rate for Payer: Signature Care EPO |
$58.17
|
| Rate for Payer: Signature Care PPO |
$61.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.58
|
| Rate for Payer: United Healthcare Commercial |
$55.23
|
| Rate for Payer: United Healthcare Medicare |
$22.43
|
|
|
HC SUTURE CHROMIC 4-0 G121H
|
Facility
|
IP
|
$16.52
|
|
| Hospital Charge Code |
41601494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cigna All Commercial |
$14.26
|
| Rate for Payer: CORVEL All Commercial |
$15.36
|
| Rate for Payer: Coventry All Commercial |
$14.54
|
| Rate for Payer: Encore All Commercial |
$15.21
|
| Rate for Payer: Frontpath All Commercial |
$15.20
|
| Rate for Payer: Humana ChoiceCare |
$14.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.87
|
| Rate for Payer: PHCS All Commercial |
$12.39
|
| Rate for Payer: PHP All Commercial |
$12.53
|
| Rate for Payer: Sagamore Health Network All Products |
$12.75
|
| Rate for Payer: Signature Care EPO |
$13.71
|
| Rate for Payer: Signature Care PPO |
$14.54
|
| Rate for Payer: United Healthcare Commercial |
$13.02
|
|
|
HC SUTURE CHROMIC 4-0 G121H
|
Facility
|
OP
|
$16.52
|
|
| Hospital Charge Code |
41601494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.94
|
| Rate for Payer: Aetna Medicare |
$5.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Centivo All Commercial |
$8.99
|
| Rate for Payer: Cigna All Commercial |
$14.26
|
| Rate for Payer: CORVEL All Commercial |
$15.36
|
| Rate for Payer: Coventry All Commercial |
$14.54
|
| Rate for Payer: Encore All Commercial |
$15.21
|
| Rate for Payer: Frontpath All Commercial |
$15.20
|
| Rate for Payer: Humana ChoiceCare |
$14.27
|
| Rate for Payer: Humana Medicare |
$5.29
|
| Rate for Payer: Lucent All Commercial |
$8.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.87
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.39
|
| Rate for Payer: PHP All Commercial |
$12.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.44
|
| Rate for Payer: Sagamore Health Network All Products |
$12.75
|
| Rate for Payer: Signature Care EPO |
$13.71
|
| Rate for Payer: Signature Care PPO |
$14.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.04
|
| Rate for Payer: United Healthcare Commercial |
$13.02
|
| Rate for Payer: United Healthcare Medicare |
$5.29
|
|
