|
HC SUTURE ETHILON 3-0 1663H
|
Facility
IP
|
$29.78
|
|
| Hospital Charge Code |
41601478
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$27.70 |
| Rate for Payer: Aetna Commercial |
$25.73
|
| Rate for Payer: Cash Price |
$18.46
|
| 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: Lutheran Preferred All Commercial |
$26.80
|
| Rate for Payer: PHCS All Commercial |
$22.34
|
| Rate for Payer: PHP All Commercial |
$22.59
|
| 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: United Healthcare Commercial |
$23.47
|
|
|
HC SUTURE ETHILON 3-0 1669H
|
Facility
IP
|
$27.09
|
|
| Hospital Charge Code |
41601136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
|
|
HC SUTURE ETHILON 3-0 1669H
|
Facility
OP
|
$27.09
|
|
| Hospital Charge Code |
41601136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.83
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centivo All Commercial |
$13.82
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Lucent All Commercial |
$13.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.57
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
| Rate for Payer: United Healthcare Medicare |
$8.94
|
|
|
HC SUTURE ETHILON 3-0 KS
|
Facility
IP
|
$23.22
|
|
| Hospital Charge Code |
41602400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna All Commercial |
$20.04
|
| Rate for Payer: CORVEL All Commercial |
$21.59
|
| Rate for Payer: Coventry All Commercial |
$20.43
|
| Rate for Payer: Encore All Commercial |
$21.37
|
| Rate for Payer: Frontpath All Commercial |
$21.36
|
| Rate for Payer: Humana ChoiceCare |
$20.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.90
|
| Rate for Payer: PHCS All Commercial |
$17.42
|
| Rate for Payer: PHP All Commercial |
$17.61
|
| Rate for Payer: Sagamore Health Network All Products |
$17.93
|
| Rate for Payer: Signature Care EPO |
$19.27
|
| Rate for Payer: Signature Care PPO |
$20.43
|
| Rate for Payer: United Healthcare Commercial |
$18.30
|
|
|
HC SUTURE ETHILON 3-0 KS
|
Facility
OP
|
$23.22
|
|
| Hospital Charge Code |
41602400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.43
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Centivo All Commercial |
$11.84
|
| Rate for Payer: Cigna All Commercial |
$20.04
|
| Rate for Payer: CORVEL All Commercial |
$21.59
|
| Rate for Payer: Coventry All Commercial |
$20.43
|
| Rate for Payer: Encore All Commercial |
$21.37
|
| Rate for Payer: Frontpath All Commercial |
$21.36
|
| Rate for Payer: Humana ChoiceCare |
$20.06
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Lucent All Commercial |
$11.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.42
|
| Rate for Payer: PHP All Commercial |
$17.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.06
|
| Rate for Payer: Sagamore Health Network All Products |
$17.93
|
| Rate for Payer: Signature Care EPO |
$19.27
|
| Rate for Payer: Signature Care PPO |
$20.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.74
|
| Rate for Payer: United Healthcare Commercial |
$18.30
|
| Rate for Payer: United Healthcare Medicare |
$7.66
|
|
|
HC SUTURE ETHILON 4-0 1629H
|
Facility
IP
|
$22.74
|
|
| Hospital Charge Code |
41601137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna All Commercial |
$19.62
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: Coventry All Commercial |
$20.01
|
| Rate for Payer: Encore All Commercial |
$20.93
|
| Rate for Payer: Frontpath All Commercial |
$20.92
|
| Rate for Payer: Humana ChoiceCare |
$19.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.47
|
| Rate for Payer: PHCS All Commercial |
$17.06
|
| Rate for Payer: PHP All Commercial |
$17.25
|
| Rate for Payer: Sagamore Health Network All Products |
$17.56
|
| Rate for Payer: Signature Care EPO |
$18.87
|
| Rate for Payer: Signature Care PPO |
$20.01
|
| Rate for Payer: United Healthcare Commercial |
$17.92
|
|
|
HC SUTURE ETHILON 4-0 1629H
|
Facility
OP
|
$22.74
|
|
| Hospital Charge Code |
41601137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.25
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Centivo All Commercial |
$11.60
|
| Rate for Payer: Cigna All Commercial |
$19.62
|
| Rate for Payer: CORVEL All Commercial |
$21.15
|
| Rate for Payer: Coventry All Commercial |
$20.01
|
| Rate for Payer: Encore All Commercial |
$20.93
|
| Rate for Payer: Frontpath All Commercial |
$20.92
|
| Rate for Payer: Humana ChoiceCare |
$19.64
|
| Rate for Payer: Humana Medicare |
$11.60
|
| Rate for Payer: Lucent All Commercial |
$11.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.06
|
| Rate for Payer: PHP All Commercial |
$17.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.87
|
| Rate for Payer: Sagamore Health Network All Products |
$17.56
|
| Rate for Payer: Signature Care EPO |
$18.87
|
| Rate for Payer: Signature Care PPO |
$20.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.33
|
| Rate for Payer: United Healthcare Commercial |
$17.92
|
| Rate for Payer: United Healthcare Medicare |
$7.50
|
|
|
HC SUTURE ETHILON 4-0 1667H
|
Facility
OP
|
$27.28
|
|
| Hospital Charge Code |
41601138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Centivo All Commercial |
$13.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Humana Medicare |
$13.91
|
| Rate for Payer: Lucent All Commercial |
$13.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.19
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
|
|
HC SUTURE ETHILON 4-0 1667H
|
Facility
IP
|
$27.28
|
|
| Hospital Charge Code |
41601138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC SUTURE ETHILON 4-0 1864G
|
Facility
IP
|
$29.96
|
|
| Hospital Charge Code |
41601139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$27.86 |
| Rate for Payer: Aetna Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cigna All Commercial |
$25.86
|
| Rate for Payer: CORVEL All Commercial |
$27.86
|
| Rate for Payer: Coventry All Commercial |
$26.36
|
| Rate for Payer: Encore All Commercial |
$27.58
|
| Rate for Payer: Frontpath All Commercial |
$27.56
|
| Rate for Payer: Humana ChoiceCare |
$25.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.96
|
| Rate for Payer: PHCS All Commercial |
$22.47
|
| Rate for Payer: PHP All Commercial |
$22.72
|
| Rate for Payer: Sagamore Health Network All Products |
$23.13
|
| Rate for Payer: Signature Care EPO |
$24.87
|
| Rate for Payer: Signature Care PPO |
$26.36
|
| Rate for Payer: United Healthcare Commercial |
$23.61
|
|
|
HC SUTURE ETHILON 4-0 1864G
|
Facility
OP
|
$29.96
|
|
| Hospital Charge Code |
41601139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.88
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Centivo All Commercial |
$15.28
|
| Rate for Payer: Cigna All Commercial |
$25.86
|
| Rate for Payer: CORVEL All Commercial |
$27.86
|
| Rate for Payer: Coventry All Commercial |
$26.36
|
| Rate for Payer: Encore All Commercial |
$27.58
|
| Rate for Payer: Frontpath All Commercial |
$27.56
|
| Rate for Payer: Humana ChoiceCare |
$25.88
|
| Rate for Payer: Humana Medicare |
$15.28
|
| Rate for Payer: Lucent All Commercial |
$15.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.47
|
| Rate for Payer: PHP All Commercial |
$22.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.68
|
| Rate for Payer: Sagamore Health Network All Products |
$23.13
|
| Rate for Payer: Signature Care EPO |
$24.87
|
| Rate for Payer: Signature Care PPO |
$26.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$23.61
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
|
|
HC SUTURE ETHILON 4-0 P-3
|
Facility
IP
|
$27.11
|
|
| Hospital Charge Code |
41602402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$25.21 |
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cigna All Commercial |
$23.40
|
| Rate for Payer: CORVEL All Commercial |
$25.21
|
| Rate for Payer: Coventry All Commercial |
$23.86
|
| Rate for Payer: Encore All Commercial |
$24.95
|
| Rate for Payer: Frontpath All Commercial |
$24.94
|
| Rate for Payer: Humana ChoiceCare |
$23.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.40
|
| Rate for Payer: PHCS All Commercial |
$20.33
|
| Rate for Payer: PHP All Commercial |
$20.56
|
| Rate for Payer: Sagamore Health Network All Products |
$20.93
|
| Rate for Payer: Signature Care EPO |
$22.50
|
| Rate for Payer: Signature Care PPO |
$23.86
|
| Rate for Payer: United Healthcare Commercial |
$21.36
|
|
|
HC SUTURE ETHILON 4-0 P-3
|
Facility
OP
|
$27.11
|
|
| Hospital Charge Code |
41602402
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.84
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Cash Price |
$16.81
|
| Rate for Payer: Centivo All Commercial |
$13.83
|
| Rate for Payer: Cigna All Commercial |
$23.40
|
| Rate for Payer: CORVEL All Commercial |
$25.21
|
| Rate for Payer: Coventry All Commercial |
$23.86
|
| Rate for Payer: Encore All Commercial |
$24.95
|
| Rate for Payer: Frontpath All Commercial |
$24.94
|
| Rate for Payer: Humana ChoiceCare |
$23.41
|
| Rate for Payer: Humana Medicare |
$13.83
|
| Rate for Payer: Lucent All Commercial |
$13.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.40
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.33
|
| Rate for Payer: PHP All Commercial |
$20.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.57
|
| Rate for Payer: Sagamore Health Network All Products |
$20.93
|
| Rate for Payer: Signature Care EPO |
$22.50
|
| Rate for Payer: Signature Care PPO |
$23.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.04
|
| Rate for Payer: United Healthcare Commercial |
$21.36
|
| Rate for Payer: United Healthcare Medicare |
$8.95
|
|
|
HC SUTURE ETHILON 4-0 P3 BLK 699G
|
Facility
OP
|
$28.68
|
|
| Hospital Charge Code |
41601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.41
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Centivo All Commercial |
$14.63
|
| Rate for Payer: Cigna All Commercial |
$24.75
|
| Rate for Payer: CORVEL All Commercial |
$26.67
|
| Rate for Payer: Coventry All Commercial |
$25.24
|
| Rate for Payer: Encore All Commercial |
$26.40
|
| Rate for Payer: Frontpath All Commercial |
$26.39
|
| Rate for Payer: Humana ChoiceCare |
$24.77
|
| Rate for Payer: Humana Medicare |
$14.63
|
| Rate for Payer: Lucent All Commercial |
$14.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.51
|
| Rate for Payer: PHP All Commercial |
$21.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.19
|
| Rate for Payer: Sagamore Health Network All Products |
$22.14
|
| Rate for Payer: Signature Care EPO |
$23.80
|
| Rate for Payer: Signature Care PPO |
$25.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.38
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
|
|
HC SUTURE ETHILON 4-0 P3 BLK 699G
|
Facility
IP
|
$28.68
|
|
| Hospital Charge Code |
41601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cigna All Commercial |
$24.75
|
| Rate for Payer: CORVEL All Commercial |
$26.67
|
| Rate for Payer: Coventry All Commercial |
$25.24
|
| Rate for Payer: Encore All Commercial |
$26.40
|
| Rate for Payer: Frontpath All Commercial |
$26.39
|
| Rate for Payer: Humana ChoiceCare |
$24.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.81
|
| Rate for Payer: PHCS All Commercial |
$21.51
|
| Rate for Payer: PHP All Commercial |
$21.75
|
| Rate for Payer: Sagamore Health Network All Products |
$22.14
|
| Rate for Payer: Signature Care EPO |
$23.80
|
| Rate for Payer: Signature Care PPO |
$25.24
|
| Rate for Payer: United Healthcare Commercial |
$22.60
|
|
|
HC SUTURE ETHILON 4-0 PS-2
|
Facility
OP
|
$27.28
|
|
| Hospital Charge Code |
41602401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Centivo All Commercial |
$13.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Humana Medicare |
$13.91
|
| Rate for Payer: Lucent All Commercial |
$13.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.19
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
|
|
HC SUTURE ETHILON 4-0 PS-2
|
Facility
IP
|
$27.28
|
|
| Hospital Charge Code |
41602401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC SUTURE ETHILON 5-0 1666H
|
Facility
IP
|
$27.57
|
|
| Hospital Charge Code |
41601140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$25.64 |
| Rate for Payer: Aetna Commercial |
$23.82
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cigna All Commercial |
$23.79
|
| Rate for Payer: CORVEL All Commercial |
$25.64
|
| Rate for Payer: Coventry All Commercial |
$24.26
|
| Rate for Payer: Encore All Commercial |
$25.38
|
| Rate for Payer: Frontpath All Commercial |
$25.36
|
| Rate for Payer: Humana ChoiceCare |
$23.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.81
|
| Rate for Payer: PHCS All Commercial |
$20.68
|
| Rate for Payer: PHP All Commercial |
$20.91
|
| Rate for Payer: Sagamore Health Network All Products |
$21.28
|
| Rate for Payer: Signature Care EPO |
$22.88
|
| Rate for Payer: Signature Care PPO |
$24.26
|
| Rate for Payer: United Healthcare Commercial |
$21.73
|
|
|
HC SUTURE ETHILON 5-0 1666H
|
Facility
OP
|
$27.57
|
|
| Hospital Charge Code |
41601140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.01
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Cash Price |
$17.09
|
| Rate for Payer: Centivo All Commercial |
$14.06
|
| Rate for Payer: Cigna All Commercial |
$23.79
|
| Rate for Payer: CORVEL All Commercial |
$25.64
|
| Rate for Payer: Coventry All Commercial |
$24.26
|
| Rate for Payer: Encore All Commercial |
$25.38
|
| Rate for Payer: Frontpath All Commercial |
$25.36
|
| Rate for Payer: Humana ChoiceCare |
$23.81
|
| Rate for Payer: Humana Medicare |
$14.06
|
| Rate for Payer: Lucent All Commercial |
$14.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.68
|
| Rate for Payer: PHP All Commercial |
$20.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.75
|
| Rate for Payer: Sagamore Health Network All Products |
$21.28
|
| Rate for Payer: Signature Care EPO |
$22.88
|
| Rate for Payer: Signature Care PPO |
$24.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.43
|
| Rate for Payer: United Healthcare Commercial |
$21.73
|
| Rate for Payer: United Healthcare Medicare |
$9.10
|
|
|
HC SUTURE ETHILON 5-0 G695G
|
Facility
IP
|
$30.21
|
|
| Hospital Charge Code |
41601141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$28.10 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Cigna All Commercial |
$26.07
|
| Rate for Payer: CORVEL All Commercial |
$28.10
|
| Rate for Payer: Coventry All Commercial |
$26.58
|
| Rate for Payer: Encore All Commercial |
$27.81
|
| Rate for Payer: Frontpath All Commercial |
$27.79
|
| Rate for Payer: Humana ChoiceCare |
$26.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.19
|
| Rate for Payer: PHCS All Commercial |
$22.66
|
| Rate for Payer: PHP All Commercial |
$22.91
|
| Rate for Payer: Sagamore Health Network All Products |
$23.32
|
| Rate for Payer: Signature Care EPO |
$25.07
|
| Rate for Payer: Signature Care PPO |
$26.58
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
|
|
HC SUTURE ETHILON 5-0 G695G
|
Facility
OP
|
$30.21
|
|
| Hospital Charge Code |
41601141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$9.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.97
|
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Centivo All Commercial |
$15.41
|
| Rate for Payer: Cigna All Commercial |
$26.07
|
| Rate for Payer: CORVEL All Commercial |
$28.10
|
| Rate for Payer: Coventry All Commercial |
$26.58
|
| Rate for Payer: Encore All Commercial |
$27.81
|
| Rate for Payer: Frontpath All Commercial |
$27.79
|
| Rate for Payer: Humana ChoiceCare |
$26.09
|
| Rate for Payer: Humana Medicare |
$15.41
|
| Rate for Payer: Lucent All Commercial |
$15.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.66
|
| Rate for Payer: PHP All Commercial |
$22.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.78
|
| Rate for Payer: Sagamore Health Network All Products |
$23.32
|
| Rate for Payer: Signature Care EPO |
$25.07
|
| Rate for Payer: Signature Care PPO |
$26.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.68
|
| Rate for Payer: United Healthcare Commercial |
$23.81
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
|
|
HC SUTURE ETHILON 5-0 MONO 1845G
|
Facility
OP
|
$32.92
|
|
| Hospital Charge Code |
41601142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$27.78
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.95
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Centivo All Commercial |
$16.79
|
| Rate for Payer: Cigna All Commercial |
$28.41
|
| Rate for Payer: CORVEL All Commercial |
$30.62
|
| Rate for Payer: Coventry All Commercial |
$28.97
|
| Rate for Payer: Encore All Commercial |
$30.30
|
| Rate for Payer: Frontpath All Commercial |
$30.29
|
| Rate for Payer: Humana ChoiceCare |
$28.43
|
| Rate for Payer: Humana Medicare |
$16.79
|
| Rate for Payer: Lucent All Commercial |
$16.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$24.69
|
| Rate for Payer: PHP All Commercial |
$24.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.84
|
| Rate for Payer: Sagamore Health Network All Products |
$25.41
|
| Rate for Payer: Signature Care EPO |
$27.32
|
| Rate for Payer: Signature Care PPO |
$28.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.98
|
| Rate for Payer: United Healthcare Commercial |
$25.94
|
| Rate for Payer: United Healthcare Medicare |
$10.86
|
|
|
HC SUTURE ETHILON 5-0 MONO 1845G
|
Facility
IP
|
$32.92
|
|
| Hospital Charge Code |
41601142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$28.44
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: Cigna All Commercial |
$28.41
|
| Rate for Payer: CORVEL All Commercial |
$30.62
|
| Rate for Payer: Coventry All Commercial |
$28.97
|
| Rate for Payer: Encore All Commercial |
$30.30
|
| Rate for Payer: Frontpath All Commercial |
$30.29
|
| Rate for Payer: Humana ChoiceCare |
$28.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.63
|
| Rate for Payer: PHCS All Commercial |
$24.69
|
| Rate for Payer: PHP All Commercial |
$24.97
|
| Rate for Payer: Sagamore Health Network All Products |
$25.41
|
| Rate for Payer: Signature Care EPO |
$27.32
|
| Rate for Payer: Signature Care PPO |
$28.97
|
| Rate for Payer: United Healthcare Commercial |
$25.94
|
|
|
HC SUTURE ETHILON 5-0 P-3 690G
|
Facility
IP
|
$33.87
|
|
| Hospital Charge Code |
41603707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.26
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna All Commercial |
$29.23
|
| Rate for Payer: CORVEL All Commercial |
$31.50
|
| Rate for Payer: Coventry All Commercial |
$29.81
|
| Rate for Payer: Encore All Commercial |
$31.18
|
| Rate for Payer: Frontpath All Commercial |
$31.16
|
| Rate for Payer: Humana ChoiceCare |
$29.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.48
|
| Rate for Payer: PHCS All Commercial |
$25.40
|
| Rate for Payer: PHP All Commercial |
$25.69
|
| Rate for Payer: Sagamore Health Network All Products |
$26.15
|
| Rate for Payer: Signature Care EPO |
$28.11
|
| Rate for Payer: Signature Care PPO |
$29.81
|
| Rate for Payer: United Healthcare Commercial |
$26.69
|
|
|
HC SUTURE ETHILON 5-0 P-3 690G
|
Facility
OP
|
$33.87
|
|
| Hospital Charge Code |
41603707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$28.59
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.29
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Centivo All Commercial |
$17.27
|
| Rate for Payer: Cigna All Commercial |
$29.23
|
| Rate for Payer: CORVEL All Commercial |
$31.50
|
| Rate for Payer: Coventry All Commercial |
$29.81
|
| Rate for Payer: Encore All Commercial |
$31.18
|
| Rate for Payer: Frontpath All Commercial |
$31.16
|
| Rate for Payer: Humana ChoiceCare |
$29.25
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Lucent All Commercial |
$17.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.48
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$25.40
|
| Rate for Payer: PHP All Commercial |
$25.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.21
|
| Rate for Payer: Sagamore Health Network All Products |
$26.15
|
| Rate for Payer: Signature Care EPO |
$28.11
|
| Rate for Payer: Signature Care PPO |
$29.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.79
|
| Rate for Payer: United Healthcare Commercial |
$26.69
|
| Rate for Payer: United Healthcare Medicare |
$11.18
|
|
