|
HC SUTURE PDS II 0 Z991G
|
Facility
|
IP
|
$43.41
|
|
| Hospital Charge Code |
41601512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$40.37 |
| Rate for Payer: Aetna Commercial |
$37.51
|
| Rate for Payer: Cash Price |
$26.91
|
| 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: Lutheran Preferred All Commercial |
$39.07
|
| Rate for Payer: PHCS All Commercial |
$32.56
|
| Rate for Payer: PHP All Commercial |
$32.92
|
| 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: United Healthcare Commercial |
$34.21
|
|
|
HC SUTURE PDS II 0 ZB340
|
Facility
|
OP
|
$26.51
|
|
| Hospital Charge Code |
41601518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.37
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.62
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Centivo All Commercial |
$13.52
|
| Rate for Payer: Cigna All Commercial |
$22.88
|
| Rate for Payer: CORVEL All Commercial |
$24.65
|
| Rate for Payer: Coventry All Commercial |
$23.33
|
| Rate for Payer: Encore All Commercial |
$24.40
|
| Rate for Payer: Frontpath All Commercial |
$24.39
|
| Rate for Payer: Humana ChoiceCare |
$22.90
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Lucent All Commercial |
$13.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$19.88
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.34
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.00
|
| Rate for Payer: Signature Care PPO |
$23.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.53
|
| Rate for Payer: United Healthcare Commercial |
$20.89
|
| Rate for Payer: United Healthcare Medicare |
$8.75
|
|
|
HC SUTURE PDS II 0 ZB340
|
Facility
|
IP
|
$26.51
|
|
| Hospital Charge Code |
41601518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$24.65 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Cash Price |
$16.44
|
| Rate for Payer: Cigna All Commercial |
$22.88
|
| Rate for Payer: CORVEL All Commercial |
$24.65
|
| Rate for Payer: Coventry All Commercial |
$23.33
|
| Rate for Payer: Encore All Commercial |
$24.40
|
| Rate for Payer: Frontpath All Commercial |
$24.39
|
| Rate for Payer: Humana ChoiceCare |
$22.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.86
|
| Rate for Payer: PHCS All Commercial |
$19.88
|
| Rate for Payer: PHP All Commercial |
$20.11
|
| Rate for Payer: Sagamore Health Network All Products |
$20.47
|
| Rate for Payer: Signature Care EPO |
$22.00
|
| Rate for Payer: Signature Care PPO |
$23.33
|
| Rate for Payer: United Healthcare Commercial |
$20.89
|
|
|
HC SUTURE PDS II 1 CTX Z371T
|
Facility
|
OP
|
$19.08
|
|
| Hospital Charge Code |
41607913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Medicare |
$6.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.93
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centivo All Commercial |
$9.73
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Humana Medicare |
$9.73
|
| Rate for Payer: Lucent All Commercial |
$9.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.44
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.22
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$6.30
|
|
|
HC SUTURE PDS II 1 CTX Z371T
|
Facility
|
IP
|
$19.08
|
|
| Hospital Charge Code |
41607913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna Commercial |
$16.49
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cigna All Commercial |
$16.47
|
| Rate for Payer: CORVEL All Commercial |
$17.74
|
| Rate for Payer: Coventry All Commercial |
$16.79
|
| Rate for Payer: Encore All Commercial |
$17.56
|
| Rate for Payer: Frontpath All Commercial |
$17.55
|
| Rate for Payer: Humana ChoiceCare |
$16.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.17
|
| Rate for Payer: PHCS All Commercial |
$14.31
|
| Rate for Payer: PHP All Commercial |
$14.47
|
| Rate for Payer: Sagamore Health Network All Products |
$14.73
|
| Rate for Payer: Signature Care EPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$16.79
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
|
|
HC SUTURE PDS II 2-0 Z317H
|
Facility
|
OP
|
$17.79
|
|
| Hospital Charge Code |
41601513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.01
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.46
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: Centivo All Commercial |
$9.07
|
| Rate for Payer: Cigna All Commercial |
$15.35
|
| Rate for Payer: CORVEL All Commercial |
$16.54
|
| Rate for Payer: Coventry All Commercial |
$15.66
|
| Rate for Payer: Encore All Commercial |
$16.38
|
| Rate for Payer: Frontpath All Commercial |
$16.37
|
| Rate for Payer: Humana ChoiceCare |
$15.37
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Lucent All Commercial |
$9.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.34
|
| Rate for Payer: PHP All Commercial |
$13.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.94
|
| Rate for Payer: Sagamore Health Network All Products |
$13.73
|
| Rate for Payer: Signature Care EPO |
$14.77
|
| Rate for Payer: Signature Care PPO |
$15.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.12
|
| Rate for Payer: United Healthcare Commercial |
$14.02
|
| Rate for Payer: United Healthcare Medicare |
$5.87
|
|
|
HC SUTURE PDS II 2-0 Z317H
|
Facility
|
IP
|
$17.79
|
|
| Hospital Charge Code |
41601513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: Cigna All Commercial |
$15.35
|
| Rate for Payer: CORVEL All Commercial |
$16.54
|
| Rate for Payer: Coventry All Commercial |
$15.66
|
| Rate for Payer: Encore All Commercial |
$16.38
|
| Rate for Payer: Frontpath All Commercial |
$16.37
|
| Rate for Payer: Humana ChoiceCare |
$15.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.01
|
| Rate for Payer: PHCS All Commercial |
$13.34
|
| Rate for Payer: PHP All Commercial |
$13.49
|
| Rate for Payer: Sagamore Health Network All Products |
$13.73
|
| Rate for Payer: Signature Care EPO |
$14.77
|
| Rate for Payer: Signature Care PPO |
$15.66
|
| Rate for Payer: United Healthcare Commercial |
$14.02
|
|
|
HC SUTURE PDS II O CTX Z990G
|
Facility
|
OP
|
$119.60
|
|
| Hospital Charge Code |
41601149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$100.94
|
| Rate for Payer: Aetna Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$74.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.41
|
| Rate for Payer: Cash Price |
$74.15
|
| Rate for Payer: Cash Price |
$74.15
|
| Rate for Payer: Centivo All Commercial |
$61.00
|
| Rate for Payer: Cigna All Commercial |
$103.21
|
| Rate for Payer: CORVEL All Commercial |
$111.23
|
| Rate for Payer: Coventry All Commercial |
$105.25
|
| Rate for Payer: Encore All Commercial |
$110.09
|
| Rate for Payer: Frontpath All Commercial |
$110.03
|
| Rate for Payer: Humana ChoiceCare |
$103.30
|
| Rate for Payer: Humana Medicare |
$61.00
|
| Rate for Payer: Lucent All Commercial |
$61.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$89.70
|
| Rate for Payer: PHP All Commercial |
$90.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.64
|
| Rate for Payer: Sagamore Health Network All Products |
$92.33
|
| Rate for Payer: Signature Care EPO |
$99.27
|
| Rate for Payer: Signature Care PPO |
$105.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$101.66
|
| Rate for Payer: United Healthcare Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare |
$39.47
|
|
|
HC SUTURE PDS II O CTX Z990G
|
Facility
|
IP
|
$119.60
|
|
| Hospital Charge Code |
41601149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$111.23 |
| Rate for Payer: Aetna Commercial |
$103.33
|
| Rate for Payer: Cash Price |
$74.15
|
| Rate for Payer: Cigna All Commercial |
$103.21
|
| Rate for Payer: CORVEL All Commercial |
$111.23
|
| Rate for Payer: Coventry All Commercial |
$105.25
|
| Rate for Payer: Encore All Commercial |
$110.09
|
| Rate for Payer: Frontpath All Commercial |
$110.03
|
| Rate for Payer: Humana ChoiceCare |
$103.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$107.64
|
| Rate for Payer: PHCS All Commercial |
$89.70
|
| Rate for Payer: PHP All Commercial |
$90.70
|
| Rate for Payer: Sagamore Health Network All Products |
$92.33
|
| Rate for Payer: Signature Care EPO |
$99.27
|
| Rate for Payer: Signature Care PPO |
$105.25
|
| Rate for Payer: United Healthcare Commercial |
$94.24
|
|
|
HC SUTURE PDS II Z316H
|
Facility
|
IP
|
$18.19
|
|
| Hospital Charge Code |
41601516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$16.92
|
| Rate for Payer: Coventry All Commercial |
$16.01
|
| Rate for Payer: Encore All Commercial |
$16.74
|
| Rate for Payer: Frontpath All Commercial |
$16.73
|
| Rate for Payer: Humana ChoiceCare |
$15.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.37
|
| Rate for Payer: PHCS All Commercial |
$13.64
|
| Rate for Payer: PHP All Commercial |
$13.80
|
| Rate for Payer: Sagamore Health Network All Products |
$14.04
|
| Rate for Payer: Signature Care EPO |
$15.10
|
| Rate for Payer: Signature Care PPO |
$16.01
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
|
|
HC SUTURE PDS II Z316H
|
Facility
|
OP
|
$18.19
|
|
| Hospital Charge Code |
41601516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.60
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Centivo All Commercial |
$9.28
|
| Rate for Payer: Cigna All Commercial |
$15.70
|
| Rate for Payer: CORVEL All Commercial |
$16.92
|
| Rate for Payer: Coventry All Commercial |
$16.01
|
| Rate for Payer: Encore All Commercial |
$16.74
|
| Rate for Payer: Frontpath All Commercial |
$16.73
|
| Rate for Payer: Humana ChoiceCare |
$15.71
|
| Rate for Payer: Humana Medicare |
$9.28
|
| Rate for Payer: Lucent All Commercial |
$9.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.64
|
| Rate for Payer: PHP All Commercial |
$13.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.09
|
| Rate for Payer: Sagamore Health Network All Products |
$14.04
|
| Rate for Payer: Signature Care EPO |
$15.10
|
| Rate for Payer: Signature Care PPO |
$16.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.46
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
|
|
HC SUTURE PDS II Z880G
|
Facility
|
IP
|
$34.83
|
|
| Hospital Charge Code |
41601515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$32.39 |
| Rate for Payer: Aetna Commercial |
$30.09
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna All Commercial |
$30.06
|
| Rate for Payer: CORVEL All Commercial |
$32.39
|
| Rate for Payer: Coventry All Commercial |
$30.65
|
| Rate for Payer: Encore All Commercial |
$32.06
|
| Rate for Payer: Frontpath All Commercial |
$32.04
|
| Rate for Payer: Humana ChoiceCare |
$30.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.35
|
| Rate for Payer: PHCS All Commercial |
$26.12
|
| Rate for Payer: PHP All Commercial |
$26.42
|
| Rate for Payer: Sagamore Health Network All Products |
$26.89
|
| Rate for Payer: Signature Care EPO |
$28.91
|
| Rate for Payer: Signature Care PPO |
$30.65
|
| Rate for Payer: United Healthcare Commercial |
$27.45
|
|
|
HC SUTURE PDS II Z880G
|
Facility
|
OP
|
$34.83
|
|
| Hospital Charge Code |
41601515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.40
|
| Rate for Payer: Aetna Medicare |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Centivo All Commercial |
$17.76
|
| Rate for Payer: Cigna All Commercial |
$30.06
|
| Rate for Payer: CORVEL All Commercial |
$32.39
|
| Rate for Payer: Coventry All Commercial |
$30.65
|
| Rate for Payer: Encore All Commercial |
$32.06
|
| Rate for Payer: Frontpath All Commercial |
$32.04
|
| Rate for Payer: Humana ChoiceCare |
$30.08
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Lucent All Commercial |
$17.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$26.12
|
| Rate for Payer: PHP All Commercial |
$26.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.58
|
| Rate for Payer: Sagamore Health Network All Products |
$26.89
|
| Rate for Payer: Signature Care EPO |
$28.91
|
| Rate for Payer: Signature Care PPO |
$30.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.61
|
| Rate for Payer: United Healthcare Commercial |
$27.45
|
| Rate for Payer: United Healthcare Medicare |
$11.49
|
|
|
HC SUTURE PDS PLUS 1 A205
|
Facility
|
OP
|
$196.44
|
|
| Hospital Charge Code |
41607489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$182.69 |
| Rate for Payer: Aetna Commercial |
$165.80
|
| Rate for Payer: Aetna Medicare |
$64.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$112.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$122.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$74.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$71.31
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Centivo All Commercial |
$100.18
|
| Rate for Payer: Cigna All Commercial |
$169.53
|
| Rate for Payer: CORVEL All Commercial |
$182.69
|
| Rate for Payer: Coventry All Commercial |
$172.87
|
| Rate for Payer: Encore All Commercial |
$180.82
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.67
|
| Rate for Payer: Humana Medicare |
$100.18
|
| Rate for Payer: Lucent All Commercial |
$100.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$147.33
|
| Rate for Payer: PHP All Commercial |
$148.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.61
|
| Rate for Payer: Sagamore Health Network All Products |
$151.65
|
| Rate for Payer: Signature Care EPO |
$163.05
|
| Rate for Payer: Signature Care PPO |
$172.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$166.97
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
| Rate for Payer: United Healthcare Medicare |
$64.83
|
|
|
HC SUTURE PDS PLUS 1 A205
|
Facility
|
IP
|
$196.44
|
|
| Hospital Charge Code |
41607489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$182.69 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Cigna All Commercial |
$169.53
|
| Rate for Payer: CORVEL All Commercial |
$182.69
|
| Rate for Payer: Coventry All Commercial |
$172.87
|
| Rate for Payer: Encore All Commercial |
$180.82
|
| Rate for Payer: Frontpath All Commercial |
$180.72
|
| Rate for Payer: Humana ChoiceCare |
$169.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.80
|
| Rate for Payer: PHCS All Commercial |
$147.33
|
| Rate for Payer: PHP All Commercial |
$148.98
|
| Rate for Payer: Sagamore Health Network All Products |
$151.65
|
| Rate for Payer: Signature Care EPO |
$163.05
|
| Rate for Payer: Signature Care PPO |
$172.87
|
| Rate for Payer: United Healthcare Commercial |
$154.79
|
|
|
HC SUTURE PLAIN 0 S104H
|
Facility
|
OP
|
$60.84
|
|
| Hospital Charge Code |
41601519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$51.35
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.08
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Centivo All Commercial |
$31.03
|
| Rate for Payer: Cigna All Commercial |
$52.50
|
| Rate for Payer: CORVEL All Commercial |
$56.58
|
| Rate for Payer: Coventry All Commercial |
$53.54
|
| Rate for Payer: Encore All Commercial |
$56.00
|
| Rate for Payer: Frontpath All Commercial |
$55.97
|
| Rate for Payer: Humana ChoiceCare |
$52.55
|
| Rate for Payer: Humana Medicare |
$31.03
|
| Rate for Payer: Lucent All Commercial |
$31.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$45.63
|
| Rate for Payer: PHP All Commercial |
$46.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.73
|
| Rate for Payer: Sagamore Health Network All Products |
$46.97
|
| Rate for Payer: Signature Care EPO |
$50.50
|
| Rate for Payer: Signature Care PPO |
$53.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.71
|
| Rate for Payer: United Healthcare Commercial |
$47.94
|
| Rate for Payer: United Healthcare Medicare |
$20.08
|
|
|
HC SUTURE PLAIN 0 S104H
|
Facility
|
IP
|
$60.84
|
|
| Hospital Charge Code |
41601519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$56.58 |
| Rate for Payer: Aetna Commercial |
$52.57
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna All Commercial |
$52.50
|
| Rate for Payer: CORVEL All Commercial |
$56.58
|
| Rate for Payer: Coventry All Commercial |
$53.54
|
| Rate for Payer: Encore All Commercial |
$56.00
|
| Rate for Payer: Frontpath All Commercial |
$55.97
|
| Rate for Payer: Humana ChoiceCare |
$52.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.76
|
| Rate for Payer: PHCS All Commercial |
$45.63
|
| Rate for Payer: PHP All Commercial |
$46.14
|
| Rate for Payer: Sagamore Health Network All Products |
$46.97
|
| Rate for Payer: Signature Care EPO |
$50.50
|
| Rate for Payer: Signature Care PPO |
$53.54
|
| Rate for Payer: United Healthcare Commercial |
$47.94
|
|
|
HC SUTURE PLAIN 2-0 N863H
|
Facility
|
IP
|
$24.57
|
|
| Hospital Charge Code |
41601463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.23
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cigna All Commercial |
$21.20
|
| Rate for Payer: CORVEL All Commercial |
$22.85
|
| Rate for Payer: Coventry All Commercial |
$21.62
|
| Rate for Payer: Encore All Commercial |
$22.62
|
| Rate for Payer: Frontpath All Commercial |
$22.60
|
| Rate for Payer: Humana ChoiceCare |
$21.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.11
|
| Rate for Payer: PHCS All Commercial |
$18.43
|
| Rate for Payer: PHP All Commercial |
$18.63
|
| Rate for Payer: Sagamore Health Network All Products |
$18.97
|
| Rate for Payer: Signature Care EPO |
$20.39
|
| Rate for Payer: Signature Care PPO |
$21.62
|
| Rate for Payer: United Healthcare Commercial |
$19.36
|
|
|
HC SUTURE PLAIN 2-0 N863H
|
Facility
|
OP
|
$24.57
|
|
| Hospital Charge Code |
41601463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.74
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.92
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Centivo All Commercial |
$12.53
|
| Rate for Payer: Cigna All Commercial |
$21.20
|
| Rate for Payer: CORVEL All Commercial |
$22.85
|
| Rate for Payer: Coventry All Commercial |
$21.62
|
| Rate for Payer: Encore All Commercial |
$22.62
|
| Rate for Payer: Frontpath All Commercial |
$22.60
|
| Rate for Payer: Humana ChoiceCare |
$21.22
|
| Rate for Payer: Humana Medicare |
$12.53
|
| Rate for Payer: Lucent All Commercial |
$12.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.43
|
| Rate for Payer: PHP All Commercial |
$18.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.58
|
| Rate for Payer: Sagamore Health Network All Products |
$18.97
|
| Rate for Payer: Signature Care EPO |
$20.39
|
| Rate for Payer: Signature Care PPO |
$21.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$19.36
|
| Rate for Payer: United Healthcare Medicare |
$8.11
|
|
|
HC SUTURE PLAIN 3-0 G322H
|
Facility
|
IP
|
$23.56
|
|
| Hospital Charge Code |
41601521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cigna All Commercial |
$20.33
|
| Rate for Payer: CORVEL All Commercial |
$21.91
|
| Rate for Payer: Coventry All Commercial |
$20.73
|
| Rate for Payer: Encore All Commercial |
$21.69
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.20
|
| Rate for Payer: PHCS All Commercial |
$17.67
|
| Rate for Payer: PHP All Commercial |
$17.87
|
| Rate for Payer: Sagamore Health Network All Products |
$18.19
|
| Rate for Payer: Signature Care EPO |
$19.55
|
| Rate for Payer: Signature Care PPO |
$20.73
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
|
|
HC SUTURE PLAIN 3-0 G322H
|
Facility
|
OP
|
$23.56
|
|
| Hospital Charge Code |
41601521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.55
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Centivo All Commercial |
$12.02
|
| Rate for Payer: Cigna All Commercial |
$20.33
|
| Rate for Payer: CORVEL All Commercial |
$21.91
|
| Rate for Payer: Coventry All Commercial |
$20.73
|
| Rate for Payer: Encore All Commercial |
$21.69
|
| Rate for Payer: Frontpath All Commercial |
$21.68
|
| Rate for Payer: Humana ChoiceCare |
$20.35
|
| Rate for Payer: Humana Medicare |
$12.02
|
| Rate for Payer: Lucent All Commercial |
$12.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.67
|
| Rate for Payer: PHP All Commercial |
$17.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.19
|
| Rate for Payer: Sagamore Health Network All Products |
$18.19
|
| Rate for Payer: Signature Care EPO |
$19.55
|
| Rate for Payer: Signature Care PPO |
$20.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.03
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
|
|
HC SUTURE PLAIN 4-0 18 IN SC-1
|
Facility
|
OP
|
$19.87
|
|
| Hospital Charge Code |
41602424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.21
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Centivo All Commercial |
$10.13
|
| Rate for Payer: Cigna All Commercial |
$17.15
|
| Rate for Payer: CORVEL All Commercial |
$18.48
|
| Rate for Payer: Coventry All Commercial |
$17.49
|
| Rate for Payer: Encore All Commercial |
$18.29
|
| Rate for Payer: Frontpath All Commercial |
$18.28
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Humana Medicare |
$10.13
|
| Rate for Payer: Lucent All Commercial |
$10.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.90
|
| Rate for Payer: PHP All Commercial |
$15.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.75
|
| Rate for Payer: Sagamore Health Network All Products |
$15.34
|
| Rate for Payer: Signature Care EPO |
$16.49
|
| Rate for Payer: Signature Care PPO |
$17.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.89
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
| Rate for Payer: United Healthcare Medicare |
$6.56
|
|
|
HC SUTURE PLAIN 4-0 18 IN SC-1
|
Facility
|
IP
|
$19.87
|
|
| Hospital Charge Code |
41602424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna Commercial |
$17.17
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cigna All Commercial |
$17.15
|
| Rate for Payer: CORVEL All Commercial |
$18.48
|
| Rate for Payer: Coventry All Commercial |
$17.49
|
| Rate for Payer: Encore All Commercial |
$18.29
|
| Rate for Payer: Frontpath All Commercial |
$18.28
|
| Rate for Payer: Humana ChoiceCare |
$17.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.88
|
| Rate for Payer: PHCS All Commercial |
$14.90
|
| Rate for Payer: PHP All Commercial |
$15.07
|
| Rate for Payer: Sagamore Health Network All Products |
$15.34
|
| Rate for Payer: Signature Care EPO |
$16.49
|
| Rate for Payer: Signature Care PPO |
$17.49
|
| Rate for Payer: United Healthcare Commercial |
$15.66
|
|
|
HC SUTURE PLAIN 6-0 775G
|
Facility
|
IP
|
$150.98
|
|
| Hospital Charge Code |
41601520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.24 |
| Max. Negotiated Rate |
$140.41 |
| Rate for Payer: Aetna Commercial |
$130.45
|
| Rate for Payer: Cash Price |
$93.61
|
| Rate for Payer: Cigna All Commercial |
$130.30
|
| Rate for Payer: CORVEL All Commercial |
$140.41
|
| Rate for Payer: Coventry All Commercial |
$132.86
|
| Rate for Payer: Encore All Commercial |
$138.98
|
| Rate for Payer: Frontpath All Commercial |
$138.90
|
| Rate for Payer: Humana ChoiceCare |
$130.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.88
|
| Rate for Payer: PHCS All Commercial |
$113.24
|
| Rate for Payer: PHP All Commercial |
$114.50
|
| Rate for Payer: Sagamore Health Network All Products |
$116.56
|
| Rate for Payer: Signature Care EPO |
$125.31
|
| Rate for Payer: Signature Care PPO |
$132.86
|
| Rate for Payer: United Healthcare Commercial |
$118.97
|
|
|
HC SUTURE PLAIN 6-0 775G
|
Facility
|
OP
|
$150.98
|
|
| Hospital Charge Code |
41601520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$140.41 |
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna Medicare |
$49.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.81
|
| Rate for Payer: Cash Price |
$93.61
|
| Rate for Payer: Cash Price |
$93.61
|
| Rate for Payer: Centivo All Commercial |
$77.00
|
| Rate for Payer: Cigna All Commercial |
$130.30
|
| Rate for Payer: CORVEL All Commercial |
$140.41
|
| Rate for Payer: Coventry All Commercial |
$132.86
|
| Rate for Payer: Encore All Commercial |
$138.98
|
| Rate for Payer: Frontpath All Commercial |
$138.90
|
| Rate for Payer: Humana ChoiceCare |
$130.40
|
| Rate for Payer: Humana Medicare |
$77.00
|
| Rate for Payer: Lucent All Commercial |
$77.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.88
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$113.24
|
| Rate for Payer: PHP All Commercial |
$114.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.88
|
| Rate for Payer: Sagamore Health Network All Products |
$116.56
|
| Rate for Payer: Signature Care EPO |
$125.31
|
| Rate for Payer: Signature Care PPO |
$132.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.33
|
| Rate for Payer: United Healthcare Commercial |
$118.97
|
| Rate for Payer: United Healthcare Medicare |
$49.82
|
|
