|
HC SUTURE CHROMIC 5-0 634G
|
Facility
IP
|
$19.97
|
|
| Hospital Charge Code |
41601495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna All Commercial |
$17.23
|
| Rate for Payer: CORVEL All Commercial |
$18.57
|
| Rate for Payer: Coventry All Commercial |
$17.57
|
| Rate for Payer: Encore All Commercial |
$18.38
|
| Rate for Payer: Frontpath All Commercial |
$18.37
|
| Rate for Payer: Humana ChoiceCare |
$17.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.97
|
| Rate for Payer: PHCS All Commercial |
$14.98
|
| Rate for Payer: PHP All Commercial |
$15.15
|
| Rate for Payer: Sagamore Health Network All Products |
$15.42
|
| Rate for Payer: Signature Care EPO |
$16.58
|
| Rate for Payer: Signature Care PPO |
$17.57
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
|
|
HC SUTURE CHROMIC 5-0 634G
|
Facility
OP
|
$19.97
|
|
| Hospital Charge Code |
41601495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.25
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Centivo All Commercial |
$10.18
|
| Rate for Payer: Cigna All Commercial |
$17.23
|
| Rate for Payer: CORVEL All Commercial |
$18.57
|
| Rate for Payer: Coventry All Commercial |
$17.57
|
| Rate for Payer: Encore All Commercial |
$18.38
|
| Rate for Payer: Frontpath All Commercial |
$18.37
|
| Rate for Payer: Humana ChoiceCare |
$17.25
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Lucent All Commercial |
$10.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.97
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.98
|
| Rate for Payer: PHP All Commercial |
$15.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.79
|
| Rate for Payer: Sagamore Health Network All Products |
$15.42
|
| Rate for Payer: Signature Care EPO |
$16.58
|
| Rate for Payer: Signature Care PPO |
$17.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
|
|
HC SUTURE CHROMIC 5-0 G180H
|
Facility
OP
|
$23.72
|
|
| Hospital Charge Code |
41601496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.61
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Centivo All Commercial |
$12.10
|
| Rate for Payer: Cigna All Commercial |
$20.47
|
| Rate for Payer: CORVEL All Commercial |
$22.06
|
| Rate for Payer: Coventry All Commercial |
$20.87
|
| Rate for Payer: Encore All Commercial |
$21.83
|
| Rate for Payer: Frontpath All Commercial |
$21.82
|
| Rate for Payer: Humana ChoiceCare |
$20.49
|
| Rate for Payer: Humana Medicare |
$12.10
|
| Rate for Payer: Lucent All Commercial |
$12.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.79
|
| Rate for Payer: PHP All Commercial |
$17.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.25
|
| Rate for Payer: Sagamore Health Network All Products |
$18.31
|
| Rate for Payer: Signature Care EPO |
$19.69
|
| Rate for Payer: Signature Care PPO |
$20.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.16
|
| Rate for Payer: United Healthcare Commercial |
$18.69
|
| Rate for Payer: United Healthcare Medicare |
$7.83
|
|
|
HC SUTURE CHROMIC 5-0 G180H
|
Facility
IP
|
$23.72
|
|
| Hospital Charge Code |
41601496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.49
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cigna All Commercial |
$20.47
|
| Rate for Payer: CORVEL All Commercial |
$22.06
|
| Rate for Payer: Coventry All Commercial |
$20.87
|
| Rate for Payer: Encore All Commercial |
$21.83
|
| Rate for Payer: Frontpath All Commercial |
$21.82
|
| Rate for Payer: Humana ChoiceCare |
$20.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.35
|
| Rate for Payer: PHCS All Commercial |
$17.79
|
| Rate for Payer: PHP All Commercial |
$17.99
|
| Rate for Payer: Sagamore Health Network All Products |
$18.31
|
| Rate for Payer: Signature Care EPO |
$19.69
|
| Rate for Payer: Signature Care PPO |
$20.87
|
| Rate for Payer: United Healthcare Commercial |
$18.69
|
|
|
HC SUTURE CHROMIC 5-0 U202H
|
Facility
OP
|
$35.16
|
|
| Hospital Charge Code |
41601497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.68
|
| Rate for Payer: Aetna Medicare |
$11.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.76
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Centivo All Commercial |
$17.93
|
| Rate for Payer: Cigna All Commercial |
$30.34
|
| Rate for Payer: CORVEL All Commercial |
$32.70
|
| Rate for Payer: Coventry All Commercial |
$30.94
|
| Rate for Payer: Encore All Commercial |
$32.36
|
| Rate for Payer: Frontpath All Commercial |
$32.35
|
| Rate for Payer: Humana ChoiceCare |
$30.37
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Lucent All Commercial |
$17.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$26.37
|
| Rate for Payer: PHP All Commercial |
$26.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.71
|
| Rate for Payer: Sagamore Health Network All Products |
$27.14
|
| Rate for Payer: Signature Care EPO |
$29.18
|
| Rate for Payer: Signature Care PPO |
$30.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.89
|
| Rate for Payer: United Healthcare Commercial |
$27.71
|
| Rate for Payer: United Healthcare Medicare |
$11.60
|
|
|
HC SUTURE CHROMIC 5-0 U202H
|
Facility
IP
|
$35.16
|
|
| Hospital Charge Code |
41601497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$32.70 |
| Rate for Payer: Aetna Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cigna All Commercial |
$30.34
|
| Rate for Payer: CORVEL All Commercial |
$32.70
|
| Rate for Payer: Coventry All Commercial |
$30.94
|
| Rate for Payer: Encore All Commercial |
$32.36
|
| Rate for Payer: Frontpath All Commercial |
$32.35
|
| Rate for Payer: Humana ChoiceCare |
$30.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.64
|
| Rate for Payer: PHCS All Commercial |
$26.37
|
| Rate for Payer: PHP All Commercial |
$26.67
|
| Rate for Payer: Sagamore Health Network All Products |
$27.14
|
| Rate for Payer: Signature Care EPO |
$29.18
|
| Rate for Payer: Signature Care PPO |
$30.94
|
| Rate for Payer: United Healthcare Commercial |
$27.71
|
|
|
HC SUTURE CHROMIC GUT 0 U246H
|
Facility
OP
|
$30.97
|
|
| Hospital Charge Code |
41601491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.24
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Centivo All Commercial |
$15.79
|
| Rate for Payer: Cigna All Commercial |
$26.73
|
| Rate for Payer: CORVEL All Commercial |
$28.80
|
| Rate for Payer: Coventry All Commercial |
$27.25
|
| Rate for Payer: Encore All Commercial |
$28.51
|
| Rate for Payer: Frontpath All Commercial |
$28.49
|
| Rate for Payer: Humana ChoiceCare |
$26.75
|
| Rate for Payer: Humana Medicare |
$15.79
|
| Rate for Payer: Lucent All Commercial |
$15.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.23
|
| Rate for Payer: PHP All Commercial |
$23.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.08
|
| Rate for Payer: Sagamore Health Network All Products |
$23.91
|
| Rate for Payer: Signature Care EPO |
$25.71
|
| Rate for Payer: Signature Care PPO |
$27.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.32
|
| Rate for Payer: United Healthcare Commercial |
$24.40
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
|
|
HC SUTURE CHROMIC GUT 0 U246H
|
Facility
IP
|
$30.97
|
|
| Hospital Charge Code |
41601491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$26.76
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna All Commercial |
$26.73
|
| Rate for Payer: CORVEL All Commercial |
$28.80
|
| Rate for Payer: Coventry All Commercial |
$27.25
|
| Rate for Payer: Encore All Commercial |
$28.51
|
| Rate for Payer: Frontpath All Commercial |
$28.49
|
| Rate for Payer: Humana ChoiceCare |
$26.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.87
|
| Rate for Payer: PHCS All Commercial |
$23.23
|
| Rate for Payer: PHP All Commercial |
$23.49
|
| Rate for Payer: Sagamore Health Network All Products |
$23.91
|
| Rate for Payer: Signature Care EPO |
$25.71
|
| Rate for Payer: Signature Care PPO |
$27.25
|
| Rate for Payer: United Healthcare Commercial |
$24.40
|
|
|
HC SUTURE CHROMIC GUT 1CTX
|
Facility
OP
|
$26.78
|
|
| Hospital Charge Code |
41605572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.60
|
| Rate for Payer: Aetna Medicare |
$8.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.72
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Centivo All Commercial |
$13.66
|
| Rate for Payer: Cigna All Commercial |
$23.11
|
| Rate for Payer: CORVEL All Commercial |
$24.91
|
| Rate for Payer: Coventry All Commercial |
$23.57
|
| Rate for Payer: Encore All Commercial |
$24.65
|
| Rate for Payer: Frontpath All Commercial |
$24.64
|
| Rate for Payer: Humana ChoiceCare |
$23.13
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Lucent All Commercial |
$13.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.08
|
| Rate for Payer: PHP All Commercial |
$20.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.44
|
| Rate for Payer: Sagamore Health Network All Products |
$20.67
|
| Rate for Payer: Signature Care EPO |
$22.23
|
| Rate for Payer: Signature Care PPO |
$23.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.76
|
| Rate for Payer: United Healthcare Commercial |
$21.10
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
|
|
HC SUTURE CHROMIC GUT 1CTX
|
Facility
IP
|
$26.78
|
|
| Hospital Charge Code |
41605572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$24.91 |
| Rate for Payer: Aetna Commercial |
$23.14
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cigna All Commercial |
$23.11
|
| Rate for Payer: CORVEL All Commercial |
$24.91
|
| Rate for Payer: Coventry All Commercial |
$23.57
|
| Rate for Payer: Encore All Commercial |
$24.65
|
| Rate for Payer: Frontpath All Commercial |
$24.64
|
| Rate for Payer: Humana ChoiceCare |
$23.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.10
|
| Rate for Payer: PHCS All Commercial |
$20.08
|
| Rate for Payer: PHP All Commercial |
$20.31
|
| Rate for Payer: Sagamore Health Network All Products |
$20.67
|
| Rate for Payer: Signature Care EPO |
$22.23
|
| Rate for Payer: Signature Care PPO |
$23.57
|
| Rate for Payer: United Healthcare Commercial |
$21.10
|
|
|
HC SUTURE CHROMIC GUT 2-0 923H
|
Facility
IP
|
$22.24
|
|
| Hospital Charge Code |
41601498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Aetna Commercial |
$19.22
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cigna All Commercial |
$19.19
|
| Rate for Payer: CORVEL All Commercial |
$20.68
|
| Rate for Payer: Coventry All Commercial |
$19.57
|
| Rate for Payer: Encore All Commercial |
$20.47
|
| Rate for Payer: Frontpath All Commercial |
$20.46
|
| Rate for Payer: Humana ChoiceCare |
$19.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.02
|
| Rate for Payer: PHCS All Commercial |
$16.68
|
| Rate for Payer: PHP All Commercial |
$16.87
|
| Rate for Payer: Sagamore Health Network All Products |
$17.17
|
| Rate for Payer: Signature Care EPO |
$18.46
|
| Rate for Payer: Signature Care PPO |
$19.57
|
| Rate for Payer: United Healthcare Commercial |
$17.53
|
|
|
HC SUTURE CHROMIC GUT 2-0 923H
|
Facility
OP
|
$22.24
|
|
| Hospital Charge Code |
41601498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Cash Price |
$13.79
|
| Rate for Payer: Centivo All Commercial |
$11.34
|
| Rate for Payer: Cigna All Commercial |
$19.19
|
| Rate for Payer: CORVEL All Commercial |
$20.68
|
| Rate for Payer: Coventry All Commercial |
$19.57
|
| Rate for Payer: Encore All Commercial |
$20.47
|
| Rate for Payer: Frontpath All Commercial |
$20.46
|
| Rate for Payer: Humana ChoiceCare |
$19.21
|
| Rate for Payer: Humana Medicare |
$11.34
|
| Rate for Payer: Lucent All Commercial |
$11.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.68
|
| Rate for Payer: PHP All Commercial |
$16.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.67
|
| Rate for Payer: Sagamore Health Network All Products |
$17.17
|
| Rate for Payer: Signature Care EPO |
$18.46
|
| Rate for Payer: Signature Care PPO |
$19.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.90
|
| Rate for Payer: United Healthcare Commercial |
$17.53
|
| Rate for Payer: United Healthcare Medicare |
$7.34
|
|
|
HC SUTURE CHROMIC GUT 2-0 G123H
|
Facility
OP
|
$33.34
|
|
| Hospital Charge Code |
41601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.10
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Centivo All Commercial |
$17.00
|
| Rate for Payer: Cigna All Commercial |
$28.77
|
| Rate for Payer: CORVEL All Commercial |
$31.01
|
| Rate for Payer: Coventry All Commercial |
$29.34
|
| Rate for Payer: Encore All Commercial |
$30.69
|
| Rate for Payer: Frontpath All Commercial |
$30.67
|
| Rate for Payer: Humana ChoiceCare |
$28.80
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: Lucent All Commercial |
$17.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$25.00
|
| Rate for Payer: PHP All Commercial |
$25.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.00
|
| Rate for Payer: Sagamore Health Network All Products |
$25.74
|
| Rate for Payer: Signature Care EPO |
$27.67
|
| Rate for Payer: Signature Care PPO |
$29.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.34
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
| Rate for Payer: United Healthcare Medicare |
$11.00
|
|
|
HC SUTURE CHROMIC GUT 2-0 G123H
|
Facility
IP
|
$33.34
|
|
| Hospital Charge Code |
41601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Cigna All Commercial |
$28.77
|
| Rate for Payer: CORVEL All Commercial |
$31.01
|
| Rate for Payer: Coventry All Commercial |
$29.34
|
| Rate for Payer: Encore All Commercial |
$30.69
|
| Rate for Payer: Frontpath All Commercial |
$30.67
|
| Rate for Payer: Humana ChoiceCare |
$28.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.01
|
| Rate for Payer: PHCS All Commercial |
$25.00
|
| Rate for Payer: PHP All Commercial |
$25.29
|
| Rate for Payer: Sagamore Health Network All Products |
$25.74
|
| Rate for Payer: Signature Care EPO |
$27.67
|
| Rate for Payer: Signature Care PPO |
$29.34
|
| Rate for Payer: United Healthcare Commercial |
$26.27
|
|
|
HC SUTURE CHROMIC GUT 2-0 U245H
|
Facility
IP
|
$30.95
|
|
| Hospital Charge Code |
41601461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.21 |
| Max. Negotiated Rate |
$28.78 |
| Rate for Payer: Aetna Commercial |
$26.74
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cigna All Commercial |
$26.71
|
| Rate for Payer: CORVEL All Commercial |
$28.78
|
| Rate for Payer: Coventry All Commercial |
$27.24
|
| Rate for Payer: Encore All Commercial |
$28.49
|
| Rate for Payer: Frontpath All Commercial |
$28.47
|
| Rate for Payer: Humana ChoiceCare |
$26.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.86
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHP All Commercial |
$23.47
|
| Rate for Payer: Sagamore Health Network All Products |
$23.89
|
| Rate for Payer: Signature Care EPO |
$25.69
|
| Rate for Payer: Signature Care PPO |
$27.24
|
| Rate for Payer: United Healthcare Commercial |
$24.39
|
|
|
HC SUTURE CHROMIC GUT 2-0 U245H
|
Facility
OP
|
$30.95
|
|
| Hospital Charge Code |
41601461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.12
|
| Rate for Payer: Aetna Medicare |
$10.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.23
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Centivo All Commercial |
$15.78
|
| Rate for Payer: Cigna All Commercial |
$26.71
|
| Rate for Payer: CORVEL All Commercial |
$28.78
|
| Rate for Payer: Coventry All Commercial |
$27.24
|
| Rate for Payer: Encore All Commercial |
$28.49
|
| Rate for Payer: Frontpath All Commercial |
$28.47
|
| Rate for Payer: Humana ChoiceCare |
$26.73
|
| Rate for Payer: Humana Medicare |
$15.78
|
| Rate for Payer: Lucent All Commercial |
$15.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.21
|
| Rate for Payer: PHP All Commercial |
$23.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.07
|
| Rate for Payer: Sagamore Health Network All Products |
$23.89
|
| Rate for Payer: Signature Care EPO |
$25.69
|
| Rate for Payer: Signature Care PPO |
$27.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.31
|
| Rate for Payer: United Healthcare Commercial |
$24.39
|
| Rate for Payer: United Healthcare Medicare |
$10.21
|
|
|
HC SUTURE CHROMIC GUT 3-0 922H
|
Facility
IP
|
$20.91
|
|
| Hospital Charge Code |
41601460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna Commercial |
$18.07
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cigna All Commercial |
$18.05
|
| Rate for Payer: CORVEL All Commercial |
$19.45
|
| Rate for Payer: Coventry All Commercial |
$18.40
|
| Rate for Payer: Encore All Commercial |
$19.25
|
| Rate for Payer: Frontpath All Commercial |
$19.24
|
| Rate for Payer: Humana ChoiceCare |
$18.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.82
|
| Rate for Payer: PHCS All Commercial |
$15.68
|
| Rate for Payer: PHP All Commercial |
$15.86
|
| Rate for Payer: Sagamore Health Network All Products |
$16.14
|
| Rate for Payer: Signature Care EPO |
$17.36
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
|
|
HC SUTURE CHROMIC GUT 3-0 922H
|
Facility
OP
|
$20.91
|
|
| Hospital Charge Code |
41601460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.59
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Centivo All Commercial |
$10.66
|
| Rate for Payer: Cigna All Commercial |
$18.05
|
| Rate for Payer: CORVEL All Commercial |
$19.45
|
| Rate for Payer: Coventry All Commercial |
$18.40
|
| Rate for Payer: Encore All Commercial |
$19.25
|
| Rate for Payer: Frontpath All Commercial |
$19.24
|
| Rate for Payer: Humana ChoiceCare |
$18.06
|
| Rate for Payer: Humana Medicare |
$10.66
|
| Rate for Payer: Lucent All Commercial |
$10.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.68
|
| Rate for Payer: PHP All Commercial |
$15.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.15
|
| Rate for Payer: Sagamore Health Network All Products |
$16.14
|
| Rate for Payer: Signature Care EPO |
$17.36
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.77
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare |
$6.90
|
|
|
HC SUTURE CHROMIC GUT 4-0 U203H
|
Facility
IP
|
$28.90
|
|
| Hospital Charge Code |
41601476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$26.88 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cigna All Commercial |
$24.94
|
| Rate for Payer: CORVEL All Commercial |
$26.88
|
| Rate for Payer: Coventry All Commercial |
$25.43
|
| Rate for Payer: Encore All Commercial |
$26.60
|
| Rate for Payer: Frontpath All Commercial |
$26.59
|
| Rate for Payer: Humana ChoiceCare |
$24.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.01
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.92
|
| Rate for Payer: Sagamore Health Network All Products |
$22.31
|
| Rate for Payer: Signature Care EPO |
$23.99
|
| Rate for Payer: Signature Care PPO |
$25.43
|
| Rate for Payer: United Healthcare Commercial |
$22.77
|
|
|
HC SUTURE CHROMIC GUT 4-0 U203H
|
Facility
OP
|
$28.90
|
|
| Hospital Charge Code |
41601476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.39
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.49
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Centivo All Commercial |
$14.74
|
| Rate for Payer: Cigna All Commercial |
$24.94
|
| Rate for Payer: CORVEL All Commercial |
$26.88
|
| Rate for Payer: Coventry All Commercial |
$25.43
|
| Rate for Payer: Encore All Commercial |
$26.60
|
| Rate for Payer: Frontpath All Commercial |
$26.59
|
| Rate for Payer: Humana ChoiceCare |
$24.96
|
| Rate for Payer: Humana Medicare |
$14.74
|
| Rate for Payer: Lucent All Commercial |
$14.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.68
|
| Rate for Payer: PHP All Commercial |
$21.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.27
|
| Rate for Payer: Sagamore Health Network All Products |
$22.31
|
| Rate for Payer: Signature Care EPO |
$23.99
|
| Rate for Payer: Signature Care PPO |
$25.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.56
|
| Rate for Payer: United Healthcare Commercial |
$22.77
|
| Rate for Payer: United Healthcare Medicare |
$9.54
|
|
|
HC SUTURE CHROMIC GUT 5-0 687G
|
Facility
IP
|
$150.62
|
|
| Hospital Charge Code |
41601477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna Commercial |
$130.14
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cigna All Commercial |
$129.99
|
| Rate for Payer: CORVEL All Commercial |
$140.08
|
| Rate for Payer: Coventry All Commercial |
$132.55
|
| Rate for Payer: Encore All Commercial |
$138.65
|
| Rate for Payer: Frontpath All Commercial |
$138.57
|
| Rate for Payer: Humana ChoiceCare |
$130.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.56
|
| Rate for Payer: PHCS All Commercial |
$112.96
|
| Rate for Payer: PHP All Commercial |
$114.23
|
| Rate for Payer: Sagamore Health Network All Products |
$116.28
|
| Rate for Payer: Signature Care EPO |
$125.01
|
| Rate for Payer: Signature Care PPO |
$132.55
|
| Rate for Payer: United Healthcare Commercial |
$118.69
|
|
|
HC SUTURE CHROMIC GUT 5-0 687G
|
Facility
OP
|
$150.62
|
|
| Hospital Charge Code |
41601477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$140.08 |
| Rate for Payer: Aetna Commercial |
$127.12
|
| Rate for Payer: Aetna Medicare |
$49.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.68
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Centivo All Commercial |
$76.82
|
| Rate for Payer: Cigna All Commercial |
$129.99
|
| Rate for Payer: CORVEL All Commercial |
$140.08
|
| Rate for Payer: Coventry All Commercial |
$132.55
|
| Rate for Payer: Encore All Commercial |
$138.65
|
| Rate for Payer: Frontpath All Commercial |
$138.57
|
| Rate for Payer: Humana ChoiceCare |
$130.09
|
| Rate for Payer: Humana Medicare |
$76.82
|
| Rate for Payer: Lucent All Commercial |
$76.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$112.96
|
| Rate for Payer: PHP All Commercial |
$114.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.74
|
| Rate for Payer: Sagamore Health Network All Products |
$116.28
|
| Rate for Payer: Signature Care EPO |
$125.01
|
| Rate for Payer: Signature Care PPO |
$132.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.03
|
| Rate for Payer: United Healthcare Commercial |
$118.69
|
| Rate for Payer: United Healthcare Medicare |
$49.70
|
|
|
HC SUTURE CHROMIC GUT 7-0 1745G
|
Facility
IP
|
$170.96
|
|
| Hospital Charge Code |
41601595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$158.99 |
| Rate for Payer: Aetna Commercial |
$147.71
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna All Commercial |
$147.54
|
| Rate for Payer: CORVEL All Commercial |
$158.99
|
| Rate for Payer: Coventry All Commercial |
$150.44
|
| Rate for Payer: Encore All Commercial |
$157.37
|
| Rate for Payer: Frontpath All Commercial |
$157.28
|
| Rate for Payer: Humana ChoiceCare |
$147.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.86
|
| Rate for Payer: PHCS All Commercial |
$128.22
|
| Rate for Payer: PHP All Commercial |
$129.66
|
| Rate for Payer: Sagamore Health Network All Products |
$131.98
|
| Rate for Payer: Signature Care EPO |
$141.90
|
| Rate for Payer: Signature Care PPO |
$150.44
|
| Rate for Payer: United Healthcare Commercial |
$134.72
|
|
|
HC SUTURE CHROMIC GUT 7-0 1745G
|
Facility
OP
|
$170.96
|
|
| Hospital Charge Code |
41601595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$158.99 |
| Rate for Payer: Aetna Commercial |
$144.29
|
| Rate for Payer: Aetna Medicare |
$56.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.06
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Centivo All Commercial |
$87.19
|
| Rate for Payer: Cigna All Commercial |
$147.54
|
| Rate for Payer: CORVEL All Commercial |
$158.99
|
| Rate for Payer: Coventry All Commercial |
$150.44
|
| Rate for Payer: Encore All Commercial |
$157.37
|
| Rate for Payer: Frontpath All Commercial |
$157.28
|
| Rate for Payer: Humana ChoiceCare |
$147.66
|
| Rate for Payer: Humana Medicare |
$87.19
|
| Rate for Payer: Lucent All Commercial |
$87.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$153.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$128.22
|
| Rate for Payer: PHP All Commercial |
$129.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.67
|
| Rate for Payer: Sagamore Health Network All Products |
$131.98
|
| Rate for Payer: Signature Care EPO |
$141.90
|
| Rate for Payer: Signature Care PPO |
$150.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.32
|
| Rate for Payer: United Healthcare Commercial |
$134.72
|
| Rate for Payer: United Healthcare Medicare |
$56.42
|
|
|
HC SUTURE CHROMIC MLD 6-0 G3756K
|
Facility
OP
|
$215.26
|
|
| Hospital Charge Code |
41601574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$200.19 |
| Rate for Payer: Aetna Commercial |
$181.68
|
| Rate for Payer: Aetna Medicare |
$71.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$123.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.14
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Centivo All Commercial |
$109.78
|
| Rate for Payer: Cigna All Commercial |
$185.77
|
| Rate for Payer: CORVEL All Commercial |
$200.19
|
| Rate for Payer: Coventry All Commercial |
$189.43
|
| Rate for Payer: Encore All Commercial |
$198.15
|
| Rate for Payer: Frontpath All Commercial |
$198.04
|
| Rate for Payer: Humana ChoiceCare |
$185.92
|
| Rate for Payer: Humana Medicare |
$109.78
|
| Rate for Payer: Lucent All Commercial |
$109.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$193.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$161.44
|
| Rate for Payer: PHP All Commercial |
$163.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.95
|
| Rate for Payer: Sagamore Health Network All Products |
$166.18
|
| Rate for Payer: Signature Care EPO |
$178.67
|
| Rate for Payer: Signature Care PPO |
$189.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$182.97
|
| Rate for Payer: United Healthcare Commercial |
$169.62
|
| Rate for Payer: United Healthcare Medicare |
$71.04
|
|
