|
HC SUTURE ETHILON 5-0 P3 698H
|
Facility
OP
|
$25.58
|
|
| Hospital Charge Code |
41601467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.29
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Centivo All Commercial |
$13.05
|
| Rate for Payer: Cigna All Commercial |
$22.08
|
| Rate for Payer: CORVEL All Commercial |
$23.79
|
| Rate for Payer: Coventry All Commercial |
$22.51
|
| Rate for Payer: Encore All Commercial |
$23.55
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$22.09
|
| Rate for Payer: Humana Medicare |
$13.05
|
| Rate for Payer: Lucent All Commercial |
$13.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.18
|
| Rate for Payer: PHP All Commercial |
$19.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.98
|
| Rate for Payer: Sagamore Health Network All Products |
$19.75
|
| Rate for Payer: Signature Care EPO |
$21.23
|
| Rate for Payer: Signature Care PPO |
$22.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.74
|
| Rate for Payer: United Healthcare Commercial |
$20.16
|
| Rate for Payer: United Healthcare Medicare |
$8.44
|
|
|
HC SUTURE ETHILON 5-0 P3 698H
|
Facility
IP
|
$25.58
|
|
| Hospital Charge Code |
41601467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$23.79 |
| Rate for Payer: Aetna Commercial |
$22.10
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cigna All Commercial |
$22.08
|
| Rate for Payer: CORVEL All Commercial |
$23.79
|
| Rate for Payer: Coventry All Commercial |
$22.51
|
| Rate for Payer: Encore All Commercial |
$23.55
|
| Rate for Payer: Frontpath All Commercial |
$23.53
|
| Rate for Payer: Humana ChoiceCare |
$22.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.02
|
| Rate for Payer: PHCS All Commercial |
$19.18
|
| Rate for Payer: PHP All Commercial |
$19.40
|
| Rate for Payer: Sagamore Health Network All Products |
$19.75
|
| Rate for Payer: Signature Care EPO |
$21.23
|
| Rate for Payer: Signature Care PPO |
$22.51
|
| Rate for Payer: United Healthcare Commercial |
$20.16
|
|
|
HC SUTURE ETHILON 6-0 697G
|
Facility
IP
|
$29.03
|
|
| Hospital Charge Code |
41601143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna All Commercial |
$25.05
|
| Rate for Payer: CORVEL All Commercial |
$27.00
|
| Rate for Payer: Coventry All Commercial |
$25.55
|
| Rate for Payer: Encore All Commercial |
$26.72
|
| Rate for Payer: Frontpath All Commercial |
$26.71
|
| Rate for Payer: Humana ChoiceCare |
$25.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.13
|
| Rate for Payer: PHCS All Commercial |
$21.77
|
| Rate for Payer: PHP All Commercial |
$22.02
|
| Rate for Payer: Sagamore Health Network All Products |
$22.41
|
| Rate for Payer: Signature Care EPO |
$24.09
|
| Rate for Payer: Signature Care PPO |
$25.55
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
|
|
HC SUTURE ETHILON 6-0 697G
|
Facility
OP
|
$29.03
|
|
| Hospital Charge Code |
41601143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.50
|
| Rate for Payer: Aetna Medicare |
$9.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.54
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Centivo All Commercial |
$14.81
|
| Rate for Payer: Cigna All Commercial |
$25.05
|
| Rate for Payer: CORVEL All Commercial |
$27.00
|
| Rate for Payer: Coventry All Commercial |
$25.55
|
| Rate for Payer: Encore All Commercial |
$26.72
|
| Rate for Payer: Frontpath All Commercial |
$26.71
|
| Rate for Payer: Humana ChoiceCare |
$25.07
|
| Rate for Payer: Humana Medicare |
$14.81
|
| Rate for Payer: Lucent All Commercial |
$14.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.13
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.77
|
| Rate for Payer: PHP All Commercial |
$22.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.32
|
| Rate for Payer: Sagamore Health Network All Products |
$22.41
|
| Rate for Payer: Signature Care EPO |
$24.09
|
| Rate for Payer: Signature Care PPO |
$25.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.68
|
| Rate for Payer: United Healthcare Commercial |
$22.88
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
|
|
HC SUTURE ETHILON 6-0 P-1 689G
|
Facility
IP
|
$28.80
|
|
| Hospital Charge Code |
41603706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cigna All Commercial |
$24.85
|
| Rate for Payer: CORVEL All Commercial |
$26.78
|
| Rate for Payer: Coventry All Commercial |
$25.34
|
| Rate for Payer: Encore All Commercial |
$26.51
|
| Rate for Payer: Frontpath All Commercial |
$26.50
|
| Rate for Payer: Humana ChoiceCare |
$24.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.92
|
| Rate for Payer: PHCS All Commercial |
$21.60
|
| Rate for Payer: PHP All Commercial |
$21.84
|
| Rate for Payer: Sagamore Health Network All Products |
$22.23
|
| Rate for Payer: Signature Care EPO |
$23.90
|
| Rate for Payer: Signature Care PPO |
$25.34
|
| Rate for Payer: United Healthcare Commercial |
$22.69
|
|
|
HC SUTURE ETHILON 6-0 P-1 689G
|
Facility
OP
|
$28.80
|
|
| Hospital Charge Code |
41603706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.31
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.45
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Centivo All Commercial |
$14.69
|
| Rate for Payer: Cigna All Commercial |
$24.85
|
| Rate for Payer: CORVEL All Commercial |
$26.78
|
| Rate for Payer: Coventry All Commercial |
$25.34
|
| Rate for Payer: Encore All Commercial |
$26.51
|
| Rate for Payer: Frontpath All Commercial |
$26.50
|
| Rate for Payer: Humana ChoiceCare |
$24.87
|
| Rate for Payer: Humana Medicare |
$14.69
|
| Rate for Payer: Lucent All Commercial |
$14.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.92
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.60
|
| Rate for Payer: PHP All Commercial |
$21.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.23
|
| Rate for Payer: Sagamore Health Network All Products |
$22.23
|
| Rate for Payer: Signature Care EPO |
$23.90
|
| Rate for Payer: Signature Care PPO |
$25.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.48
|
| Rate for Payer: United Healthcare Commercial |
$22.69
|
| Rate for Payer: United Healthcare Medicare |
$9.50
|
|
|
HC SUTURE ETHILON 6-0 PS-3 1665G
|
Facility
IP
|
$26.25
|
|
| Hospital Charge Code |
41601144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Aetna Commercial |
$22.68
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Cigna All Commercial |
$22.65
|
| Rate for Payer: CORVEL All Commercial |
$24.41
|
| Rate for Payer: Coventry All Commercial |
$23.10
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Frontpath All Commercial |
$24.15
|
| Rate for Payer: Humana ChoiceCare |
$22.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.62
|
| Rate for Payer: PHCS All Commercial |
$19.69
|
| Rate for Payer: PHP All Commercial |
$19.91
|
| Rate for Payer: Sagamore Health Network All Products |
$20.26
|
| Rate for Payer: Signature Care EPO |
$21.79
|
| Rate for Payer: Signature Care PPO |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$20.68
|
|
|
HC SUTURE ETHILON 6-0 PS-3 1665G
|
Facility
OP
|
$26.25
|
|
| Hospital Charge Code |
41601144
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.53
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Centivo All Commercial |
$13.39
|
| Rate for Payer: Cigna All Commercial |
$22.65
|
| Rate for Payer: CORVEL All Commercial |
$24.41
|
| Rate for Payer: Coventry All Commercial |
$23.10
|
| Rate for Payer: Encore All Commercial |
$24.16
|
| Rate for Payer: Frontpath All Commercial |
$24.15
|
| Rate for Payer: Humana ChoiceCare |
$22.67
|
| Rate for Payer: Humana Medicare |
$13.39
|
| Rate for Payer: Lucent All Commercial |
$13.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.69
|
| Rate for Payer: PHP All Commercial |
$19.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.24
|
| Rate for Payer: Sagamore Health Network All Products |
$20.26
|
| Rate for Payer: Signature Care EPO |
$21.79
|
| Rate for Payer: Signature Care PPO |
$23.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$20.68
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
|
|
HC SUTURE ETHILON 9-0 7717G
|
Facility
OP
|
$145.08
|
|
| Hospital Charge Code |
41601507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Aetna Commercial |
$122.45
|
| Rate for Payer: Aetna Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.66
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Centivo All Commercial |
$73.99
|
| Rate for Payer: Cigna All Commercial |
$125.20
|
| Rate for Payer: CORVEL All Commercial |
$134.92
|
| Rate for Payer: Coventry All Commercial |
$127.67
|
| Rate for Payer: Encore All Commercial |
$133.55
|
| Rate for Payer: Frontpath All Commercial |
$133.47
|
| Rate for Payer: Humana ChoiceCare |
$125.31
|
| Rate for Payer: Humana Medicare |
$73.99
|
| Rate for Payer: Lucent All Commercial |
$73.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$108.81
|
| Rate for Payer: PHP All Commercial |
$110.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.58
|
| Rate for Payer: Sagamore Health Network All Products |
$112.00
|
| Rate for Payer: Signature Care EPO |
$120.42
|
| Rate for Payer: Signature Care PPO |
$127.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.32
|
| Rate for Payer: United Healthcare Commercial |
$114.32
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
|
|
HC SUTURE ETHILON 9-0 7717G
|
Facility
IP
|
$145.08
|
|
| Hospital Charge Code |
41601507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Aetna Commercial |
$125.35
|
| Rate for Payer: Cash Price |
$89.95
|
| Rate for Payer: Cigna All Commercial |
$125.20
|
| Rate for Payer: CORVEL All Commercial |
$134.92
|
| Rate for Payer: Coventry All Commercial |
$127.67
|
| Rate for Payer: Encore All Commercial |
$133.55
|
| Rate for Payer: Frontpath All Commercial |
$133.47
|
| Rate for Payer: Humana ChoiceCare |
$125.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.57
|
| Rate for Payer: PHCS All Commercial |
$108.81
|
| Rate for Payer: PHP All Commercial |
$110.03
|
| Rate for Payer: Sagamore Health Network All Products |
$112.00
|
| Rate for Payer: Signature Care EPO |
$120.42
|
| Rate for Payer: Signature Care PPO |
$127.67
|
| Rate for Payer: United Healthcare Commercial |
$114.32
|
|
|
HC SUTURE FIBERLOOP 0
|
Facility
IP
|
$385.00
|
|
| Hospital Charge Code |
41603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC SUTURE FIBERLOOP 0
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
41603250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.76
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Centivo All Commercial |
$196.35
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$196.35
|
| Rate for Payer: Lucent All Commercial |
$196.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$127.05
|
|
|
HC SUTURE FIBERLOOP #2
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
41602388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.76
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Centivo All Commercial |
$196.35
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$196.35
|
| Rate for Payer: Lucent All Commercial |
$196.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$127.05
|
|
|
HC SUTURE FIBERLOOP #2
|
Facility
IP
|
$385.00
|
|
| Hospital Charge Code |
41602388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cigna All Commercial |
$332.26
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC SUTURE FIBERLOOP 4.0
|
Facility
IP
|
$32.08
|
|
| Hospital Charge Code |
41601465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cigna All Commercial |
$27.69
|
| Rate for Payer: CORVEL All Commercial |
$29.83
|
| Rate for Payer: Coventry All Commercial |
$28.23
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Frontpath All Commercial |
$29.51
|
| Rate for Payer: Humana ChoiceCare |
$27.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.87
|
| Rate for Payer: PHCS All Commercial |
$24.06
|
| Rate for Payer: PHP All Commercial |
$24.33
|
| Rate for Payer: Sagamore Health Network All Products |
$24.77
|
| Rate for Payer: Signature Care EPO |
$26.63
|
| Rate for Payer: Signature Care PPO |
$28.23
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
|
|
HC SUTURE FIBERLOOP 4.0
|
Facility
OP
|
$32.08
|
|
| Hospital Charge Code |
41601465
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$27.08
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.65
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Centivo All Commercial |
$16.36
|
| Rate for Payer: Cigna All Commercial |
$27.69
|
| Rate for Payer: CORVEL All Commercial |
$29.83
|
| Rate for Payer: Coventry All Commercial |
$28.23
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Frontpath All Commercial |
$29.51
|
| Rate for Payer: Humana ChoiceCare |
$27.71
|
| Rate for Payer: Humana Medicare |
$16.36
|
| Rate for Payer: Lucent All Commercial |
$16.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$24.06
|
| Rate for Payer: PHP All Commercial |
$24.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.51
|
| Rate for Payer: Sagamore Health Network All Products |
$24.77
|
| Rate for Payer: Signature Care EPO |
$26.63
|
| Rate for Payer: Signature Care PPO |
$28.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.27
|
| Rate for Payer: United Healthcare Commercial |
$25.28
|
| Rate for Payer: United Healthcare Medicare |
$10.59
|
|
|
HC SUTURE GORTEX CV-0
|
Facility
IP
|
$147.58
|
|
| Hospital Charge Code |
41601508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$127.51
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna All Commercial |
$127.36
|
| Rate for Payer: CORVEL All Commercial |
$137.25
|
| Rate for Payer: Coventry All Commercial |
$129.87
|
| Rate for Payer: Encore All Commercial |
$135.85
|
| Rate for Payer: Frontpath All Commercial |
$135.77
|
| Rate for Payer: Humana ChoiceCare |
$127.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.82
|
| Rate for Payer: PHCS All Commercial |
$110.68
|
| Rate for Payer: PHP All Commercial |
$111.92
|
| Rate for Payer: Sagamore Health Network All Products |
$113.93
|
| Rate for Payer: Signature Care EPO |
$122.49
|
| Rate for Payer: Signature Care PPO |
$129.87
|
| Rate for Payer: United Healthcare Commercial |
$116.29
|
|
|
HC SUTURE GORTEX CV-0
|
Facility
OP
|
$147.58
|
|
| Hospital Charge Code |
41601508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.70 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$124.56
|
| Rate for Payer: Aetna Medicare |
$48.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.57
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Centivo All Commercial |
$75.27
|
| Rate for Payer: Cigna All Commercial |
$127.36
|
| Rate for Payer: CORVEL All Commercial |
$137.25
|
| Rate for Payer: Coventry All Commercial |
$129.87
|
| Rate for Payer: Encore All Commercial |
$135.85
|
| Rate for Payer: Frontpath All Commercial |
$135.77
|
| Rate for Payer: Humana ChoiceCare |
$127.46
|
| Rate for Payer: Humana Medicare |
$75.27
|
| Rate for Payer: Lucent All Commercial |
$75.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$110.68
|
| Rate for Payer: PHP All Commercial |
$111.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.56
|
| Rate for Payer: Sagamore Health Network All Products |
$113.93
|
| Rate for Payer: Signature Care EPO |
$122.49
|
| Rate for Payer: Signature Care PPO |
$129.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.44
|
| Rate for Payer: United Healthcare Commercial |
$116.29
|
| Rate for Payer: United Healthcare Medicare |
$48.70
|
|
|
HC SUTURE GORTEX CV-2
|
Facility
OP
|
$147.58
|
|
| Hospital Charge Code |
41601576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.70 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$124.56
|
| Rate for Payer: Aetna Medicare |
$48.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.57
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Centivo All Commercial |
$75.27
|
| Rate for Payer: Cigna All Commercial |
$127.36
|
| Rate for Payer: CORVEL All Commercial |
$137.25
|
| Rate for Payer: Coventry All Commercial |
$129.87
|
| Rate for Payer: Encore All Commercial |
$135.85
|
| Rate for Payer: Frontpath All Commercial |
$135.77
|
| Rate for Payer: Humana ChoiceCare |
$127.46
|
| Rate for Payer: Humana Medicare |
$75.27
|
| Rate for Payer: Lucent All Commercial |
$75.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$110.68
|
| Rate for Payer: PHP All Commercial |
$111.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.56
|
| Rate for Payer: Sagamore Health Network All Products |
$113.93
|
| Rate for Payer: Signature Care EPO |
$122.49
|
| Rate for Payer: Signature Care PPO |
$129.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.44
|
| Rate for Payer: United Healthcare Commercial |
$116.29
|
| Rate for Payer: United Healthcare Medicare |
$48.70
|
|
|
HC SUTURE GORTEX CV-2
|
Facility
IP
|
$147.58
|
|
| Hospital Charge Code |
41601576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Aetna Commercial |
$127.51
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna All Commercial |
$127.36
|
| Rate for Payer: CORVEL All Commercial |
$137.25
|
| Rate for Payer: Coventry All Commercial |
$129.87
|
| Rate for Payer: Encore All Commercial |
$135.85
|
| Rate for Payer: Frontpath All Commercial |
$135.77
|
| Rate for Payer: Humana ChoiceCare |
$127.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$132.82
|
| Rate for Payer: PHCS All Commercial |
$110.68
|
| Rate for Payer: PHP All Commercial |
$111.92
|
| Rate for Payer: Sagamore Health Network All Products |
$113.93
|
| Rate for Payer: Signature Care EPO |
$122.49
|
| Rate for Payer: Signature Care PPO |
$129.87
|
| Rate for Payer: United Healthcare Commercial |
$116.29
|
|
|
HC SUTURE MAXBRAID #2 900335
|
Facility
OP
|
$1,890.00
|
|
| Hospital Charge Code |
41601393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,595.16
|
| Rate for Payer: Aetna Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$623.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,085.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,181.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$717.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$686.07
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Centivo All Commercial |
$963.90
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Humana Medicare |
$963.90
|
| Rate for Payer: Lucent All Commercial |
$963.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$737.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
| Rate for Payer: United Healthcare Medicare |
$623.70
|
|
|
HC SUTURE MAXBRAID #2 900335
|
Facility
IP
|
$1,890.00
|
|
| Hospital Charge Code |
41601393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,417.50 |
| Max. Negotiated Rate |
$1,757.70 |
| Rate for Payer: Aetna Commercial |
$1,632.96
|
| Rate for Payer: Cash Price |
$1,171.80
|
| Rate for Payer: Cigna All Commercial |
$1,631.07
|
| Rate for Payer: CORVEL All Commercial |
$1,757.70
|
| Rate for Payer: Coventry All Commercial |
$1,663.20
|
| Rate for Payer: Encore All Commercial |
$1,739.74
|
| Rate for Payer: Frontpath All Commercial |
$1,738.80
|
| Rate for Payer: Humana ChoiceCare |
$1,632.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,701.00
|
| Rate for Payer: PHCS All Commercial |
$1,417.50
|
| Rate for Payer: PHP All Commercial |
$1,433.38
|
| Rate for Payer: Sagamore Health Network All Products |
$1,459.08
|
| Rate for Payer: Signature Care EPO |
$1,568.70
|
| Rate for Payer: Signature Care PPO |
$1,663.20
|
| Rate for Payer: United Healthcare Commercial |
$1,489.32
|
|
|
HC SUTURE MERSILENE 4-0 1779G
|
Facility
IP
|
$106.52
|
|
| Hospital Charge Code |
41601510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.89 |
| Max. Negotiated Rate |
$99.06 |
| Rate for Payer: Aetna Commercial |
$92.03
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
|
|
HC SUTURE MERSILENE 4-0 1779G
|
Facility
OP
|
$106.52
|
|
| Hospital Charge Code |
41601510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$89.90
|
| Rate for Payer: Aetna Medicare |
$35.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.67
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Cash Price |
$66.04
|
| Rate for Payer: Centivo All Commercial |
$54.33
|
| Rate for Payer: Cigna All Commercial |
$91.93
|
| Rate for Payer: CORVEL All Commercial |
$99.06
|
| Rate for Payer: Coventry All Commercial |
$93.74
|
| Rate for Payer: Encore All Commercial |
$98.05
|
| Rate for Payer: Frontpath All Commercial |
$98.00
|
| Rate for Payer: Humana ChoiceCare |
$92.00
|
| Rate for Payer: Humana Medicare |
$54.33
|
| Rate for Payer: Lucent All Commercial |
$54.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$79.89
|
| Rate for Payer: PHP All Commercial |
$80.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.54
|
| Rate for Payer: Sagamore Health Network All Products |
$82.23
|
| Rate for Payer: Signature Care EPO |
$88.41
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.54
|
| Rate for Payer: United Healthcare Commercial |
$83.94
|
| Rate for Payer: United Healthcare Medicare |
$35.15
|
|
|
HC SUTURE MERSILENE 4-0 R691G
|
Facility
OP
|
$37.58
|
|
| Hospital Charge Code |
41601509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Medicare |
$12.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Centivo All Commercial |
$19.17
|
| Rate for Payer: Cigna All Commercial |
$32.43
|
| Rate for Payer: CORVEL All Commercial |
$34.95
|
| Rate for Payer: Coventry All Commercial |
$33.07
|
| Rate for Payer: Encore All Commercial |
$34.59
|
| Rate for Payer: Frontpath All Commercial |
$34.57
|
| Rate for Payer: Humana ChoiceCare |
$32.46
|
| Rate for Payer: Humana Medicare |
$19.17
|
| Rate for Payer: Lucent All Commercial |
$19.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.18
|
| Rate for Payer: PHP All Commercial |
$28.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.66
|
| Rate for Payer: Sagamore Health Network All Products |
$29.01
|
| Rate for Payer: Signature Care EPO |
$31.19
|
| Rate for Payer: Signature Care PPO |
$33.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.94
|
| Rate for Payer: United Healthcare Commercial |
$29.61
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
|
