|
HC SUTURE CHROMIC MLD 6-0 G3756K
|
Facility
IP
|
$215.26
|
|
| Hospital Charge Code |
41601574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.44 |
| Max. Negotiated Rate |
$200.19 |
| Rate for Payer: Aetna Commercial |
$185.98
|
| Rate for Payer: Cash Price |
$133.46
|
| 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: Lutheran Preferred All Commercial |
$193.73
|
| Rate for Payer: PHCS All Commercial |
$161.44
|
| Rate for Payer: PHP All Commercial |
$163.25
|
| 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: United Healthcare Commercial |
$169.62
|
|
|
HC SUTURE CHROMIC MLD 6-0 G3790K
|
Facility
OP
|
$349.45
|
|
| Hospital Charge Code |
41601575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.32 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$294.94
|
| Rate for Payer: Aetna Medicare |
$115.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$200.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.85
|
| Rate for Payer: Cash Price |
$216.66
|
| Rate for Payer: Cash Price |
$216.66
|
| Rate for Payer: Centivo All Commercial |
$178.22
|
| Rate for Payer: Cigna All Commercial |
$301.58
|
| Rate for Payer: CORVEL All Commercial |
$324.99
|
| Rate for Payer: Coventry All Commercial |
$307.52
|
| Rate for Payer: Encore All Commercial |
$321.67
|
| Rate for Payer: Frontpath All Commercial |
$321.49
|
| Rate for Payer: Humana ChoiceCare |
$301.82
|
| Rate for Payer: Humana Medicare |
$178.22
|
| Rate for Payer: Lucent All Commercial |
$178.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$262.09
|
| Rate for Payer: PHP All Commercial |
$265.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.29
|
| Rate for Payer: Sagamore Health Network All Products |
$269.78
|
| Rate for Payer: Signature Care EPO |
$290.04
|
| Rate for Payer: Signature Care PPO |
$307.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.03
|
| Rate for Payer: United Healthcare Commercial |
$275.37
|
| Rate for Payer: United Healthcare Medicare |
$115.32
|
|
|
HC SUTURE CHROMIC MLD 6-0 G3790K
|
Facility
IP
|
$349.45
|
|
| Hospital Charge Code |
41601575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.09 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$301.92
|
| Rate for Payer: Cash Price |
$216.66
|
| Rate for Payer: Cigna All Commercial |
$301.58
|
| Rate for Payer: CORVEL All Commercial |
$324.99
|
| Rate for Payer: Coventry All Commercial |
$307.52
|
| Rate for Payer: Encore All Commercial |
$321.67
|
| Rate for Payer: Frontpath All Commercial |
$321.49
|
| Rate for Payer: Humana ChoiceCare |
$301.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$314.50
|
| Rate for Payer: PHCS All Commercial |
$262.09
|
| Rate for Payer: PHP All Commercial |
$265.02
|
| Rate for Payer: Sagamore Health Network All Products |
$269.78
|
| Rate for Payer: Signature Care EPO |
$290.04
|
| Rate for Payer: Signature Care PPO |
$307.52
|
| Rate for Payer: United Healthcare Commercial |
$275.37
|
|
|
HC SUTURE CV3 36IN TH26 DBLE
|
Facility
IP
|
$165.08
|
|
| Hospital Charge Code |
41601499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.81 |
| Max. Negotiated Rate |
$153.52 |
| Rate for Payer: Aetna Commercial |
$142.63
|
| Rate for Payer: Cash Price |
$102.35
|
| Rate for Payer: Cigna All Commercial |
$142.46
|
| Rate for Payer: CORVEL All Commercial |
$153.52
|
| Rate for Payer: Coventry All Commercial |
$145.27
|
| Rate for Payer: Encore All Commercial |
$151.96
|
| Rate for Payer: Frontpath All Commercial |
$151.87
|
| Rate for Payer: Humana ChoiceCare |
$142.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.57
|
| Rate for Payer: PHCS All Commercial |
$123.81
|
| Rate for Payer: PHP All Commercial |
$125.20
|
| Rate for Payer: Sagamore Health Network All Products |
$127.44
|
| Rate for Payer: Signature Care EPO |
$137.02
|
| Rate for Payer: Signature Care PPO |
$145.27
|
| Rate for Payer: United Healthcare Commercial |
$130.08
|
|
|
HC SUTURE CV3 36IN TH26 DBLE
|
Facility
OP
|
$165.08
|
|
| Hospital Charge Code |
41601499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$153.52 |
| Rate for Payer: Aetna Commercial |
$139.33
|
| Rate for Payer: Aetna Medicare |
$54.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$103.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.92
|
| Rate for Payer: Cash Price |
$102.35
|
| Rate for Payer: Cash Price |
$102.35
|
| Rate for Payer: Centivo All Commercial |
$84.19
|
| Rate for Payer: Cigna All Commercial |
$142.46
|
| Rate for Payer: CORVEL All Commercial |
$153.52
|
| Rate for Payer: Coventry All Commercial |
$145.27
|
| Rate for Payer: Encore All Commercial |
$151.96
|
| Rate for Payer: Frontpath All Commercial |
$151.87
|
| Rate for Payer: Humana ChoiceCare |
$142.58
|
| Rate for Payer: Humana Medicare |
$84.19
|
| Rate for Payer: Lucent All Commercial |
$84.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$148.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$123.81
|
| Rate for Payer: PHP All Commercial |
$125.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.38
|
| Rate for Payer: Sagamore Health Network All Products |
$127.44
|
| Rate for Payer: Signature Care EPO |
$137.02
|
| Rate for Payer: Signature Care PPO |
$145.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$140.32
|
| Rate for Payer: United Healthcare Commercial |
$130.08
|
| Rate for Payer: United Healthcare Medicare |
$54.48
|
|
|
HC SUTURE CV4 30 IN CS-50 NDLE
|
Facility
IP
|
$138.83
|
|
| Hospital Charge Code |
41601500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$129.11
|
| Rate for Payer: Coventry All Commercial |
$122.17
|
| Rate for Payer: Encore All Commercial |
$127.79
|
| Rate for Payer: Frontpath All Commercial |
$127.72
|
| Rate for Payer: Humana ChoiceCare |
$119.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.95
|
| Rate for Payer: PHCS All Commercial |
$104.12
|
| Rate for Payer: PHP All Commercial |
$105.29
|
| Rate for Payer: Sagamore Health Network All Products |
$107.18
|
| Rate for Payer: Signature Care EPO |
$115.23
|
| Rate for Payer: Signature Care PPO |
$122.17
|
| Rate for Payer: United Healthcare Commercial |
$109.40
|
|
|
HC SUTURE CV4 30 IN CS-50 NDLE
|
Facility
OP
|
$138.83
|
|
| Hospital Charge Code |
41601500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Medicare |
$45.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.40
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Centivo All Commercial |
$70.80
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$129.11
|
| Rate for Payer: Coventry All Commercial |
$122.17
|
| Rate for Payer: Encore All Commercial |
$127.79
|
| Rate for Payer: Frontpath All Commercial |
$127.72
|
| Rate for Payer: Humana ChoiceCare |
$119.91
|
| Rate for Payer: Humana Medicare |
$70.80
|
| Rate for Payer: Lucent All Commercial |
$70.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$104.12
|
| Rate for Payer: PHP All Commercial |
$105.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.14
|
| Rate for Payer: Sagamore Health Network All Products |
$107.18
|
| Rate for Payer: Signature Care EPO |
$115.23
|
| Rate for Payer: Signature Care PPO |
$122.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.01
|
| Rate for Payer: United Healthcare Commercial |
$109.40
|
| Rate for Payer: United Healthcare Medicare |
$45.81
|
|
|
HC SUTURE ENDOSTITCH 2-0 POLYSORB
|
Facility
OP
|
$141.19
|
|
| Hospital Charge Code |
41601596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna Commercial |
$119.16
|
| Rate for Payer: Aetna Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$88.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.25
|
| Rate for Payer: Cash Price |
$87.54
|
| Rate for Payer: Cash Price |
$87.54
|
| Rate for Payer: Centivo All Commercial |
$72.01
|
| Rate for Payer: Cigna All Commercial |
$121.85
|
| Rate for Payer: CORVEL All Commercial |
$131.31
|
| Rate for Payer: Coventry All Commercial |
$124.25
|
| Rate for Payer: Encore All Commercial |
$129.97
|
| Rate for Payer: Frontpath All Commercial |
$129.89
|
| Rate for Payer: Humana ChoiceCare |
$121.95
|
| Rate for Payer: Humana Medicare |
$72.01
|
| Rate for Payer: Lucent All Commercial |
$72.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$105.89
|
| Rate for Payer: PHP All Commercial |
$107.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.06
|
| Rate for Payer: Sagamore Health Network All Products |
$109.00
|
| Rate for Payer: Signature Care EPO |
$117.19
|
| Rate for Payer: Signature Care PPO |
$124.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.01
|
| Rate for Payer: United Healthcare Commercial |
$111.26
|
| Rate for Payer: United Healthcare Medicare |
$46.59
|
|
|
HC SUTURE ENDOSTITCH 2-0 POLYSORB
|
Facility
IP
|
$141.19
|
|
| Hospital Charge Code |
41601596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.89 |
| Max. Negotiated Rate |
$131.31 |
| Rate for Payer: Aetna Commercial |
$121.99
|
| Rate for Payer: Cash Price |
$87.54
|
| Rate for Payer: Cigna All Commercial |
$121.85
|
| Rate for Payer: CORVEL All Commercial |
$131.31
|
| Rate for Payer: Coventry All Commercial |
$124.25
|
| Rate for Payer: Encore All Commercial |
$129.97
|
| Rate for Payer: Frontpath All Commercial |
$129.89
|
| Rate for Payer: Humana ChoiceCare |
$121.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$127.07
|
| Rate for Payer: PHCS All Commercial |
$105.89
|
| Rate for Payer: PHP All Commercial |
$107.08
|
| Rate for Payer: Sagamore Health Network All Products |
$109.00
|
| Rate for Payer: Signature Care EPO |
$117.19
|
| Rate for Payer: Signature Care PPO |
$124.25
|
| Rate for Payer: United Healthcare Commercial |
$111.26
|
|
|
HC SUTURE ETHIBOND 0 X424H
|
Facility
IP
|
$12.54
|
|
| Hospital Charge Code |
41601505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
|
|
HC SUTURE ETHIBOND 0 X424H
|
Facility
OP
|
$12.54
|
|
| Hospital Charge Code |
41601505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.55
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Centivo All Commercial |
$6.40
|
| Rate for Payer: Cigna All Commercial |
$10.82
|
| Rate for Payer: CORVEL All Commercial |
$11.66
|
| Rate for Payer: Coventry All Commercial |
$11.04
|
| Rate for Payer: Encore All Commercial |
$11.54
|
| Rate for Payer: Frontpath All Commercial |
$11.54
|
| Rate for Payer: Humana ChoiceCare |
$10.83
|
| Rate for Payer: Humana Medicare |
$6.40
|
| Rate for Payer: Lucent All Commercial |
$6.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.29
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.40
|
| Rate for Payer: PHP All Commercial |
$9.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.89
|
| Rate for Payer: Sagamore Health Network All Products |
$9.68
|
| Rate for Payer: Signature Care EPO |
$10.41
|
| Rate for Payer: Signature Care PPO |
$11.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$9.88
|
| Rate for Payer: United Healthcare Medicare |
$4.14
|
|
|
HC SUTURE ETHIBOND 0 X834H
|
Facility
IP
|
$14.23
|
|
| Hospital Charge Code |
41601134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$13.23 |
| Rate for Payer: Aetna Commercial |
$12.29
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cigna All Commercial |
$12.28
|
| Rate for Payer: CORVEL All Commercial |
$13.23
|
| Rate for Payer: Coventry All Commercial |
$12.52
|
| Rate for Payer: Encore All Commercial |
$13.10
|
| Rate for Payer: Frontpath All Commercial |
$13.09
|
| Rate for Payer: Humana ChoiceCare |
$12.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.81
|
| Rate for Payer: PHCS All Commercial |
$10.67
|
| Rate for Payer: PHP All Commercial |
$10.79
|
| Rate for Payer: Sagamore Health Network All Products |
$10.99
|
| Rate for Payer: Signature Care EPO |
$11.81
|
| Rate for Payer: Signature Care PPO |
$12.52
|
| Rate for Payer: United Healthcare Commercial |
$11.21
|
|
|
HC SUTURE ETHIBOND 0 X834H
|
Facility
OP
|
$14.23
|
|
| Hospital Charge Code |
41601134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.01
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.17
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Centivo All Commercial |
$7.26
|
| Rate for Payer: Cigna All Commercial |
$12.28
|
| Rate for Payer: CORVEL All Commercial |
$13.23
|
| Rate for Payer: Coventry All Commercial |
$12.52
|
| Rate for Payer: Encore All Commercial |
$13.10
|
| Rate for Payer: Frontpath All Commercial |
$13.09
|
| Rate for Payer: Humana ChoiceCare |
$12.29
|
| Rate for Payer: Humana Medicare |
$7.26
|
| Rate for Payer: Lucent All Commercial |
$7.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.67
|
| Rate for Payer: PHP All Commercial |
$10.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.55
|
| Rate for Payer: Sagamore Health Network All Products |
$10.99
|
| Rate for Payer: Signature Care EPO |
$11.81
|
| Rate for Payer: Signature Care PPO |
$12.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.10
|
| Rate for Payer: United Healthcare Commercial |
$11.21
|
| Rate for Payer: United Healthcare Medicare |
$4.70
|
|
|
HC SUTURE ETHIBOND 1-0 X425H
|
Facility
IP
|
$11.46
|
|
| Hospital Charge Code |
41601501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cigna All Commercial |
$9.89
|
| Rate for Payer: CORVEL All Commercial |
$10.66
|
| Rate for Payer: Coventry All Commercial |
$10.08
|
| Rate for Payer: Encore All Commercial |
$10.55
|
| Rate for Payer: Frontpath All Commercial |
$10.54
|
| Rate for Payer: Humana ChoiceCare |
$9.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.31
|
| Rate for Payer: PHCS All Commercial |
$8.60
|
| Rate for Payer: PHP All Commercial |
$8.69
|
| Rate for Payer: Sagamore Health Network All Products |
$8.85
|
| Rate for Payer: Signature Care EPO |
$9.51
|
| Rate for Payer: Signature Care PPO |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$9.03
|
|
|
HC SUTURE ETHIBOND 1-0 X425H
|
Facility
OP
|
$11.46
|
|
| Hospital Charge Code |
41601501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.16
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Centivo All Commercial |
$5.84
|
| Rate for Payer: Cigna All Commercial |
$9.89
|
| Rate for Payer: CORVEL All Commercial |
$10.66
|
| Rate for Payer: Coventry All Commercial |
$10.08
|
| Rate for Payer: Encore All Commercial |
$10.55
|
| Rate for Payer: Frontpath All Commercial |
$10.54
|
| Rate for Payer: Humana ChoiceCare |
$9.90
|
| Rate for Payer: Humana Medicare |
$5.84
|
| Rate for Payer: Lucent All Commercial |
$5.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.60
|
| Rate for Payer: PHP All Commercial |
$8.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.85
|
| Rate for Payer: Signature Care EPO |
$9.51
|
| Rate for Payer: Signature Care PPO |
$10.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$9.03
|
| Rate for Payer: United Healthcare Medicare |
$3.78
|
|
|
HC SUTURE ETHIBOND 1 EXCEL V-37
|
Facility
IP
|
$18.62
|
|
| Hospital Charge Code |
41602395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cigna All Commercial |
$16.07
|
| Rate for Payer: CORVEL All Commercial |
$17.32
|
| Rate for Payer: Coventry All Commercial |
$16.39
|
| Rate for Payer: Encore All Commercial |
$17.14
|
| Rate for Payer: Frontpath All Commercial |
$17.13
|
| Rate for Payer: Humana ChoiceCare |
$16.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.76
|
| Rate for Payer: PHCS All Commercial |
$13.96
|
| Rate for Payer: PHP All Commercial |
$14.12
|
| Rate for Payer: Sagamore Health Network All Products |
$14.37
|
| Rate for Payer: Signature Care EPO |
$15.45
|
| Rate for Payer: Signature Care PPO |
$16.39
|
| Rate for Payer: United Healthcare Commercial |
$14.67
|
|
|
HC SUTURE ETHIBOND 1 EXCEL V-37
|
Facility
OP
|
$18.62
|
|
| Hospital Charge Code |
41602395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$6.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.76
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Centivo All Commercial |
$9.50
|
| Rate for Payer: Cigna All Commercial |
$16.07
|
| Rate for Payer: CORVEL All Commercial |
$17.32
|
| Rate for Payer: Coventry All Commercial |
$16.39
|
| Rate for Payer: Encore All Commercial |
$17.14
|
| Rate for Payer: Frontpath All Commercial |
$17.13
|
| Rate for Payer: Humana ChoiceCare |
$16.08
|
| Rate for Payer: Humana Medicare |
$9.50
|
| Rate for Payer: Lucent All Commercial |
$9.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.96
|
| Rate for Payer: PHP All Commercial |
$14.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.26
|
| Rate for Payer: Sagamore Health Network All Products |
$14.37
|
| Rate for Payer: Signature Care EPO |
$15.45
|
| Rate for Payer: Signature Care PPO |
$16.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.83
|
| Rate for Payer: United Healthcare Commercial |
$14.67
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
|
|
HC SUTURE ETHIBOND 2-0 CX46D
|
Facility
IP
|
$87.13
|
|
| Hospital Charge Code |
41601620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.35 |
| Max. Negotiated Rate |
$81.03 |
| Rate for Payer: Aetna Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna All Commercial |
$75.19
|
| Rate for Payer: CORVEL All Commercial |
$81.03
|
| Rate for Payer: Coventry All Commercial |
$76.67
|
| Rate for Payer: Encore All Commercial |
$80.20
|
| Rate for Payer: Frontpath All Commercial |
$80.16
|
| Rate for Payer: Humana ChoiceCare |
$75.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.42
|
| Rate for Payer: PHCS All Commercial |
$65.35
|
| Rate for Payer: PHP All Commercial |
$66.08
|
| Rate for Payer: Sagamore Health Network All Products |
$67.26
|
| Rate for Payer: Signature Care EPO |
$72.32
|
| Rate for Payer: Signature Care PPO |
$76.67
|
| Rate for Payer: United Healthcare Commercial |
$68.66
|
|
|
HC SUTURE ETHIBOND 2-0 CX46D
|
Facility
OP
|
$87.13
|
|
| Hospital Charge Code |
41601620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$73.54
|
| Rate for Payer: Aetna Medicare |
$28.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.63
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Centivo All Commercial |
$44.44
|
| Rate for Payer: Cigna All Commercial |
$75.19
|
| Rate for Payer: CORVEL All Commercial |
$81.03
|
| Rate for Payer: Coventry All Commercial |
$76.67
|
| Rate for Payer: Encore All Commercial |
$80.20
|
| Rate for Payer: Frontpath All Commercial |
$80.16
|
| Rate for Payer: Humana ChoiceCare |
$75.25
|
| Rate for Payer: Humana Medicare |
$44.44
|
| Rate for Payer: Lucent All Commercial |
$44.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$65.35
|
| Rate for Payer: PHP All Commercial |
$66.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.98
|
| Rate for Payer: Sagamore Health Network All Products |
$67.26
|
| Rate for Payer: Signature Care EPO |
$72.32
|
| Rate for Payer: Signature Care PPO |
$76.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.06
|
| Rate for Payer: United Healthcare Commercial |
$68.66
|
| Rate for Payer: United Healthcare Medicare |
$28.75
|
|
|
HC SUTURE ETHIBOND 2 GREEN OS-4
|
Facility
OP
|
$26.52
|
|
| Hospital Charge Code |
41602396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.63
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Centivo All Commercial |
$13.53
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Humana Medicare |
$13.53
|
| Rate for Payer: Lucent All Commercial |
$13.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.34
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.54
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
| Rate for Payer: United Healthcare Medicare |
$8.75
|
|
|
HC SUTURE ETHIBOND 2 GREEN OS-4
|
Facility
IP
|
$26.52
|
|
| Hospital Charge Code |
41602396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Aetna Commercial |
$22.91
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna All Commercial |
$22.89
|
| Rate for Payer: CORVEL All Commercial |
$24.66
|
| Rate for Payer: Coventry All Commercial |
$23.34
|
| Rate for Payer: Encore All Commercial |
$24.41
|
| Rate for Payer: Frontpath All Commercial |
$24.40
|
| Rate for Payer: Humana ChoiceCare |
$22.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.87
|
| Rate for Payer: PHCS All Commercial |
$19.89
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.01
|
| Rate for Payer: Signature Care PPO |
$23.34
|
| Rate for Payer: United Healthcare Commercial |
$20.90
|
|
|
HC SUTURE ETHIBOND 2 X496T
|
Facility
IP
|
$31.42
|
|
| Hospital Charge Code |
41601503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cigna All Commercial |
$27.12
|
| Rate for Payer: CORVEL All Commercial |
$29.22
|
| Rate for Payer: Coventry All Commercial |
$27.65
|
| Rate for Payer: Encore All Commercial |
$28.92
|
| Rate for Payer: Frontpath All Commercial |
$28.91
|
| Rate for Payer: Humana ChoiceCare |
$27.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.28
|
| Rate for Payer: PHCS All Commercial |
$23.56
|
| Rate for Payer: PHP All Commercial |
$23.83
|
| Rate for Payer: Sagamore Health Network All Products |
$24.26
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$27.65
|
| Rate for Payer: United Healthcare Commercial |
$24.76
|
|
|
HC SUTURE ETHIBOND 2 X496T
|
Facility
OP
|
$31.42
|
|
| Hospital Charge Code |
41601503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.52
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.41
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Centivo All Commercial |
$16.02
|
| Rate for Payer: Cigna All Commercial |
$27.12
|
| Rate for Payer: CORVEL All Commercial |
$29.22
|
| Rate for Payer: Coventry All Commercial |
$27.65
|
| Rate for Payer: Encore All Commercial |
$28.92
|
| Rate for Payer: Frontpath All Commercial |
$28.91
|
| Rate for Payer: Humana ChoiceCare |
$27.14
|
| Rate for Payer: Humana Medicare |
$16.02
|
| Rate for Payer: Lucent All Commercial |
$16.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.56
|
| Rate for Payer: PHP All Commercial |
$23.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.25
|
| Rate for Payer: Sagamore Health Network All Products |
$24.26
|
| Rate for Payer: Signature Care EPO |
$26.08
|
| Rate for Payer: Signature Care PPO |
$27.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.71
|
| Rate for Payer: United Healthcare Commercial |
$24.76
|
| Rate for Payer: United Healthcare Medicare |
$10.37
|
|
|
HC SUTURE ETHIBOND 3-0 X832H
|
Facility
OP
|
$18.24
|
|
| Hospital Charge Code |
41601504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.39
|
| Rate for Payer: Aetna Medicare |
$6.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.62
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Centivo All Commercial |
$9.30
|
| Rate for Payer: Cigna All Commercial |
$15.74
|
| Rate for Payer: CORVEL All Commercial |
$16.96
|
| Rate for Payer: Coventry All Commercial |
$16.05
|
| Rate for Payer: Encore All Commercial |
$16.79
|
| Rate for Payer: Frontpath All Commercial |
$16.78
|
| Rate for Payer: Humana ChoiceCare |
$15.75
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Lucent All Commercial |
$9.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.42
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.68
|
| Rate for Payer: PHP All Commercial |
$13.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.11
|
| Rate for Payer: Sagamore Health Network All Products |
$14.08
|
| Rate for Payer: Signature Care EPO |
$15.14
|
| Rate for Payer: Signature Care PPO |
$16.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.50
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$6.02
|
|
|
HC SUTURE ETHIBOND 3-0 X832H
|
Facility
IP
|
$18.24
|
|
| Hospital Charge Code |
41601504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Cigna All Commercial |
$15.74
|
| Rate for Payer: CORVEL All Commercial |
$16.96
|
| Rate for Payer: Coventry All Commercial |
$16.05
|
| Rate for Payer: Encore All Commercial |
$16.79
|
| Rate for Payer: Frontpath All Commercial |
$16.78
|
| Rate for Payer: Humana ChoiceCare |
$15.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.42
|
| Rate for Payer: PHCS All Commercial |
$13.68
|
| Rate for Payer: PHP All Commercial |
$13.83
|
| Rate for Payer: Sagamore Health Network All Products |
$14.08
|
| Rate for Payer: Signature Care EPO |
$15.14
|
| Rate for Payer: Signature Care PPO |
$16.05
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
|
