|
HC SUTURE MERSILENE 4-0 R691G
|
Facility
|
IP
|
$37.58
|
|
| Hospital Charge Code |
41601509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Cash Price |
$23.30
|
| 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: Lutheran Preferred All Commercial |
$33.82
|
| Rate for Payer: PHCS All Commercial |
$28.18
|
| Rate for Payer: PHP All Commercial |
$28.50
|
| 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: United Healthcare Commercial |
$29.61
|
|
|
HC SUTURE MONOCRYL 0 36 IN Y358H
|
Facility
|
IP
|
$14.53
|
|
| Hospital Charge Code |
41601145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
|
|
HC SUTURE MONOCRYL 0 36 IN Y358H
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
41601145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.27
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Centivo All Commercial |
$7.41
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Humana Medicare |
$7.41
|
| Rate for Payer: Lucent All Commercial |
$7.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.67
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
| Rate for Payer: United Healthcare Medicare |
$4.79
|
|
|
HC SUTURE MONOCRYL 2-0 D8786
|
Facility
|
OP
|
$299.37
|
|
| Hospital Charge Code |
41606247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.79 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$252.67
|
| Rate for Payer: Aetna Medicare |
$98.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.67
|
| Rate for Payer: Cash Price |
$185.61
|
| Rate for Payer: Cash Price |
$185.61
|
| Rate for Payer: Centivo All Commercial |
$152.68
|
| Rate for Payer: Cigna All Commercial |
$258.36
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.45
|
| Rate for Payer: Encore All Commercial |
$275.57
|
| Rate for Payer: Frontpath All Commercial |
$275.42
|
| Rate for Payer: Humana ChoiceCare |
$258.57
|
| Rate for Payer: Humana Medicare |
$152.68
|
| Rate for Payer: Lucent All Commercial |
$152.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$224.53
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.75
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.48
|
| Rate for Payer: Signature Care PPO |
$263.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.46
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
| Rate for Payer: United Healthcare Medicare |
$98.79
|
|
|
HC SUTURE MONOCRYL 2-0 D8786
|
Facility
|
IP
|
$299.37
|
|
| Hospital Charge Code |
41606247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.53 |
| Max. Negotiated Rate |
$278.41 |
| Rate for Payer: Aetna Commercial |
$258.66
|
| Rate for Payer: Cash Price |
$185.61
|
| Rate for Payer: Cigna All Commercial |
$258.36
|
| Rate for Payer: CORVEL All Commercial |
$278.41
|
| Rate for Payer: Coventry All Commercial |
$263.45
|
| Rate for Payer: Encore All Commercial |
$275.57
|
| Rate for Payer: Frontpath All Commercial |
$275.42
|
| Rate for Payer: Humana ChoiceCare |
$258.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$269.43
|
| Rate for Payer: PHCS All Commercial |
$224.53
|
| Rate for Payer: PHP All Commercial |
$227.04
|
| Rate for Payer: Sagamore Health Network All Products |
$231.11
|
| Rate for Payer: Signature Care EPO |
$248.48
|
| Rate for Payer: Signature Care PPO |
$263.45
|
| Rate for Payer: United Healthcare Commercial |
$235.90
|
|
|
HC SUTURE MONOCRYL 2-0 STRATAFIX
|
Facility
|
OP
|
$217.16
|
|
| Hospital Charge Code |
41607790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$183.28
|
| Rate for Payer: Aetna Medicare |
$71.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.83
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Centivo All Commercial |
$110.75
|
| Rate for Payer: Cigna All Commercial |
$187.41
|
| Rate for Payer: CORVEL All Commercial |
$201.96
|
| Rate for Payer: Coventry All Commercial |
$191.10
|
| Rate for Payer: Encore All Commercial |
$199.90
|
| Rate for Payer: Frontpath All Commercial |
$199.79
|
| Rate for Payer: Humana ChoiceCare |
$187.56
|
| Rate for Payer: Humana Medicare |
$110.75
|
| Rate for Payer: Lucent All Commercial |
$110.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$162.87
|
| Rate for Payer: PHP All Commercial |
$164.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.69
|
| Rate for Payer: Sagamore Health Network All Products |
$167.65
|
| Rate for Payer: Signature Care EPO |
$180.24
|
| Rate for Payer: Signature Care PPO |
$191.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.59
|
| Rate for Payer: United Healthcare Commercial |
$171.12
|
| Rate for Payer: United Healthcare Medicare |
$71.66
|
|
|
HC SUTURE MONOCRYL 2-0 STRATAFIX
|
Facility
|
IP
|
$217.16
|
|
| Hospital Charge Code |
41607790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.87 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$187.63
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cigna All Commercial |
$187.41
|
| Rate for Payer: CORVEL All Commercial |
$201.96
|
| Rate for Payer: Coventry All Commercial |
$191.10
|
| Rate for Payer: Encore All Commercial |
$199.90
|
| Rate for Payer: Frontpath All Commercial |
$199.79
|
| Rate for Payer: Humana ChoiceCare |
$187.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.44
|
| Rate for Payer: PHCS All Commercial |
$162.87
|
| Rate for Payer: PHP All Commercial |
$164.69
|
| Rate for Payer: Sagamore Health Network All Products |
$167.65
|
| Rate for Payer: Signature Care EPO |
$180.24
|
| Rate for Payer: Signature Care PPO |
$191.10
|
| Rate for Payer: United Healthcare Commercial |
$171.12
|
|
|
HC SUTURE MONOCRYL 2-0 Y417
|
Facility
|
OP
|
$14.65
|
|
| Hospital Charge Code |
41606903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.36
|
| Rate for Payer: Aetna Medicare |
$4.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.32
|
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: Centivo All Commercial |
$7.47
|
| Rate for Payer: Cigna All Commercial |
$12.64
|
| Rate for Payer: CORVEL All Commercial |
$13.62
|
| Rate for Payer: Coventry All Commercial |
$12.89
|
| Rate for Payer: Encore All Commercial |
$13.49
|
| Rate for Payer: Frontpath All Commercial |
$13.48
|
| Rate for Payer: Humana ChoiceCare |
$12.65
|
| Rate for Payer: Humana Medicare |
$7.47
|
| Rate for Payer: Lucent All Commercial |
$7.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.99
|
| Rate for Payer: PHP All Commercial |
$11.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.71
|
| Rate for Payer: Sagamore Health Network All Products |
$11.31
|
| Rate for Payer: Signature Care EPO |
$12.16
|
| Rate for Payer: Signature Care PPO |
$12.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$11.54
|
| Rate for Payer: United Healthcare Medicare |
$4.83
|
|
|
HC SUTURE MONOCRYL 2-0 Y417
|
Facility
|
IP
|
$14.65
|
|
| Hospital Charge Code |
41606903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$13.62 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Cash Price |
$9.08
|
| Rate for Payer: Cigna All Commercial |
$12.64
|
| Rate for Payer: CORVEL All Commercial |
$13.62
|
| Rate for Payer: Coventry All Commercial |
$12.89
|
| Rate for Payer: Encore All Commercial |
$13.49
|
| Rate for Payer: Frontpath All Commercial |
$13.48
|
| Rate for Payer: Humana ChoiceCare |
$12.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.18
|
| Rate for Payer: PHCS All Commercial |
$10.99
|
| Rate for Payer: PHP All Commercial |
$11.11
|
| Rate for Payer: Sagamore Health Network All Products |
$11.31
|
| Rate for Payer: Signature Care EPO |
$12.16
|
| Rate for Payer: Signature Care PPO |
$12.89
|
| Rate for Payer: United Healthcare Commercial |
$11.54
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN KS Y523H
|
Facility
|
OP
|
$38.84
|
|
| Hospital Charge Code |
41601146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.78
|
| Rate for Payer: Aetna Medicare |
$12.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.10
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Centivo All Commercial |
$19.81
|
| Rate for Payer: Cigna All Commercial |
$33.52
|
| Rate for Payer: CORVEL All Commercial |
$36.12
|
| Rate for Payer: Coventry All Commercial |
$34.18
|
| Rate for Payer: Encore All Commercial |
$35.75
|
| Rate for Payer: Frontpath All Commercial |
$35.73
|
| Rate for Payer: Humana ChoiceCare |
$33.55
|
| Rate for Payer: Humana Medicare |
$19.81
|
| Rate for Payer: Lucent All Commercial |
$19.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.15
|
| Rate for Payer: Sagamore Health Network All Products |
$29.98
|
| Rate for Payer: Signature Care EPO |
$32.24
|
| Rate for Payer: Signature Care PPO |
$34.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.01
|
| Rate for Payer: United Healthcare Commercial |
$30.61
|
| Rate for Payer: United Healthcare Medicare |
$12.82
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN KS Y523H
|
Facility
|
IP
|
$38.84
|
|
| Hospital Charge Code |
41601146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$36.12 |
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cigna All Commercial |
$33.52
|
| Rate for Payer: CORVEL All Commercial |
$36.12
|
| Rate for Payer: Coventry All Commercial |
$34.18
|
| Rate for Payer: Encore All Commercial |
$35.75
|
| Rate for Payer: Frontpath All Commercial |
$35.73
|
| Rate for Payer: Humana ChoiceCare |
$33.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.96
|
| Rate for Payer: PHCS All Commercial |
$29.13
|
| Rate for Payer: PHP All Commercial |
$29.46
|
| Rate for Payer: Sagamore Health Network All Products |
$29.98
|
| Rate for Payer: Signature Care EPO |
$32.24
|
| Rate for Payer: Signature Care PPO |
$34.18
|
| Rate for Payer: United Healthcare Commercial |
$30.61
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN PS-2 Y427H
|
Facility
|
OP
|
$37.50
|
|
| Hospital Charge Code |
41601147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.65
|
| Rate for Payer: Aetna Medicare |
$12.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.61
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Centivo All Commercial |
$19.12
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Humana Medicare |
$19.12
|
| Rate for Payer: Lucent All Commercial |
$19.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.62
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.88
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
| Rate for Payer: United Healthcare Medicare |
$12.38
|
|
|
HC SUTURE MONOCRYL 3-0 27 IN PS-2 Y427H
|
Facility
|
IP
|
$37.50
|
|
| Hospital Charge Code |
41601147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cigna All Commercial |
$32.36
|
| Rate for Payer: CORVEL All Commercial |
$34.88
|
| Rate for Payer: Coventry All Commercial |
$33.00
|
| Rate for Payer: Encore All Commercial |
$34.52
|
| Rate for Payer: Frontpath All Commercial |
$34.50
|
| Rate for Payer: Humana ChoiceCare |
$32.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.75
|
| Rate for Payer: PHCS All Commercial |
$28.12
|
| Rate for Payer: PHP All Commercial |
$28.44
|
| Rate for Payer: Sagamore Health Network All Products |
$28.95
|
| Rate for Payer: Signature Care EPO |
$31.12
|
| Rate for Payer: Signature Care PPO |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$29.55
|
|
|
HC SUTURE MONOCRYL 3-0 STRFIX 101
|
Facility
|
OP
|
$132.92
|
|
| Hospital Charge Code |
41607488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$112.18
|
| Rate for Payer: Aetna Medicare |
$43.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.25
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Centivo All Commercial |
$67.79
|
| Rate for Payer: Cigna All Commercial |
$114.71
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.97
|
| Rate for Payer: Encore All Commercial |
$122.35
|
| Rate for Payer: Frontpath All Commercial |
$122.29
|
| Rate for Payer: Humana ChoiceCare |
$114.80
|
| Rate for Payer: Humana Medicare |
$67.79
|
| Rate for Payer: Lucent All Commercial |
$67.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$99.69
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.84
|
| Rate for Payer: Sagamore Health Network All Products |
$102.61
|
| Rate for Payer: Signature Care EPO |
$110.32
|
| Rate for Payer: Signature Care PPO |
$116.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.98
|
| Rate for Payer: United Healthcare Commercial |
$104.74
|
| Rate for Payer: United Healthcare Medicare |
$43.86
|
|
|
HC SUTURE MONOCRYL 3-0 STRFIX 101
|
Facility
|
IP
|
$132.92
|
|
| Hospital Charge Code |
41607488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.69 |
| Max. Negotiated Rate |
$123.62 |
| Rate for Payer: Aetna Commercial |
$114.84
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: Cigna All Commercial |
$114.71
|
| Rate for Payer: CORVEL All Commercial |
$123.62
|
| Rate for Payer: Coventry All Commercial |
$116.97
|
| Rate for Payer: Encore All Commercial |
$122.35
|
| Rate for Payer: Frontpath All Commercial |
$122.29
|
| Rate for Payer: Humana ChoiceCare |
$114.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.63
|
| Rate for Payer: PHCS All Commercial |
$99.69
|
| Rate for Payer: PHP All Commercial |
$100.81
|
| Rate for Payer: Sagamore Health Network All Products |
$102.61
|
| Rate for Payer: Signature Care EPO |
$110.32
|
| Rate for Payer: Signature Care PPO |
$116.97
|
| Rate for Payer: United Healthcare Commercial |
$104.74
|
|
|
HC SUTURE MONOCRYL 4-0 STRFIX 117
|
Facility
|
OP
|
$113.62
|
|
| Hospital Charge Code |
41607491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$95.90
|
| Rate for Payer: Aetna Medicare |
$37.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$71.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.24
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Centivo All Commercial |
$57.95
|
| Rate for Payer: Cigna All Commercial |
$98.05
|
| Rate for Payer: CORVEL All Commercial |
$105.67
|
| Rate for Payer: Coventry All Commercial |
$99.99
|
| Rate for Payer: Encore All Commercial |
$104.59
|
| Rate for Payer: Frontpath All Commercial |
$104.53
|
| Rate for Payer: Humana ChoiceCare |
$98.13
|
| Rate for Payer: Humana Medicare |
$57.95
|
| Rate for Payer: Lucent All Commercial |
$57.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$85.22
|
| Rate for Payer: PHP All Commercial |
$86.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.31
|
| Rate for Payer: Sagamore Health Network All Products |
$87.71
|
| Rate for Payer: Signature Care EPO |
$94.30
|
| Rate for Payer: Signature Care PPO |
$99.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.58
|
| Rate for Payer: United Healthcare Commercial |
$89.53
|
| Rate for Payer: United Healthcare Medicare |
$37.49
|
|
|
HC SUTURE MONOCRYL 4-0 STRFIX 117
|
Facility
|
IP
|
$113.62
|
|
| Hospital Charge Code |
41607491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.22 |
| Max. Negotiated Rate |
$105.67 |
| Rate for Payer: Aetna Commercial |
$98.17
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cigna All Commercial |
$98.05
|
| Rate for Payer: CORVEL All Commercial |
$105.67
|
| Rate for Payer: Coventry All Commercial |
$99.99
|
| Rate for Payer: Encore All Commercial |
$104.59
|
| Rate for Payer: Frontpath All Commercial |
$104.53
|
| Rate for Payer: Humana ChoiceCare |
$98.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.26
|
| Rate for Payer: PHCS All Commercial |
$85.22
|
| Rate for Payer: PHP All Commercial |
$86.17
|
| Rate for Payer: Sagamore Health Network All Products |
$87.71
|
| Rate for Payer: Signature Care EPO |
$94.30
|
| Rate for Payer: Signature Care PPO |
$99.99
|
| Rate for Payer: United Healthcare Commercial |
$89.53
|
|
|
HC SUTURE MONOCRYL 4-0 Y494G
|
Facility
|
IP
|
$39.41
|
|
| Hospital Charge Code |
41601479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$36.65 |
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cigna All Commercial |
$34.01
|
| Rate for Payer: CORVEL All Commercial |
$36.65
|
| Rate for Payer: Coventry All Commercial |
$34.68
|
| Rate for Payer: Encore All Commercial |
$36.28
|
| Rate for Payer: Frontpath All Commercial |
$36.26
|
| Rate for Payer: Humana ChoiceCare |
$34.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.47
|
| Rate for Payer: PHCS All Commercial |
$29.56
|
| Rate for Payer: PHP All Commercial |
$29.89
|
| Rate for Payer: Sagamore Health Network All Products |
$30.42
|
| Rate for Payer: Signature Care EPO |
$32.71
|
| Rate for Payer: Signature Care PPO |
$34.68
|
| Rate for Payer: United Healthcare Commercial |
$31.06
|
|
|
HC SUTURE MONOCRYL 4-0 Y494G
|
Facility
|
OP
|
$39.41
|
|
| Hospital Charge Code |
41601479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Centivo All Commercial |
$20.10
|
| Rate for Payer: Cigna All Commercial |
$34.01
|
| Rate for Payer: CORVEL All Commercial |
$36.65
|
| Rate for Payer: Coventry All Commercial |
$34.68
|
| Rate for Payer: Encore All Commercial |
$36.28
|
| Rate for Payer: Frontpath All Commercial |
$36.26
|
| Rate for Payer: Humana ChoiceCare |
$34.04
|
| Rate for Payer: Humana Medicare |
$20.10
|
| Rate for Payer: Lucent All Commercial |
$20.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.56
|
| Rate for Payer: PHP All Commercial |
$29.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.37
|
| Rate for Payer: Sagamore Health Network All Products |
$30.42
|
| Rate for Payer: Signature Care EPO |
$32.71
|
| Rate for Payer: Signature Care PPO |
$34.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$31.06
|
| Rate for Payer: United Healthcare Medicare |
$13.01
|
|
|
HC SUTURE MONOCRYL 4-0 Y496G
|
Facility
|
IP
|
$36.89
|
|
| Hospital Charge Code |
41601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$34.31 |
| Rate for Payer: Aetna Commercial |
$31.87
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cigna All Commercial |
$31.84
|
| Rate for Payer: CORVEL All Commercial |
$34.31
|
| Rate for Payer: Coventry All Commercial |
$32.46
|
| Rate for Payer: Encore All Commercial |
$33.96
|
| Rate for Payer: Frontpath All Commercial |
$33.94
|
| Rate for Payer: Humana ChoiceCare |
$31.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.20
|
| Rate for Payer: PHCS All Commercial |
$27.67
|
| Rate for Payer: PHP All Commercial |
$27.98
|
| Rate for Payer: Sagamore Health Network All Products |
$28.48
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$32.46
|
| Rate for Payer: United Healthcare Commercial |
$29.07
|
|
|
HC SUTURE MONOCRYL 4-0 Y496G
|
Facility
|
OP
|
$36.89
|
|
| Hospital Charge Code |
41601480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Cash Price |
$22.87
|
| Rate for Payer: Centivo All Commercial |
$18.81
|
| Rate for Payer: Cigna All Commercial |
$31.84
|
| Rate for Payer: CORVEL All Commercial |
$34.31
|
| Rate for Payer: Coventry All Commercial |
$32.46
|
| Rate for Payer: Encore All Commercial |
$33.96
|
| Rate for Payer: Frontpath All Commercial |
$33.94
|
| Rate for Payer: Humana ChoiceCare |
$31.86
|
| Rate for Payer: Humana Medicare |
$18.81
|
| Rate for Payer: Lucent All Commercial |
$18.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$27.67
|
| Rate for Payer: PHP All Commercial |
$27.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.39
|
| Rate for Payer: Sagamore Health Network All Products |
$28.48
|
| Rate for Payer: Signature Care EPO |
$30.62
|
| Rate for Payer: Signature Care PPO |
$32.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.36
|
| Rate for Payer: United Healthcare Commercial |
$29.07
|
| Rate for Payer: United Healthcare Medicare |
$12.17
|
|
|
HC SUTURE MONOCRYL 5-0 Y493G
|
Facility
|
IP
|
$129.82
|
|
| Hospital Charge Code |
41601481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Cigna All Commercial |
$112.03
|
| Rate for Payer: CORVEL All Commercial |
$120.73
|
| Rate for Payer: Coventry All Commercial |
$114.24
|
| Rate for Payer: Encore All Commercial |
$119.50
|
| Rate for Payer: Frontpath All Commercial |
$119.43
|
| Rate for Payer: Humana ChoiceCare |
$112.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.84
|
| Rate for Payer: PHCS All Commercial |
$97.36
|
| Rate for Payer: PHP All Commercial |
$98.46
|
| Rate for Payer: Sagamore Health Network All Products |
$100.22
|
| Rate for Payer: Signature Care EPO |
$107.75
|
| Rate for Payer: Signature Care PPO |
$114.24
|
| Rate for Payer: United Healthcare Commercial |
$102.30
|
|
|
HC SUTURE MONOCRYL 5-0 Y493G
|
Facility
|
OP
|
$129.82
|
|
| Hospital Charge Code |
41601481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$109.57
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.12
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Centivo All Commercial |
$66.21
|
| Rate for Payer: Cigna All Commercial |
$112.03
|
| Rate for Payer: CORVEL All Commercial |
$120.73
|
| Rate for Payer: Coventry All Commercial |
$114.24
|
| Rate for Payer: Encore All Commercial |
$119.50
|
| Rate for Payer: Frontpath All Commercial |
$119.43
|
| Rate for Payer: Humana ChoiceCare |
$112.13
|
| Rate for Payer: Humana Medicare |
$66.21
|
| Rate for Payer: Lucent All Commercial |
$66.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$116.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$97.36
|
| Rate for Payer: PHP All Commercial |
$98.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.63
|
| Rate for Payer: Sagamore Health Network All Products |
$100.22
|
| Rate for Payer: Signature Care EPO |
$107.75
|
| Rate for Payer: Signature Care PPO |
$114.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.35
|
| Rate for Payer: United Healthcare Commercial |
$102.30
|
| Rate for Payer: United Healthcare Medicare |
$42.84
|
|
|
HC SUTURE MONOCRYL UD 4-0 27IN
|
Facility
|
OP
|
$23.38
|
|
| Hospital Charge Code |
41607165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.73
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.49
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Centivo All Commercial |
$11.92
|
| Rate for Payer: Cigna All Commercial |
$20.18
|
| Rate for Payer: CORVEL All Commercial |
$21.74
|
| Rate for Payer: Coventry All Commercial |
$20.57
|
| Rate for Payer: Encore All Commercial |
$21.52
|
| Rate for Payer: Frontpath All Commercial |
$21.51
|
| Rate for Payer: Humana ChoiceCare |
$20.19
|
| Rate for Payer: Humana Medicare |
$11.92
|
| Rate for Payer: Lucent All Commercial |
$11.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.54
|
| Rate for Payer: PHP All Commercial |
$17.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.12
|
| Rate for Payer: Sagamore Health Network All Products |
$18.05
|
| Rate for Payer: Signature Care EPO |
$19.41
|
| Rate for Payer: Signature Care PPO |
$20.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.87
|
| Rate for Payer: United Healthcare Commercial |
$18.42
|
| Rate for Payer: United Healthcare Medicare |
$7.72
|
|
|
HC SUTURE MONOCRYL UD 4-0 27IN
|
Facility
|
IP
|
$23.38
|
|
| Hospital Charge Code |
41607165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cigna All Commercial |
$20.18
|
| Rate for Payer: CORVEL All Commercial |
$21.74
|
| Rate for Payer: Coventry All Commercial |
$20.57
|
| Rate for Payer: Encore All Commercial |
$21.52
|
| Rate for Payer: Frontpath All Commercial |
$21.51
|
| Rate for Payer: Humana ChoiceCare |
$20.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.04
|
| Rate for Payer: PHCS All Commercial |
$17.54
|
| Rate for Payer: PHP All Commercial |
$17.73
|
| Rate for Payer: Sagamore Health Network All Products |
$18.05
|
| Rate for Payer: Signature Care EPO |
$19.41
|
| Rate for Payer: Signature Care PPO |
$20.57
|
| Rate for Payer: United Healthcare Commercial |
$18.42
|
|
