|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
OP
|
$40.37
|
|
| Hospital Charge Code |
41602403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.21
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Centivo All Commercial |
$21.96
|
| Rate for Payer: Cigna All Commercial |
$34.84
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.53
|
| Rate for Payer: Encore All Commercial |
$37.16
|
| Rate for Payer: Frontpath All Commercial |
$37.14
|
| Rate for Payer: Humana ChoiceCare |
$34.87
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Lucent All Commercial |
$21.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$30.28
|
| Rate for Payer: PHP All Commercial |
$30.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.74
|
| Rate for Payer: Sagamore Health Network All Products |
$31.17
|
| Rate for Payer: Signature Care EPO |
$33.51
|
| Rate for Payer: Signature Care PPO |
$35.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.31
|
| Rate for Payer: United Healthcare Commercial |
$31.81
|
| Rate for Payer: United Healthcare Medicare |
$12.92
|
|
|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
IP
|
$40.37
|
|
| Hospital Charge Code |
41602403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cigna All Commercial |
$34.84
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.53
|
| Rate for Payer: Encore All Commercial |
$37.16
|
| Rate for Payer: Frontpath All Commercial |
$37.14
|
| Rate for Payer: Humana ChoiceCare |
$34.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: PHCS All Commercial |
$30.28
|
| Rate for Payer: PHP All Commercial |
$30.62
|
| Rate for Payer: Sagamore Health Network All Products |
$31.17
|
| Rate for Payer: Signature Care EPO |
$33.51
|
| Rate for Payer: Signature Care PPO |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$31.81
|
|
|
HC SUTURE VICRYL 0 J287G UNDYED
|
Facility
|
IP
|
$14.47
|
|
| Hospital Charge Code |
41601566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cigna All Commercial |
$12.49
|
| Rate for Payer: CORVEL All Commercial |
$13.46
|
| Rate for Payer: Coventry All Commercial |
$12.73
|
| Rate for Payer: Encore All Commercial |
$13.32
|
| Rate for Payer: Frontpath All Commercial |
$13.31
|
| Rate for Payer: Humana ChoiceCare |
$12.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.02
|
| Rate for Payer: PHCS All Commercial |
$10.85
|
| Rate for Payer: PHP All Commercial |
$10.97
|
| Rate for Payer: Sagamore Health Network All Products |
$11.17
|
| Rate for Payer: Signature Care EPO |
$12.01
|
| Rate for Payer: Signature Care PPO |
$12.73
|
| Rate for Payer: United Healthcare Commercial |
$11.40
|
|
|
HC SUTURE VICRYL 0 J287G UNDYED
|
Facility
|
OP
|
$14.47
|
|
| Hospital Charge Code |
41601566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.09
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Centivo All Commercial |
$7.87
|
| Rate for Payer: Cigna All Commercial |
$12.49
|
| Rate for Payer: CORVEL All Commercial |
$13.46
|
| Rate for Payer: Coventry All Commercial |
$12.73
|
| Rate for Payer: Encore All Commercial |
$13.32
|
| Rate for Payer: Frontpath All Commercial |
$13.31
|
| Rate for Payer: Humana ChoiceCare |
$12.50
|
| Rate for Payer: Humana Medicare |
$4.63
|
| Rate for Payer: Lucent All Commercial |
$7.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.02
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.85
|
| Rate for Payer: PHP All Commercial |
$10.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11.17
|
| Rate for Payer: Signature Care EPO |
$12.01
|
| Rate for Payer: Signature Care PPO |
$12.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.30
|
| Rate for Payer: United Healthcare Commercial |
$11.40
|
| Rate for Payer: United Healthcare Medicare |
$4.63
|
|
|
HC SUTURE VICRYL 0 J370H
|
Facility
|
OP
|
$11.40
|
|
| Hospital Charge Code |
41603246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.01
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Centivo All Commercial |
$6.20
|
| Rate for Payer: Cigna All Commercial |
$9.84
|
| Rate for Payer: CORVEL All Commercial |
$10.60
|
| Rate for Payer: Coventry All Commercial |
$10.03
|
| Rate for Payer: Encore All Commercial |
$10.49
|
| Rate for Payer: Frontpath All Commercial |
$10.49
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Humana Medicare |
$3.65
|
| Rate for Payer: Lucent All Commercial |
$6.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.26
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.55
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.45
|
| Rate for Payer: Sagamore Health Network All Products |
$8.80
|
| Rate for Payer: Signature Care EPO |
$9.46
|
| Rate for Payer: Signature Care PPO |
$10.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.69
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
| Rate for Payer: United Healthcare Medicare |
$3.65
|
|
|
HC SUTURE VICRYL 0 J370H
|
Facility
|
IP
|
$11.40
|
|
| Hospital Charge Code |
41603246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$6.84
|
| Rate for Payer: Cigna All Commercial |
$9.84
|
| Rate for Payer: CORVEL All Commercial |
$10.60
|
| Rate for Payer: Coventry All Commercial |
$10.03
|
| Rate for Payer: Encore All Commercial |
$10.49
|
| Rate for Payer: Frontpath All Commercial |
$10.49
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.26
|
| Rate for Payer: PHCS All Commercial |
$8.55
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Sagamore Health Network All Products |
$8.80
|
| Rate for Payer: Signature Care EPO |
$9.46
|
| Rate for Payer: Signature Care PPO |
$10.03
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
|
|
HC SUTURE VICRYL 0 J376H
|
Facility
|
OP
|
$12.99
|
|
| Hospital Charge Code |
41601158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.57
|
| Rate for Payer: Cash Price |
$7.79
|
| Rate for Payer: Cash Price |
$7.79
|
| Rate for Payer: Centivo All Commercial |
$7.07
|
| Rate for Payer: Cigna All Commercial |
$11.21
|
| Rate for Payer: CORVEL All Commercial |
$12.08
|
| Rate for Payer: Coventry All Commercial |
$11.43
|
| Rate for Payer: Encore All Commercial |
$11.96
|
| Rate for Payer: Frontpath All Commercial |
$11.95
|
| Rate for Payer: Humana ChoiceCare |
$11.22
|
| Rate for Payer: Humana Medicare |
$4.16
|
| Rate for Payer: Lucent All Commercial |
$7.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.69
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.74
|
| Rate for Payer: PHP All Commercial |
$9.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.03
|
| Rate for Payer: Signature Care EPO |
$10.78
|
| Rate for Payer: Signature Care PPO |
$11.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: United Healthcare Medicare |
$4.16
|
|
|
HC SUTURE VICRYL 0 J376H
|
Facility
|
IP
|
$12.99
|
|
| Hospital Charge Code |
41601158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Cash Price |
$7.79
|
| Rate for Payer: Cigna All Commercial |
$11.21
|
| Rate for Payer: CORVEL All Commercial |
$12.08
|
| Rate for Payer: Coventry All Commercial |
$11.43
|
| Rate for Payer: Encore All Commercial |
$11.96
|
| Rate for Payer: Frontpath All Commercial |
$11.95
|
| Rate for Payer: Humana ChoiceCare |
$11.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.69
|
| Rate for Payer: PHCS All Commercial |
$9.74
|
| Rate for Payer: PHP All Commercial |
$9.85
|
| Rate for Payer: Sagamore Health Network All Products |
$10.03
|
| Rate for Payer: Signature Care EPO |
$10.78
|
| Rate for Payer: Signature Care PPO |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
|
|
HC SUTURE VICRYL 0 J946H
|
Facility
|
IP
|
$10.89
|
|
| Hospital Charge Code |
41601564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna All Commercial |
$9.40
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: Coventry All Commercial |
$9.58
|
| Rate for Payer: Encore All Commercial |
$10.02
|
| Rate for Payer: Frontpath All Commercial |
$10.02
|
| Rate for Payer: Humana ChoiceCare |
$9.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.80
|
| Rate for Payer: PHCS All Commercial |
$8.17
|
| Rate for Payer: PHP All Commercial |
$8.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8.41
|
| Rate for Payer: Signature Care EPO |
$9.04
|
| Rate for Payer: Signature Care PPO |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
|
|
HC SUTURE VICRYL 0 J946H
|
Facility
|
OP
|
$10.89
|
|
| Hospital Charge Code |
41601564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Centivo All Commercial |
$5.92
|
| Rate for Payer: Cigna All Commercial |
$9.40
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: Coventry All Commercial |
$9.58
|
| Rate for Payer: Encore All Commercial |
$10.02
|
| Rate for Payer: Frontpath All Commercial |
$10.02
|
| Rate for Payer: Humana ChoiceCare |
$9.41
|
| Rate for Payer: Humana Medicare |
$3.48
|
| Rate for Payer: Lucent All Commercial |
$5.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.17
|
| Rate for Payer: PHP All Commercial |
$8.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.25
|
| Rate for Payer: Sagamore Health Network All Products |
$8.41
|
| Rate for Payer: Signature Care EPO |
$9.04
|
| Rate for Payer: Signature Care PPO |
$9.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$3.48
|
|
|
HC SUTURE VICRYL 1 J347H
|
Facility
|
OP
|
$10.63
|
|
| Hospital Charge Code |
41601578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.97
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.74
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Centivo All Commercial |
$5.78
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana Medicare |
$3.40
|
| Rate for Payer: Lucent All Commercial |
$5.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$3.40
|
|
|
HC SUTURE VICRYL 1 J347H
|
Facility
|
IP
|
$10.63
|
|
| Hospital Charge Code |
41601578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
|
|
HC SUTURE VICRYL 2-0 417H
|
Facility
|
OP
|
$9.15
|
|
| Hospital Charge Code |
41607490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$7.72
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.22
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Centivo All Commercial |
$4.98
|
| Rate for Payer: Cigna All Commercial |
$7.90
|
| Rate for Payer: CORVEL All Commercial |
$8.51
|
| Rate for Payer: Coventry All Commercial |
$8.05
|
| Rate for Payer: Encore All Commercial |
$8.42
|
| Rate for Payer: Frontpath All Commercial |
$8.42
|
| Rate for Payer: Humana ChoiceCare |
$7.90
|
| Rate for Payer: Humana Medicare |
$2.93
|
| Rate for Payer: Lucent All Commercial |
$4.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.86
|
| Rate for Payer: PHP All Commercial |
$6.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.57
|
| Rate for Payer: Sagamore Health Network All Products |
$7.06
|
| Rate for Payer: Signature Care EPO |
$7.59
|
| Rate for Payer: Signature Care PPO |
$8.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.78
|
| Rate for Payer: United Healthcare Commercial |
$7.21
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
|
|
HC SUTURE VICRYL 2-0 417H
|
Facility
|
IP
|
$9.15
|
|
| Hospital Charge Code |
41607490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cigna All Commercial |
$7.90
|
| Rate for Payer: CORVEL All Commercial |
$8.51
|
| Rate for Payer: Coventry All Commercial |
$8.05
|
| Rate for Payer: Encore All Commercial |
$8.42
|
| Rate for Payer: Frontpath All Commercial |
$8.42
|
| Rate for Payer: Humana ChoiceCare |
$7.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.23
|
| Rate for Payer: PHCS All Commercial |
$6.86
|
| Rate for Payer: PHP All Commercial |
$6.94
|
| Rate for Payer: Sagamore Health Network All Products |
$7.06
|
| Rate for Payer: Signature Care EPO |
$7.59
|
| Rate for Payer: Signature Care PPO |
$8.05
|
| Rate for Payer: United Healthcare Commercial |
$7.21
|
|
|
HC SUTURE VICRYL 2-0 CP-1 27IN
|
Facility
|
IP
|
$11.17
|
|
| Hospital Charge Code |
41607166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
|
|
HC SUTURE VICRYL 2-0 CP-1 27IN
|
Facility
|
OP
|
$11.17
|
|
| Hospital Charge Code |
41607166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.43
|
| Rate for Payer: Aetna Medicare |
$3.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Centivo All Commercial |
$6.08
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.39
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.28
|
| Rate for Payer: Humana ChoiceCare |
$9.65
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: Lucent All Commercial |
$6.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.38
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.36
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$3.57
|
|
|
HC SUTURE VICRYL 2-0 J 259H
|
Facility
|
IP
|
$9.70
|
|
| Hospital Charge Code |
41601162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC SUTURE VICRYL 2-0 J 259H
|
Facility
|
OP
|
$9.70
|
|
| Hospital Charge Code |
41601162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$3.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Centivo All Commercial |
$5.28
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Humana Medicare |
$3.10
|
| Rate for Payer: Lucent All Commercial |
$5.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.10
|
|
|
HC SUTURE VICRYL 2-0 J339H
|
Facility
|
OP
|
$9.70
|
|
| Hospital Charge Code |
41601164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$3.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Centivo All Commercial |
$5.28
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Humana Medicare |
$3.10
|
| Rate for Payer: Lucent All Commercial |
$5.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.10
|
|
|
HC SUTURE VICRYL 2-0 J339H
|
Facility
|
IP
|
$9.70
|
|
| Hospital Charge Code |
41601164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC SUTURE VICRYL 2-0 J375H
|
Facility
|
OP
|
$12.23
|
|
| Hospital Charge Code |
41603563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Medicare |
$3.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.30
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Centivo All Commercial |
$6.65
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Lucent All Commercial |
$6.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.77
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
| Rate for Payer: United Healthcare Medicare |
$3.91
|
|
|
HC SUTURE VICRYL 2-0 J375H
|
Facility
|
IP
|
$12.23
|
|
| Hospital Charge Code |
41603563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
|
|
HC SUTURE VICRYL 2-0 J417H
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
41601165
|
|
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 VICRYL 2-0 J417H
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
41601165
|
|
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 VICRYL 3-0 J285G
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
41601593
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.80
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Centivo All Commercial |
$7.43
|
| Rate for Payer: Cigna All Commercial |
$11.78
|
| Rate for Payer: CORVEL All Commercial |
$12.69
|
| Rate for Payer: Coventry All Commercial |
$12.01
|
| Rate for Payer: Encore All Commercial |
$12.56
|
| Rate for Payer: Frontpath All Commercial |
$12.56
|
| Rate for Payer: Humana ChoiceCare |
$11.79
|
| Rate for Payer: Humana Medicare |
$4.37
|
| Rate for Payer: Lucent All Commercial |
$7.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.29
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$10.24
|
| Rate for Payer: PHP All Commercial |
$10.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.32
|
| Rate for Payer: Sagamore Health Network All Products |
$10.54
|
| Rate for Payer: Signature Care EPO |
$11.33
|
| Rate for Payer: Signature Care PPO |
$12.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$10.76
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
|
