|
HC SUTURE ETHILON 5-0 MONO 1845G
|
Facility
|
OP
|
$32.92
|
|
| Hospital Charge Code |
41601142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$27.78
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$19.75
|
| Rate for Payer: Cash Price |
$19.75
|
| Rate for Payer: Centivo All Commercial |
$17.91
|
| Rate for Payer: Cigna All Commercial |
$28.41
|
| Rate for Payer: CORVEL All Commercial |
$30.62
|
| Rate for Payer: Coventry All Commercial |
$28.97
|
| Rate for Payer: Encore All Commercial |
$30.30
|
| Rate for Payer: Frontpath All Commercial |
$30.29
|
| Rate for Payer: Humana ChoiceCare |
$28.43
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Lucent All Commercial |
$17.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.63
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$24.69
|
| Rate for Payer: PHP All Commercial |
$24.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.84
|
| Rate for Payer: Sagamore Health Network All Products |
$25.41
|
| Rate for Payer: Signature Care EPO |
$27.32
|
| Rate for Payer: Signature Care PPO |
$28.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.98
|
| Rate for Payer: United Healthcare Commercial |
$25.94
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
|
|
HC SUTURE ETHILON 5-0 MONO 1845G
|
Facility
|
IP
|
$32.92
|
|
| Hospital Charge Code |
41601142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$28.44
|
| Rate for Payer: Cash Price |
$19.75
|
| Rate for Payer: Cigna All Commercial |
$28.41
|
| Rate for Payer: CORVEL All Commercial |
$30.62
|
| Rate for Payer: Coventry All Commercial |
$28.97
|
| Rate for Payer: Encore All Commercial |
$30.30
|
| Rate for Payer: Frontpath All Commercial |
$30.29
|
| Rate for Payer: Humana ChoiceCare |
$28.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.63
|
| Rate for Payer: PHCS All Commercial |
$24.69
|
| Rate for Payer: PHP All Commercial |
$24.97
|
| Rate for Payer: Sagamore Health Network All Products |
$25.41
|
| Rate for Payer: Signature Care EPO |
$27.32
|
| Rate for Payer: Signature Care PPO |
$28.97
|
| Rate for Payer: United Healthcare Commercial |
$25.94
|
|
|
HC SUTURE ETHILON 5-0 P3 698H
|
Facility
|
OP
|
$19.72
|
|
| Hospital Charge Code |
41601467
|
|
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 5-0 P3 698H
|
Facility
|
IP
|
$19.72
|
|
| Hospital Charge Code |
41601467
|
|
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 6-0 697G
|
Facility
|
IP
|
$29.03
|
|
| Hospital Charge Code |
41601143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.08
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cigna All Commercial |
$25.05
|
| Rate for Payer: CORVEL All Commercial |
$27.00
|
| Rate for Payer: Coventry All Commercial |
$25.55
|
| Rate for Payer: Encore All Commercial |
$26.72
|
| Rate for Payer: Frontpath All Commercial |
$26.71
|
| Rate for Payer: Humana ChoiceCare |
$25.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.13
|
| Rate for Payer: PHCS All Commercial |
$21.77
|
| Rate for Payer: PHP All Commercial |
$22.02
|
| Rate for Payer: Sagamore Health Network All Products |
$22.41
|
| Rate for Payer: Signature Care EPO |
$24.09
|
| Rate for Payer: Signature Care PPO |
$25.55
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
|
|
HC SUTURE ETHILON 6-0 697G
|
Facility
|
OP
|
$29.03
|
|
| Hospital Charge Code |
41601143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$24.50
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.22
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Centivo All Commercial |
$15.79
|
| Rate for Payer: Cigna All Commercial |
$25.05
|
| Rate for Payer: CORVEL All Commercial |
$27.00
|
| Rate for Payer: Coventry All Commercial |
$25.55
|
| Rate for Payer: Encore All Commercial |
$26.72
|
| Rate for Payer: Frontpath All Commercial |
$26.71
|
| Rate for Payer: Humana ChoiceCare |
$25.07
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Lucent All Commercial |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.13
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$21.77
|
| Rate for Payer: PHP All Commercial |
$22.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.32
|
| Rate for Payer: Sagamore Health Network All Products |
$22.41
|
| Rate for Payer: Signature Care EPO |
$24.09
|
| Rate for Payer: Signature Care PPO |
$25.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.68
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
| Rate for Payer: United Healthcare Medicare |
$9.29
|
|
|
HC SUTURE ETHILON 6-0 PS-3 1665G
|
Facility
|
IP
|
$26.25
|
|
| Hospital Charge Code |
41601144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Aetna Commercial |
$22.68
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna All Commercial |
$22.65
|
| Rate for Payer: CORVEL All Commercial |
$24.41
|
| Rate for Payer: Coventry All Commercial |
$23.10
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Frontpath All Commercial |
$24.15
|
| Rate for Payer: Humana ChoiceCare |
$22.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.62
|
| Rate for Payer: PHCS All Commercial |
$19.69
|
| Rate for Payer: PHP All Commercial |
$19.91
|
| Rate for Payer: Sagamore Health Network All Products |
$20.27
|
| Rate for Payer: Signature Care EPO |
$21.79
|
| Rate for Payer: Signature Care PPO |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$20.68
|
|
|
HC SUTURE ETHILON 6-0 PS-3 1665G
|
Facility
|
OP
|
$26.25
|
|
| Hospital Charge Code |
41601144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.24
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Centivo All Commercial |
$14.28
|
| Rate for Payer: Cigna All Commercial |
$22.65
|
| Rate for Payer: CORVEL All Commercial |
$24.41
|
| Rate for Payer: Coventry All Commercial |
$23.10
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Frontpath All Commercial |
$24.15
|
| Rate for Payer: Humana ChoiceCare |
$22.67
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Lucent All Commercial |
$14.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.62
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$19.69
|
| Rate for Payer: PHP All Commercial |
$19.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.24
|
| Rate for Payer: Sagamore Health Network All Products |
$20.27
|
| Rate for Payer: Signature Care EPO |
$21.79
|
| Rate for Payer: Signature Care PPO |
$23.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$20.68
|
| Rate for Payer: United Healthcare Medicare |
$8.40
|
|
|
HC SUTURE FIBERLOOP #2
|
Facility
|
IP
|
$385.00
|
|
| Hospital Charge Code |
41602388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna All Commercial |
$332.25
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC SUTURE FIBERLOOP #2
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
41602388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$123.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.52
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Centivo All Commercial |
$209.44
|
| Rate for Payer: Cigna All Commercial |
$332.25
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$123.20
|
| Rate for Payer: Lucent All Commercial |
$209.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$123.20
|
|
|
HC SUTURE MONOCRYL 0 36 IN Y358H
|
Facility
|
IP
|
$14.53
|
|
| Hospital Charge Code |
41601145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
|
|
HC SUTURE MONOCRYL 0 36 IN Y358H
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
41601145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.11
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Centivo All Commercial |
$7.90
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Lucent All Commercial |
$7.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.67
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
| Rate for Payer: United Healthcare Medicare |
$4.65
|
|
|
HC SUTURE MONOCRYL 2-0 D8786
|
Facility
|
IP
|
$299.37
|
|
| Hospital Charge Code |
41606247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.53 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$258.66
|
| Rate for Payer: Cash Price |
$179.62
|
| Rate for Payer: Cigna All Commercial |
$258.36
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.45
|
| Rate for Payer: Encore All Commercial |
$275.57
|
| Rate for Payer: Frontpath All Commercial |
$275.42
|
| Rate for Payer: Humana ChoiceCare |
$258.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: PHCS All Commercial |
$224.53
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.48
|
| Rate for Payer: Signature Care PPO |
$263.45
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
|
|
HC SUTURE MONOCRYL 2-0 D8786
|
Facility
|
OP
|
$299.37
|
|
| Hospital Charge Code |
41606247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$252.67
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$171.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.38
|
| Rate for Payer: Cash Price |
$179.62
|
| Rate for Payer: Cash Price |
$179.62
|
| Rate for Payer: Centivo All Commercial |
$162.86
|
| Rate for Payer: Cigna All Commercial |
$258.36
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.45
|
| Rate for Payer: Encore All Commercial |
$275.57
|
| Rate for Payer: Frontpath All Commercial |
$275.42
|
| Rate for Payer: Humana ChoiceCare |
$258.57
|
| Rate for Payer: Humana Medicare |
$95.80
|
| Rate for Payer: Lucent All Commercial |
$162.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$224.53
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.75
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.48
|
| Rate for Payer: Signature Care PPO |
$263.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.46
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
| Rate for Payer: United Healthcare Medicare |
$95.80
|
|
|
HC SUTURE MONOCRYL 2-0 STRATAFIX
|
Facility
|
OP
|
$204.03
|
|
| Hospital Charge Code |
41607790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Aetna Commercial |
$172.20
|
| Rate for Payer: Aetna Medicare |
$65.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$117.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.82
|
| Rate for Payer: Cash Price |
$122.42
|
| Rate for Payer: Cash Price |
$122.42
|
| Rate for Payer: Centivo All Commercial |
$110.99
|
| Rate for Payer: Cigna All Commercial |
$176.08
|
| Rate for Payer: CORVEL All Commercial |
$189.75
|
| Rate for Payer: Coventry All Commercial |
$179.55
|
| Rate for Payer: Encore All Commercial |
$187.81
|
| Rate for Payer: Frontpath All Commercial |
$187.71
|
| Rate for Payer: Humana ChoiceCare |
$176.22
|
| Rate for Payer: Humana Medicare |
$65.29
|
| Rate for Payer: Lucent All Commercial |
$110.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.63
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$153.02
|
| Rate for Payer: PHP All Commercial |
$154.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.57
|
| Rate for Payer: Sagamore Health Network All Products |
$157.51
|
| Rate for Payer: Signature Care EPO |
$169.34
|
| Rate for Payer: Signature Care PPO |
$179.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.43
|
| Rate for Payer: United Healthcare Commercial |
$160.78
|
| Rate for Payer: United Healthcare Medicare |
$65.29
|
|
|
HC SUTURE MONOCRYL 2-0 STRATAFIX
|
Facility
|
IP
|
$204.03
|
|
| Hospital Charge Code |
41607790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.02 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Aetna Commercial |
$176.28
|
| Rate for Payer: Cash Price |
$122.42
|
| Rate for Payer: Cigna All Commercial |
$176.08
|
| Rate for Payer: CORVEL All Commercial |
$189.75
|
| Rate for Payer: Coventry All Commercial |
$179.55
|
| Rate for Payer: Encore All Commercial |
$187.81
|
| Rate for Payer: Frontpath All Commercial |
$187.71
|
| Rate for Payer: Humana ChoiceCare |
$176.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.63
|
| Rate for Payer: PHCS All Commercial |
$153.02
|
| Rate for Payer: PHP All Commercial |
$154.74
|
| Rate for Payer: Sagamore Health Network All Products |
$157.51
|
| Rate for Payer: Signature Care EPO |
$169.34
|
| Rate for Payer: Signature Care PPO |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$160.78
|
|
|
HC SUTURE MONOCRYL 2-0 Y417
|
Facility
|
OP
|
$14.65
|
|
| Hospital Charge Code |
41606903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.36
|
| Rate for Payer: Aetna Medicare |
$4.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.16
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Centivo All Commercial |
$7.97
|
| Rate for Payer: Cigna All Commercial |
$12.64
|
| Rate for Payer: CORVEL All Commercial |
$13.62
|
| Rate for Payer: Coventry All Commercial |
$12.89
|
| Rate for Payer: Encore All Commercial |
$13.49
|
| Rate for Payer: Frontpath All Commercial |
$13.48
|
| Rate for Payer: Humana ChoiceCare |
$12.65
|
| Rate for Payer: Humana Medicare |
$4.69
|
| Rate for Payer: Lucent All Commercial |
$7.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.99
|
| Rate for Payer: PHP All Commercial |
$11.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.71
|
| Rate for Payer: Sagamore Health Network All Products |
$11.31
|
| Rate for Payer: Signature Care EPO |
$12.16
|
| Rate for Payer: Signature Care PPO |
$12.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$11.54
|
| Rate for Payer: United Healthcare Medicare |
$4.69
|
|
|
HC SUTURE MONOCRYL 2-0 Y417
|
Facility
|
IP
|
$14.65
|
|
| Hospital Charge Code |
41606903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna All Commercial |
$12.64
|
| Rate for Payer: CORVEL All Commercial |
$13.62
|
| Rate for Payer: Coventry All Commercial |
$12.89
|
| Rate for Payer: Encore All Commercial |
$13.49
|
| Rate for Payer: Frontpath All Commercial |
$13.48
|
| Rate for Payer: Humana ChoiceCare |
$12.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.19
|
| Rate for Payer: PHCS All Commercial |
$10.99
|
| Rate for Payer: PHP All Commercial |
$11.11
|
| Rate for Payer: Sagamore Health Network All Products |
$11.31
|
| Rate for Payer: Signature Care EPO |
$12.16
|
| Rate for Payer: Signature Care PPO |
$12.89
|
| Rate for Payer: United Healthcare Commercial |
$11.54
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN KS Y523H
|
Facility
|
IP
|
$38.84
|
|
| Hospital Charge Code |
41601146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$36.12 |
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cigna All Commercial |
$33.52
|
| Rate for Payer: CORVEL All Commercial |
$36.12
|
| Rate for Payer: Coventry All Commercial |
$34.18
|
| Rate for Payer: Encore All Commercial |
$35.75
|
| Rate for Payer: Frontpath All Commercial |
$35.73
|
| Rate for Payer: Humana ChoiceCare |
$33.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.96
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Sagamore Health Network All Products |
$29.98
|
| Rate for Payer: Signature Care EPO |
$32.24
|
| Rate for Payer: Signature Care PPO |
$34.18
|
| Rate for Payer: United Healthcare Commercial |
$30.61
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN KS Y523H
|
Facility
|
OP
|
$38.84
|
|
| Hospital Charge Code |
41601146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$36.12 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare |
$12.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.67
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Centivo All Commercial |
$21.13
|
| Rate for Payer: Cigna All Commercial |
$33.52
|
| Rate for Payer: CORVEL All Commercial |
$36.12
|
| Rate for Payer: Coventry All Commercial |
$34.18
|
| Rate for Payer: Encore All Commercial |
$35.75
|
| Rate for Payer: Frontpath All Commercial |
$35.73
|
| Rate for Payer: Humana ChoiceCare |
$33.55
|
| Rate for Payer: Humana Medicare |
$12.43
|
| Rate for Payer: Lucent All Commercial |
$21.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.15
|
| Rate for Payer: Sagamore Health Network All Products |
$29.98
|
| Rate for Payer: Signature Care EPO |
$32.24
|
| Rate for Payer: Signature Care PPO |
$34.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.01
|
| Rate for Payer: United Healthcare Commercial |
$30.61
|
| Rate for Payer: United Healthcare Medicare |
$12.43
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN PS-2 Y427H
|
Facility
|
IP
|
$37.50
|
|
| Hospital Charge Code |
41601147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN PS-2 Y427H
|
Facility
|
OP
|
$37.50
|
|
| Hospital Charge Code |
41601147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Centivo All Commercial |
$20.40
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Lucent All Commercial |
$20.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.88
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
| Rate for Payer: United Healthcare Medicare |
$12.00
|
|
|
HC SUTURE MONOCRYL 3-0 STRFIX 101
|
Facility
|
OP
|
$124.89
|
|
| Hospital Charge Code |
41607488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Aetna Commercial |
$105.41
|
| Rate for Payer: Aetna Medicare |
$39.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$71.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$78.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.96
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Centivo All Commercial |
$67.94
|
| Rate for Payer: Cigna All Commercial |
$107.78
|
| Rate for Payer: CORVEL All Commercial |
$116.15
|
| Rate for Payer: Coventry All Commercial |
$109.90
|
| Rate for Payer: Encore All Commercial |
$114.96
|
| Rate for Payer: Frontpath All Commercial |
$114.90
|
| Rate for Payer: Humana ChoiceCare |
$107.87
|
| Rate for Payer: Humana Medicare |
$39.96
|
| Rate for Payer: Lucent All Commercial |
$67.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.40
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$93.67
|
| Rate for Payer: PHP All Commercial |
$94.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.71
|
| Rate for Payer: Sagamore Health Network All Products |
$96.42
|
| Rate for Payer: Signature Care EPO |
$103.66
|
| Rate for Payer: Signature Care PPO |
$109.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$106.16
|
| Rate for Payer: United Healthcare Commercial |
$98.41
|
| Rate for Payer: United Healthcare Medicare |
$39.96
|
|
|
HC SUTURE MONOCRYL 3-0 STRFIX 101
|
Facility
|
IP
|
$124.89
|
|
| Hospital Charge Code |
41607488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$116.15 |
| Rate for Payer: Aetna Commercial |
$107.90
|
| Rate for Payer: Cash Price |
$74.93
|
| Rate for Payer: Cigna All Commercial |
$107.78
|
| Rate for Payer: CORVEL All Commercial |
$116.15
|
| Rate for Payer: Coventry All Commercial |
$109.90
|
| Rate for Payer: Encore All Commercial |
$114.96
|
| Rate for Payer: Frontpath All Commercial |
$114.90
|
| Rate for Payer: Humana ChoiceCare |
$107.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$112.40
|
| Rate for Payer: PHCS All Commercial |
$93.67
|
| Rate for Payer: PHP All Commercial |
$94.72
|
| Rate for Payer: Sagamore Health Network All Products |
$96.42
|
| Rate for Payer: Signature Care EPO |
$103.66
|
| Rate for Payer: Signature Care PPO |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$98.41
|
|
|
HC SUTURE MONOCRYL 4-0 STRFIX 117
|
Facility
|
OP
|
$106.75
|
|
| Hospital Charge Code |
41607491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.28 |
| Rate for Payer: Aetna Commercial |
$90.10
|
| Rate for Payer: Aetna Medicare |
$34.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$61.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.58
|
| Rate for Payer: Cash Price |
$64.05
|
| Rate for Payer: Cash Price |
$64.05
|
| Rate for Payer: Centivo All Commercial |
$58.07
|
| Rate for Payer: Cigna All Commercial |
$92.13
|
| Rate for Payer: CORVEL All Commercial |
$99.28
|
| Rate for Payer: Coventry All Commercial |
$93.94
|
| Rate for Payer: Encore All Commercial |
$98.26
|
| Rate for Payer: Frontpath All Commercial |
$98.21
|
| Rate for Payer: Humana ChoiceCare |
$92.20
|
| Rate for Payer: Humana Medicare |
$34.16
|
| Rate for Payer: Lucent All Commercial |
$58.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$80.06
|
| Rate for Payer: PHP All Commercial |
$80.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.63
|
| Rate for Payer: Sagamore Health Network All Products |
$82.41
|
| Rate for Payer: Signature Care EPO |
$88.60
|
| Rate for Payer: Signature Care PPO |
$93.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.74
|
| Rate for Payer: United Healthcare Commercial |
$84.12
|
| Rate for Payer: United Healthcare Medicare |
$34.16
|
|
