|
HC SUTURE ETHIBOND O X517H
|
Facility
|
IP
|
$15.40
|
|
| Hospital Charge Code |
41601603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$9.24
|
| 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: Lutheran Preferred All Commercial |
$13.86
|
| Rate for Payer: PHCS All Commercial |
$11.55
|
| Rate for Payer: PHP All Commercial |
$11.68
|
| 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: United Healthcare Commercial |
$12.14
|
|
|
HC SUTURE ETHILON 2-0 1674H
|
Facility
|
IP
|
$13.87
|
|
| Hospital Charge Code |
41607019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cigna All Commercial |
$11.97
|
| Rate for Payer: CORVEL All Commercial |
$12.90
|
| Rate for Payer: Coventry All Commercial |
$12.21
|
| Rate for Payer: Encore All Commercial |
$12.77
|
| Rate for Payer: Frontpath All Commercial |
$12.76
|
| Rate for Payer: Humana ChoiceCare |
$11.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.48
|
| Rate for Payer: PHCS All Commercial |
$10.40
|
| Rate for Payer: PHP All Commercial |
$10.52
|
| Rate for Payer: Sagamore Health Network All Products |
$10.71
|
| Rate for Payer: Signature Care EPO |
$11.51
|
| Rate for Payer: Signature Care PPO |
$12.21
|
| Rate for Payer: United Healthcare Commercial |
$10.93
|
|
|
HC SUTURE ETHILON 2-0 1674H
|
Facility
|
OP
|
$13.87
|
|
| Hospital Charge Code |
41607019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.88
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Centivo All Commercial |
$7.55
|
| Rate for Payer: Cigna All Commercial |
$11.97
|
| Rate for Payer: CORVEL All Commercial |
$12.90
|
| Rate for Payer: Coventry All Commercial |
$12.21
|
| Rate for Payer: Encore All Commercial |
$12.77
|
| Rate for Payer: Frontpath All Commercial |
$12.76
|
| Rate for Payer: Humana ChoiceCare |
$11.98
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Lucent All Commercial |
$7.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.48
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.40
|
| Rate for Payer: PHP All Commercial |
$10.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.41
|
| Rate for Payer: Sagamore Health Network All Products |
$10.71
|
| Rate for Payer: Signature Care EPO |
$11.51
|
| Rate for Payer: Signature Care PPO |
$12.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.79
|
| Rate for Payer: United Healthcare Commercial |
$10.93
|
| Rate for Payer: United Healthcare Medicare |
$4.44
|
|
|
HC SUTURE ETHILON 2-0 593H
|
Facility
|
IP
|
$43.93
|
|
| Hospital Charge Code |
41601597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cigna All Commercial |
$37.91
|
| Rate for Payer: CORVEL All Commercial |
$40.85
|
| Rate for Payer: Coventry All Commercial |
$38.66
|
| Rate for Payer: Encore All Commercial |
$40.44
|
| Rate for Payer: Frontpath All Commercial |
$40.42
|
| Rate for Payer: Humana ChoiceCare |
$37.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.54
|
| Rate for Payer: PHCS All Commercial |
$32.95
|
| Rate for Payer: PHP All Commercial |
$33.32
|
| Rate for Payer: Sagamore Health Network All Products |
$33.91
|
| Rate for Payer: Signature Care EPO |
$36.46
|
| Rate for Payer: Signature Care PPO |
$38.66
|
| Rate for Payer: United Healthcare Commercial |
$34.62
|
|
|
HC SUTURE ETHILON 2-0 593H
|
Facility
|
OP
|
$43.93
|
|
| Hospital Charge Code |
41601597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$37.08
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.46
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Cash Price |
$26.36
|
| Rate for Payer: Centivo All Commercial |
$23.90
|
| Rate for Payer: Cigna All Commercial |
$37.91
|
| Rate for Payer: CORVEL All Commercial |
$40.85
|
| Rate for Payer: Coventry All Commercial |
$38.66
|
| Rate for Payer: Encore All Commercial |
$40.44
|
| Rate for Payer: Frontpath All Commercial |
$40.42
|
| Rate for Payer: Humana ChoiceCare |
$37.94
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Lucent All Commercial |
$23.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.54
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$32.95
|
| Rate for Payer: PHP All Commercial |
$33.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.13
|
| Rate for Payer: Sagamore Health Network All Products |
$33.91
|
| Rate for Payer: Signature Care EPO |
$36.46
|
| Rate for Payer: Signature Care PPO |
$38.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.34
|
| Rate for Payer: United Healthcare Commercial |
$34.62
|
| Rate for Payer: United Healthcare Medicare |
$14.06
|
|
|
HC SUTURE ETHILON 2-0 FS
|
Facility
|
IP
|
$10.33
|
|
| Hospital Charge Code |
41602399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
|
|
HC SUTURE ETHILON 2-0 FS
|
Facility
|
OP
|
$10.33
|
|
| Hospital Charge Code |
41602399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.64
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Centivo All Commercial |
$5.62
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Humana Medicare |
$3.31
|
| Rate for Payer: Lucent All Commercial |
$5.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.03
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
| Rate for Payer: United Healthcare Medicare |
$3.31
|
|
|
HC SUTURE ETHILON 3-0 1663H
|
Facility
|
OP
|
$22.95
|
|
| Hospital Charge Code |
41601478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Centivo All Commercial |
$12.48
|
| Rate for Payer: Cigna All Commercial |
$19.81
|
| Rate for Payer: CORVEL All Commercial |
$21.34
|
| Rate for Payer: Coventry All Commercial |
$20.20
|
| Rate for Payer: Encore All Commercial |
$21.13
|
| Rate for Payer: Frontpath All Commercial |
$21.11
|
| Rate for Payer: Humana ChoiceCare |
$19.82
|
| Rate for Payer: Humana Medicare |
$7.34
|
| Rate for Payer: Lucent All Commercial |
$12.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.66
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.21
|
| Rate for Payer: PHP All Commercial |
$17.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.95
|
| Rate for Payer: Sagamore Health Network All Products |
$17.72
|
| Rate for Payer: Signature Care EPO |
$19.05
|
| Rate for Payer: Signature Care PPO |
$20.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.51
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare |
$7.34
|
|
|
HC SUTURE ETHILON 3-0 1663H
|
Facility
|
IP
|
$22.95
|
|
| Hospital Charge Code |
41601478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Aetna Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cigna All Commercial |
$19.81
|
| Rate for Payer: CORVEL All Commercial |
$21.34
|
| Rate for Payer: Coventry All Commercial |
$20.20
|
| Rate for Payer: Encore All Commercial |
$21.13
|
| Rate for Payer: Frontpath All Commercial |
$21.11
|
| Rate for Payer: Humana ChoiceCare |
$19.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.66
|
| Rate for Payer: PHCS All Commercial |
$17.21
|
| Rate for Payer: PHP All Commercial |
$17.41
|
| Rate for Payer: Sagamore Health Network All Products |
$17.72
|
| Rate for Payer: Signature Care EPO |
$19.05
|
| Rate for Payer: Signature Care PPO |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$18.08
|
|
|
HC SUTURE ETHILON 3-0 1669H
|
Facility
|
IP
|
$20.88
|
|
| Hospital Charge Code |
41601136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cigna All Commercial |
$18.02
|
| Rate for Payer: CORVEL All Commercial |
$19.42
|
| Rate for Payer: Coventry All Commercial |
$18.37
|
| Rate for Payer: Encore All Commercial |
$19.22
|
| Rate for Payer: Frontpath All Commercial |
$19.21
|
| Rate for Payer: Humana ChoiceCare |
$18.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.79
|
| Rate for Payer: PHCS All Commercial |
$15.66
|
| Rate for Payer: PHP All Commercial |
$15.84
|
| Rate for Payer: Sagamore Health Network All Products |
$16.12
|
| Rate for Payer: Signature Care EPO |
$17.33
|
| Rate for Payer: Signature Care PPO |
$18.37
|
| Rate for Payer: United Healthcare Commercial |
$16.45
|
|
|
HC SUTURE ETHILON 3-0 1669H
|
Facility
|
OP
|
$20.88
|
|
| Hospital Charge Code |
41601136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.35
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Centivo All Commercial |
$11.36
|
| Rate for Payer: Cigna All Commercial |
$18.02
|
| Rate for Payer: CORVEL All Commercial |
$19.42
|
| Rate for Payer: Coventry All Commercial |
$18.37
|
| Rate for Payer: Encore All Commercial |
$19.22
|
| Rate for Payer: Frontpath All Commercial |
$19.21
|
| Rate for Payer: Humana ChoiceCare |
$18.03
|
| Rate for Payer: Humana Medicare |
$6.68
|
| Rate for Payer: Lucent All Commercial |
$11.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.79
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.66
|
| Rate for Payer: PHP All Commercial |
$15.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.14
|
| Rate for Payer: Sagamore Health Network All Products |
$16.12
|
| Rate for Payer: Signature Care EPO |
$17.33
|
| Rate for Payer: Signature Care PPO |
$18.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.75
|
| Rate for Payer: United Healthcare Commercial |
$16.45
|
| Rate for Payer: United Healthcare Medicare |
$6.68
|
|
|
HC SUTURE ETHILON 3-0 KS
|
Facility
|
OP
|
$10.93
|
|
| Hospital Charge Code |
41602400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.22
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.85
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Centivo All Commercial |
$5.95
|
| Rate for Payer: Cigna All Commercial |
$9.43
|
| Rate for Payer: CORVEL All Commercial |
$10.16
|
| Rate for Payer: Coventry All Commercial |
$9.62
|
| Rate for Payer: Encore All Commercial |
$10.06
|
| Rate for Payer: Frontpath All Commercial |
$10.06
|
| Rate for Payer: Humana ChoiceCare |
$9.44
|
| Rate for Payer: Humana Medicare |
$3.50
|
| Rate for Payer: Lucent All Commercial |
$5.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.84
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.20
|
| Rate for Payer: PHP All Commercial |
$8.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8.44
|
| Rate for Payer: Signature Care EPO |
$9.07
|
| Rate for Payer: Signature Care PPO |
$9.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.29
|
| Rate for Payer: United Healthcare Commercial |
$8.61
|
| Rate for Payer: United Healthcare Medicare |
$3.50
|
|
|
HC SUTURE ETHILON 3-0 KS
|
Facility
|
IP
|
$10.93
|
|
| Hospital Charge Code |
41602400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Cash Price |
$6.56
|
| Rate for Payer: Cigna All Commercial |
$9.43
|
| Rate for Payer: CORVEL All Commercial |
$10.16
|
| Rate for Payer: Coventry All Commercial |
$9.62
|
| Rate for Payer: Encore All Commercial |
$10.06
|
| Rate for Payer: Frontpath All Commercial |
$10.06
|
| Rate for Payer: Humana ChoiceCare |
$9.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.84
|
| Rate for Payer: PHCS All Commercial |
$8.20
|
| Rate for Payer: PHP All Commercial |
$8.29
|
| Rate for Payer: Sagamore Health Network All Products |
$8.44
|
| Rate for Payer: Signature Care EPO |
$9.07
|
| Rate for Payer: Signature Care PPO |
$9.62
|
| Rate for Payer: United Healthcare Commercial |
$8.61
|
|
|
HC SUTURE ETHILON 4-0 1629H
|
Facility
|
OP
|
$22.74
|
|
| Hospital Charge Code |
41601137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Centivo All Commercial |
$12.37
|
| Rate for Payer: Cigna All Commercial |
$19.62
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: Coventry All Commercial |
$20.01
|
| Rate for Payer: Encore All Commercial |
$20.93
|
| Rate for Payer: Frontpath All Commercial |
$20.92
|
| Rate for Payer: Humana ChoiceCare |
$19.64
|
| Rate for Payer: Humana Medicare |
$7.28
|
| Rate for Payer: Lucent All Commercial |
$12.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.47
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.05
|
| Rate for Payer: PHP All Commercial |
$17.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.87
|
| Rate for Payer: Sagamore Health Network All Products |
$17.56
|
| Rate for Payer: Signature Care EPO |
$18.87
|
| Rate for Payer: Signature Care PPO |
$20.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.33
|
| Rate for Payer: United Healthcare Commercial |
$17.92
|
| Rate for Payer: United Healthcare Medicare |
$7.28
|
|
|
HC SUTURE ETHILON 4-0 1629H
|
Facility
|
IP
|
$22.74
|
|
| Hospital Charge Code |
41601137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cigna All Commercial |
$19.62
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: Coventry All Commercial |
$20.01
|
| Rate for Payer: Encore All Commercial |
$20.93
|
| Rate for Payer: Frontpath All Commercial |
$20.92
|
| Rate for Payer: Humana ChoiceCare |
$19.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.47
|
| Rate for Payer: PHCS All Commercial |
$17.05
|
| Rate for Payer: PHP All Commercial |
$17.25
|
| Rate for Payer: Sagamore Health Network All Products |
$17.56
|
| Rate for Payer: Signature Care EPO |
$18.87
|
| Rate for Payer: Signature Care PPO |
$20.01
|
| Rate for Payer: United Healthcare Commercial |
$17.92
|
|
|
HC SUTURE ETHILON 4-0 1667H
|
Facility
|
IP
|
$19.72
|
|
| Hospital Charge Code |
41601138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: Aetna Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cigna All Commercial |
$17.02
|
| Rate for Payer: CORVEL All Commercial |
$18.34
|
| Rate for Payer: Coventry All Commercial |
$17.35
|
| Rate for Payer: Encore All Commercial |
$18.15
|
| Rate for Payer: Frontpath All Commercial |
$18.14
|
| Rate for Payer: Humana ChoiceCare |
$17.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.75
|
| Rate for Payer: PHCS All Commercial |
$14.79
|
| Rate for Payer: PHP All Commercial |
$14.96
|
| Rate for Payer: Sagamore Health Network All Products |
$15.22
|
| Rate for Payer: Signature Care EPO |
$16.37
|
| Rate for Payer: Signature Care PPO |
$17.35
|
| Rate for Payer: United Healthcare Commercial |
$15.54
|
|
|
HC SUTURE ETHILON 4-0 1667H
|
Facility
|
OP
|
$19.72
|
|
| Hospital Charge Code |
41601138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.94
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centivo All Commercial |
$10.73
|
| Rate for Payer: Cigna All Commercial |
$17.02
|
| Rate for Payer: CORVEL All Commercial |
$18.34
|
| Rate for Payer: Coventry All Commercial |
$17.35
|
| Rate for Payer: Encore All Commercial |
$18.15
|
| Rate for Payer: Frontpath All Commercial |
$18.14
|
| Rate for Payer: Humana ChoiceCare |
$17.03
|
| Rate for Payer: Humana Medicare |
$6.31
|
| Rate for Payer: Lucent All Commercial |
$10.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$14.79
|
| Rate for Payer: PHP All Commercial |
$14.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.69
|
| Rate for Payer: Sagamore Health Network All Products |
$15.22
|
| Rate for Payer: Signature Care EPO |
$16.37
|
| Rate for Payer: Signature Care PPO |
$17.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.76
|
| Rate for Payer: United Healthcare Commercial |
$15.54
|
| Rate for Payer: United Healthcare Medicare |
$6.31
|
|
|
HC SUTURE ETHILON 4-0 1864G
|
Facility
|
OP
|
$23.09
|
|
| Hospital Charge Code |
41601139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.49
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.13
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Centivo All Commercial |
$12.56
|
| Rate for Payer: Cigna All Commercial |
$19.93
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: Coventry All Commercial |
$20.32
|
| Rate for Payer: Encore All Commercial |
$21.25
|
| Rate for Payer: Frontpath All Commercial |
$21.24
|
| Rate for Payer: Humana ChoiceCare |
$19.94
|
| Rate for Payer: Humana Medicare |
$7.39
|
| Rate for Payer: Lucent All Commercial |
$12.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.78
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.32
|
| Rate for Payer: PHP All Commercial |
$17.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.01
|
| Rate for Payer: Sagamore Health Network All Products |
$17.83
|
| Rate for Payer: Signature Care EPO |
$19.16
|
| Rate for Payer: Signature Care PPO |
$20.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.63
|
| Rate for Payer: United Healthcare Commercial |
$18.19
|
| Rate for Payer: United Healthcare Medicare |
$7.39
|
|
|
HC SUTURE ETHILON 4-0 1864G
|
Facility
|
IP
|
$23.09
|
|
| Hospital Charge Code |
41601139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cigna All Commercial |
$19.93
|
| Rate for Payer: CORVEL All Commercial |
$21.47
|
| Rate for Payer: Coventry All Commercial |
$20.32
|
| Rate for Payer: Encore All Commercial |
$21.25
|
| Rate for Payer: Frontpath All Commercial |
$21.24
|
| Rate for Payer: Humana ChoiceCare |
$19.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.78
|
| Rate for Payer: PHCS All Commercial |
$17.32
|
| Rate for Payer: PHP All Commercial |
$17.51
|
| Rate for Payer: Sagamore Health Network All Products |
$17.83
|
| Rate for Payer: Signature Care EPO |
$19.16
|
| Rate for Payer: Signature Care PPO |
$20.32
|
| Rate for Payer: United Healthcare Commercial |
$18.19
|
|
|
HC SUTURE ETHILON 4-0 PS-2
|
Facility
|
OP
|
$21.03
|
|
| Hospital Charge Code |
41602401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.40
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Centivo All Commercial |
$11.44
|
| Rate for Payer: Cigna All Commercial |
$18.15
|
| Rate for Payer: CORVEL All Commercial |
$19.56
|
| Rate for Payer: Coventry All Commercial |
$18.51
|
| Rate for Payer: Encore All Commercial |
$19.36
|
| Rate for Payer: Frontpath All Commercial |
$19.35
|
| Rate for Payer: Humana ChoiceCare |
$18.16
|
| Rate for Payer: Humana Medicare |
$6.73
|
| Rate for Payer: Lucent All Commercial |
$11.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.93
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.77
|
| Rate for Payer: PHP All Commercial |
$15.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.20
|
| Rate for Payer: Sagamore Health Network All Products |
$16.24
|
| Rate for Payer: Signature Care EPO |
$17.45
|
| Rate for Payer: Signature Care PPO |
$18.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.88
|
| Rate for Payer: United Healthcare Commercial |
$16.57
|
| Rate for Payer: United Healthcare Medicare |
$6.73
|
|
|
HC SUTURE ETHILON 4-0 PS-2
|
Facility
|
IP
|
$21.03
|
|
| Hospital Charge Code |
41602401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cigna All Commercial |
$18.15
|
| Rate for Payer: CORVEL All Commercial |
$19.56
|
| Rate for Payer: Coventry All Commercial |
$18.51
|
| Rate for Payer: Encore All Commercial |
$19.36
|
| Rate for Payer: Frontpath All Commercial |
$19.35
|
| Rate for Payer: Humana ChoiceCare |
$18.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.93
|
| Rate for Payer: PHCS All Commercial |
$15.77
|
| Rate for Payer: PHP All Commercial |
$15.95
|
| Rate for Payer: Sagamore Health Network All Products |
$16.24
|
| Rate for Payer: Signature Care EPO |
$17.45
|
| Rate for Payer: Signature Care PPO |
$18.51
|
| Rate for Payer: United Healthcare Commercial |
$16.57
|
|
|
HC SUTURE ETHILON 5-0 1666H
|
Facility
|
OP
|
$21.25
|
|
| Hospital Charge Code |
41601140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.48
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Centivo All Commercial |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$18.34
|
| Rate for Payer: CORVEL All Commercial |
$19.76
|
| Rate for Payer: Coventry All Commercial |
$18.70
|
| Rate for Payer: Encore All Commercial |
$19.56
|
| Rate for Payer: Frontpath All Commercial |
$19.55
|
| Rate for Payer: Humana ChoiceCare |
$18.35
|
| Rate for Payer: Humana Medicare |
$6.80
|
| Rate for Payer: Lucent All Commercial |
$11.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.12
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.94
|
| Rate for Payer: PHP All Commercial |
$16.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.29
|
| Rate for Payer: Sagamore Health Network All Products |
$16.41
|
| Rate for Payer: Signature Care EPO |
$17.64
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.06
|
| Rate for Payer: United Healthcare Commercial |
$16.75
|
| Rate for Payer: United Healthcare Medicare |
$6.80
|
|
|
HC SUTURE ETHILON 5-0 1666H
|
Facility
|
IP
|
$21.25
|
|
| Hospital Charge Code |
41601140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Cash Price |
$12.75
|
| Rate for Payer: Cigna All Commercial |
$18.34
|
| Rate for Payer: CORVEL All Commercial |
$19.76
|
| Rate for Payer: Coventry All Commercial |
$18.70
|
| Rate for Payer: Encore All Commercial |
$19.56
|
| Rate for Payer: Frontpath All Commercial |
$19.55
|
| Rate for Payer: Humana ChoiceCare |
$18.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.12
|
| Rate for Payer: PHCS All Commercial |
$15.94
|
| Rate for Payer: PHP All Commercial |
$16.12
|
| Rate for Payer: Sagamore Health Network All Products |
$16.41
|
| Rate for Payer: Signature Care EPO |
$17.64
|
| Rate for Payer: Signature Care PPO |
$18.70
|
| Rate for Payer: United Healthcare Commercial |
$16.75
|
|
|
HC SUTURE ETHILON 5-0 G695G
|
Facility
|
IP
|
$23.28
|
|
| Hospital Charge Code |
41601141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cigna All Commercial |
$20.09
|
| Rate for Payer: CORVEL All Commercial |
$21.65
|
| Rate for Payer: Coventry All Commercial |
$20.49
|
| Rate for Payer: Encore All Commercial |
$21.43
|
| Rate for Payer: Frontpath All Commercial |
$21.42
|
| Rate for Payer: Humana ChoiceCare |
$20.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.95
|
| Rate for Payer: PHCS All Commercial |
$17.46
|
| Rate for Payer: PHP All Commercial |
$17.66
|
| Rate for Payer: Sagamore Health Network All Products |
$17.97
|
| Rate for Payer: Signature Care EPO |
$19.32
|
| Rate for Payer: Signature Care PPO |
$20.49
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
|
|
HC SUTURE ETHILON 5-0 G695G
|
Facility
|
OP
|
$23.28
|
|
| Hospital Charge Code |
41601141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.19
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Centivo All Commercial |
$12.66
|
| Rate for Payer: Cigna All Commercial |
$20.09
|
| Rate for Payer: CORVEL All Commercial |
$21.65
|
| Rate for Payer: Coventry All Commercial |
$20.49
|
| Rate for Payer: Encore All Commercial |
$21.43
|
| Rate for Payer: Frontpath All Commercial |
$21.42
|
| Rate for Payer: Humana ChoiceCare |
$20.11
|
| Rate for Payer: Humana Medicare |
$7.45
|
| Rate for Payer: Lucent All Commercial |
$12.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.95
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.46
|
| Rate for Payer: PHP All Commercial |
$17.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.08
|
| Rate for Payer: Sagamore Health Network All Products |
$17.97
|
| Rate for Payer: Signature Care EPO |
$19.32
|
| Rate for Payer: Signature Care PPO |
$20.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.79
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Medicare |
$7.45
|
|
