|
HC SUTURE VICRYL 3-0 J285G
|
Facility
|
IP
|
$13.65
|
|
| Hospital Charge Code |
41601593
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$8.19
|
| 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: Lutheran Preferred All Commercial |
$12.29
|
| Rate for Payer: PHCS All Commercial |
$10.24
|
| Rate for Payer: PHP All Commercial |
$10.35
|
| 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: United Healthcare Commercial |
$10.76
|
|
|
HC SUTURE VICRYL 3-0 J316H
|
Facility
|
OP
|
$16.24
|
|
| Hospital Charge Code |
41601554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.72
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Centivo All Commercial |
$8.83
|
| Rate for Payer: Cigna All Commercial |
$14.02
|
| Rate for Payer: CORVEL All Commercial |
$15.10
|
| Rate for Payer: Coventry All Commercial |
$14.29
|
| Rate for Payer: Encore All Commercial |
$14.95
|
| Rate for Payer: Frontpath All Commercial |
$14.94
|
| Rate for Payer: Humana ChoiceCare |
$14.03
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Lucent All Commercial |
$8.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.62
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$12.18
|
| Rate for Payer: PHP All Commercial |
$12.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.33
|
| Rate for Payer: Sagamore Health Network All Products |
$12.54
|
| Rate for Payer: Signature Care EPO |
$13.48
|
| Rate for Payer: Signature Care PPO |
$14.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.80
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
|
|
HC SUTURE VICRYL 3-0 J316H
|
Facility
|
IP
|
$16.24
|
|
| Hospital Charge Code |
41601554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cigna All Commercial |
$14.02
|
| Rate for Payer: CORVEL All Commercial |
$15.10
|
| Rate for Payer: Coventry All Commercial |
$14.29
|
| Rate for Payer: Encore All Commercial |
$14.95
|
| Rate for Payer: Frontpath All Commercial |
$14.94
|
| Rate for Payer: Humana ChoiceCare |
$14.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.62
|
| Rate for Payer: PHCS All Commercial |
$12.18
|
| Rate for Payer: PHP All Commercial |
$12.32
|
| Rate for Payer: Sagamore Health Network All Products |
$12.54
|
| Rate for Payer: Signature Care EPO |
$13.48
|
| Rate for Payer: Signature Care PPO |
$14.29
|
| Rate for Payer: United Healthcare Commercial |
$12.80
|
|
|
HC SUTURE VICRYL 3-0 UNDYED J416H
|
Facility
|
OP
|
$10.33
|
|
| Hospital Charge Code |
41601168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.64
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Centivo All Commercial |
$5.62
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Humana Medicare |
$3.31
|
| Rate for Payer: Lucent All Commercial |
$5.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.03
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
| Rate for Payer: United Healthcare Medicare |
$3.31
|
|
|
HC SUTURE VICRYL 3-0 UNDYED J416H
|
Facility
|
IP
|
$10.33
|
|
| Hospital Charge Code |
41601168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
|
|
HC SUTURE VICRYL 3-0 UNDYED PS2 J497H
|
Facility
|
IP
|
$27.09
|
|
| Hospital Charge Code |
41601169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
|
|
HC SUTURE VICRYL 3-0 UNDYED PS2 J497H
|
Facility
|
OP
|
$27.09
|
|
| Hospital Charge Code |
41601169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$8.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.54
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Centivo All Commercial |
$14.74
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Humana Medicare |
$8.67
|
| Rate for Payer: Lucent All Commercial |
$14.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.57
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
|
|
HC SUTURE VICRYL 3-0 V34 J516H
|
Facility
|
IP
|
$17.20
|
|
| Hospital Charge Code |
41601166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cigna All Commercial |
$14.84
|
| Rate for Payer: CORVEL All Commercial |
$16.00
|
| Rate for Payer: Coventry All Commercial |
$15.14
|
| Rate for Payer: Encore All Commercial |
$15.83
|
| Rate for Payer: Frontpath All Commercial |
$15.82
|
| Rate for Payer: Humana ChoiceCare |
$14.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.48
|
| Rate for Payer: PHCS All Commercial |
$12.90
|
| Rate for Payer: PHP All Commercial |
$13.04
|
| Rate for Payer: Sagamore Health Network All Products |
$13.28
|
| Rate for Payer: Signature Care EPO |
$14.28
|
| Rate for Payer: Signature Care PPO |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
|
|
HC SUTURE VICRYL 3-0 V34 J516H
|
Facility
|
OP
|
$17.20
|
|
| Hospital Charge Code |
41601166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$14.52
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.05
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centivo All Commercial |
$9.36
|
| Rate for Payer: Cigna All Commercial |
$14.84
|
| Rate for Payer: CORVEL All Commercial |
$16.00
|
| Rate for Payer: Coventry All Commercial |
$15.14
|
| Rate for Payer: Encore All Commercial |
$15.83
|
| Rate for Payer: Frontpath All Commercial |
$15.82
|
| Rate for Payer: Humana ChoiceCare |
$14.86
|
| Rate for Payer: Humana Medicare |
$5.50
|
| Rate for Payer: Lucent All Commercial |
$9.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.48
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$12.90
|
| Rate for Payer: PHP All Commercial |
$13.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.71
|
| Rate for Payer: Sagamore Health Network All Products |
$13.28
|
| Rate for Payer: Signature Care EPO |
$14.28
|
| Rate for Payer: Signature Care PPO |
$15.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.62
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
| Rate for Payer: United Healthcare Medicare |
$5.50
|
|
|
HC SUTURE VICRYL 4-0 J218H
|
Facility
|
OP
|
$9.54
|
|
| Hospital Charge Code |
41601571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$8.05
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.36
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Centivo All Commercial |
$5.19
|
| Rate for Payer: Cigna All Commercial |
$8.23
|
| Rate for Payer: CORVEL All Commercial |
$8.87
|
| Rate for Payer: Coventry All Commercial |
$8.40
|
| Rate for Payer: Encore All Commercial |
$8.78
|
| Rate for Payer: Frontpath All Commercial |
$8.78
|
| Rate for Payer: Humana ChoiceCare |
$8.24
|
| Rate for Payer: Humana Medicare |
$3.05
|
| Rate for Payer: Lucent All Commercial |
$5.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.59
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$7.16
|
| Rate for Payer: PHP All Commercial |
$7.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.72
|
| Rate for Payer: Sagamore Health Network All Products |
$7.36
|
| Rate for Payer: Signature Care EPO |
$7.92
|
| Rate for Payer: Signature Care PPO |
$8.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$7.52
|
| Rate for Payer: United Healthcare Medicare |
$3.05
|
|
|
HC SUTURE VICRYL 4-0 J218H
|
Facility
|
IP
|
$9.54
|
|
| Hospital Charge Code |
41601571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna All Commercial |
$8.23
|
| Rate for Payer: CORVEL All Commercial |
$8.87
|
| Rate for Payer: Coventry All Commercial |
$8.40
|
| Rate for Payer: Encore All Commercial |
$8.78
|
| Rate for Payer: Frontpath All Commercial |
$8.78
|
| Rate for Payer: Humana ChoiceCare |
$8.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.59
|
| Rate for Payer: PHCS All Commercial |
$7.16
|
| Rate for Payer: PHP All Commercial |
$7.24
|
| Rate for Payer: Sagamore Health Network All Products |
$7.36
|
| Rate for Payer: Signature Care EPO |
$7.92
|
| Rate for Payer: Signature Care PPO |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$7.52
|
|
|
HC SUTURE VICRYL 4-0 J315H
|
Facility
|
IP
|
$8.27
|
|
| Hospital Charge Code |
41601484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna All Commercial |
$7.14
|
| Rate for Payer: CORVEL All Commercial |
$7.69
|
| Rate for Payer: Coventry All Commercial |
$7.28
|
| Rate for Payer: Encore All Commercial |
$7.61
|
| Rate for Payer: Frontpath All Commercial |
$7.61
|
| Rate for Payer: Humana ChoiceCare |
$7.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.44
|
| Rate for Payer: PHCS All Commercial |
$6.20
|
| Rate for Payer: PHP All Commercial |
$6.27
|
| Rate for Payer: Sagamore Health Network All Products |
$6.38
|
| Rate for Payer: Signature Care EPO |
$6.86
|
| Rate for Payer: Signature Care PPO |
$7.28
|
| Rate for Payer: United Healthcare Commercial |
$6.52
|
|
|
HC SUTURE VICRYL 4-0 J315H
|
Facility
|
OP
|
$8.27
|
|
| Hospital Charge Code |
41601484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.91
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Centivo All Commercial |
$4.50
|
| Rate for Payer: Cigna All Commercial |
$7.14
|
| Rate for Payer: CORVEL All Commercial |
$7.69
|
| Rate for Payer: Coventry All Commercial |
$7.28
|
| Rate for Payer: Encore All Commercial |
$7.61
|
| Rate for Payer: Frontpath All Commercial |
$7.61
|
| Rate for Payer: Humana ChoiceCare |
$7.14
|
| Rate for Payer: Humana Medicare |
$2.65
|
| Rate for Payer: Lucent All Commercial |
$4.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.44
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$6.20
|
| Rate for Payer: PHP All Commercial |
$6.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.23
|
| Rate for Payer: Sagamore Health Network All Products |
$6.38
|
| Rate for Payer: Signature Care EPO |
$6.86
|
| Rate for Payer: Signature Care PPO |
$7.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.03
|
| Rate for Payer: United Healthcare Commercial |
$6.52
|
| Rate for Payer: United Healthcare Medicare |
$2.65
|
|
|
HC SUTURE VICRYL 4-0 J392H
|
Facility
|
IP
|
$13.92
|
|
| Hospital Charge Code |
41601485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cigna All Commercial |
$12.01
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.25
|
| Rate for Payer: Encore All Commercial |
$12.81
|
| Rate for Payer: Frontpath All Commercial |
$12.81
|
| Rate for Payer: Humana ChoiceCare |
$12.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.53
|
| Rate for Payer: PHCS All Commercial |
$10.44
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.55
|
| Rate for Payer: Signature Care PPO |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$10.97
|
|
|
HC SUTURE VICRYL 4-0 J392H
|
Facility
|
OP
|
$13.92
|
|
| Hospital Charge Code |
41601485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$11.75
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.90
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Centivo All Commercial |
$7.57
|
| Rate for Payer: Cigna All Commercial |
$12.01
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.25
|
| Rate for Payer: Encore All Commercial |
$12.81
|
| Rate for Payer: Frontpath All Commercial |
$12.81
|
| Rate for Payer: Humana ChoiceCare |
$12.02
|
| Rate for Payer: Humana Medicare |
$4.45
|
| Rate for Payer: Lucent All Commercial |
$7.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.53
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.44
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.43
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.55
|
| Rate for Payer: Signature Care PPO |
$12.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.83
|
| Rate for Payer: United Healthcare Commercial |
$10.97
|
| Rate for Payer: United Healthcare Medicare |
$4.45
|
|
|
HC SUTURE VICRYL 4-0 J441H
|
Facility
|
IP
|
$14.78
|
|
| Hospital Charge Code |
41601555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$8.87
|
| Rate for Payer: Cigna All Commercial |
$12.76
|
| Rate for Payer: CORVEL All Commercial |
$13.75
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Encore All Commercial |
$13.60
|
| Rate for Payer: Frontpath All Commercial |
$13.60
|
| Rate for Payer: Humana ChoiceCare |
$12.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.30
|
| Rate for Payer: PHCS All Commercial |
$11.09
|
| Rate for Payer: PHP All Commercial |
$11.21
|
| Rate for Payer: Sagamore Health Network All Products |
$11.41
|
| Rate for Payer: Signature Care EPO |
$12.27
|
| Rate for Payer: Signature Care PPO |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$11.65
|
|
|
HC SUTURE VICRYL 4-0 J441H
|
Facility
|
OP
|
$14.78
|
|
| Hospital Charge Code |
41601555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.20
|
| Rate for Payer: Cash Price |
$8.87
|
| Rate for Payer: Cash Price |
$8.87
|
| Rate for Payer: Centivo All Commercial |
$8.04
|
| Rate for Payer: Cigna All Commercial |
$12.76
|
| Rate for Payer: CORVEL All Commercial |
$13.75
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Encore All Commercial |
$13.60
|
| Rate for Payer: Frontpath All Commercial |
$13.60
|
| Rate for Payer: Humana ChoiceCare |
$12.77
|
| Rate for Payer: Humana Medicare |
$4.73
|
| Rate for Payer: Lucent All Commercial |
$8.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.30
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$11.09
|
| Rate for Payer: PHP All Commercial |
$11.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.76
|
| Rate for Payer: Sagamore Health Network All Products |
$11.41
|
| Rate for Payer: Signature Care EPO |
$12.27
|
| Rate for Payer: Signature Care PPO |
$13.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$11.65
|
| Rate for Payer: United Healthcare Medicare |
$4.73
|
|
|
HC SUTURE VICRYL 4-0 UNDYED PS2 J496H
|
Facility
|
IP
|
$27.28
|
|
| Hospital Charge Code |
41601170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC SUTURE VICRYL 4-0 UNDYED PS2 J496H
|
Facility
|
OP
|
$27.28
|
|
| Hospital Charge Code |
41601170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.60
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Centivo All Commercial |
$14.84
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Humana Medicare |
$8.73
|
| Rate for Payer: Lucent All Commercial |
$14.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.19
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
|
|
HC SUTURE VICRYL 5-0 J493G
|
Facility
|
IP
|
$28.48
|
|
| Hospital Charge Code |
41601171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
|
|
HC SUTURE VICRYL 5-0 J493G
|
Facility
|
OP
|
$28.48
|
|
| Hospital Charge Code |
41601171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.02
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Centivo All Commercial |
$15.49
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Humana Medicare |
$9.11
|
| Rate for Payer: Lucent All Commercial |
$15.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.11
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.21
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
|
|
HC SUTURE VICRYL 5-0 J553G
|
Facility
|
IP
|
$75.32
|
|
| Hospital Charge Code |
41601562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$70.05 |
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Cigna All Commercial |
$65.00
|
| Rate for Payer: CORVEL All Commercial |
$70.05
|
| Rate for Payer: Coventry All Commercial |
$66.28
|
| Rate for Payer: Encore All Commercial |
$69.33
|
| Rate for Payer: Frontpath All Commercial |
$69.29
|
| Rate for Payer: Humana ChoiceCare |
$65.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.79
|
| Rate for Payer: PHCS All Commercial |
$56.49
|
| Rate for Payer: PHP All Commercial |
$57.12
|
| Rate for Payer: Sagamore Health Network All Products |
$58.15
|
| Rate for Payer: Signature Care EPO |
$62.52
|
| Rate for Payer: Signature Care PPO |
$66.28
|
| Rate for Payer: United Healthcare Commercial |
$59.35
|
|
|
HC SUTURE VICRYL 5-0 J553G
|
Facility
|
OP
|
$75.32
|
|
| Hospital Charge Code |
41601562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$70.05 |
| Rate for Payer: Aetna Commercial |
$63.57
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.51
|
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Centivo All Commercial |
$40.97
|
| Rate for Payer: Cigna All Commercial |
$65.00
|
| Rate for Payer: CORVEL All Commercial |
$70.05
|
| Rate for Payer: Coventry All Commercial |
$66.28
|
| Rate for Payer: Encore All Commercial |
$69.33
|
| Rate for Payer: Frontpath All Commercial |
$69.29
|
| Rate for Payer: Humana ChoiceCare |
$65.05
|
| Rate for Payer: Humana Medicare |
$24.10
|
| Rate for Payer: Lucent All Commercial |
$40.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.79
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$56.49
|
| Rate for Payer: PHP All Commercial |
$57.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.37
|
| Rate for Payer: Sagamore Health Network All Products |
$58.15
|
| Rate for Payer: Signature Care EPO |
$62.52
|
| Rate for Payer: Signature Care PPO |
$66.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.02
|
| Rate for Payer: United Healthcare Commercial |
$59.35
|
| Rate for Payer: United Healthcare Medicare |
$24.10
|
|
|
HC SUTURE VICRYL 6-0 J555G
|
Facility
|
IP
|
$91.85
|
|
| Hospital Charge Code |
41601559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna Commercial |
$79.36
|
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Cigna All Commercial |
$79.27
|
| Rate for Payer: CORVEL All Commercial |
$85.42
|
| Rate for Payer: Coventry All Commercial |
$80.83
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$84.50
|
| Rate for Payer: Humana ChoiceCare |
$79.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.67
|
| Rate for Payer: PHCS All Commercial |
$68.89
|
| Rate for Payer: PHP All Commercial |
$69.66
|
| Rate for Payer: Sagamore Health Network All Products |
$70.91
|
| Rate for Payer: Signature Care EPO |
$76.24
|
| Rate for Payer: Signature Care PPO |
$80.83
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
|
|
HC SUTURE VICRYL 6-0 J555G
|
Facility
|
OP
|
$91.85
|
|
| Hospital Charge Code |
41601559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.47 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare |
$29.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.33
|
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Centivo All Commercial |
$49.97
|
| Rate for Payer: Cigna All Commercial |
$79.27
|
| Rate for Payer: CORVEL All Commercial |
$85.42
|
| Rate for Payer: Coventry All Commercial |
$80.83
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$84.50
|
| Rate for Payer: Humana ChoiceCare |
$79.33
|
| Rate for Payer: Humana Medicare |
$29.39
|
| Rate for Payer: Lucent All Commercial |
$49.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.67
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$68.89
|
| Rate for Payer: PHP All Commercial |
$69.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.82
|
| Rate for Payer: Sagamore Health Network All Products |
$70.91
|
| Rate for Payer: Signature Care EPO |
$76.24
|
| Rate for Payer: Signature Care PPO |
$80.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.07
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
| Rate for Payer: United Healthcare Medicare |
$29.39
|
|
