|
HC SUTURE NEEDLE DAVIS TONSIL 1/2 IN CIRCL
|
Facility
|
IP
|
$19.18
|
|
| Hospital Charge Code |
41601588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cigna All Commercial |
$16.55
|
| Rate for Payer: CORVEL All Commercial |
$17.84
|
| Rate for Payer: Coventry All Commercial |
$16.88
|
| Rate for Payer: Encore All Commercial |
$17.66
|
| Rate for Payer: Frontpath All Commercial |
$17.65
|
| Rate for Payer: Humana ChoiceCare |
$16.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.26
|
| Rate for Payer: PHCS All Commercial |
$14.38
|
| Rate for Payer: PHP All Commercial |
$14.55
|
| Rate for Payer: Sagamore Health Network All Products |
$14.81
|
| Rate for Payer: Signature Care EPO |
$15.92
|
| Rate for Payer: Signature Care PPO |
$16.88
|
| Rate for Payer: United Healthcare Commercial |
$15.11
|
|
|
HC SUTURE NEEDLE DAVIS TONSIL 1/2 IN CIRCL
|
Facility
|
OP
|
$19.18
|
|
| Hospital Charge Code |
41601588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna Medicare |
$6.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.96
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Centivo All Commercial |
$9.78
|
| Rate for Payer: Cigna All Commercial |
$16.55
|
| Rate for Payer: CORVEL All Commercial |
$17.84
|
| Rate for Payer: Coventry All Commercial |
$16.88
|
| Rate for Payer: Encore All Commercial |
$17.66
|
| Rate for Payer: Frontpath All Commercial |
$17.65
|
| Rate for Payer: Humana ChoiceCare |
$16.57
|
| Rate for Payer: Humana Medicare |
$9.78
|
| Rate for Payer: Lucent All Commercial |
$9.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.38
|
| Rate for Payer: PHP All Commercial |
$14.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.48
|
| Rate for Payer: Sagamore Health Network All Products |
$14.81
|
| Rate for Payer: Signature Care EPO |
$15.92
|
| Rate for Payer: Signature Care PPO |
$16.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.30
|
| Rate for Payer: United Healthcare Commercial |
$15.11
|
| Rate for Payer: United Healthcare Medicare |
$6.33
|
|
|
HC SUTURE NEEDLE FERGUSONS SZ6
|
Facility
|
OP
|
$11.42
|
|
| Hospital Charge Code |
41601589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.15
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Centivo All Commercial |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$9.86
|
| Rate for Payer: CORVEL All Commercial |
$10.62
|
| Rate for Payer: Coventry All Commercial |
$10.05
|
| Rate for Payer: Encore All Commercial |
$10.51
|
| Rate for Payer: Frontpath All Commercial |
$10.51
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Lucent All Commercial |
$5.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.45
|
| Rate for Payer: Sagamore Health Network All Products |
$8.82
|
| Rate for Payer: Signature Care EPO |
$9.48
|
| Rate for Payer: Signature Care PPO |
$10.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$9.00
|
| Rate for Payer: United Healthcare Medicare |
$3.77
|
|
|
HC SUTURE NEEDLE FERGUSONS SZ6
|
Facility
|
IP
|
$11.42
|
|
| Hospital Charge Code |
41601589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cigna All Commercial |
$9.86
|
| Rate for Payer: CORVEL All Commercial |
$10.62
|
| Rate for Payer: Coventry All Commercial |
$10.05
|
| Rate for Payer: Encore All Commercial |
$10.51
|
| Rate for Payer: Frontpath All Commercial |
$10.51
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.28
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.66
|
| Rate for Payer: Sagamore Health Network All Products |
$8.82
|
| Rate for Payer: Signature Care EPO |
$9.48
|
| Rate for Payer: Signature Care PPO |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$9.00
|
|
|
HC SUTURE NEEDLE FRENCH SIZE 3
|
Facility
|
IP
|
$14.50
|
|
| Hospital Charge Code |
41601591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: Aetna Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: Cigna All Commercial |
$12.51
|
| Rate for Payer: CORVEL All Commercial |
$13.48
|
| Rate for Payer: Coventry All Commercial |
$12.76
|
| Rate for Payer: Encore All Commercial |
$13.35
|
| Rate for Payer: Frontpath All Commercial |
$13.34
|
| Rate for Payer: Humana ChoiceCare |
$12.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.05
|
| Rate for Payer: PHCS All Commercial |
$10.88
|
| Rate for Payer: PHP All Commercial |
$11.00
|
| Rate for Payer: Sagamore Health Network All Products |
$11.19
|
| Rate for Payer: Signature Care EPO |
$12.04
|
| Rate for Payer: Signature Care PPO |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$11.43
|
|
|
HC SUTURE NEEDLE FRENCH SIZE 3
|
Facility
|
OP
|
$14.50
|
|
| Hospital Charge Code |
41601591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.24
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.26
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: Centivo All Commercial |
$7.40
|
| Rate for Payer: Cigna All Commercial |
$12.51
|
| Rate for Payer: CORVEL All Commercial |
$13.48
|
| Rate for Payer: Coventry All Commercial |
$12.76
|
| Rate for Payer: Encore All Commercial |
$13.35
|
| Rate for Payer: Frontpath All Commercial |
$13.34
|
| Rate for Payer: Humana ChoiceCare |
$12.52
|
| Rate for Payer: Humana Medicare |
$7.40
|
| Rate for Payer: Lucent All Commercial |
$7.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.88
|
| Rate for Payer: PHP All Commercial |
$11.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.66
|
| Rate for Payer: Sagamore Health Network All Products |
$11.19
|
| Rate for Payer: Signature Care EPO |
$12.04
|
| Rate for Payer: Signature Care PPO |
$12.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$11.43
|
| Rate for Payer: United Healthcare Medicare |
$4.78
|
|
|
HC SUTURE NEEDLE KEITHS SZ 2 1/2
|
Facility
|
OP
|
$15.12
|
|
| Hospital Charge Code |
41601586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.76
|
| Rate for Payer: Aetna Medicare |
$4.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.49
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: Centivo All Commercial |
$7.71
|
| Rate for Payer: Cigna All Commercial |
$13.05
|
| Rate for Payer: CORVEL All Commercial |
$14.06
|
| Rate for Payer: Coventry All Commercial |
$13.31
|
| Rate for Payer: Encore All Commercial |
$13.92
|
| Rate for Payer: Frontpath All Commercial |
$13.91
|
| Rate for Payer: Humana ChoiceCare |
$13.06
|
| Rate for Payer: Humana Medicare |
$7.71
|
| Rate for Payer: Lucent All Commercial |
$7.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.61
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.34
|
| Rate for Payer: PHP All Commercial |
$11.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.90
|
| Rate for Payer: Sagamore Health Network All Products |
$11.67
|
| Rate for Payer: Signature Care EPO |
$12.55
|
| Rate for Payer: Signature Care PPO |
$13.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.85
|
| Rate for Payer: United Healthcare Commercial |
$11.91
|
| Rate for Payer: United Healthcare Medicare |
$4.99
|
|
|
HC SUTURE NEEDLE KEITHS SZ 2 1/2
|
Facility
|
IP
|
$15.12
|
|
| Hospital Charge Code |
41601586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$9.37
|
| Rate for Payer: Cigna All Commercial |
$13.05
|
| Rate for Payer: CORVEL All Commercial |
$14.06
|
| Rate for Payer: Coventry All Commercial |
$13.31
|
| Rate for Payer: Encore All Commercial |
$13.92
|
| Rate for Payer: Frontpath All Commercial |
$13.91
|
| Rate for Payer: Humana ChoiceCare |
$13.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.61
|
| Rate for Payer: PHCS All Commercial |
$11.34
|
| Rate for Payer: PHP All Commercial |
$11.47
|
| Rate for Payer: Sagamore Health Network All Products |
$11.67
|
| Rate for Payer: Signature Care EPO |
$12.55
|
| Rate for Payer: Signature Care PPO |
$13.31
|
| Rate for Payer: United Healthcare Commercial |
$11.91
|
|
|
HC SUTURE NEEDLE MAYO 3.5
|
Facility
|
IP
|
$34.39
|
|
| Hospital Charge Code |
41607040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$31.98 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Cigna All Commercial |
$29.68
|
| Rate for Payer: CORVEL All Commercial |
$31.98
|
| Rate for Payer: Coventry All Commercial |
$30.26
|
| Rate for Payer: Encore All Commercial |
$31.66
|
| Rate for Payer: Frontpath All Commercial |
$31.64
|
| Rate for Payer: Humana ChoiceCare |
$29.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.95
|
| Rate for Payer: PHCS All Commercial |
$25.79
|
| Rate for Payer: PHP All Commercial |
$26.08
|
| Rate for Payer: Sagamore Health Network All Products |
$26.55
|
| Rate for Payer: Signature Care EPO |
$28.54
|
| Rate for Payer: Signature Care PPO |
$30.26
|
| Rate for Payer: United Healthcare Commercial |
$27.10
|
|
|
HC SUTURE NEEDLE MAYO 3.5
|
Facility
|
OP
|
$34.39
|
|
| Hospital Charge Code |
41607040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.03
|
| Rate for Payer: Aetna Medicare |
$11.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.48
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Centivo All Commercial |
$17.54
|
| Rate for Payer: Cigna All Commercial |
$29.68
|
| Rate for Payer: CORVEL All Commercial |
$31.98
|
| Rate for Payer: Coventry All Commercial |
$30.26
|
| Rate for Payer: Encore All Commercial |
$31.66
|
| Rate for Payer: Frontpath All Commercial |
$31.64
|
| Rate for Payer: Humana ChoiceCare |
$29.70
|
| Rate for Payer: Humana Medicare |
$17.54
|
| Rate for Payer: Lucent All Commercial |
$17.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$25.79
|
| Rate for Payer: PHP All Commercial |
$26.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.41
|
| Rate for Payer: Sagamore Health Network All Products |
$26.55
|
| Rate for Payer: Signature Care EPO |
$28.54
|
| Rate for Payer: Signature Care PPO |
$30.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.23
|
| Rate for Payer: United Healthcare Commercial |
$27.10
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
|
|
HC SUTURE NEEDLE MAYOS SZ5
|
Facility
|
OP
|
$14.56
|
|
| Hospital Charge Code |
41601587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.29
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.29
|
| Rate for Payer: Cash Price |
$9.03
|
| Rate for Payer: Cash Price |
$9.03
|
| Rate for Payer: Centivo All Commercial |
$7.43
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.54
|
| Rate for Payer: Coventry All Commercial |
$12.81
|
| Rate for Payer: Encore All Commercial |
$13.40
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Humana Medicare |
$7.43
|
| Rate for Payer: Lucent All Commercial |
$7.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.92
|
| Rate for Payer: PHP All Commercial |
$11.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.68
|
| Rate for Payer: Sagamore Health Network All Products |
$11.24
|
| Rate for Payer: Signature Care EPO |
$12.08
|
| Rate for Payer: Signature Care PPO |
$12.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.38
|
| Rate for Payer: United Healthcare Commercial |
$11.47
|
| Rate for Payer: United Healthcare Medicare |
$4.80
|
|
|
HC SUTURE NEEDLE MAYOS SZ5
|
Facility
|
IP
|
$14.56
|
|
| Hospital Charge Code |
41601587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$9.03
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.54
|
| Rate for Payer: Coventry All Commercial |
$12.81
|
| Rate for Payer: Encore All Commercial |
$13.40
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.10
|
| Rate for Payer: PHCS All Commercial |
$10.92
|
| Rate for Payer: PHP All Commercial |
$11.04
|
| Rate for Payer: Sagamore Health Network All Products |
$11.24
|
| Rate for Payer: Signature Care EPO |
$12.08
|
| Rate for Payer: Signature Care PPO |
$12.81
|
| Rate for Payer: United Healthcare Commercial |
$11.47
|
|
|
HC SUTURE NEEDLE SZ 2
|
Facility
|
IP
|
$11.93
|
|
| Hospital Charge Code |
41606926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Aetna Commercial |
$10.31
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cigna All Commercial |
$10.30
|
| Rate for Payer: CORVEL All Commercial |
$11.09
|
| Rate for Payer: Coventry All Commercial |
$10.50
|
| Rate for Payer: Encore All Commercial |
$10.98
|
| Rate for Payer: Frontpath All Commercial |
$10.98
|
| Rate for Payer: Humana ChoiceCare |
$10.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.74
|
| Rate for Payer: PHCS All Commercial |
$8.95
|
| Rate for Payer: PHP All Commercial |
$9.05
|
| Rate for Payer: Sagamore Health Network All Products |
$9.21
|
| Rate for Payer: Signature Care EPO |
$9.90
|
| Rate for Payer: Signature Care PPO |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
|
|
HC SUTURE NEEDLE SZ 2
|
Facility
|
OP
|
$11.93
|
|
| Hospital Charge Code |
41606926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.07
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Centivo All Commercial |
$6.08
|
| Rate for Payer: Cigna All Commercial |
$10.30
|
| Rate for Payer: CORVEL All Commercial |
$11.09
|
| Rate for Payer: Coventry All Commercial |
$10.50
|
| Rate for Payer: Encore All Commercial |
$10.98
|
| Rate for Payer: Frontpath All Commercial |
$10.98
|
| Rate for Payer: Humana ChoiceCare |
$10.30
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Lucent All Commercial |
$6.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.95
|
| Rate for Payer: PHP All Commercial |
$9.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.65
|
| Rate for Payer: Sagamore Health Network All Products |
$9.21
|
| Rate for Payer: Signature Care EPO |
$9.90
|
| Rate for Payer: Signature Care PPO |
$10.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.14
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
| Rate for Payer: United Healthcare Medicare |
$3.94
|
|
|
HC SUTURE NYLON 10-0 AU5
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
41601489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$188.79 |
| Rate for Payer: Aetna Commercial |
$171.33
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.69
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Centivo All Commercial |
$103.53
|
| Rate for Payer: Cigna All Commercial |
$175.19
|
| Rate for Payer: CORVEL All Commercial |
$188.79
|
| Rate for Payer: Coventry All Commercial |
$178.64
|
| Rate for Payer: Encore All Commercial |
$186.86
|
| Rate for Payer: Frontpath All Commercial |
$186.76
|
| Rate for Payer: Humana ChoiceCare |
$175.33
|
| Rate for Payer: Humana Medicare |
$103.53
|
| Rate for Payer: Lucent All Commercial |
$103.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.70
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$152.25
|
| Rate for Payer: PHP All Commercial |
$153.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.17
|
| Rate for Payer: Sagamore Health Network All Products |
$156.72
|
| Rate for Payer: Signature Care EPO |
$168.49
|
| Rate for Payer: Signature Care PPO |
$178.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$172.55
|
| Rate for Payer: United Healthcare Commercial |
$159.96
|
| Rate for Payer: United Healthcare Medicare |
$66.99
|
|
|
HC SUTURE NYLON 10-0 AU5
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
41601489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.25 |
| Max. Negotiated Rate |
$188.79 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cigna All Commercial |
$175.19
|
| Rate for Payer: CORVEL All Commercial |
$188.79
|
| Rate for Payer: Coventry All Commercial |
$178.64
|
| Rate for Payer: Encore All Commercial |
$186.86
|
| Rate for Payer: Frontpath All Commercial |
$186.76
|
| Rate for Payer: Humana ChoiceCare |
$175.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.70
|
| Rate for Payer: PHCS All Commercial |
$152.25
|
| Rate for Payer: PHP All Commercial |
$153.96
|
| Rate for Payer: Sagamore Health Network All Products |
$156.72
|
| Rate for Payer: Signature Care EPO |
$168.49
|
| Rate for Payer: Signature Care PPO |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$159.96
|
|
|
HC SUTURE PANACRYL 1 T947H
|
Facility
|
IP
|
$30.61
|
|
| Hospital Charge Code |
41601511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$28.47 |
| Rate for Payer: Aetna Commercial |
$26.45
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna All Commercial |
$26.42
|
| Rate for Payer: CORVEL All Commercial |
$28.47
|
| Rate for Payer: Coventry All Commercial |
$26.94
|
| Rate for Payer: Encore All Commercial |
$28.18
|
| Rate for Payer: Frontpath All Commercial |
$28.16
|
| Rate for Payer: Humana ChoiceCare |
$26.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.55
|
| Rate for Payer: PHCS All Commercial |
$22.96
|
| Rate for Payer: PHP All Commercial |
$23.21
|
| Rate for Payer: Sagamore Health Network All Products |
$23.63
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.94
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
|
|
HC SUTURE PANACRYL 1 T947H
|
Facility
|
OP
|
$30.61
|
|
| Hospital Charge Code |
41601511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.83
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.11
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Centivo All Commercial |
$15.61
|
| Rate for Payer: Cigna All Commercial |
$26.42
|
| Rate for Payer: CORVEL All Commercial |
$28.47
|
| Rate for Payer: Coventry All Commercial |
$26.94
|
| Rate for Payer: Encore All Commercial |
$28.18
|
| Rate for Payer: Frontpath All Commercial |
$28.16
|
| Rate for Payer: Humana ChoiceCare |
$26.44
|
| Rate for Payer: Humana Medicare |
$15.61
|
| Rate for Payer: Lucent All Commercial |
$15.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.96
|
| Rate for Payer: PHP All Commercial |
$23.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.94
|
| Rate for Payer: Sagamore Health Network All Products |
$23.63
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.02
|
| Rate for Payer: United Healthcare Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
|
|
HC SUTURE PDS 1 Z341H
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
41601148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.59
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
|
|
HC SUTURE PDS 1 Z341H
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
41601148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.13
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Centivo All Commercial |
$8.61
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Lucent All Commercial |
$8.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.59
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.36
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare |
$5.57
|
|
|
HC SUTURE PDS II 0 Z334H
|
Facility
|
OP
|
$30.75
|
|
| Hospital Charge Code |
41601517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.95
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Centivo All Commercial |
$15.68
|
| Rate for Payer: Cigna All Commercial |
$26.54
|
| Rate for Payer: CORVEL All Commercial |
$28.60
|
| Rate for Payer: Coventry All Commercial |
$27.06
|
| Rate for Payer: Encore All Commercial |
$28.31
|
| Rate for Payer: Frontpath All Commercial |
$28.29
|
| Rate for Payer: Humana ChoiceCare |
$26.56
|
| Rate for Payer: Humana Medicare |
$15.68
|
| Rate for Payer: Lucent All Commercial |
$15.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.06
|
| Rate for Payer: PHP All Commercial |
$23.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.99
|
| Rate for Payer: Sagamore Health Network All Products |
$23.74
|
| Rate for Payer: Signature Care EPO |
$25.52
|
| Rate for Payer: Signature Care PPO |
$27.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.14
|
| Rate for Payer: United Healthcare Commercial |
$24.23
|
| Rate for Payer: United Healthcare Medicare |
$10.15
|
|
|
HC SUTURE PDS II 0 Z334H
|
Facility
|
IP
|
$30.75
|
|
| Hospital Charge Code |
41601517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: Cash Price |
$19.07
|
| Rate for Payer: Cigna All Commercial |
$26.54
|
| Rate for Payer: CORVEL All Commercial |
$28.60
|
| Rate for Payer: Coventry All Commercial |
$27.06
|
| Rate for Payer: Encore All Commercial |
$28.31
|
| Rate for Payer: Frontpath All Commercial |
$28.29
|
| Rate for Payer: Humana ChoiceCare |
$26.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.68
|
| Rate for Payer: PHCS All Commercial |
$23.06
|
| Rate for Payer: PHP All Commercial |
$23.32
|
| Rate for Payer: Sagamore Health Network All Products |
$23.74
|
| Rate for Payer: Signature Care EPO |
$25.52
|
| Rate for Payer: Signature Care PPO |
$27.06
|
| Rate for Payer: United Healthcare Commercial |
$24.23
|
|
|
HC SUTURE PDS II 0 Z340H
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
41601514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Centivo All Commercial |
$8.45
|
| Rate for Payer: Cigna All Commercial |
$14.29
|
| Rate for Payer: CORVEL All Commercial |
$15.40
|
| Rate for Payer: Coventry All Commercial |
$14.57
|
| Rate for Payer: Encore All Commercial |
$15.24
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Humana Medicare |
$8.45
|
| Rate for Payer: Lucent All Commercial |
$8.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.42
|
| Rate for Payer: PHP All Commercial |
$12.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.46
|
| Rate for Payer: Sagamore Health Network All Products |
$12.78
|
| Rate for Payer: Signature Care EPO |
$13.74
|
| Rate for Payer: Signature Care PPO |
$14.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$5.46
|
|
|
HC SUTURE PDS II 0 Z340H
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
41601514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Cigna All Commercial |
$14.29
|
| Rate for Payer: CORVEL All Commercial |
$15.40
|
| Rate for Payer: Coventry All Commercial |
$14.57
|
| Rate for Payer: Encore All Commercial |
$15.24
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.90
|
| Rate for Payer: PHCS All Commercial |
$12.42
|
| Rate for Payer: PHP All Commercial |
$12.56
|
| Rate for Payer: Sagamore Health Network All Products |
$12.78
|
| Rate for Payer: Signature Care EPO |
$13.74
|
| Rate for Payer: Signature Care PPO |
$14.57
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
|
|
HC SUTURE PDS II 0 Z991G
|
Facility
|
OP
|
$43.41
|
|
| Hospital Charge Code |
41601512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.64
|
| Rate for Payer: Aetna Medicare |
$14.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.76
|
| Rate for Payer: Cash Price |
$26.91
|
| Rate for Payer: Cash Price |
$26.91
|
| Rate for Payer: Centivo All Commercial |
$22.14
|
| Rate for Payer: Cigna All Commercial |
$37.46
|
| Rate for Payer: CORVEL All Commercial |
$40.37
|
| Rate for Payer: Coventry All Commercial |
$38.20
|
| Rate for Payer: Encore All Commercial |
$39.96
|
| Rate for Payer: Frontpath All Commercial |
$39.94
|
| Rate for Payer: Humana ChoiceCare |
$37.49
|
| Rate for Payer: Humana Medicare |
$22.14
|
| Rate for Payer: Lucent All Commercial |
$22.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.56
|
| Rate for Payer: PHP All Commercial |
$32.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.93
|
| Rate for Payer: Sagamore Health Network All Products |
$33.51
|
| Rate for Payer: Signature Care EPO |
$36.03
|
| Rate for Payer: Signature Care PPO |
$38.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.90
|
| Rate for Payer: United Healthcare Commercial |
$34.21
|
| Rate for Payer: United Healthcare Medicare |
$14.33
|
|
