|
HC SUTURE ANCHOR MINI BC S-TAK 2.4 X 8.5
|
Facility
IP
|
$1,625.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
|
|
HC SUTURE BONE WAX W31G
|
Facility
IP
|
$35.62
|
|
| Hospital Charge Code |
41601475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.72 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cigna All Commercial |
$30.74
|
| Rate for Payer: CORVEL All Commercial |
$33.13
|
| Rate for Payer: Coventry All Commercial |
$31.35
|
| Rate for Payer: Encore All Commercial |
$32.79
|
| Rate for Payer: Frontpath All Commercial |
$32.77
|
| Rate for Payer: Humana ChoiceCare |
$30.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.06
|
| Rate for Payer: PHCS All Commercial |
$26.72
|
| Rate for Payer: PHP All Commercial |
$27.01
|
| Rate for Payer: Sagamore Health Network All Products |
$27.50
|
| Rate for Payer: Signature Care EPO |
$29.56
|
| Rate for Payer: Signature Care PPO |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$28.07
|
|
|
HC SUTURE BONE WAX W31G
|
Facility
OP
|
$35.62
|
|
| Hospital Charge Code |
41601475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.93
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Centivo All Commercial |
$18.17
|
| Rate for Payer: Cigna All Commercial |
$30.74
|
| Rate for Payer: CORVEL All Commercial |
$33.13
|
| Rate for Payer: Coventry All Commercial |
$31.35
|
| Rate for Payer: Encore All Commercial |
$32.79
|
| Rate for Payer: Frontpath All Commercial |
$32.77
|
| Rate for Payer: Humana ChoiceCare |
$30.76
|
| Rate for Payer: Humana Medicare |
$18.17
|
| Rate for Payer: Lucent All Commercial |
$18.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$26.72
|
| Rate for Payer: PHP All Commercial |
$27.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.89
|
| Rate for Payer: Sagamore Health Network All Products |
$27.50
|
| Rate for Payer: Signature Care EPO |
$29.56
|
| Rate for Payer: Signature Care PPO |
$31.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.28
|
| Rate for Payer: United Healthcare Commercial |
$28.07
|
| Rate for Payer: United Healthcare Medicare |
$11.75
|
|
|
HC SUTURE BUTTONS 520G
|
Facility
OP
|
$23.56
|
|
| Hospital Charge Code |
41601490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.55
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Centivo All Commercial |
$12.02
|
| Rate for Payer: Cigna All Commercial |
$20.33
|
| Rate for Payer: CORVEL All Commercial |
$21.91
|
| Rate for Payer: Coventry All Commercial |
$20.73
|
| Rate for Payer: Encore All Commercial |
$21.69
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.35
|
| Rate for Payer: Humana Medicare |
$12.02
|
| Rate for Payer: Lucent All Commercial |
$12.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.67
|
| Rate for Payer: PHP All Commercial |
$17.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.19
|
| Rate for Payer: Signature Care EPO |
$19.55
|
| Rate for Payer: Signature Care PPO |
$20.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.03
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
|
|
HC SUTURE BUTTONS 520G
|
Facility
IP
|
$23.56
|
|
| Hospital Charge Code |
41601490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cigna All Commercial |
$20.33
|
| Rate for Payer: CORVEL All Commercial |
$21.91
|
| Rate for Payer: Coventry All Commercial |
$20.73
|
| Rate for Payer: Encore All Commercial |
$21.69
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.20
|
| Rate for Payer: PHCS All Commercial |
$17.67
|
| Rate for Payer: PHP All Commercial |
$17.87
|
| Rate for Payer: Sagamore Health Network All Products |
$18.19
|
| Rate for Payer: Signature Care EPO |
$19.55
|
| Rate for Payer: Signature Care PPO |
$20.73
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
|
|
HC SUTURE CHROMIC 0 884H
|
Facility
IP
|
$27.28
|
|
| Hospital Charge Code |
41601573
|
|
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 |
$16.91
|
| 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 CHROMIC 0 884H
|
Facility
OP
|
$27.28
|
|
| Hospital Charge Code |
41601573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Centivo All Commercial |
$13.91
|
| 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 |
$13.91
|
| Rate for Payer: Lucent All Commercial |
$13.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$9.00
|
|
|
HC SUTURE CHROMIC 2-0 18 PS-2
|
Facility
IP
|
$64.76
|
|
| Hospital Charge Code |
41602420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$60.23 |
| Rate for Payer: Aetna Commercial |
$55.95
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna All Commercial |
$55.89
|
| Rate for Payer: CORVEL All Commercial |
$60.23
|
| Rate for Payer: Coventry All Commercial |
$56.99
|
| Rate for Payer: Encore All Commercial |
$59.61
|
| Rate for Payer: Frontpath All Commercial |
$59.58
|
| Rate for Payer: Humana ChoiceCare |
$55.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.28
|
| Rate for Payer: PHCS All Commercial |
$48.57
|
| Rate for Payer: PHP All Commercial |
$49.11
|
| Rate for Payer: Sagamore Health Network All Products |
$49.99
|
| Rate for Payer: Signature Care EPO |
$53.75
|
| Rate for Payer: Signature Care PPO |
$56.99
|
| Rate for Payer: United Healthcare Commercial |
$51.03
|
|
|
HC SUTURE CHROMIC 2-0 18 PS-2
|
Facility
OP
|
$64.76
|
|
| Hospital Charge Code |
41602420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: Aetna Medicare |
$21.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.51
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Centivo All Commercial |
$33.03
|
| Rate for Payer: Cigna All Commercial |
$55.89
|
| Rate for Payer: CORVEL All Commercial |
$60.23
|
| Rate for Payer: Coventry All Commercial |
$56.99
|
| Rate for Payer: Encore All Commercial |
$59.61
|
| Rate for Payer: Frontpath All Commercial |
$59.58
|
| Rate for Payer: Humana ChoiceCare |
$55.93
|
| Rate for Payer: Humana Medicare |
$33.03
|
| Rate for Payer: Lucent All Commercial |
$33.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$48.57
|
| Rate for Payer: PHP All Commercial |
$49.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.26
|
| Rate for Payer: Sagamore Health Network All Products |
$49.99
|
| Rate for Payer: Signature Care EPO |
$53.75
|
| Rate for Payer: Signature Care PPO |
$56.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.05
|
| Rate for Payer: United Healthcare Commercial |
$51.03
|
| Rate for Payer: United Healthcare Medicare |
$21.37
|
|
|
HC SUTURE CHROMIC 3-0 636H
|
Facility
IP
|
$32.03
|
|
| Hospital Charge Code |
41601492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cigna All Commercial |
$27.64
|
| Rate for Payer: CORVEL All Commercial |
$29.79
|
| Rate for Payer: Coventry All Commercial |
$28.19
|
| Rate for Payer: Encore All Commercial |
$29.48
|
| Rate for Payer: Frontpath All Commercial |
$29.47
|
| Rate for Payer: Humana ChoiceCare |
$27.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.83
|
| Rate for Payer: PHCS All Commercial |
$24.02
|
| Rate for Payer: PHP All Commercial |
$24.29
|
| Rate for Payer: Sagamore Health Network All Products |
$24.73
|
| Rate for Payer: Signature Care EPO |
$26.58
|
| Rate for Payer: Signature Care PPO |
$28.19
|
| Rate for Payer: United Healthcare Commercial |
$25.24
|
|
|
HC SUTURE CHROMIC 3-0 636H
|
Facility
OP
|
$32.03
|
|
| Hospital Charge Code |
41601492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$27.03
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.63
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Centivo All Commercial |
$16.34
|
| Rate for Payer: Cigna All Commercial |
$27.64
|
| Rate for Payer: CORVEL All Commercial |
$29.79
|
| Rate for Payer: Coventry All Commercial |
$28.19
|
| Rate for Payer: Encore All Commercial |
$29.48
|
| Rate for Payer: Frontpath All Commercial |
$29.47
|
| Rate for Payer: Humana ChoiceCare |
$27.66
|
| Rate for Payer: Humana Medicare |
$16.34
|
| Rate for Payer: Lucent All Commercial |
$16.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.83
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$24.02
|
| Rate for Payer: PHP All Commercial |
$24.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.49
|
| Rate for Payer: Sagamore Health Network All Products |
$24.73
|
| Rate for Payer: Signature Care EPO |
$26.58
|
| Rate for Payer: Signature Care PPO |
$28.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.23
|
| Rate for Payer: United Healthcare Commercial |
$25.24
|
| Rate for Payer: United Healthcare Medicare |
$10.57
|
|
|
HC SUTURE CHROMIC 3-0 G122H
|
Facility
IP
|
$19.46
|
|
| Hospital Charge Code |
41601493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$18.10 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cigna All Commercial |
$16.79
|
| Rate for Payer: CORVEL All Commercial |
$18.10
|
| Rate for Payer: Coventry All Commercial |
$17.12
|
| Rate for Payer: Encore All Commercial |
$17.91
|
| Rate for Payer: Frontpath All Commercial |
$17.90
|
| Rate for Payer: Humana ChoiceCare |
$16.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$14.60
|
| Rate for Payer: PHP All Commercial |
$14.76
|
| Rate for Payer: Sagamore Health Network All Products |
$15.02
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$17.12
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
|
|
HC SUTURE CHROMIC 3-0 G122H
|
Facility
OP
|
$19.46
|
|
| Hospital Charge Code |
41601493
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.06
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Centivo All Commercial |
$9.92
|
| Rate for Payer: Cigna All Commercial |
$16.79
|
| Rate for Payer: CORVEL All Commercial |
$18.10
|
| Rate for Payer: Coventry All Commercial |
$17.12
|
| Rate for Payer: Encore All Commercial |
$17.91
|
| Rate for Payer: Frontpath All Commercial |
$17.90
|
| Rate for Payer: Humana ChoiceCare |
$16.81
|
| Rate for Payer: Humana Medicare |
$9.92
|
| Rate for Payer: Lucent All Commercial |
$9.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.60
|
| Rate for Payer: PHP All Commercial |
$14.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.59
|
| Rate for Payer: Sagamore Health Network All Products |
$15.02
|
| Rate for Payer: Signature Care EPO |
$16.15
|
| Rate for Payer: Signature Care PPO |
$17.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.54
|
| Rate for Payer: United Healthcare Commercial |
$15.33
|
| Rate for Payer: United Healthcare Medicare |
$6.42
|
|
|
HC SUTURE CHROMIC 4-0
|
Facility
OP
|
$44.91
|
|
| Hospital Charge Code |
41602421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna Medicare |
$14.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.30
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Centivo All Commercial |
$22.90
|
| Rate for Payer: Cigna All Commercial |
$38.76
|
| Rate for Payer: CORVEL All Commercial |
$41.77
|
| Rate for Payer: Coventry All Commercial |
$39.52
|
| Rate for Payer: Encore All Commercial |
$41.34
|
| Rate for Payer: Frontpath All Commercial |
$41.32
|
| Rate for Payer: Humana ChoiceCare |
$38.79
|
| Rate for Payer: Humana Medicare |
$22.90
|
| Rate for Payer: Lucent All Commercial |
$22.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$33.68
|
| Rate for Payer: PHP All Commercial |
$34.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.51
|
| Rate for Payer: Sagamore Health Network All Products |
$34.67
|
| Rate for Payer: Signature Care EPO |
$37.28
|
| Rate for Payer: Signature Care PPO |
$39.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.17
|
| Rate for Payer: United Healthcare Commercial |
$35.39
|
| Rate for Payer: United Healthcare Medicare |
$14.82
|
|
|
HC SUTURE CHROMIC 4-0
|
Facility
IP
|
$44.91
|
|
| Hospital Charge Code |
41602421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$41.77 |
| Rate for Payer: Aetna Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cigna All Commercial |
$38.76
|
| Rate for Payer: CORVEL All Commercial |
$41.77
|
| Rate for Payer: Coventry All Commercial |
$39.52
|
| Rate for Payer: Encore All Commercial |
$41.34
|
| Rate for Payer: Frontpath All Commercial |
$41.32
|
| Rate for Payer: Humana ChoiceCare |
$38.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.42
|
| Rate for Payer: PHCS All Commercial |
$33.68
|
| Rate for Payer: PHP All Commercial |
$34.06
|
| Rate for Payer: Sagamore Health Network All Products |
$34.67
|
| Rate for Payer: Signature Care EPO |
$37.28
|
| Rate for Payer: Signature Care PPO |
$39.52
|
| Rate for Payer: United Healthcare Commercial |
$35.39
|
|
|
HC SUTURE CHROMIC 4-0 18 IN
|
Facility
OP
|
$70.09
|
|
| Hospital Charge Code |
41602422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$59.16
|
| Rate for Payer: Aetna Medicare |
$23.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.44
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Centivo All Commercial |
$35.75
|
| Rate for Payer: Cigna All Commercial |
$60.49
|
| Rate for Payer: CORVEL All Commercial |
$65.18
|
| Rate for Payer: Coventry All Commercial |
$61.68
|
| Rate for Payer: Encore All Commercial |
$64.52
|
| Rate for Payer: Frontpath All Commercial |
$64.48
|
| Rate for Payer: Humana ChoiceCare |
$60.54
|
| Rate for Payer: Humana Medicare |
$35.75
|
| Rate for Payer: Lucent All Commercial |
$35.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$52.57
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.34
|
| Rate for Payer: Sagamore Health Network All Products |
$54.11
|
| Rate for Payer: Signature Care EPO |
$58.17
|
| Rate for Payer: Signature Care PPO |
$61.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.58
|
| Rate for Payer: United Healthcare Commercial |
$55.23
|
| Rate for Payer: United Healthcare Medicare |
$23.13
|
|
|
HC SUTURE CHROMIC 4-0 18 IN
|
Facility
IP
|
$70.09
|
|
| Hospital Charge Code |
41602422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.57 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Cigna All Commercial |
$60.49
|
| Rate for Payer: CORVEL All Commercial |
$65.18
|
| Rate for Payer: Coventry All Commercial |
$61.68
|
| Rate for Payer: Encore All Commercial |
$64.52
|
| Rate for Payer: Frontpath All Commercial |
$64.48
|
| Rate for Payer: Humana ChoiceCare |
$60.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.08
|
| Rate for Payer: PHCS All Commercial |
$52.57
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Sagamore Health Network All Products |
$54.11
|
| Rate for Payer: Signature Care EPO |
$58.17
|
| Rate for Payer: Signature Care PPO |
$61.68
|
| Rate for Payer: United Healthcare Commercial |
$55.23
|
|
|
HC SUTURE CHROMIC 4-0 18 IN P2
|
Facility
IP
|
$46.64
|
|
| Hospital Charge Code |
41602423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$43.38 |
| Rate for Payer: Aetna Commercial |
$40.30
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cigna All Commercial |
$40.25
|
| Rate for Payer: CORVEL All Commercial |
$43.38
|
| Rate for Payer: Coventry All Commercial |
$41.04
|
| Rate for Payer: Encore All Commercial |
$42.93
|
| Rate for Payer: Frontpath All Commercial |
$42.91
|
| Rate for Payer: Humana ChoiceCare |
$40.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.98
|
| Rate for Payer: PHCS All Commercial |
$34.98
|
| Rate for Payer: PHP All Commercial |
$35.37
|
| Rate for Payer: Sagamore Health Network All Products |
$36.01
|
| Rate for Payer: Signature Care EPO |
$38.71
|
| Rate for Payer: Signature Care PPO |
$41.04
|
| Rate for Payer: United Healthcare Commercial |
$36.75
|
|
|
HC SUTURE CHROMIC 4-0 18 IN P2
|
Facility
OP
|
$46.64
|
|
| Hospital Charge Code |
41602423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$15.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.93
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Centivo All Commercial |
$23.79
|
| Rate for Payer: Cigna All Commercial |
$40.25
|
| Rate for Payer: CORVEL All Commercial |
$43.38
|
| Rate for Payer: Coventry All Commercial |
$41.04
|
| Rate for Payer: Encore All Commercial |
$42.93
|
| Rate for Payer: Frontpath All Commercial |
$42.91
|
| Rate for Payer: Humana ChoiceCare |
$40.28
|
| Rate for Payer: Humana Medicare |
$23.79
|
| Rate for Payer: Lucent All Commercial |
$23.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$34.98
|
| Rate for Payer: PHP All Commercial |
$35.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.19
|
| Rate for Payer: Sagamore Health Network All Products |
$36.01
|
| Rate for Payer: Signature Care EPO |
$38.71
|
| Rate for Payer: Signature Care PPO |
$41.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.64
|
| Rate for Payer: United Healthcare Commercial |
$36.75
|
| Rate for Payer: United Healthcare Medicare |
$15.39
|
|
|
HC SUTURE CHROMIC 4-0 744G
|
Facility
IP
|
$43.86
|
|
| Hospital Charge Code |
41601581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$40.79 |
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cigna All Commercial |
$37.85
|
| Rate for Payer: CORVEL All Commercial |
$40.79
|
| Rate for Payer: Coventry All Commercial |
$38.60
|
| Rate for Payer: Encore All Commercial |
$40.37
|
| Rate for Payer: Frontpath All Commercial |
$40.35
|
| Rate for Payer: Humana ChoiceCare |
$37.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.47
|
| Rate for Payer: PHCS All Commercial |
$32.90
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: Sagamore Health Network All Products |
$33.86
|
| Rate for Payer: Signature Care EPO |
$36.40
|
| Rate for Payer: Signature Care PPO |
$38.60
|
| Rate for Payer: United Healthcare Commercial |
$34.56
|
|
|
HC SUTURE CHROMIC 4-0 744G
|
Facility
OP
|
$43.86
|
|
| Hospital Charge Code |
41601581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$37.02
|
| Rate for Payer: Aetna Medicare |
$14.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.92
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Centivo All Commercial |
$22.37
|
| Rate for Payer: Cigna All Commercial |
$37.85
|
| Rate for Payer: CORVEL All Commercial |
$40.79
|
| Rate for Payer: Coventry All Commercial |
$38.60
|
| Rate for Payer: Encore All Commercial |
$40.37
|
| Rate for Payer: Frontpath All Commercial |
$40.35
|
| Rate for Payer: Humana ChoiceCare |
$37.88
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Lucent All Commercial |
$22.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.90
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.11
|
| Rate for Payer: Sagamore Health Network All Products |
$33.86
|
| Rate for Payer: Signature Care EPO |
$36.40
|
| Rate for Payer: Signature Care PPO |
$38.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.28
|
| Rate for Payer: United Healthcare Commercial |
$34.56
|
| Rate for Payer: United Healthcare Medicare |
$14.47
|
|
|
HC SUTURE CHROMIC 4-0 G121H
|
Facility
OP
|
$23.45
|
|
| Hospital Charge Code |
41601494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.51
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Centivo All Commercial |
$11.96
|
| Rate for Payer: Cigna All Commercial |
$20.24
|
| Rate for Payer: CORVEL All Commercial |
$21.81
|
| Rate for Payer: Coventry All Commercial |
$20.64
|
| Rate for Payer: Encore All Commercial |
$21.59
|
| Rate for Payer: Frontpath All Commercial |
$21.57
|
| Rate for Payer: Humana ChoiceCare |
$20.25
|
| Rate for Payer: Humana Medicare |
$11.96
|
| Rate for Payer: Lucent All Commercial |
$11.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.59
|
| Rate for Payer: PHP All Commercial |
$17.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.15
|
| Rate for Payer: Sagamore Health Network All Products |
$18.10
|
| Rate for Payer: Signature Care EPO |
$19.46
|
| Rate for Payer: Signature Care PPO |
$20.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.93
|
| Rate for Payer: United Healthcare Commercial |
$18.48
|
| Rate for Payer: United Healthcare Medicare |
$7.74
|
|
|
HC SUTURE CHROMIC 4-0 G121H
|
Facility
IP
|
$23.45
|
|
| Hospital Charge Code |
41601494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna All Commercial |
$20.24
|
| Rate for Payer: CORVEL All Commercial |
$21.81
|
| Rate for Payer: Coventry All Commercial |
$20.64
|
| Rate for Payer: Encore All Commercial |
$21.59
|
| Rate for Payer: Frontpath All Commercial |
$21.57
|
| Rate for Payer: Humana ChoiceCare |
$20.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.10
|
| Rate for Payer: PHCS All Commercial |
$17.59
|
| Rate for Payer: PHP All Commercial |
$17.78
|
| Rate for Payer: Sagamore Health Network All Products |
$18.10
|
| Rate for Payer: Signature Care EPO |
$19.46
|
| Rate for Payer: Signature Care PPO |
$20.64
|
| Rate for Payer: United Healthcare Commercial |
$18.48
|
|
|
HC SUTURE CHROMIC 5-0 1792G
|
Facility
IP
|
$109.75
|
|
| Hospital Charge Code |
41601582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.31 |
| Max. Negotiated Rate |
$102.07 |
| Rate for Payer: Aetna Commercial |
$94.82
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cigna All Commercial |
$94.71
|
| Rate for Payer: CORVEL All Commercial |
$102.07
|
| Rate for Payer: Coventry All Commercial |
$96.58
|
| Rate for Payer: Encore All Commercial |
$101.02
|
| Rate for Payer: Frontpath All Commercial |
$100.97
|
| Rate for Payer: Humana ChoiceCare |
$94.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.78
|
| Rate for Payer: PHCS All Commercial |
$82.31
|
| Rate for Payer: PHP All Commercial |
$83.23
|
| Rate for Payer: Sagamore Health Network All Products |
$84.73
|
| Rate for Payer: Signature Care EPO |
$91.09
|
| Rate for Payer: Signature Care PPO |
$96.58
|
| Rate for Payer: United Healthcare Commercial |
$86.48
|
|
|
HC SUTURE CHROMIC 5-0 1792G
|
Facility
OP
|
$109.75
|
|
| Hospital Charge Code |
41601582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$92.63
|
| Rate for Payer: Aetna Medicare |
$36.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.84
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Cash Price |
$68.05
|
| Rate for Payer: Centivo All Commercial |
$55.97
|
| Rate for Payer: Cigna All Commercial |
$94.71
|
| Rate for Payer: CORVEL All Commercial |
$102.07
|
| Rate for Payer: Coventry All Commercial |
$96.58
|
| Rate for Payer: Encore All Commercial |
$101.02
|
| Rate for Payer: Frontpath All Commercial |
$100.97
|
| Rate for Payer: Humana ChoiceCare |
$94.79
|
| Rate for Payer: Humana Medicare |
$55.97
|
| Rate for Payer: Lucent All Commercial |
$55.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$82.31
|
| Rate for Payer: PHP All Commercial |
$83.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.80
|
| Rate for Payer: Sagamore Health Network All Products |
$84.73
|
| Rate for Payer: Signature Care EPO |
$91.09
|
| Rate for Payer: Signature Care PPO |
$96.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.29
|
| Rate for Payer: United Healthcare Commercial |
$86.48
|
| Rate for Payer: United Healthcare Medicare |
$36.22
|
|
