|
HC SUTURE CHROMIC GUT 2-0 923H
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
41601498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cigna All Commercial |
$14.79
|
| Rate for Payer: CORVEL All Commercial |
$15.94
|
| Rate for Payer: Coventry All Commercial |
$15.08
|
| Rate for Payer: Encore All Commercial |
$15.78
|
| Rate for Payer: Frontpath All Commercial |
$15.77
|
| Rate for Payer: Humana ChoiceCare |
$14.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.43
|
| Rate for Payer: PHCS All Commercial |
$12.86
|
| Rate for Payer: PHP All Commercial |
$13.00
|
| Rate for Payer: Sagamore Health Network All Products |
$13.23
|
| Rate for Payer: Signature Care EPO |
$14.23
|
| Rate for Payer: Signature Care PPO |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
|
|
HC SUTURE CHROMIC GUT 2-0 923H
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
41601498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.47
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.03
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Cash Price |
$10.28
|
| Rate for Payer: Centivo All Commercial |
$9.32
|
| Rate for Payer: Cigna All Commercial |
$14.79
|
| Rate for Payer: CORVEL All Commercial |
$15.94
|
| Rate for Payer: Coventry All Commercial |
$15.08
|
| Rate for Payer: Encore All Commercial |
$15.78
|
| Rate for Payer: Frontpath All Commercial |
$15.77
|
| Rate for Payer: Humana ChoiceCare |
$14.80
|
| Rate for Payer: Humana Medicare |
$5.48
|
| Rate for Payer: Lucent All Commercial |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.43
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.86
|
| Rate for Payer: PHP All Commercial |
$13.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.68
|
| Rate for Payer: Sagamore Health Network All Products |
$13.23
|
| Rate for Payer: Signature Care EPO |
$14.23
|
| Rate for Payer: Signature Care PPO |
$15.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
| Rate for Payer: United Healthcare Medicare |
$5.48
|
|
|
HC SUTURE CHROMIC GUT 3-0 922H
|
Facility
|
OP
|
$20.91
|
|
| Hospital Charge Code |
41601460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Medicare |
$6.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.36
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Centivo All Commercial |
$11.38
|
| Rate for Payer: Cigna All Commercial |
$18.05
|
| Rate for Payer: CORVEL All Commercial |
$19.45
|
| Rate for Payer: Coventry All Commercial |
$18.40
|
| Rate for Payer: Encore All Commercial |
$19.25
|
| Rate for Payer: Frontpath All Commercial |
$19.24
|
| Rate for Payer: Humana ChoiceCare |
$18.06
|
| Rate for Payer: Humana Medicare |
$6.69
|
| Rate for Payer: Lucent All Commercial |
$11.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.68
|
| Rate for Payer: PHP All Commercial |
$15.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.15
|
| Rate for Payer: Sagamore Health Network All Products |
$16.14
|
| Rate for Payer: Signature Care EPO |
$17.36
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.77
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare |
$6.69
|
|
|
HC SUTURE CHROMIC GUT 3-0 922H
|
Facility
|
IP
|
$20.91
|
|
| Hospital Charge Code |
41601460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.07
|
| Rate for Payer: Cash Price |
$12.55
|
| Rate for Payer: Cigna All Commercial |
$18.05
|
| Rate for Payer: CORVEL All Commercial |
$19.45
|
| Rate for Payer: Coventry All Commercial |
$18.40
|
| Rate for Payer: Encore All Commercial |
$19.25
|
| Rate for Payer: Frontpath All Commercial |
$19.24
|
| Rate for Payer: Humana ChoiceCare |
$18.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.82
|
| Rate for Payer: PHCS All Commercial |
$15.68
|
| Rate for Payer: PHP All Commercial |
$15.86
|
| Rate for Payer: Sagamore Health Network All Products |
$16.14
|
| Rate for Payer: Signature Care EPO |
$17.36
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
|
|
HC SUTURE CHROMIC GUT 4-0 U203H
|
Facility
|
IP
|
$14.86
|
|
| Hospital Charge Code |
41601476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cigna All Commercial |
$12.82
|
| Rate for Payer: CORVEL All Commercial |
$13.82
|
| Rate for Payer: Coventry All Commercial |
$13.08
|
| Rate for Payer: Encore All Commercial |
$13.68
|
| Rate for Payer: Frontpath All Commercial |
$13.67
|
| Rate for Payer: Humana ChoiceCare |
$12.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.37
|
| Rate for Payer: PHCS All Commercial |
$11.14
|
| Rate for Payer: PHP All Commercial |
$11.27
|
| Rate for Payer: Sagamore Health Network All Products |
$11.47
|
| Rate for Payer: Signature Care EPO |
$12.33
|
| Rate for Payer: Signature Care PPO |
$13.08
|
| Rate for Payer: United Healthcare Commercial |
$11.71
|
|
|
HC SUTURE CHROMIC GUT 4-0 U203H
|
Facility
|
OP
|
$14.86
|
|
| Hospital Charge Code |
41601476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.23
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Centivo All Commercial |
$8.08
|
| Rate for Payer: Cigna All Commercial |
$12.82
|
| Rate for Payer: CORVEL All Commercial |
$13.82
|
| Rate for Payer: Coventry All Commercial |
$13.08
|
| Rate for Payer: Encore All Commercial |
$13.68
|
| Rate for Payer: Frontpath All Commercial |
$13.67
|
| Rate for Payer: Humana ChoiceCare |
$12.83
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: Lucent All Commercial |
$8.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.14
|
| Rate for Payer: PHP All Commercial |
$11.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.80
|
| Rate for Payer: Sagamore Health Network All Products |
$11.47
|
| Rate for Payer: Signature Care EPO |
$12.33
|
| Rate for Payer: Signature Care PPO |
$13.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.63
|
| Rate for Payer: United Healthcare Commercial |
$11.71
|
| Rate for Payer: United Healthcare Medicare |
$4.76
|
|
|
HC SUTURE CHROMIC GUT 5-0 687G
|
Facility
|
OP
|
$39.56
|
|
| Hospital Charge Code |
41601477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$36.79 |
| Rate for Payer: Aetna Commercial |
$33.39
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Centivo All Commercial |
$21.52
|
| Rate for Payer: Cigna All Commercial |
$34.14
|
| Rate for Payer: CORVEL All Commercial |
$36.79
|
| Rate for Payer: Coventry All Commercial |
$34.81
|
| Rate for Payer: Encore All Commercial |
$36.41
|
| Rate for Payer: Frontpath All Commercial |
$36.40
|
| Rate for Payer: Humana ChoiceCare |
$34.17
|
| Rate for Payer: Humana Medicare |
$12.66
|
| Rate for Payer: Lucent All Commercial |
$21.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$29.67
|
| Rate for Payer: PHP All Commercial |
$30.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.43
|
| Rate for Payer: Sagamore Health Network All Products |
$30.54
|
| Rate for Payer: Signature Care EPO |
$32.83
|
| Rate for Payer: Signature Care PPO |
$34.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.63
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
|
HC SUTURE CHROMIC GUT 5-0 687G
|
Facility
|
IP
|
$39.56
|
|
| Hospital Charge Code |
41601477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$36.79 |
| Rate for Payer: Aetna Commercial |
$34.18
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna All Commercial |
$34.14
|
| Rate for Payer: CORVEL All Commercial |
$36.79
|
| Rate for Payer: Coventry All Commercial |
$34.81
|
| Rate for Payer: Encore All Commercial |
$36.41
|
| Rate for Payer: Frontpath All Commercial |
$36.40
|
| Rate for Payer: Humana ChoiceCare |
$34.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.60
|
| Rate for Payer: PHCS All Commercial |
$29.67
|
| Rate for Payer: PHP All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$30.54
|
| Rate for Payer: Signature Care EPO |
$32.83
|
| Rate for Payer: Signature Care PPO |
$34.81
|
| Rate for Payer: United Healthcare Commercial |
$31.17
|
|
|
HC SUTURE CHROMIC MLD 6-0 G3790K
|
Facility
|
IP
|
$349.45
|
|
| Hospital Charge Code |
41601575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.09 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$301.92
|
| Rate for Payer: Cash Price |
$209.67
|
| Rate for Payer: Cigna All Commercial |
$301.58
|
| Rate for Payer: CORVEL All Commercial |
$324.99
|
| Rate for Payer: Coventry All Commercial |
$307.52
|
| Rate for Payer: Encore All Commercial |
$321.67
|
| Rate for Payer: Frontpath All Commercial |
$321.49
|
| Rate for Payer: Humana ChoiceCare |
$301.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.50
|
| Rate for Payer: PHCS All Commercial |
$262.09
|
| Rate for Payer: PHP All Commercial |
$265.02
|
| Rate for Payer: Sagamore Health Network All Products |
$269.78
|
| Rate for Payer: Signature Care EPO |
$290.04
|
| Rate for Payer: Signature Care PPO |
$307.52
|
| Rate for Payer: United Healthcare Commercial |
$275.37
|
|
|
HC SUTURE CHROMIC MLD 6-0 G3790K
|
Facility
|
OP
|
$349.45
|
|
| Hospital Charge Code |
41601575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$294.94
|
| Rate for Payer: Aetna Medicare |
$111.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$200.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.01
|
| Rate for Payer: Cash Price |
$209.67
|
| Rate for Payer: Cash Price |
$209.67
|
| Rate for Payer: Centivo All Commercial |
$190.10
|
| Rate for Payer: Cigna All Commercial |
$301.58
|
| Rate for Payer: CORVEL All Commercial |
$324.99
|
| Rate for Payer: Coventry All Commercial |
$307.52
|
| Rate for Payer: Encore All Commercial |
$321.67
|
| Rate for Payer: Frontpath All Commercial |
$321.49
|
| Rate for Payer: Humana ChoiceCare |
$301.82
|
| Rate for Payer: Humana Medicare |
$111.82
|
| Rate for Payer: Lucent All Commercial |
$190.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$262.09
|
| Rate for Payer: PHP All Commercial |
$265.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.29
|
| Rate for Payer: Sagamore Health Network All Products |
$269.78
|
| Rate for Payer: Signature Care EPO |
$290.04
|
| Rate for Payer: Signature Care PPO |
$307.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.03
|
| Rate for Payer: United Healthcare Commercial |
$275.37
|
| Rate for Payer: United Healthcare Medicare |
$111.82
|
|
|
HC SUTURE ETHIBOND 0 X424H
|
Facility
|
IP
|
$12.54
|
|
| Hospital Charge Code |
41601505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
|
|
HC SUTURE ETHIBOND 0 X424H
|
Facility
|
OP
|
$12.54
|
|
| Hospital Charge Code |
41601505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Aetna Medicare |
$4.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.41
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Centivo All Commercial |
$6.82
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Lucent All Commercial |
$6.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.89
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
| Rate for Payer: United Healthcare Medicare |
$4.01
|
|
|
HC SUTURE ETHIBOND 0 X834H
|
Facility
|
IP
|
$23.32
|
|
| Hospital Charge Code |
41601134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$21.69 |
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cigna All Commercial |
$20.13
|
| Rate for Payer: CORVEL All Commercial |
$21.69
|
| Rate for Payer: Coventry All Commercial |
$20.52
|
| Rate for Payer: Encore All Commercial |
$21.47
|
| Rate for Payer: Frontpath All Commercial |
$21.45
|
| Rate for Payer: Humana ChoiceCare |
$20.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.99
|
| Rate for Payer: PHCS All Commercial |
$17.49
|
| Rate for Payer: PHP All Commercial |
$17.69
|
| Rate for Payer: Sagamore Health Network All Products |
$18.00
|
| Rate for Payer: Signature Care EPO |
$19.36
|
| Rate for Payer: Signature Care PPO |
$20.52
|
| Rate for Payer: United Healthcare Commercial |
$18.38
|
|
|
HC SUTURE ETHIBOND 0 X834H
|
Facility
|
OP
|
$23.32
|
|
| Hospital Charge Code |
41601134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.21
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Centivo All Commercial |
$12.69
|
| Rate for Payer: Cigna All Commercial |
$20.13
|
| Rate for Payer: CORVEL All Commercial |
$21.69
|
| Rate for Payer: Coventry All Commercial |
$20.52
|
| Rate for Payer: Encore All Commercial |
$21.47
|
| Rate for Payer: Frontpath All Commercial |
$21.45
|
| Rate for Payer: Humana ChoiceCare |
$20.14
|
| Rate for Payer: Humana Medicare |
$7.46
|
| Rate for Payer: Lucent All Commercial |
$12.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.99
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.49
|
| Rate for Payer: PHP All Commercial |
$17.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.09
|
| Rate for Payer: Sagamore Health Network All Products |
$18.00
|
| Rate for Payer: Signature Care EPO |
$19.36
|
| Rate for Payer: Signature Care PPO |
$20.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.82
|
| Rate for Payer: United Healthcare Commercial |
$18.38
|
| Rate for Payer: United Healthcare Medicare |
$7.46
|
|
|
HC SUTURE ETHIBOND 1-0 X425H
|
Facility
|
OP
|
$8.83
|
|
| Hospital Charge Code |
41601501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$2.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.11
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Centivo All Commercial |
$4.80
|
| Rate for Payer: Cigna All Commercial |
$7.62
|
| Rate for Payer: CORVEL All Commercial |
$8.21
|
| Rate for Payer: Coventry All Commercial |
$7.77
|
| Rate for Payer: Encore All Commercial |
$8.13
|
| Rate for Payer: Frontpath All Commercial |
$8.12
|
| Rate for Payer: Humana ChoiceCare |
$7.63
|
| Rate for Payer: Humana Medicare |
$2.83
|
| Rate for Payer: Lucent All Commercial |
$4.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.95
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.62
|
| Rate for Payer: PHP All Commercial |
$6.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.44
|
| Rate for Payer: Sagamore Health Network All Products |
$6.82
|
| Rate for Payer: Signature Care EPO |
$7.33
|
| Rate for Payer: Signature Care PPO |
$7.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.51
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: United Healthcare Medicare |
$2.83
|
|
|
HC SUTURE ETHIBOND 1-0 X425H
|
Facility
|
IP
|
$8.83
|
|
| Hospital Charge Code |
41601501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cigna All Commercial |
$7.62
|
| Rate for Payer: CORVEL All Commercial |
$8.21
|
| Rate for Payer: Coventry All Commercial |
$7.77
|
| Rate for Payer: Encore All Commercial |
$8.13
|
| Rate for Payer: Frontpath All Commercial |
$8.12
|
| Rate for Payer: Humana ChoiceCare |
$7.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.95
|
| Rate for Payer: PHCS All Commercial |
$6.62
|
| Rate for Payer: PHP All Commercial |
$6.70
|
| Rate for Payer: Sagamore Health Network All Products |
$6.82
|
| Rate for Payer: Signature Care EPO |
$7.33
|
| Rate for Payer: Signature Care PPO |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
|
|
HC SUTURE ETHIBOND 2-0 CX46D
|
Facility
|
OP
|
$87.13
|
|
| Hospital Charge Code |
41601620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$81.03 |
| Rate for Payer: Aetna Commercial |
$73.54
|
| Rate for Payer: Aetna Medicare |
$27.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.67
|
| Rate for Payer: Cash Price |
$52.28
|
| Rate for Payer: Cash Price |
$52.28
|
| Rate for Payer: Centivo All Commercial |
$47.40
|
| Rate for Payer: Cigna All Commercial |
$75.19
|
| Rate for Payer: CORVEL All Commercial |
$81.03
|
| Rate for Payer: Coventry All Commercial |
$76.67
|
| Rate for Payer: Encore All Commercial |
$80.20
|
| Rate for Payer: Frontpath All Commercial |
$80.16
|
| Rate for Payer: Humana ChoiceCare |
$75.25
|
| Rate for Payer: Humana Medicare |
$27.88
|
| Rate for Payer: Lucent All Commercial |
$47.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.42
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$65.35
|
| Rate for Payer: PHP All Commercial |
$66.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.98
|
| Rate for Payer: Sagamore Health Network All Products |
$67.26
|
| Rate for Payer: Signature Care EPO |
$72.32
|
| Rate for Payer: Signature Care PPO |
$76.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.06
|
| Rate for Payer: United Healthcare Commercial |
$68.66
|
| Rate for Payer: United Healthcare Medicare |
$27.88
|
|
|
HC SUTURE ETHIBOND 2-0 CX46D
|
Facility
|
IP
|
$87.13
|
|
| Hospital Charge Code |
41601620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.35 |
| Max. Negotiated Rate |
$81.03 |
| Rate for Payer: Aetna Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$52.28
|
| Rate for Payer: Cigna All Commercial |
$75.19
|
| Rate for Payer: CORVEL All Commercial |
$81.03
|
| Rate for Payer: Coventry All Commercial |
$76.67
|
| Rate for Payer: Encore All Commercial |
$80.20
|
| Rate for Payer: Frontpath All Commercial |
$80.16
|
| Rate for Payer: Humana ChoiceCare |
$75.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.42
|
| Rate for Payer: PHCS All Commercial |
$65.35
|
| Rate for Payer: PHP All Commercial |
$66.08
|
| Rate for Payer: Sagamore Health Network All Products |
$67.26
|
| Rate for Payer: Signature Care EPO |
$72.32
|
| Rate for Payer: Signature Care PPO |
$76.67
|
| Rate for Payer: United Healthcare Commercial |
$68.66
|
|
|
HC SUTURE ETHIBOND 2 GREEN OS-4
|
Facility
|
OP
|
$26.52
|
|
| Hospital Charge Code |
41602396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.34
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Centivo All Commercial |
$14.43
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Humana Medicare |
$8.49
|
| Rate for Payer: Lucent All Commercial |
$14.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.34
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.54
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Medicare |
$8.49
|
|
|
HC SUTURE ETHIBOND 2 GREEN OS-4
|
Facility
|
IP
|
$26.52
|
|
| Hospital Charge Code |
41602396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Cash Price |
$15.91
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
|
|
HC SUTURE ETHIBOND 5-0 MB47G
|
Facility
|
IP
|
$80.90
|
|
| Hospital Charge Code |
41601502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: Aetna Commercial |
$69.90
|
| Rate for Payer: Cash Price |
$48.54
|
| Rate for Payer: Cigna All Commercial |
$69.82
|
| Rate for Payer: CORVEL All Commercial |
$75.24
|
| Rate for Payer: Coventry All Commercial |
$71.19
|
| Rate for Payer: Encore All Commercial |
$74.47
|
| Rate for Payer: Frontpath All Commercial |
$74.43
|
| Rate for Payer: Humana ChoiceCare |
$69.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.81
|
| Rate for Payer: PHCS All Commercial |
$60.67
|
| Rate for Payer: PHP All Commercial |
$61.35
|
| Rate for Payer: Sagamore Health Network All Products |
$62.45
|
| Rate for Payer: Signature Care EPO |
$67.15
|
| Rate for Payer: Signature Care PPO |
$71.19
|
| Rate for Payer: United Healthcare Commercial |
$63.75
|
|
|
HC SUTURE ETHIBOND 5-0 MB47G
|
Facility
|
OP
|
$80.90
|
|
| Hospital Charge Code |
41601502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$25.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.48
|
| Rate for Payer: Cash Price |
$48.54
|
| Rate for Payer: Cash Price |
$48.54
|
| Rate for Payer: Centivo All Commercial |
$44.01
|
| Rate for Payer: Cigna All Commercial |
$69.82
|
| Rate for Payer: CORVEL All Commercial |
$75.24
|
| Rate for Payer: Coventry All Commercial |
$71.19
|
| Rate for Payer: Encore All Commercial |
$74.47
|
| Rate for Payer: Frontpath All Commercial |
$74.43
|
| Rate for Payer: Humana ChoiceCare |
$69.87
|
| Rate for Payer: Humana Medicare |
$25.89
|
| Rate for Payer: Lucent All Commercial |
$44.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.81
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$60.67
|
| Rate for Payer: PHP All Commercial |
$61.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.55
|
| Rate for Payer: Sagamore Health Network All Products |
$62.45
|
| Rate for Payer: Signature Care EPO |
$67.15
|
| Rate for Payer: Signature Care PPO |
$71.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.77
|
| Rate for Payer: United Healthcare Commercial |
$63.75
|
| Rate for Payer: United Healthcare Medicare |
$25.89
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-40
|
Facility
|
IP
|
$91.66
|
|
| Hospital Charge Code |
41602398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$85.24 |
| Rate for Payer: Aetna Commercial |
$79.19
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna All Commercial |
$79.10
|
| Rate for Payer: CORVEL All Commercial |
$85.24
|
| Rate for Payer: Coventry All Commercial |
$80.66
|
| Rate for Payer: Encore All Commercial |
$84.37
|
| Rate for Payer: Frontpath All Commercial |
$84.33
|
| Rate for Payer: Humana ChoiceCare |
$79.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.49
|
| Rate for Payer: PHCS All Commercial |
$68.75
|
| Rate for Payer: PHP All Commercial |
$69.51
|
| Rate for Payer: Sagamore Health Network All Products |
$70.76
|
| Rate for Payer: Signature Care EPO |
$76.08
|
| Rate for Payer: Signature Care PPO |
$80.66
|
| Rate for Payer: United Healthcare Commercial |
$72.23
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-40
|
Facility
|
OP
|
$91.66
|
|
| Hospital Charge Code |
41602398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$85.24 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$29.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.26
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Centivo All Commercial |
$49.86
|
| Rate for Payer: Cigna All Commercial |
$79.10
|
| Rate for Payer: CORVEL All Commercial |
$85.24
|
| Rate for Payer: Coventry All Commercial |
$80.66
|
| Rate for Payer: Encore All Commercial |
$84.37
|
| Rate for Payer: Frontpath All Commercial |
$84.33
|
| Rate for Payer: Humana ChoiceCare |
$79.17
|
| Rate for Payer: Humana Medicare |
$29.33
|
| Rate for Payer: Lucent All Commercial |
$49.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.49
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$68.75
|
| Rate for Payer: PHP All Commercial |
$69.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.75
|
| Rate for Payer: Sagamore Health Network All Products |
$70.76
|
| Rate for Payer: Signature Care EPO |
$76.08
|
| Rate for Payer: Signature Care PPO |
$80.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.91
|
| Rate for Payer: United Healthcare Commercial |
$72.23
|
| Rate for Payer: United Healthcare Medicare |
$29.33
|
|
|
HC SUTURE ETHIBOND O X517H
|
Facility
|
OP
|
$15.40
|
|
| Hospital Charge Code |
41601603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.42
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Cash Price |
$9.24
|
| Rate for Payer: Centivo All Commercial |
$8.38
|
| Rate for Payer: Cigna All Commercial |
$13.29
|
| Rate for Payer: CORVEL All Commercial |
$14.32
|
| Rate for Payer: Coventry All Commercial |
$13.55
|
| Rate for Payer: Encore All Commercial |
$14.18
|
| Rate for Payer: Frontpath All Commercial |
$14.17
|
| Rate for Payer: Humana ChoiceCare |
$13.30
|
| Rate for Payer: Humana Medicare |
$4.93
|
| Rate for Payer: Lucent All Commercial |
$8.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.86
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.55
|
| Rate for Payer: PHP All Commercial |
$11.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.01
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$12.78
|
| Rate for Payer: Signature Care PPO |
$13.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.09
|
| Rate for Payer: United Healthcare Commercial |
$12.14
|
| Rate for Payer: United Healthcare Medicare |
$4.93
|
|
