|
HC SUTURE PDS PLUS 1 A205
|
Facility
|
IP
|
$184.56
|
|
| Hospital Charge Code |
41607489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.42 |
| Max. Negotiated Rate |
$171.64 |
| Rate for Payer: Aetna Commercial |
$159.46
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cigna All Commercial |
$159.28
|
| Rate for Payer: CORVEL All Commercial |
$171.64
|
| Rate for Payer: Coventry All Commercial |
$162.41
|
| Rate for Payer: Encore All Commercial |
$169.89
|
| Rate for Payer: Frontpath All Commercial |
$169.80
|
| Rate for Payer: Humana ChoiceCare |
$159.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.10
|
| Rate for Payer: PHCS All Commercial |
$138.42
|
| Rate for Payer: PHP All Commercial |
$139.97
|
| Rate for Payer: Sagamore Health Network All Products |
$142.48
|
| Rate for Payer: Signature Care EPO |
$153.18
|
| Rate for Payer: Signature Care PPO |
$162.41
|
| Rate for Payer: United Healthcare Commercial |
$145.43
|
|
|
HC SUTURE PDS PLUS 1 A205
|
Facility
|
OP
|
$184.56
|
|
| Hospital Charge Code |
41607489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$171.64 |
| Rate for Payer: Aetna Commercial |
$155.77
|
| Rate for Payer: Aetna Medicare |
$59.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.97
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Centivo All Commercial |
$100.40
|
| Rate for Payer: Cigna All Commercial |
$159.28
|
| Rate for Payer: CORVEL All Commercial |
$171.64
|
| Rate for Payer: Coventry All Commercial |
$162.41
|
| Rate for Payer: Encore All Commercial |
$169.89
|
| Rate for Payer: Frontpath All Commercial |
$169.80
|
| Rate for Payer: Humana ChoiceCare |
$159.40
|
| Rate for Payer: Humana Medicare |
$59.06
|
| Rate for Payer: Lucent All Commercial |
$100.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.10
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$138.42
|
| Rate for Payer: PHP All Commercial |
$139.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.98
|
| Rate for Payer: Sagamore Health Network All Products |
$142.48
|
| Rate for Payer: Signature Care EPO |
$153.18
|
| Rate for Payer: Signature Care PPO |
$162.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.88
|
| Rate for Payer: United Healthcare Commercial |
$145.43
|
| Rate for Payer: United Healthcare Medicare |
$59.06
|
|
|
HC SUTURE PLAIN GUT 2-0 H823H
|
Facility
|
IP
|
$20.59
|
|
| Hospital Charge Code |
41601151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$19.15 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: Cigna All Commercial |
$17.77
|
| Rate for Payer: CORVEL All Commercial |
$19.15
|
| Rate for Payer: Coventry All Commercial |
$18.12
|
| Rate for Payer: Encore All Commercial |
$18.95
|
| Rate for Payer: Frontpath All Commercial |
$18.94
|
| Rate for Payer: Humana ChoiceCare |
$17.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.53
|
| Rate for Payer: PHCS All Commercial |
$15.44
|
| Rate for Payer: PHP All Commercial |
$15.62
|
| Rate for Payer: Sagamore Health Network All Products |
$15.90
|
| Rate for Payer: Signature Care EPO |
$17.09
|
| Rate for Payer: Signature Care PPO |
$18.12
|
| Rate for Payer: United Healthcare Commercial |
$16.22
|
|
|
HC SUTURE PLAIN GUT 2-0 H823H
|
Facility
|
OP
|
$20.59
|
|
| Hospital Charge Code |
41601151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.25
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: Centivo All Commercial |
$11.20
|
| Rate for Payer: Cigna All Commercial |
$17.77
|
| Rate for Payer: CORVEL All Commercial |
$19.15
|
| Rate for Payer: Coventry All Commercial |
$18.12
|
| Rate for Payer: Encore All Commercial |
$18.95
|
| Rate for Payer: Frontpath All Commercial |
$18.94
|
| Rate for Payer: Humana ChoiceCare |
$17.78
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Lucent All Commercial |
$11.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.53
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$15.44
|
| Rate for Payer: PHP All Commercial |
$15.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.03
|
| Rate for Payer: Sagamore Health Network All Products |
$15.90
|
| Rate for Payer: Signature Care EPO |
$17.09
|
| Rate for Payer: Signature Care PPO |
$18.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$16.22
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
|
|
HC SUTURE PROLENE 0 8412H
|
Facility
|
IP
|
$13.53
|
|
| Hospital Charge Code |
41601580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cigna All Commercial |
$11.68
|
| Rate for Payer: CORVEL All Commercial |
$12.58
|
| Rate for Payer: Coventry All Commercial |
$11.91
|
| Rate for Payer: Encore All Commercial |
$12.45
|
| Rate for Payer: Frontpath All Commercial |
$12.45
|
| Rate for Payer: Humana ChoiceCare |
$11.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.18
|
| Rate for Payer: PHCS All Commercial |
$10.15
|
| Rate for Payer: PHP All Commercial |
$10.26
|
| Rate for Payer: Sagamore Health Network All Products |
$10.45
|
| Rate for Payer: Signature Care EPO |
$11.23
|
| Rate for Payer: Signature Care PPO |
$11.91
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
|
|
HC SUTURE PROLENE 0 8412H
|
Facility
|
OP
|
$13.53
|
|
| Hospital Charge Code |
41601580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.76
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Centivo All Commercial |
$7.36
|
| Rate for Payer: Cigna All Commercial |
$11.68
|
| Rate for Payer: CORVEL All Commercial |
$12.58
|
| Rate for Payer: Coventry All Commercial |
$11.91
|
| Rate for Payer: Encore All Commercial |
$12.45
|
| Rate for Payer: Frontpath All Commercial |
$12.45
|
| Rate for Payer: Humana ChoiceCare |
$11.69
|
| Rate for Payer: Humana Medicare |
$4.33
|
| Rate for Payer: Lucent All Commercial |
$7.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.18
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$10.15
|
| Rate for Payer: PHP All Commercial |
$10.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.28
|
| Rate for Payer: Sagamore Health Network All Products |
$10.45
|
| Rate for Payer: Signature Care EPO |
$11.23
|
| Rate for Payer: Signature Care PPO |
$11.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.50
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
|
|
HC SUTURE PROLENE 0 8418H
|
Facility
|
IP
|
$17.47
|
|
| Hospital Charge Code |
41601525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$15.08
|
| Rate for Payer: CORVEL All Commercial |
$16.25
|
| Rate for Payer: Coventry All Commercial |
$15.37
|
| Rate for Payer: Encore All Commercial |
$16.08
|
| Rate for Payer: Frontpath All Commercial |
$16.07
|
| Rate for Payer: Humana ChoiceCare |
$15.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.72
|
| Rate for Payer: PHCS All Commercial |
$13.10
|
| Rate for Payer: PHP All Commercial |
$13.25
|
| Rate for Payer: Sagamore Health Network All Products |
$13.49
|
| Rate for Payer: Signature Care EPO |
$14.50
|
| Rate for Payer: Signature Care PPO |
$15.37
|
| Rate for Payer: United Healthcare Commercial |
$13.77
|
|
|
HC SUTURE PROLENE 0 8418H
|
Facility
|
OP
|
$17.47
|
|
| Hospital Charge Code |
41601525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.74
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.15
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Centivo All Commercial |
$9.50
|
| Rate for Payer: Cigna All Commercial |
$15.08
|
| Rate for Payer: CORVEL All Commercial |
$16.25
|
| Rate for Payer: Coventry All Commercial |
$15.37
|
| Rate for Payer: Encore All Commercial |
$16.08
|
| Rate for Payer: Frontpath All Commercial |
$16.07
|
| Rate for Payer: Humana ChoiceCare |
$15.09
|
| Rate for Payer: Humana Medicare |
$5.59
|
| Rate for Payer: Lucent All Commercial |
$9.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.10
|
| Rate for Payer: PHP All Commercial |
$13.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.81
|
| Rate for Payer: Sagamore Health Network All Products |
$13.49
|
| Rate for Payer: Signature Care EPO |
$14.50
|
| Rate for Payer: Signature Care PPO |
$15.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.85
|
| Rate for Payer: United Healthcare Commercial |
$13.77
|
| Rate for Payer: United Healthcare Medicare |
$5.59
|
|
|
HC SUTURE PROLENE 0 8444H
|
Facility
|
IP
|
$14.13
|
|
| Hospital Charge Code |
41601598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$13.14 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cigna All Commercial |
$12.19
|
| Rate for Payer: CORVEL All Commercial |
$13.14
|
| Rate for Payer: Coventry All Commercial |
$12.43
|
| Rate for Payer: Encore All Commercial |
$13.01
|
| Rate for Payer: Frontpath All Commercial |
$13.00
|
| Rate for Payer: Humana ChoiceCare |
$12.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.72
|
| Rate for Payer: PHCS All Commercial |
$10.60
|
| Rate for Payer: PHP All Commercial |
$10.72
|
| Rate for Payer: Sagamore Health Network All Products |
$10.91
|
| Rate for Payer: Signature Care EPO |
$11.73
|
| Rate for Payer: Signature Care PPO |
$12.43
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
|
|
HC SUTURE PROLENE 0 8444H
|
Facility
|
OP
|
$14.13
|
|
| Hospital Charge Code |
41601598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.97
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Cash Price |
$8.48
|
| Rate for Payer: Centivo All Commercial |
$7.69
|
| Rate for Payer: Cigna All Commercial |
$12.19
|
| Rate for Payer: CORVEL All Commercial |
$13.14
|
| Rate for Payer: Coventry All Commercial |
$12.43
|
| Rate for Payer: Encore All Commercial |
$13.01
|
| Rate for Payer: Frontpath All Commercial |
$13.00
|
| Rate for Payer: Humana ChoiceCare |
$12.20
|
| Rate for Payer: Humana Medicare |
$4.52
|
| Rate for Payer: Lucent All Commercial |
$7.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.72
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.60
|
| Rate for Payer: PHP All Commercial |
$10.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.51
|
| Rate for Payer: Sagamore Health Network All Products |
$10.91
|
| Rate for Payer: Signature Care EPO |
$11.73
|
| Rate for Payer: Signature Care PPO |
$12.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$11.13
|
| Rate for Payer: United Healthcare Medicare |
$4.52
|
|
|
HC SUTURE PROLENE 0 C845G
|
Facility
|
IP
|
$105.67
|
|
| Hospital Charge Code |
41601152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Aetna Commercial |
$91.30
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cigna All Commercial |
$91.19
|
| Rate for Payer: CORVEL All Commercial |
$98.27
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Encore All Commercial |
$97.27
|
| Rate for Payer: Frontpath All Commercial |
$97.22
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.10
|
| Rate for Payer: PHCS All Commercial |
$79.25
|
| Rate for Payer: PHP All Commercial |
$80.14
|
| Rate for Payer: Sagamore Health Network All Products |
$81.58
|
| Rate for Payer: Signature Care EPO |
$87.71
|
| Rate for Payer: Signature Care PPO |
$92.99
|
| Rate for Payer: United Healthcare Commercial |
$83.27
|
|
|
HC SUTURE PROLENE 0 C845G
|
Facility
|
OP
|
$105.67
|
|
| Hospital Charge Code |
41601152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$60.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.20
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Cash Price |
$63.40
|
| Rate for Payer: Centivo All Commercial |
$57.48
|
| Rate for Payer: Cigna All Commercial |
$91.19
|
| Rate for Payer: CORVEL All Commercial |
$98.27
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Encore All Commercial |
$97.27
|
| Rate for Payer: Frontpath All Commercial |
$97.22
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Humana Medicare |
$33.81
|
| Rate for Payer: Lucent All Commercial |
$57.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.10
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$79.25
|
| Rate for Payer: PHP All Commercial |
$80.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.21
|
| Rate for Payer: Sagamore Health Network All Products |
$81.58
|
| Rate for Payer: Signature Care EPO |
$87.71
|
| Rate for Payer: Signature Care PPO |
$92.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.82
|
| Rate for Payer: United Healthcare Commercial |
$83.27
|
| Rate for Payer: United Healthcare Medicare |
$33.81
|
|
|
HC SUTURE PROLENE 2-0 8833H
|
Facility
|
OP
|
$17.83
|
|
| Hospital Charge Code |
41601579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.28
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Centivo All Commercial |
$9.70
|
| Rate for Payer: Cigna All Commercial |
$15.39
|
| Rate for Payer: CORVEL All Commercial |
$16.58
|
| Rate for Payer: Coventry All Commercial |
$15.69
|
| Rate for Payer: Encore All Commercial |
$16.41
|
| Rate for Payer: Frontpath All Commercial |
$16.40
|
| Rate for Payer: Humana ChoiceCare |
$15.40
|
| Rate for Payer: Humana Medicare |
$5.71
|
| Rate for Payer: Lucent All Commercial |
$9.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$13.37
|
| Rate for Payer: PHP All Commercial |
$13.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.95
|
| Rate for Payer: Sagamore Health Network All Products |
$13.76
|
| Rate for Payer: Signature Care EPO |
$14.80
|
| Rate for Payer: Signature Care PPO |
$15.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.16
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$5.71
|
|
|
HC SUTURE PROLENE 2-0 8833H
|
Facility
|
IP
|
$17.83
|
|
| Hospital Charge Code |
41601579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$16.58 |
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cigna All Commercial |
$15.39
|
| Rate for Payer: CORVEL All Commercial |
$16.58
|
| Rate for Payer: Coventry All Commercial |
$15.69
|
| Rate for Payer: Encore All Commercial |
$16.41
|
| Rate for Payer: Frontpath All Commercial |
$16.40
|
| Rate for Payer: Humana ChoiceCare |
$15.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.05
|
| Rate for Payer: PHCS All Commercial |
$13.37
|
| Rate for Payer: PHP All Commercial |
$13.52
|
| Rate for Payer: Sagamore Health Network All Products |
$13.76
|
| Rate for Payer: Signature Care EPO |
$14.80
|
| Rate for Payer: Signature Care PPO |
$15.69
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
|
|
HC SUTURE PROLENE 3-0 8675H
|
Facility
|
IP
|
$17.17
|
|
| Hospital Charge Code |
41601482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cigna All Commercial |
$14.82
|
| Rate for Payer: CORVEL All Commercial |
$15.97
|
| Rate for Payer: Coventry All Commercial |
$15.11
|
| Rate for Payer: Encore All Commercial |
$15.80
|
| Rate for Payer: Frontpath All Commercial |
$15.80
|
| Rate for Payer: Humana ChoiceCare |
$14.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.45
|
| Rate for Payer: PHCS All Commercial |
$12.88
|
| Rate for Payer: PHP All Commercial |
$13.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.26
|
| Rate for Payer: Signature Care EPO |
$14.25
|
| Rate for Payer: Signature Care PPO |
$15.11
|
| Rate for Payer: United Healthcare Commercial |
$13.53
|
|
|
HC SUTURE PROLENE 3-0 8675H
|
Facility
|
OP
|
$17.17
|
|
| Hospital Charge Code |
41601482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Centivo All Commercial |
$9.34
|
| Rate for Payer: Cigna All Commercial |
$14.82
|
| Rate for Payer: CORVEL All Commercial |
$15.97
|
| Rate for Payer: Coventry All Commercial |
$15.11
|
| Rate for Payer: Encore All Commercial |
$15.80
|
| Rate for Payer: Frontpath All Commercial |
$15.80
|
| Rate for Payer: Humana ChoiceCare |
$14.83
|
| Rate for Payer: Humana Medicare |
$5.49
|
| Rate for Payer: Lucent All Commercial |
$9.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.45
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.88
|
| Rate for Payer: PHP All Commercial |
$13.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.70
|
| Rate for Payer: Sagamore Health Network All Products |
$13.26
|
| Rate for Payer: Signature Care EPO |
$14.25
|
| Rate for Payer: Signature Care PPO |
$15.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.59
|
| Rate for Payer: United Healthcare Commercial |
$13.53
|
| Rate for Payer: United Healthcare Medicare |
$5.49
|
|
|
HC SUTURE PROLENE 3-0 8687H
|
Facility
|
OP
|
$29.59
|
|
| Hospital Charge Code |
41601528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.42
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Centivo All Commercial |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$25.54
|
| Rate for Payer: CORVEL All Commercial |
$27.52
|
| Rate for Payer: Coventry All Commercial |
$26.04
|
| Rate for Payer: Encore All Commercial |
$27.24
|
| Rate for Payer: Frontpath All Commercial |
$27.22
|
| Rate for Payer: Humana ChoiceCare |
$25.56
|
| Rate for Payer: Humana Medicare |
$9.47
|
| Rate for Payer: Lucent All Commercial |
$16.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.63
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$22.19
|
| Rate for Payer: PHP All Commercial |
$22.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.54
|
| Rate for Payer: Sagamore Health Network All Products |
$22.84
|
| Rate for Payer: Signature Care EPO |
$24.56
|
| Rate for Payer: Signature Care PPO |
$26.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.15
|
| Rate for Payer: United Healthcare Commercial |
$23.32
|
| Rate for Payer: United Healthcare Medicare |
$9.47
|
|
|
HC SUTURE PROLENE 3-0 8687H
|
Facility
|
IP
|
$29.59
|
|
| Hospital Charge Code |
41601528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.19 |
| Max. Negotiated Rate |
$27.52 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna All Commercial |
$25.54
|
| Rate for Payer: CORVEL All Commercial |
$27.52
|
| Rate for Payer: Coventry All Commercial |
$26.04
|
| Rate for Payer: Encore All Commercial |
$27.24
|
| Rate for Payer: Frontpath All Commercial |
$27.22
|
| Rate for Payer: Humana ChoiceCare |
$25.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.63
|
| Rate for Payer: PHCS All Commercial |
$22.19
|
| Rate for Payer: PHP All Commercial |
$22.44
|
| Rate for Payer: Sagamore Health Network All Products |
$22.84
|
| Rate for Payer: Signature Care EPO |
$24.56
|
| Rate for Payer: Signature Care PPO |
$26.04
|
| Rate for Payer: United Healthcare Commercial |
$23.32
|
|
|
HC SUTURE PROLENE 4-0 8682H
|
Facility
|
IP
|
$39.18
|
|
| Hospital Charge Code |
41601153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$36.44 |
| Rate for Payer: Aetna Commercial |
$33.85
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cigna All Commercial |
$33.81
|
| Rate for Payer: CORVEL All Commercial |
$36.44
|
| Rate for Payer: Coventry All Commercial |
$34.48
|
| Rate for Payer: Encore All Commercial |
$36.07
|
| Rate for Payer: Frontpath All Commercial |
$36.05
|
| Rate for Payer: Humana ChoiceCare |
$33.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.26
|
| Rate for Payer: PHCS All Commercial |
$29.39
|
| Rate for Payer: PHP All Commercial |
$29.71
|
| Rate for Payer: Sagamore Health Network All Products |
$30.25
|
| Rate for Payer: Signature Care EPO |
$32.52
|
| Rate for Payer: Signature Care PPO |
$34.48
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
|
|
HC SUTURE PROLENE 4-0 8682H
|
Facility
|
OP
|
$39.18
|
|
| Hospital Charge Code |
41601153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$36.44 |
| Rate for Payer: Aetna Commercial |
$33.07
|
| Rate for Payer: Aetna Medicare |
$12.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Centivo All Commercial |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$33.81
|
| Rate for Payer: CORVEL All Commercial |
$36.44
|
| Rate for Payer: Coventry All Commercial |
$34.48
|
| Rate for Payer: Encore All Commercial |
$36.07
|
| Rate for Payer: Frontpath All Commercial |
$36.05
|
| Rate for Payer: Humana ChoiceCare |
$33.84
|
| Rate for Payer: Humana Medicare |
$12.54
|
| Rate for Payer: Lucent All Commercial |
$21.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.26
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$29.39
|
| Rate for Payer: PHP All Commercial |
$29.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.28
|
| Rate for Payer: Sagamore Health Network All Products |
$30.25
|
| Rate for Payer: Signature Care EPO |
$32.52
|
| Rate for Payer: Signature Care PPO |
$34.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
|
|
HC SUTURE PROLENE 5-0 8630G
|
Facility
|
IP
|
$42.48
|
|
| Hospital Charge Code |
41601154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$39.51 |
| Rate for Payer: Aetna Commercial |
$36.70
|
| Rate for Payer: Cash Price |
$25.49
|
| Rate for Payer: Cigna All Commercial |
$36.66
|
| Rate for Payer: CORVEL All Commercial |
$39.51
|
| Rate for Payer: Coventry All Commercial |
$37.38
|
| Rate for Payer: Encore All Commercial |
$39.10
|
| Rate for Payer: Frontpath All Commercial |
$39.08
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.23
|
| Rate for Payer: PHCS All Commercial |
$31.86
|
| Rate for Payer: PHP All Commercial |
$32.22
|
| Rate for Payer: Sagamore Health Network All Products |
$32.79
|
| Rate for Payer: Signature Care EPO |
$35.26
|
| Rate for Payer: Signature Care PPO |
$37.38
|
| Rate for Payer: United Healthcare Commercial |
$33.47
|
|
|
HC SUTURE PROLENE 5-0 8630G
|
Facility
|
OP
|
$42.48
|
|
| Hospital Charge Code |
41601154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$39.51 |
| Rate for Payer: Aetna Commercial |
$35.85
|
| Rate for Payer: Aetna Medicare |
$13.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.95
|
| Rate for Payer: Cash Price |
$25.49
|
| Rate for Payer: Cash Price |
$25.49
|
| Rate for Payer: Centivo All Commercial |
$23.11
|
| Rate for Payer: Cigna All Commercial |
$36.66
|
| Rate for Payer: CORVEL All Commercial |
$39.51
|
| Rate for Payer: Coventry All Commercial |
$37.38
|
| Rate for Payer: Encore All Commercial |
$39.10
|
| Rate for Payer: Frontpath All Commercial |
$39.08
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare |
$13.59
|
| Rate for Payer: Lucent All Commercial |
$23.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.86
|
| Rate for Payer: PHP All Commercial |
$32.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.57
|
| Rate for Payer: Sagamore Health Network All Products |
$32.79
|
| Rate for Payer: Signature Care EPO |
$35.26
|
| Rate for Payer: Signature Care PPO |
$37.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.11
|
| Rate for Payer: United Healthcare Commercial |
$33.47
|
| Rate for Payer: United Healthcare Medicare |
$13.59
|
|
|
HC SUTURE PROLENE 5-0 9702H
|
Facility
|
OP
|
$129.48
|
|
| Hospital Charge Code |
41601532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Aetna Commercial |
$109.28
|
| Rate for Payer: Aetna Medicare |
$41.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.58
|
| Rate for Payer: Cash Price |
$77.69
|
| Rate for Payer: Cash Price |
$77.69
|
| Rate for Payer: Centivo All Commercial |
$70.44
|
| Rate for Payer: Cigna All Commercial |
$111.74
|
| Rate for Payer: CORVEL All Commercial |
$120.42
|
| Rate for Payer: Coventry All Commercial |
$113.94
|
| Rate for Payer: Encore All Commercial |
$119.19
|
| Rate for Payer: Frontpath All Commercial |
$119.12
|
| Rate for Payer: Humana ChoiceCare |
$111.83
|
| Rate for Payer: Humana Medicare |
$41.43
|
| Rate for Payer: Lucent All Commercial |
$70.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.53
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$97.11
|
| Rate for Payer: PHP All Commercial |
$98.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.50
|
| Rate for Payer: Sagamore Health Network All Products |
$99.96
|
| Rate for Payer: Signature Care EPO |
$107.47
|
| Rate for Payer: Signature Care PPO |
$113.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.06
|
| Rate for Payer: United Healthcare Commercial |
$102.03
|
| Rate for Payer: United Healthcare Medicare |
$41.43
|
|
|
HC SUTURE PROLENE 5-0 9702H
|
Facility
|
IP
|
$129.48
|
|
| Hospital Charge Code |
41601532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.11 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Cash Price |
$77.69
|
| Rate for Payer: Cigna All Commercial |
$111.74
|
| Rate for Payer: CORVEL All Commercial |
$120.42
|
| Rate for Payer: Coventry All Commercial |
$113.94
|
| Rate for Payer: Encore All Commercial |
$119.19
|
| Rate for Payer: Frontpath All Commercial |
$119.12
|
| Rate for Payer: Humana ChoiceCare |
$111.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.53
|
| Rate for Payer: PHCS All Commercial |
$97.11
|
| Rate for Payer: PHP All Commercial |
$98.20
|
| Rate for Payer: Sagamore Health Network All Products |
$99.96
|
| Rate for Payer: Signature Care EPO |
$107.47
|
| Rate for Payer: Signature Care PPO |
$113.94
|
| Rate for Payer: United Healthcare Commercial |
$102.03
|
|
|
HC SUTURE PROLENE 6-0 8680G
|
Facility
|
IP
|
$40.63
|
|
| Hospital Charge Code |
41601524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$37.79 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: Cigna All Commercial |
$35.06
|
| Rate for Payer: CORVEL All Commercial |
$37.79
|
| Rate for Payer: Coventry All Commercial |
$35.75
|
| Rate for Payer: Encore All Commercial |
$37.40
|
| Rate for Payer: Frontpath All Commercial |
$37.38
|
| Rate for Payer: Humana ChoiceCare |
$35.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.57
|
| Rate for Payer: PHCS All Commercial |
$30.47
|
| Rate for Payer: PHP All Commercial |
$30.81
|
| Rate for Payer: Sagamore Health Network All Products |
$31.37
|
| Rate for Payer: Signature Care EPO |
$33.72
|
| Rate for Payer: Signature Care PPO |
$35.75
|
| Rate for Payer: United Healthcare Commercial |
$32.02
|
|
