|
HC SUTURE MONOCRYL 4-0 STRFIX 117
|
Facility
|
IP
|
$106.75
|
|
| Hospital Charge Code |
41607491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$99.28 |
| Rate for Payer: Aetna Commercial |
$92.23
|
| Rate for Payer: Cash Price |
$64.05
|
| 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: Lutheran Preferred All Commercial |
$96.08
|
| Rate for Payer: PHCS All Commercial |
$80.06
|
| Rate for Payer: PHP All Commercial |
$80.96
|
| 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: United Healthcare Commercial |
$84.12
|
|
|
HC SUTURE MONOCRYL 4-0 Y496G
|
Facility
|
OP
|
$36.89
|
|
| Hospital Charge Code |
41601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.99
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Centivo All Commercial |
$20.07
|
| Rate for Payer: Cigna All Commercial |
$31.84
|
| Rate for Payer: CORVEL All Commercial |
$34.31
|
| Rate for Payer: Coventry All Commercial |
$32.46
|
| Rate for Payer: Encore All Commercial |
$33.96
|
| Rate for Payer: Frontpath All Commercial |
$33.94
|
| Rate for Payer: Humana ChoiceCare |
$31.86
|
| Rate for Payer: Humana Medicare |
$11.80
|
| Rate for Payer: Lucent All Commercial |
$20.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$27.67
|
| Rate for Payer: PHP All Commercial |
$27.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.39
|
| Rate for Payer: Sagamore Health Network All Products |
$28.48
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$32.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.36
|
| Rate for Payer: United Healthcare Commercial |
$29.07
|
| Rate for Payer: United Healthcare Medicare |
$11.80
|
|
|
HC SUTURE MONOCRYL 4-0 Y496G
|
Facility
|
IP
|
$36.89
|
|
| Hospital Charge Code |
41601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna Commercial |
$31.87
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cigna All Commercial |
$31.84
|
| Rate for Payer: CORVEL All Commercial |
$34.31
|
| Rate for Payer: Coventry All Commercial |
$32.46
|
| Rate for Payer: Encore All Commercial |
$33.96
|
| Rate for Payer: Frontpath All Commercial |
$33.94
|
| Rate for Payer: Humana ChoiceCare |
$31.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.20
|
| Rate for Payer: PHCS All Commercial |
$27.67
|
| Rate for Payer: PHP All Commercial |
$27.98
|
| Rate for Payer: Sagamore Health Network All Products |
$28.48
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$32.46
|
| Rate for Payer: United Healthcare Commercial |
$29.07
|
|
|
HC SUTURE MONOCRYL UD 4-0 27IN
|
Facility
|
IP
|
$43.64
|
|
| Hospital Charge Code |
41607165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna Commercial |
$37.70
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cigna All Commercial |
$37.66
|
| Rate for Payer: CORVEL All Commercial |
$40.59
|
| Rate for Payer: Coventry All Commercial |
$38.40
|
| Rate for Payer: Encore All Commercial |
$40.17
|
| Rate for Payer: Frontpath All Commercial |
$40.15
|
| Rate for Payer: Humana ChoiceCare |
$37.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.28
|
| Rate for Payer: PHCS All Commercial |
$32.73
|
| Rate for Payer: PHP All Commercial |
$33.10
|
| Rate for Payer: Sagamore Health Network All Products |
$33.69
|
| Rate for Payer: Signature Care EPO |
$36.22
|
| Rate for Payer: Signature Care PPO |
$38.40
|
| Rate for Payer: United Healthcare Commercial |
$34.39
|
|
|
HC SUTURE MONOCRYL UD 4-0 27IN
|
Facility
|
OP
|
$43.64
|
|
| Hospital Charge Code |
41607165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna Commercial |
$36.83
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.36
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Centivo All Commercial |
$23.74
|
| Rate for Payer: Cigna All Commercial |
$37.66
|
| Rate for Payer: CORVEL All Commercial |
$40.59
|
| Rate for Payer: Coventry All Commercial |
$38.40
|
| Rate for Payer: Encore All Commercial |
$40.17
|
| Rate for Payer: Frontpath All Commercial |
$40.15
|
| Rate for Payer: Humana ChoiceCare |
$37.69
|
| Rate for Payer: Humana Medicare |
$13.96
|
| Rate for Payer: Lucent All Commercial |
$23.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$32.73
|
| Rate for Payer: PHP All Commercial |
$33.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.02
|
| Rate for Payer: Sagamore Health Network All Products |
$33.69
|
| Rate for Payer: Signature Care EPO |
$36.22
|
| Rate for Payer: Signature Care PPO |
$38.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.09
|
| Rate for Payer: United Healthcare Commercial |
$34.39
|
| Rate for Payer: United Healthcare Medicare |
$13.96
|
|
|
HC SUTURE NEEDLE DAVIS TONSIL 1/2 IN CIRCL
|
Facility
|
IP
|
$22.40
|
|
| Hospital Charge Code |
41601588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cigna All Commercial |
$19.33
|
| Rate for Payer: CORVEL All Commercial |
$20.83
|
| Rate for Payer: Coventry All Commercial |
$19.71
|
| Rate for Payer: Encore All Commercial |
$20.62
|
| Rate for Payer: Frontpath All Commercial |
$20.61
|
| Rate for Payer: Humana ChoiceCare |
$19.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.16
|
| Rate for Payer: PHCS All Commercial |
$16.80
|
| Rate for Payer: PHP All Commercial |
$16.99
|
| Rate for Payer: Sagamore Health Network All Products |
$17.29
|
| Rate for Payer: Signature Care EPO |
$18.59
|
| Rate for Payer: Signature Care PPO |
$19.71
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
|
|
HC SUTURE NEEDLE DAVIS TONSIL 1/2 IN CIRCL
|
Facility
|
OP
|
$22.40
|
|
| Hospital Charge Code |
41601588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.88
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Centivo All Commercial |
$12.19
|
| Rate for Payer: Cigna All Commercial |
$19.33
|
| Rate for Payer: CORVEL All Commercial |
$20.83
|
| Rate for Payer: Coventry All Commercial |
$19.71
|
| Rate for Payer: Encore All Commercial |
$20.62
|
| Rate for Payer: Frontpath All Commercial |
$20.61
|
| Rate for Payer: Humana ChoiceCare |
$19.35
|
| Rate for Payer: Humana Medicare |
$7.17
|
| Rate for Payer: Lucent All Commercial |
$12.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$16.80
|
| Rate for Payer: PHP All Commercial |
$16.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.74
|
| Rate for Payer: Sagamore Health Network All Products |
$17.29
|
| Rate for Payer: Signature Care EPO |
$18.59
|
| Rate for Payer: Signature Care PPO |
$19.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.04
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$7.17
|
|
|
HC SUTURE NEEDLE MAYO 3.5
|
Facility
|
OP
|
$33.37
|
|
| Hospital Charge Code |
41607040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.75
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Centivo All Commercial |
$18.15
|
| Rate for Payer: Cigna All Commercial |
$28.80
|
| Rate for Payer: CORVEL All Commercial |
$31.03
|
| Rate for Payer: Coventry All Commercial |
$29.37
|
| Rate for Payer: Encore All Commercial |
$30.72
|
| Rate for Payer: Frontpath All Commercial |
$30.70
|
| Rate for Payer: Humana ChoiceCare |
$28.82
|
| Rate for Payer: Humana Medicare |
$10.68
|
| Rate for Payer: Lucent All Commercial |
$18.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.03
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$25.03
|
| Rate for Payer: PHP All Commercial |
$25.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.01
|
| Rate for Payer: Sagamore Health Network All Products |
$25.76
|
| Rate for Payer: Signature Care EPO |
$27.70
|
| Rate for Payer: Signature Care PPO |
$29.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.36
|
| Rate for Payer: United Healthcare Commercial |
$26.30
|
| Rate for Payer: United Healthcare Medicare |
$10.68
|
|
|
HC SUTURE NEEDLE MAYO 3.5
|
Facility
|
IP
|
$33.37
|
|
| Hospital Charge Code |
41607040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$28.83
|
| Rate for Payer: Cash Price |
$20.02
|
| Rate for Payer: Cigna All Commercial |
$28.80
|
| Rate for Payer: CORVEL All Commercial |
$31.03
|
| Rate for Payer: Coventry All Commercial |
$29.37
|
| Rate for Payer: Encore All Commercial |
$30.72
|
| Rate for Payer: Frontpath All Commercial |
$30.70
|
| Rate for Payer: Humana ChoiceCare |
$28.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.03
|
| Rate for Payer: PHCS All Commercial |
$25.03
|
| Rate for Payer: PHP All Commercial |
$25.31
|
| Rate for Payer: Sagamore Health Network All Products |
$25.76
|
| Rate for Payer: Signature Care EPO |
$27.70
|
| Rate for Payer: Signature Care PPO |
$29.37
|
| Rate for Payer: United Healthcare Commercial |
$26.30
|
|
|
HC SUTURE PDS 1 Z341H
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
41601148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.95
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Centivo All Commercial |
$9.19
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Humana Medicare |
$5.40
|
| Rate for Payer: Lucent All Commercial |
$9.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.59
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.36
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare |
$5.40
|
|
|
HC SUTURE PDS 1 Z341H
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
41601148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.59
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
|
|
HC SUTURE PDS II 0 Z334H
|
Facility
|
OP
|
$30.75
|
|
| Hospital Charge Code |
41601517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.82
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Centivo All Commercial |
$16.73
|
| Rate for Payer: Cigna All Commercial |
$26.54
|
| Rate for Payer: CORVEL All Commercial |
$28.60
|
| Rate for Payer: Coventry All Commercial |
$27.06
|
| Rate for Payer: Encore All Commercial |
$28.31
|
| Rate for Payer: Frontpath All Commercial |
$28.29
|
| Rate for Payer: Humana ChoiceCare |
$26.56
|
| Rate for Payer: Humana Medicare |
$9.84
|
| Rate for Payer: Lucent All Commercial |
$16.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$23.06
|
| Rate for Payer: PHP All Commercial |
$23.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.99
|
| Rate for Payer: Sagamore Health Network All Products |
$23.74
|
| Rate for Payer: Signature Care EPO |
$25.52
|
| Rate for Payer: Signature Care PPO |
$27.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.14
|
| Rate for Payer: United Healthcare Commercial |
$24.23
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
|
|
HC SUTURE PDS II 0 Z334H
|
Facility
|
IP
|
$30.75
|
|
| Hospital Charge Code |
41601517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna All Commercial |
$26.54
|
| Rate for Payer: CORVEL All Commercial |
$28.60
|
| Rate for Payer: Coventry All Commercial |
$27.06
|
| Rate for Payer: Encore All Commercial |
$28.31
|
| Rate for Payer: Frontpath All Commercial |
$28.29
|
| Rate for Payer: Humana ChoiceCare |
$26.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.68
|
| Rate for Payer: PHCS All Commercial |
$23.06
|
| Rate for Payer: PHP All Commercial |
$23.32
|
| Rate for Payer: Sagamore Health Network All Products |
$23.74
|
| Rate for Payer: Signature Care EPO |
$25.52
|
| Rate for Payer: Signature Care PPO |
$27.06
|
| Rate for Payer: United Healthcare Commercial |
$24.23
|
|
|
HC SUTURE PDS II 0 Z340H
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
41601514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.83
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Centivo All Commercial |
$9.01
|
| Rate for Payer: Cigna All Commercial |
$14.29
|
| Rate for Payer: CORVEL All Commercial |
$15.40
|
| Rate for Payer: Coventry All Commercial |
$14.57
|
| Rate for Payer: Encore All Commercial |
$15.24
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Humana Medicare |
$5.30
|
| Rate for Payer: Lucent All Commercial |
$9.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.42
|
| Rate for Payer: PHP All Commercial |
$12.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.46
|
| Rate for Payer: Sagamore Health Network All Products |
$12.78
|
| Rate for Payer: Signature Care EPO |
$13.74
|
| Rate for Payer: Signature Care PPO |
$14.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$5.30
|
|
|
HC SUTURE PDS II 0 Z340H
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
41601514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cigna All Commercial |
$14.29
|
| Rate for Payer: CORVEL All Commercial |
$15.40
|
| Rate for Payer: Coventry All Commercial |
$14.57
|
| Rate for Payer: Encore All Commercial |
$15.24
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.90
|
| Rate for Payer: PHCS All Commercial |
$12.42
|
| Rate for Payer: PHP All Commercial |
$12.56
|
| Rate for Payer: Sagamore Health Network All Products |
$12.78
|
| Rate for Payer: Signature Care EPO |
$13.74
|
| Rate for Payer: Signature Care PPO |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
|
|
HC SUTURE PDS II 1 CTX Z371T
|
Facility
|
IP
|
$19.08
|
|
| Hospital Charge Code |
41607913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
|
|
HC SUTURE PDS II 1 CTX Z371T
|
Facility
|
OP
|
$19.08
|
|
| Hospital Charge Code |
41607913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.72
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: Centivo All Commercial |
$10.38
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Humana Medicare |
$6.11
|
| Rate for Payer: Lucent All Commercial |
$10.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.44
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$6.11
|
|
|
HC SUTURE PDS II 2-0 Z317H
|
Facility
|
OP
|
$13.71
|
|
| Hospital Charge Code |
41601513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.83
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Centivo All Commercial |
$7.46
|
| Rate for Payer: Cigna All Commercial |
$11.83
|
| Rate for Payer: CORVEL All Commercial |
$12.75
|
| Rate for Payer: Coventry All Commercial |
$12.06
|
| Rate for Payer: Encore All Commercial |
$12.62
|
| Rate for Payer: Frontpath All Commercial |
$12.61
|
| Rate for Payer: Humana ChoiceCare |
$11.84
|
| Rate for Payer: Humana Medicare |
$4.39
|
| Rate for Payer: Lucent All Commercial |
$7.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.34
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.28
|
| Rate for Payer: PHP All Commercial |
$10.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.35
|
| Rate for Payer: Sagamore Health Network All Products |
$10.58
|
| Rate for Payer: Signature Care EPO |
$11.38
|
| Rate for Payer: Signature Care PPO |
$12.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.65
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
| Rate for Payer: United Healthcare Medicare |
$4.39
|
|
|
HC SUTURE PDS II 2-0 Z317H
|
Facility
|
IP
|
$13.71
|
|
| Hospital Charge Code |
41601513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Aetna Commercial |
$11.85
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cigna All Commercial |
$11.83
|
| Rate for Payer: CORVEL All Commercial |
$12.75
|
| Rate for Payer: Coventry All Commercial |
$12.06
|
| Rate for Payer: Encore All Commercial |
$12.62
|
| Rate for Payer: Frontpath All Commercial |
$12.61
|
| Rate for Payer: Humana ChoiceCare |
$11.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.34
|
| Rate for Payer: PHCS All Commercial |
$10.28
|
| Rate for Payer: PHP All Commercial |
$10.40
|
| Rate for Payer: Sagamore Health Network All Products |
$10.58
|
| Rate for Payer: Signature Care EPO |
$11.38
|
| Rate for Payer: Signature Care PPO |
$12.06
|
| Rate for Payer: United Healthcare Commercial |
$10.80
|
|
|
HC SUTURE PDS II O CTX Z990G
|
Facility
|
IP
|
$36.85
|
|
| Hospital Charge Code |
41601149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Cigna All Commercial |
$31.80
|
| Rate for Payer: CORVEL All Commercial |
$34.27
|
| Rate for Payer: Coventry All Commercial |
$32.43
|
| Rate for Payer: Encore All Commercial |
$33.92
|
| Rate for Payer: Frontpath All Commercial |
$33.90
|
| Rate for Payer: Humana ChoiceCare |
$31.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.16
|
| Rate for Payer: PHCS All Commercial |
$27.64
|
| Rate for Payer: PHP All Commercial |
$27.95
|
| Rate for Payer: Sagamore Health Network All Products |
$28.45
|
| Rate for Payer: Signature Care EPO |
$30.59
|
| Rate for Payer: Signature Care PPO |
$32.43
|
| Rate for Payer: United Healthcare Commercial |
$29.04
|
|
|
HC SUTURE PDS II O CTX Z990G
|
Facility
|
OP
|
$36.85
|
|
| Hospital Charge Code |
41601149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: Aetna Commercial |
$31.10
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.97
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Cash Price |
$22.11
|
| Rate for Payer: Centivo All Commercial |
$20.05
|
| Rate for Payer: Cigna All Commercial |
$31.80
|
| Rate for Payer: CORVEL All Commercial |
$34.27
|
| Rate for Payer: Coventry All Commercial |
$32.43
|
| Rate for Payer: Encore All Commercial |
$33.92
|
| Rate for Payer: Frontpath All Commercial |
$33.90
|
| Rate for Payer: Humana ChoiceCare |
$31.83
|
| Rate for Payer: Humana Medicare |
$11.79
|
| Rate for Payer: Lucent All Commercial |
$20.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.16
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$27.64
|
| Rate for Payer: PHP All Commercial |
$27.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.37
|
| Rate for Payer: Sagamore Health Network All Products |
$28.45
|
| Rate for Payer: Signature Care EPO |
$30.59
|
| Rate for Payer: Signature Care PPO |
$32.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.32
|
| Rate for Payer: United Healthcare Commercial |
$29.04
|
| Rate for Payer: United Healthcare Medicare |
$11.79
|
|
|
HC SUTURE PDS II Z316H
|
Facility
|
IP
|
$18.19
|
|
| Hospital Charge Code |
41601516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$16.92
|
| Rate for Payer: Coventry All Commercial |
$16.01
|
| Rate for Payer: Encore All Commercial |
$16.74
|
| Rate for Payer: Frontpath All Commercial |
$16.73
|
| Rate for Payer: Humana ChoiceCare |
$15.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.37
|
| Rate for Payer: PHCS All Commercial |
$13.64
|
| Rate for Payer: PHP All Commercial |
$13.80
|
| Rate for Payer: Sagamore Health Network All Products |
$14.04
|
| Rate for Payer: Signature Care EPO |
$15.10
|
| Rate for Payer: Signature Care PPO |
$16.01
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
|
|
HC SUTURE PDS II Z316H
|
Facility
|
OP
|
$18.19
|
|
| Hospital Charge Code |
41601516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.40
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: Centivo All Commercial |
$9.90
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$16.92
|
| Rate for Payer: Coventry All Commercial |
$16.01
|
| Rate for Payer: Encore All Commercial |
$16.74
|
| Rate for Payer: Frontpath All Commercial |
$16.73
|
| Rate for Payer: Humana ChoiceCare |
$15.71
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Lucent All Commercial |
$9.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.37
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.64
|
| Rate for Payer: PHP All Commercial |
$13.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.09
|
| Rate for Payer: Sagamore Health Network All Products |
$14.04
|
| Rate for Payer: Signature Care EPO |
$15.10
|
| Rate for Payer: Signature Care PPO |
$16.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$5.82
|
|
|
HC SUTURE PDS II Z880G
|
Facility
|
IP
|
$34.83
|
|
| Hospital Charge Code |
41601515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$32.39 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cigna All Commercial |
$30.06
|
| Rate for Payer: CORVEL All Commercial |
$32.39
|
| Rate for Payer: Coventry All Commercial |
$30.65
|
| Rate for Payer: Encore All Commercial |
$32.06
|
| Rate for Payer: Frontpath All Commercial |
$32.04
|
| Rate for Payer: Humana ChoiceCare |
$30.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.35
|
| Rate for Payer: PHCS All Commercial |
$26.12
|
| Rate for Payer: PHP All Commercial |
$26.42
|
| Rate for Payer: Sagamore Health Network All Products |
$26.89
|
| Rate for Payer: Signature Care EPO |
$28.91
|
| Rate for Payer: Signature Care PPO |
$30.65
|
| Rate for Payer: United Healthcare Commercial |
$27.45
|
|
|
HC SUTURE PDS II Z880G
|
Facility
|
OP
|
$34.83
|
|
| Hospital Charge Code |
41601515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$32.39 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.26
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Centivo All Commercial |
$18.95
|
| Rate for Payer: Cigna All Commercial |
$30.06
|
| Rate for Payer: CORVEL All Commercial |
$32.39
|
| Rate for Payer: Coventry All Commercial |
$30.65
|
| Rate for Payer: Encore All Commercial |
$32.06
|
| Rate for Payer: Frontpath All Commercial |
$32.04
|
| Rate for Payer: Humana ChoiceCare |
$30.08
|
| Rate for Payer: Humana Medicare |
$11.15
|
| Rate for Payer: Lucent All Commercial |
$18.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.12
|
| Rate for Payer: PHP All Commercial |
$26.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.58
|
| Rate for Payer: Sagamore Health Network All Products |
$26.89
|
| Rate for Payer: Signature Care EPO |
$28.91
|
| Rate for Payer: Signature Care PPO |
$30.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.61
|
| Rate for Payer: United Healthcare Commercial |
$27.45
|
| Rate for Payer: United Healthcare Medicare |
$11.15
|
|
