|
HC SUTURE ETHIBOND 5-0 MB47G
|
Facility
OP
|
$157.31
|
|
| Hospital Charge Code |
41601502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$51.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.10
|
| Rate for Payer: Cash Price |
$97.53
|
| Rate for Payer: Cash Price |
$97.53
|
| Rate for Payer: Centivo All Commercial |
$80.23
|
| Rate for Payer: Cigna All Commercial |
$135.76
|
| Rate for Payer: CORVEL All Commercial |
$146.30
|
| Rate for Payer: Coventry All Commercial |
$138.43
|
| Rate for Payer: Encore All Commercial |
$144.80
|
| Rate for Payer: Frontpath All Commercial |
$144.73
|
| Rate for Payer: Humana ChoiceCare |
$135.87
|
| Rate for Payer: Humana Medicare |
$80.23
|
| Rate for Payer: Lucent All Commercial |
$80.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$117.98
|
| Rate for Payer: PHP All Commercial |
$119.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.35
|
| Rate for Payer: Sagamore Health Network All Products |
$121.44
|
| Rate for Payer: Signature Care EPO |
$130.57
|
| Rate for Payer: Signature Care PPO |
$138.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.71
|
| Rate for Payer: United Healthcare Commercial |
$123.96
|
| Rate for Payer: United Healthcare Medicare |
$51.91
|
|
|
HC SUTURE ETHIBOND 5-0 MB47G
|
Facility
IP
|
$157.31
|
|
| Hospital Charge Code |
41601502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$135.92
|
| Rate for Payer: Cash Price |
$97.53
|
| Rate for Payer: Cigna All Commercial |
$135.76
|
| Rate for Payer: CORVEL All Commercial |
$146.30
|
| Rate for Payer: Coventry All Commercial |
$138.43
|
| Rate for Payer: Encore All Commercial |
$144.80
|
| Rate for Payer: Frontpath All Commercial |
$144.73
|
| Rate for Payer: Humana ChoiceCare |
$135.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.58
|
| Rate for Payer: PHCS All Commercial |
$117.98
|
| Rate for Payer: PHP All Commercial |
$119.30
|
| Rate for Payer: Sagamore Health Network All Products |
$121.44
|
| Rate for Payer: Signature Care EPO |
$130.57
|
| Rate for Payer: Signature Care PPO |
$138.43
|
| Rate for Payer: United Healthcare Commercial |
$123.96
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-37
|
Facility
OP
|
$329.33
|
|
| Hospital Charge Code |
41602397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$306.28 |
| Rate for Payer: Aetna Commercial |
$277.95
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$189.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.55
|
| Rate for Payer: Cash Price |
$204.19
|
| Rate for Payer: Cash Price |
$204.19
|
| Rate for Payer: Centivo All Commercial |
$167.96
|
| Rate for Payer: Cigna All Commercial |
$284.21
|
| Rate for Payer: CORVEL All Commercial |
$306.28
|
| Rate for Payer: Coventry All Commercial |
$289.81
|
| Rate for Payer: Encore All Commercial |
$303.15
|
| Rate for Payer: Frontpath All Commercial |
$302.98
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Humana Medicare |
$167.96
|
| Rate for Payer: Lucent All Commercial |
$167.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$247.00
|
| Rate for Payer: PHP All Commercial |
$249.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.44
|
| Rate for Payer: Sagamore Health Network All Products |
$254.24
|
| Rate for Payer: Signature Care EPO |
$273.34
|
| Rate for Payer: Signature Care PPO |
$289.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$279.93
|
| Rate for Payer: United Healthcare Commercial |
$259.51
|
| Rate for Payer: United Healthcare Medicare |
$108.68
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-37
|
Facility
IP
|
$329.33
|
|
| Hospital Charge Code |
41602397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$306.28 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Cash Price |
$204.19
|
| Rate for Payer: Cigna All Commercial |
$284.21
|
| Rate for Payer: CORVEL All Commercial |
$306.28
|
| Rate for Payer: Coventry All Commercial |
$289.81
|
| Rate for Payer: Encore All Commercial |
$303.15
|
| Rate for Payer: Frontpath All Commercial |
$302.98
|
| Rate for Payer: Humana ChoiceCare |
$284.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.40
|
| Rate for Payer: PHCS All Commercial |
$247.00
|
| Rate for Payer: PHP All Commercial |
$249.76
|
| Rate for Payer: Sagamore Health Network All Products |
$254.24
|
| Rate for Payer: Signature Care EPO |
$273.34
|
| Rate for Payer: Signature Care PPO |
$289.81
|
| Rate for Payer: United Healthcare Commercial |
$259.51
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-40
|
Facility
IP
|
$118.92
|
|
| Hospital Charge Code |
41602398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.19 |
| Max. Negotiated Rate |
$110.60 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Cash Price |
$73.73
|
| Rate for Payer: Cigna All Commercial |
$102.63
|
| Rate for Payer: CORVEL All Commercial |
$110.60
|
| Rate for Payer: Coventry All Commercial |
$104.65
|
| Rate for Payer: Encore All Commercial |
$109.47
|
| Rate for Payer: Frontpath All Commercial |
$109.41
|
| Rate for Payer: Humana ChoiceCare |
$102.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.03
|
| Rate for Payer: PHCS All Commercial |
$89.19
|
| Rate for Payer: PHP All Commercial |
$90.19
|
| Rate for Payer: Sagamore Health Network All Products |
$91.81
|
| Rate for Payer: Signature Care EPO |
$98.70
|
| Rate for Payer: Signature Care PPO |
$104.65
|
| Rate for Payer: United Healthcare Commercial |
$93.71
|
|
|
HC SUTURE ETHIBOND 5 EXCEL V-40
|
Facility
OP
|
$118.92
|
|
| Hospital Charge Code |
41602398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.17
|
| Rate for Payer: Cash Price |
$73.73
|
| Rate for Payer: Cash Price |
$73.73
|
| Rate for Payer: Centivo All Commercial |
$60.65
|
| Rate for Payer: Cigna All Commercial |
$102.63
|
| Rate for Payer: CORVEL All Commercial |
$110.60
|
| Rate for Payer: Coventry All Commercial |
$104.65
|
| Rate for Payer: Encore All Commercial |
$109.47
|
| Rate for Payer: Frontpath All Commercial |
$109.41
|
| Rate for Payer: Humana ChoiceCare |
$102.71
|
| Rate for Payer: Humana Medicare |
$60.65
|
| Rate for Payer: Lucent All Commercial |
$60.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.03
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$89.19
|
| Rate for Payer: PHP All Commercial |
$90.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.38
|
| Rate for Payer: Sagamore Health Network All Products |
$91.81
|
| Rate for Payer: Signature Care EPO |
$98.70
|
| Rate for Payer: Signature Care PPO |
$104.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.08
|
| Rate for Payer: United Healthcare Commercial |
$93.71
|
| Rate for Payer: United Healthcare Medicare |
$39.24
|
|
|
HC SUTURE ETHIBOND O X517H
|
Facility
OP
|
$15.40
|
|
| Hospital Charge Code |
41601603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.59
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Centivo All Commercial |
$7.85
|
| Rate for Payer: Cigna All Commercial |
$13.29
|
| Rate for Payer: CORVEL All Commercial |
$14.32
|
| Rate for Payer: Coventry All Commercial |
$13.55
|
| Rate for Payer: Encore All Commercial |
$14.18
|
| Rate for Payer: Frontpath All Commercial |
$14.17
|
| Rate for Payer: Humana ChoiceCare |
$13.30
|
| Rate for Payer: Humana Medicare |
$7.85
|
| Rate for Payer: Lucent All Commercial |
$7.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.55
|
| Rate for Payer: PHP All Commercial |
$11.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.01
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$12.78
|
| Rate for Payer: Signature Care PPO |
$13.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.09
|
| Rate for Payer: United Healthcare Commercial |
$12.14
|
| Rate for Payer: United Healthcare Medicare |
$5.08
|
|
|
HC SUTURE ETHIBOND O X517H
|
Facility
IP
|
$15.40
|
|
| Hospital Charge Code |
41601603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Cash Price |
$9.55
|
| Rate for Payer: Cigna All Commercial |
$13.29
|
| Rate for Payer: CORVEL All Commercial |
$14.32
|
| Rate for Payer: Coventry All Commercial |
$13.55
|
| Rate for Payer: Encore All Commercial |
$14.18
|
| Rate for Payer: Frontpath All Commercial |
$14.17
|
| Rate for Payer: Humana ChoiceCare |
$13.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.86
|
| Rate for Payer: PHCS All Commercial |
$11.55
|
| Rate for Payer: PHP All Commercial |
$11.68
|
| Rate for Payer: Sagamore Health Network All Products |
$11.89
|
| Rate for Payer: Signature Care EPO |
$12.78
|
| Rate for Payer: Signature Care PPO |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$12.14
|
|
|
HC SUTURE ETHILON 10-0 CUM 15
|
Facility
IP
|
$194.25
|
|
| Hospital Charge Code |
41601601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$180.65 |
| Rate for Payer: Aetna Commercial |
$167.83
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: Cigna All Commercial |
$167.64
|
| Rate for Payer: CORVEL All Commercial |
$180.65
|
| Rate for Payer: Coventry All Commercial |
$170.94
|
| Rate for Payer: Encore All Commercial |
$178.81
|
| Rate for Payer: Frontpath All Commercial |
$178.71
|
| Rate for Payer: Humana ChoiceCare |
$167.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.82
|
| Rate for Payer: PHCS All Commercial |
$145.69
|
| Rate for Payer: PHP All Commercial |
$147.32
|
| Rate for Payer: Sagamore Health Network All Products |
$149.96
|
| Rate for Payer: Signature Care EPO |
$161.23
|
| Rate for Payer: Signature Care PPO |
$170.94
|
| Rate for Payer: United Healthcare Commercial |
$153.07
|
|
|
HC SUTURE ETHILON 10-0 CUM 15
|
Facility
OP
|
$194.25
|
|
| Hospital Charge Code |
41601601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$180.65 |
| Rate for Payer: Aetna Commercial |
$163.95
|
| Rate for Payer: Aetna Medicare |
$64.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.51
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: Centivo All Commercial |
$99.07
|
| Rate for Payer: Cigna All Commercial |
$167.64
|
| Rate for Payer: CORVEL All Commercial |
$180.65
|
| Rate for Payer: Coventry All Commercial |
$170.94
|
| Rate for Payer: Encore All Commercial |
$178.81
|
| Rate for Payer: Frontpath All Commercial |
$178.71
|
| Rate for Payer: Humana ChoiceCare |
$167.77
|
| Rate for Payer: Humana Medicare |
$99.07
|
| Rate for Payer: Lucent All Commercial |
$99.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.82
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$145.69
|
| Rate for Payer: PHP All Commercial |
$147.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.76
|
| Rate for Payer: Sagamore Health Network All Products |
$149.96
|
| Rate for Payer: Signature Care EPO |
$161.23
|
| Rate for Payer: Signature Care PPO |
$170.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.11
|
| Rate for Payer: United Healthcare Commercial |
$153.07
|
| Rate for Payer: United Healthcare Medicare |
$64.10
|
|
|
HC SUTURE ETHILON 2-0 1674H
|
Facility
OP
|
$13.87
|
|
| Hospital Charge Code |
41607019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Centivo All Commercial |
$7.07
|
| Rate for Payer: Cigna All Commercial |
$11.97
|
| Rate for Payer: CORVEL All Commercial |
$12.90
|
| Rate for Payer: Coventry All Commercial |
$12.21
|
| Rate for Payer: Encore All Commercial |
$12.77
|
| Rate for Payer: Frontpath All Commercial |
$12.76
|
| Rate for Payer: Humana ChoiceCare |
$11.98
|
| Rate for Payer: Humana Medicare |
$7.07
|
| Rate for Payer: Lucent All Commercial |
$7.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.40
|
| Rate for Payer: PHP All Commercial |
$10.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.41
|
| Rate for Payer: Sagamore Health Network All Products |
$10.71
|
| Rate for Payer: Signature Care EPO |
$11.51
|
| Rate for Payer: Signature Care PPO |
$12.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.79
|
| Rate for Payer: United Healthcare Commercial |
$10.93
|
| Rate for Payer: United Healthcare Medicare |
$4.58
|
|
|
HC SUTURE ETHILON 2-0 1674H
|
Facility
IP
|
$13.87
|
|
| Hospital Charge Code |
41607019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Cigna All Commercial |
$11.97
|
| Rate for Payer: CORVEL All Commercial |
$12.90
|
| Rate for Payer: Coventry All Commercial |
$12.21
|
| Rate for Payer: Encore All Commercial |
$12.77
|
| Rate for Payer: Frontpath All Commercial |
$12.76
|
| Rate for Payer: Humana ChoiceCare |
$11.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.48
|
| Rate for Payer: PHCS All Commercial |
$10.40
|
| Rate for Payer: PHP All Commercial |
$10.52
|
| Rate for Payer: Sagamore Health Network All Products |
$10.71
|
| Rate for Payer: Signature Care EPO |
$11.51
|
| Rate for Payer: Signature Care PPO |
$12.21
|
| Rate for Payer: United Healthcare Commercial |
$10.93
|
|
|
HC SUTURE ETHILON 2-0 585H
|
Facility
OP
|
$31.93
|
|
| Hospital Charge Code |
41601135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Centivo All Commercial |
$16.28
|
| Rate for Payer: Cigna All Commercial |
$27.56
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.10
|
| Rate for Payer: Encore All Commercial |
$29.39
|
| Rate for Payer: Frontpath All Commercial |
$29.38
|
| Rate for Payer: Humana ChoiceCare |
$27.58
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Lucent All Commercial |
$16.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.95
|
| Rate for Payer: PHP All Commercial |
$24.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.45
|
| Rate for Payer: Sagamore Health Network All Products |
$24.65
|
| Rate for Payer: Signature Care EPO |
$26.50
|
| Rate for Payer: Signature Care PPO |
$28.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$25.16
|
| Rate for Payer: United Healthcare Medicare |
$10.54
|
|
|
HC SUTURE ETHILON 2-0 585H
|
Facility
IP
|
$31.93
|
|
| Hospital Charge Code |
41601135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$29.69 |
| Rate for Payer: Aetna Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna All Commercial |
$27.56
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.10
|
| Rate for Payer: Encore All Commercial |
$29.39
|
| Rate for Payer: Frontpath All Commercial |
$29.38
|
| Rate for Payer: Humana ChoiceCare |
$27.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.74
|
| Rate for Payer: PHCS All Commercial |
$23.95
|
| Rate for Payer: PHP All Commercial |
$24.22
|
| Rate for Payer: Sagamore Health Network All Products |
$24.65
|
| Rate for Payer: Signature Care EPO |
$26.50
|
| Rate for Payer: Signature Care PPO |
$28.10
|
| Rate for Payer: United Healthcare Commercial |
$25.16
|
|
|
HC SUTURE ETHILON 2-0 593H
|
Facility
IP
|
$8.09
|
|
| Hospital Charge Code |
41601597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna Commercial |
$6.99
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cigna All Commercial |
$6.98
|
| Rate for Payer: CORVEL All Commercial |
$7.52
|
| Rate for Payer: Coventry All Commercial |
$7.12
|
| Rate for Payer: Encore All Commercial |
$7.45
|
| Rate for Payer: Frontpath All Commercial |
$7.44
|
| Rate for Payer: Humana ChoiceCare |
$6.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.28
|
| Rate for Payer: PHCS All Commercial |
$6.07
|
| Rate for Payer: PHP All Commercial |
$6.14
|
| Rate for Payer: Sagamore Health Network All Products |
$6.25
|
| Rate for Payer: Signature Care EPO |
$6.71
|
| Rate for Payer: Signature Care PPO |
$7.12
|
| Rate for Payer: United Healthcare Commercial |
$6.37
|
|
|
HC SUTURE ETHILON 2-0 593H
|
Facility
OP
|
$8.09
|
|
| Hospital Charge Code |
41601597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.94
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Centivo All Commercial |
$4.13
|
| Rate for Payer: Cigna All Commercial |
$6.98
|
| Rate for Payer: CORVEL All Commercial |
$7.52
|
| Rate for Payer: Coventry All Commercial |
$7.12
|
| Rate for Payer: Encore All Commercial |
$7.45
|
| Rate for Payer: Frontpath All Commercial |
$7.44
|
| Rate for Payer: Humana ChoiceCare |
$6.99
|
| Rate for Payer: Humana Medicare |
$4.13
|
| Rate for Payer: Lucent All Commercial |
$4.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.07
|
| Rate for Payer: PHP All Commercial |
$6.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.16
|
| Rate for Payer: Sagamore Health Network All Products |
$6.25
|
| Rate for Payer: Signature Care EPO |
$6.71
|
| Rate for Payer: Signature Care PPO |
$7.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.88
|
| Rate for Payer: United Healthcare Commercial |
$6.37
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
|
|
HC SUTURE ETHILON 2-0 628H
|
Facility
IP
|
$14.60
|
|
| Hospital Charge Code |
41601599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cigna All Commercial |
$12.60
|
| Rate for Payer: CORVEL All Commercial |
$13.58
|
| Rate for Payer: Coventry All Commercial |
$12.85
|
| Rate for Payer: Encore All Commercial |
$13.44
|
| Rate for Payer: Frontpath All Commercial |
$13.43
|
| Rate for Payer: Humana ChoiceCare |
$12.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.14
|
| Rate for Payer: PHCS All Commercial |
$10.95
|
| Rate for Payer: PHP All Commercial |
$11.07
|
| Rate for Payer: Sagamore Health Network All Products |
$11.27
|
| Rate for Payer: Signature Care EPO |
$12.12
|
| Rate for Payer: Signature Care PPO |
$12.85
|
| Rate for Payer: United Healthcare Commercial |
$11.50
|
|
|
HC SUTURE ETHILON 2-0 628H
|
Facility
OP
|
$14.60
|
|
| Hospital Charge Code |
41601599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Centivo All Commercial |
$7.45
|
| Rate for Payer: Cigna All Commercial |
$12.60
|
| Rate for Payer: CORVEL All Commercial |
$13.58
|
| Rate for Payer: Coventry All Commercial |
$12.85
|
| Rate for Payer: Encore All Commercial |
$13.44
|
| Rate for Payer: Frontpath All Commercial |
$13.43
|
| Rate for Payer: Humana ChoiceCare |
$12.61
|
| Rate for Payer: Humana Medicare |
$7.45
|
| Rate for Payer: Lucent All Commercial |
$7.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.95
|
| Rate for Payer: PHP All Commercial |
$11.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.69
|
| Rate for Payer: Sagamore Health Network All Products |
$11.27
|
| Rate for Payer: Signature Care EPO |
$12.12
|
| Rate for Payer: Signature Care PPO |
$12.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$11.50
|
| Rate for Payer: United Healthcare Medicare |
$4.82
|
|
|
HC SUTURE ETHILON 2-0 FS
|
Facility
OP
|
$13.40
|
|
| Hospital Charge Code |
41602399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.31
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$8.31
|
| Rate for Payer: Cash Price |
$8.31
|
| Rate for Payer: Centivo All Commercial |
$6.83
|
| Rate for Payer: Cigna All Commercial |
$11.56
|
| Rate for Payer: CORVEL All Commercial |
$12.46
|
| Rate for Payer: Coventry All Commercial |
$11.79
|
| Rate for Payer: Encore All Commercial |
$12.33
|
| Rate for Payer: Frontpath All Commercial |
$12.33
|
| Rate for Payer: Humana ChoiceCare |
$11.57
|
| Rate for Payer: Humana Medicare |
$6.83
|
| Rate for Payer: Lucent All Commercial |
$6.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.05
|
| Rate for Payer: PHP All Commercial |
$10.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.23
|
| Rate for Payer: Sagamore Health Network All Products |
$10.34
|
| Rate for Payer: Signature Care EPO |
$11.12
|
| Rate for Payer: Signature Care PPO |
$11.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.39
|
| Rate for Payer: United Healthcare Commercial |
$10.56
|
| Rate for Payer: United Healthcare Medicare |
$4.42
|
|
|
HC SUTURE ETHILON 2-0 FS
|
Facility
IP
|
$13.40
|
|
| Hospital Charge Code |
41602399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$12.46 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Cash Price |
$8.31
|
| Rate for Payer: Cigna All Commercial |
$11.56
|
| Rate for Payer: CORVEL All Commercial |
$12.46
|
| Rate for Payer: Coventry All Commercial |
$11.79
|
| Rate for Payer: Encore All Commercial |
$12.33
|
| Rate for Payer: Frontpath All Commercial |
$12.33
|
| Rate for Payer: Humana ChoiceCare |
$11.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.06
|
| Rate for Payer: PHCS All Commercial |
$10.05
|
| Rate for Payer: PHP All Commercial |
$10.16
|
| Rate for Payer: Sagamore Health Network All Products |
$10.34
|
| Rate for Payer: Signature Care EPO |
$11.12
|
| Rate for Payer: Signature Care PPO |
$11.79
|
| Rate for Payer: United Healthcare Commercial |
$10.56
|
|
|
HC SUTURE ETHILON 2 490T
|
Facility
IP
|
$28.94
|
|
| Hospital Charge Code |
41601583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$26.91 |
| Rate for Payer: Aetna Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$17.94
|
| Rate for Payer: Cigna All Commercial |
$24.98
|
| Rate for Payer: CORVEL All Commercial |
$26.91
|
| Rate for Payer: Coventry All Commercial |
$25.47
|
| Rate for Payer: Encore All Commercial |
$26.64
|
| Rate for Payer: Frontpath All Commercial |
$26.62
|
| Rate for Payer: Humana ChoiceCare |
$25.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.05
|
| Rate for Payer: PHCS All Commercial |
$21.70
|
| Rate for Payer: PHP All Commercial |
$21.95
|
| Rate for Payer: Sagamore Health Network All Products |
$22.34
|
| Rate for Payer: Signature Care EPO |
$24.02
|
| Rate for Payer: Signature Care PPO |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
|
|
HC SUTURE ETHILON 2 490T
|
Facility
OP
|
$28.94
|
|
| Hospital Charge Code |
41601583
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.43
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.51
|
| Rate for Payer: Cash Price |
$17.94
|
| Rate for Payer: Cash Price |
$17.94
|
| Rate for Payer: Centivo All Commercial |
$14.76
|
| Rate for Payer: Cigna All Commercial |
$24.98
|
| Rate for Payer: CORVEL All Commercial |
$26.91
|
| Rate for Payer: Coventry All Commercial |
$25.47
|
| Rate for Payer: Encore All Commercial |
$26.64
|
| Rate for Payer: Frontpath All Commercial |
$26.62
|
| Rate for Payer: Humana ChoiceCare |
$25.00
|
| Rate for Payer: Humana Medicare |
$14.76
|
| Rate for Payer: Lucent All Commercial |
$14.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.70
|
| Rate for Payer: PHP All Commercial |
$21.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.29
|
| Rate for Payer: Sagamore Health Network All Products |
$22.34
|
| Rate for Payer: Signature Care EPO |
$24.02
|
| Rate for Payer: Signature Care PPO |
$25.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.60
|
| Rate for Payer: United Healthcare Commercial |
$22.80
|
| Rate for Payer: United Healthcare Medicare |
$9.55
|
|
|
HC SUTURE ETHILON 2 LR 460T
|
Facility
OP
|
$16.33
|
|
| Hospital Charge Code |
41607507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.93
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Centivo All Commercial |
$8.33
|
| Rate for Payer: Cigna All Commercial |
$14.09
|
| Rate for Payer: CORVEL All Commercial |
$15.19
|
| Rate for Payer: Coventry All Commercial |
$14.37
|
| Rate for Payer: Encore All Commercial |
$15.03
|
| Rate for Payer: Frontpath All Commercial |
$15.02
|
| Rate for Payer: Humana ChoiceCare |
$14.10
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Lucent All Commercial |
$8.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.70
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.25
|
| Rate for Payer: PHP All Commercial |
$12.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.37
|
| Rate for Payer: Sagamore Health Network All Products |
$12.61
|
| Rate for Payer: Signature Care EPO |
$13.55
|
| Rate for Payer: Signature Care PPO |
$14.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.88
|
| Rate for Payer: United Healthcare Commercial |
$12.87
|
| Rate for Payer: United Healthcare Medicare |
$5.39
|
|
|
HC SUTURE ETHILON 2 LR 460T
|
Facility
IP
|
$16.33
|
|
| Hospital Charge Code |
41607507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.11
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cigna All Commercial |
$14.09
|
| Rate for Payer: CORVEL All Commercial |
$15.19
|
| Rate for Payer: Coventry All Commercial |
$14.37
|
| Rate for Payer: Encore All Commercial |
$15.03
|
| Rate for Payer: Frontpath All Commercial |
$15.02
|
| Rate for Payer: Humana ChoiceCare |
$14.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.70
|
| Rate for Payer: PHCS All Commercial |
$12.25
|
| Rate for Payer: PHP All Commercial |
$12.38
|
| Rate for Payer: Sagamore Health Network All Products |
$12.61
|
| Rate for Payer: Signature Care EPO |
$13.55
|
| Rate for Payer: Signature Care PPO |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$12.87
|
|
|
HC SUTURE ETHILON 3-0 1663H
|
Facility
OP
|
$29.78
|
|
| Hospital Charge Code |
41601478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.13
|
| Rate for Payer: Aetna Medicare |
$9.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.81
|
| Rate for Payer: Cash Price |
$18.46
|
| Rate for Payer: Cash Price |
$18.46
|
| Rate for Payer: Centivo All Commercial |
$15.19
|
| Rate for Payer: Cigna All Commercial |
$25.70
|
| Rate for Payer: CORVEL All Commercial |
$27.70
|
| Rate for Payer: Coventry All Commercial |
$26.21
|
| Rate for Payer: Encore All Commercial |
$27.41
|
| Rate for Payer: Frontpath All Commercial |
$27.40
|
| Rate for Payer: Humana ChoiceCare |
$25.72
|
| Rate for Payer: Humana Medicare |
$15.19
|
| Rate for Payer: Lucent All Commercial |
$15.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.34
|
| Rate for Payer: PHP All Commercial |
$22.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.61
|
| Rate for Payer: Sagamore Health Network All Products |
$22.99
|
| Rate for Payer: Signature Care EPO |
$24.72
|
| Rate for Payer: Signature Care PPO |
$26.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.31
|
| Rate for Payer: United Healthcare Commercial |
$23.47
|
| Rate for Payer: United Healthcare Medicare |
$9.83
|
|
