|
HC SUTURE PLAIN GUT 2-0 843H
|
Facility
|
OP
|
$23.40
|
|
| Hospital Charge Code |
41601150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.75
|
| 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 |
$13.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.49
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Centivo All Commercial |
$11.93
|
| Rate for Payer: Cigna All Commercial |
$20.19
|
| Rate for Payer: CORVEL All Commercial |
$21.76
|
| Rate for Payer: Coventry All Commercial |
$20.59
|
| Rate for Payer: Encore All Commercial |
$21.54
|
| Rate for Payer: Frontpath All Commercial |
$21.53
|
| Rate for Payer: Humana ChoiceCare |
$20.21
|
| Rate for Payer: Humana Medicare |
$11.93
|
| Rate for Payer: Lucent All Commercial |
$11.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.55
|
| Rate for Payer: PHP All Commercial |
$17.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.13
|
| Rate for Payer: Sagamore Health Network All Products |
$18.06
|
| Rate for Payer: Signature Care EPO |
$19.42
|
| Rate for Payer: Signature Care PPO |
$20.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.89
|
| Rate for Payer: United Healthcare Commercial |
$18.44
|
| Rate for Payer: United Healthcare Medicare |
$7.72
|
|
|
HC SUTURE PLAIN GUT 2-0 843H
|
Facility
|
IP
|
$23.40
|
|
| Hospital Charge Code |
41601150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$21.76 |
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$14.51
|
| Rate for Payer: Cigna All Commercial |
$20.19
|
| Rate for Payer: CORVEL All Commercial |
$21.76
|
| Rate for Payer: Coventry All Commercial |
$20.59
|
| Rate for Payer: Encore All Commercial |
$21.54
|
| Rate for Payer: Frontpath All Commercial |
$21.53
|
| Rate for Payer: Humana ChoiceCare |
$20.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.06
|
| Rate for Payer: PHCS All Commercial |
$17.55
|
| Rate for Payer: PHP All Commercial |
$17.75
|
| Rate for Payer: Sagamore Health Network All Products |
$18.06
|
| Rate for Payer: Signature Care EPO |
$19.42
|
| Rate for Payer: Signature Care PPO |
$20.59
|
| Rate for Payer: United Healthcare Commercial |
$18.44
|
|
|
HC SUTURE PLAIN GUT 2-0 H823H
|
Facility
|
OP
|
$20.59
|
|
| Hospital Charge Code |
41601151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Medicare |
$6.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.47
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Centivo All Commercial |
$10.50
|
| Rate for Payer: Cigna All Commercial |
$17.77
|
| Rate for Payer: CORVEL All Commercial |
$19.15
|
| Rate for Payer: Coventry All Commercial |
$18.12
|
| Rate for Payer: Encore All Commercial |
$18.95
|
| Rate for Payer: Frontpath All Commercial |
$18.94
|
| Rate for Payer: Humana ChoiceCare |
$17.78
|
| Rate for Payer: Humana Medicare |
$10.50
|
| Rate for Payer: Lucent All Commercial |
$10.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.44
|
| Rate for Payer: PHP All Commercial |
$15.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.03
|
| Rate for Payer: Sagamore Health Network All Products |
$15.90
|
| Rate for Payer: Signature Care EPO |
$17.09
|
| Rate for Payer: Signature Care PPO |
$18.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.50
|
| Rate for Payer: United Healthcare Commercial |
$16.22
|
| Rate for Payer: United Healthcare Medicare |
$6.79
|
|
|
HC SUTURE PLAIN GUT 2-0 H823H
|
Facility
|
IP
|
$20.59
|
|
| Hospital Charge Code |
41601151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$19.15 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna All Commercial |
$17.77
|
| Rate for Payer: CORVEL All Commercial |
$19.15
|
| Rate for Payer: Coventry All Commercial |
$18.12
|
| Rate for Payer: Encore All Commercial |
$18.95
|
| Rate for Payer: Frontpath All Commercial |
$18.94
|
| Rate for Payer: Humana ChoiceCare |
$17.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.53
|
| Rate for Payer: PHCS All Commercial |
$15.44
|
| Rate for Payer: PHP All Commercial |
$15.62
|
| Rate for Payer: Sagamore Health Network All Products |
$15.90
|
| Rate for Payer: Signature Care EPO |
$17.09
|
| Rate for Payer: Signature Care PPO |
$18.12
|
| Rate for Payer: United Healthcare Commercial |
$16.22
|
|
|
HC SUTURE PLEDGET
|
Facility
|
OP
|
$126.93
|
|
| Hospital Charge Code |
41601621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$118.04 |
| Rate for Payer: Aetna Commercial |
$107.13
|
| Rate for Payer: Aetna Medicare |
$41.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.08
|
| Rate for Payer: Cash Price |
$78.70
|
| Rate for Payer: Cash Price |
$78.70
|
| Rate for Payer: Centivo All Commercial |
$64.73
|
| Rate for Payer: Cigna All Commercial |
$109.54
|
| Rate for Payer: CORVEL All Commercial |
$118.04
|
| Rate for Payer: Coventry All Commercial |
$111.70
|
| Rate for Payer: Encore All Commercial |
$116.84
|
| Rate for Payer: Frontpath All Commercial |
$116.78
|
| Rate for Payer: Humana ChoiceCare |
$109.63
|
| Rate for Payer: Humana Medicare |
$64.73
|
| Rate for Payer: Lucent All Commercial |
$64.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.24
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$95.20
|
| Rate for Payer: PHP All Commercial |
$96.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.50
|
| Rate for Payer: Sagamore Health Network All Products |
$97.99
|
| Rate for Payer: Signature Care EPO |
$105.35
|
| Rate for Payer: Signature Care PPO |
$111.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.89
|
| Rate for Payer: United Healthcare Commercial |
$100.02
|
| Rate for Payer: United Healthcare Medicare |
$41.89
|
|
|
HC SUTURE PLEDGET
|
Facility
|
IP
|
$126.93
|
|
| Hospital Charge Code |
41601621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$118.04 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Cash Price |
$78.70
|
| Rate for Payer: Cigna All Commercial |
$109.54
|
| Rate for Payer: CORVEL All Commercial |
$118.04
|
| Rate for Payer: Coventry All Commercial |
$111.70
|
| Rate for Payer: Encore All Commercial |
$116.84
|
| Rate for Payer: Frontpath All Commercial |
$116.78
|
| Rate for Payer: Humana ChoiceCare |
$109.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.24
|
| Rate for Payer: PHCS All Commercial |
$95.20
|
| Rate for Payer: PHP All Commercial |
$96.26
|
| Rate for Payer: Sagamore Health Network All Products |
$97.99
|
| Rate for Payer: Signature Care EPO |
$105.35
|
| Rate for Payer: Signature Care PPO |
$111.70
|
| Rate for Payer: United Healthcare Commercial |
$100.02
|
|
|
HC SUTURE POLYSORB ANCHOR 3MM
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
41601462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$950.40
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
|
|
HC SUTURE POLYSORB ANCHOR 3MM
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
41601462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,023.00 |
| Rate for Payer: Aetna Commercial |
$928.40
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$363.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$631.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$687.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$417.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$399.30
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Centivo All Commercial |
$561.00
|
| Rate for Payer: Cigna All Commercial |
$949.30
|
| Rate for Payer: CORVEL All Commercial |
$1,023.00
|
| Rate for Payer: Coventry All Commercial |
$968.00
|
| Rate for Payer: Encore All Commercial |
$1,012.55
|
| Rate for Payer: Frontpath All Commercial |
$1,012.00
|
| Rate for Payer: Humana ChoiceCare |
$950.07
|
| Rate for Payer: Humana Medicare |
$561.00
|
| Rate for Payer: Lucent All Commercial |
$561.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$990.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$825.00
|
| Rate for Payer: PHP All Commercial |
$834.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$429.00
|
| Rate for Payer: Sagamore Health Network All Products |
$849.20
|
| Rate for Payer: Signature Care EPO |
$913.00
|
| Rate for Payer: Signature Care PPO |
$968.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$935.00
|
| Rate for Payer: United Healthcare Commercial |
$866.80
|
| Rate for Payer: United Healthcare Medicare |
$363.00
|
|
|
HC SUTURE POLYSORB UL245
|
Facility
|
IP
|
$10.57
|
|
| Hospital Charge Code |
41601522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.02
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
|
|
HC SUTURE POLYSORB UL245
|
Facility
|
OP
|
$10.57
|
|
| Hospital Charge Code |
41601522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.84
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$9.12
|
| Rate for Payer: CORVEL All Commercial |
$9.83
|
| Rate for Payer: Coventry All Commercial |
$9.30
|
| Rate for Payer: Encore All Commercial |
$9.73
|
| Rate for Payer: Frontpath All Commercial |
$9.72
|
| Rate for Payer: Humana ChoiceCare |
$9.13
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Lucent All Commercial |
$5.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.93
|
| Rate for Payer: PHP All Commercial |
$8.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.12
|
| Rate for Payer: Sagamore Health Network All Products |
$8.16
|
| Rate for Payer: Signature Care EPO |
$8.77
|
| Rate for Payer: Signature Care PPO |
$9.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$8.33
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
|
|
HC SUTURE PROLENE 0 8412H
|
Facility
|
OP
|
$17.55
|
|
| Hospital Charge Code |
41601580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$14.81
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.37
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Centivo All Commercial |
$8.95
|
| Rate for Payer: Cigna All Commercial |
$15.15
|
| Rate for Payer: CORVEL All Commercial |
$16.32
|
| Rate for Payer: Coventry All Commercial |
$15.44
|
| Rate for Payer: Encore All Commercial |
$16.15
|
| Rate for Payer: Frontpath All Commercial |
$16.15
|
| Rate for Payer: Humana ChoiceCare |
$15.16
|
| Rate for Payer: Humana Medicare |
$8.95
|
| Rate for Payer: Lucent All Commercial |
$8.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.80
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$13.16
|
| Rate for Payer: PHP All Commercial |
$13.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.84
|
| Rate for Payer: Sagamore Health Network All Products |
$13.55
|
| Rate for Payer: Signature Care EPO |
$14.57
|
| Rate for Payer: Signature Care PPO |
$15.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$13.83
|
| Rate for Payer: United Healthcare Medicare |
$5.79
|
|
|
HC SUTURE PROLENE 0 8412H
|
Facility
|
IP
|
$17.55
|
|
| Hospital Charge Code |
41601580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cigna All Commercial |
$15.15
|
| Rate for Payer: CORVEL All Commercial |
$16.32
|
| Rate for Payer: Coventry All Commercial |
$15.44
|
| Rate for Payer: Encore All Commercial |
$16.15
|
| Rate for Payer: Frontpath All Commercial |
$16.15
|
| Rate for Payer: Humana ChoiceCare |
$15.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.80
|
| Rate for Payer: PHCS All Commercial |
$13.16
|
| Rate for Payer: PHP All Commercial |
$13.31
|
| Rate for Payer: Sagamore Health Network All Products |
$13.55
|
| Rate for Payer: Signature Care EPO |
$14.57
|
| Rate for Payer: Signature Care PPO |
$15.44
|
| Rate for Payer: United Healthcare Commercial |
$13.83
|
|
|
HC SUTURE PROLENE 0 8418H
|
Facility
|
IP
|
$22.66
|
|
| Hospital Charge Code |
41601525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$21.07 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cigna All Commercial |
$19.56
|
| Rate for Payer: CORVEL All Commercial |
$21.07
|
| Rate for Payer: Coventry All Commercial |
$19.94
|
| Rate for Payer: Encore All Commercial |
$20.86
|
| Rate for Payer: Frontpath All Commercial |
$20.85
|
| Rate for Payer: Humana ChoiceCare |
$19.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.39
|
| Rate for Payer: PHCS All Commercial |
$17.00
|
| Rate for Payer: PHP All Commercial |
$17.19
|
| Rate for Payer: Sagamore Health Network All Products |
$17.49
|
| Rate for Payer: Signature Care EPO |
$18.81
|
| Rate for Payer: Signature Care PPO |
$19.94
|
| Rate for Payer: United Healthcare Commercial |
$17.86
|
|
|
HC SUTURE PROLENE 0 8418H
|
Facility
|
OP
|
$22.66
|
|
| Hospital Charge Code |
41601525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.23
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Centivo All Commercial |
$11.56
|
| Rate for Payer: Cigna All Commercial |
$19.56
|
| Rate for Payer: CORVEL All Commercial |
$21.07
|
| Rate for Payer: Coventry All Commercial |
$19.94
|
| Rate for Payer: Encore All Commercial |
$20.86
|
| Rate for Payer: Frontpath All Commercial |
$20.85
|
| Rate for Payer: Humana ChoiceCare |
$19.57
|
| Rate for Payer: Humana Medicare |
$11.56
|
| Rate for Payer: Lucent All Commercial |
$11.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.39
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.00
|
| Rate for Payer: PHP All Commercial |
$17.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.84
|
| Rate for Payer: Sagamore Health Network All Products |
$17.49
|
| Rate for Payer: Signature Care EPO |
$18.81
|
| Rate for Payer: Signature Care PPO |
$19.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.26
|
| Rate for Payer: United Healthcare Commercial |
$17.86
|
| Rate for Payer: United Healthcare Medicare |
$7.48
|
|
|
HC SUTURE PROLENE 0 8434H
|
Facility
|
IP
|
$17.54
|
|
| Hospital Charge Code |
41601523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cigna All Commercial |
$15.14
|
| Rate for Payer: CORVEL All Commercial |
$16.31
|
| Rate for Payer: Coventry All Commercial |
$15.44
|
| Rate for Payer: Encore All Commercial |
$16.15
|
| Rate for Payer: Frontpath All Commercial |
$16.14
|
| Rate for Payer: Humana ChoiceCare |
$15.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.79
|
| Rate for Payer: PHCS All Commercial |
$13.16
|
| Rate for Payer: PHP All Commercial |
$13.30
|
| Rate for Payer: Sagamore Health Network All Products |
$13.54
|
| Rate for Payer: Signature Care EPO |
$14.56
|
| Rate for Payer: Signature Care PPO |
$15.44
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
|
|
HC SUTURE PROLENE 0 8434H
|
Facility
|
OP
|
$17.54
|
|
| Hospital Charge Code |
41601523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.80
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.37
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Centivo All Commercial |
$8.95
|
| Rate for Payer: Cigna All Commercial |
$15.14
|
| Rate for Payer: CORVEL All Commercial |
$16.31
|
| Rate for Payer: Coventry All Commercial |
$15.44
|
| Rate for Payer: Encore All Commercial |
$16.15
|
| Rate for Payer: Frontpath All Commercial |
$16.14
|
| Rate for Payer: Humana ChoiceCare |
$15.15
|
| Rate for Payer: Humana Medicare |
$8.95
|
| Rate for Payer: Lucent All Commercial |
$8.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.79
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.16
|
| Rate for Payer: PHP All Commercial |
$13.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.84
|
| Rate for Payer: Sagamore Health Network All Products |
$13.54
|
| Rate for Payer: Signature Care EPO |
$14.56
|
| Rate for Payer: Signature Care PPO |
$15.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.91
|
| Rate for Payer: United Healthcare Commercial |
$13.82
|
| Rate for Payer: United Healthcare Medicare |
$5.79
|
|
|
HC SUTURE PROLENE 0 8444H
|
Facility
|
OP
|
$27.48
|
|
| Hospital Charge Code |
41601598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.19
|
| Rate for Payer: Aetna Medicare |
$9.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.98
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Centivo All Commercial |
$14.01
|
| Rate for Payer: Cigna All Commercial |
$23.72
|
| Rate for Payer: CORVEL All Commercial |
$25.56
|
| Rate for Payer: Coventry All Commercial |
$24.18
|
| Rate for Payer: Encore All Commercial |
$25.30
|
| Rate for Payer: Frontpath All Commercial |
$25.28
|
| Rate for Payer: Humana ChoiceCare |
$23.73
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Lucent All Commercial |
$14.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.61
|
| Rate for Payer: PHP All Commercial |
$20.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.72
|
| Rate for Payer: Sagamore Health Network All Products |
$21.21
|
| Rate for Payer: Signature Care EPO |
$22.81
|
| Rate for Payer: Signature Care PPO |
$24.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.36
|
| Rate for Payer: United Healthcare Commercial |
$21.65
|
| Rate for Payer: United Healthcare Medicare |
$9.07
|
|
|
HC SUTURE PROLENE 0 8444H
|
Facility
|
IP
|
$27.48
|
|
| Hospital Charge Code |
41601598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$25.56 |
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Cigna All Commercial |
$23.72
|
| Rate for Payer: CORVEL All Commercial |
$25.56
|
| Rate for Payer: Coventry All Commercial |
$24.18
|
| Rate for Payer: Encore All Commercial |
$25.30
|
| Rate for Payer: Frontpath All Commercial |
$25.28
|
| Rate for Payer: Humana ChoiceCare |
$23.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.73
|
| Rate for Payer: PHCS All Commercial |
$20.61
|
| Rate for Payer: PHP All Commercial |
$20.84
|
| Rate for Payer: Sagamore Health Network All Products |
$21.21
|
| Rate for Payer: Signature Care EPO |
$22.81
|
| Rate for Payer: Signature Care PPO |
$24.18
|
| Rate for Payer: United Healthcare Commercial |
$21.65
|
|
|
HC SUTURE PROLENE 0 C845G
|
Facility
|
OP
|
$105.67
|
|
| Hospital Charge Code |
41601152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$34.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.36
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Centivo All Commercial |
$53.89
|
| Rate for Payer: Cigna All Commercial |
$91.19
|
| Rate for Payer: CORVEL All Commercial |
$98.27
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Encore All Commercial |
$97.27
|
| Rate for Payer: Frontpath All Commercial |
$97.22
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Humana Medicare |
$53.89
|
| Rate for Payer: Lucent All Commercial |
$53.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.10
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$79.25
|
| Rate for Payer: PHP All Commercial |
$80.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.21
|
| Rate for Payer: Sagamore Health Network All Products |
$81.58
|
| Rate for Payer: Signature Care EPO |
$87.71
|
| Rate for Payer: Signature Care PPO |
$92.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89.82
|
| Rate for Payer: United Healthcare Commercial |
$83.27
|
| Rate for Payer: United Healthcare Medicare |
$34.87
|
|
|
HC SUTURE PROLENE 0 C845G
|
Facility
|
IP
|
$105.67
|
|
| Hospital Charge Code |
41601152
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Aetna Commercial |
$91.30
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cigna All Commercial |
$91.19
|
| Rate for Payer: CORVEL All Commercial |
$98.27
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Encore All Commercial |
$97.27
|
| Rate for Payer: Frontpath All Commercial |
$97.22
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.10
|
| Rate for Payer: PHCS All Commercial |
$79.25
|
| Rate for Payer: PHP All Commercial |
$80.14
|
| Rate for Payer: Sagamore Health Network All Products |
$81.58
|
| Rate for Payer: Signature Care EPO |
$87.71
|
| Rate for Payer: Signature Care PPO |
$92.99
|
| Rate for Payer: United Healthcare Commercial |
$83.27
|
|
|
HC SUTURE PROLENE 1 8190G
|
Facility
|
OP
|
$66.97
|
|
| Hospital Charge Code |
41601529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna Medicare |
$22.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.31
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Centivo All Commercial |
$34.15
|
| Rate for Payer: Cigna All Commercial |
$57.80
|
| Rate for Payer: CORVEL All Commercial |
$62.28
|
| Rate for Payer: Coventry All Commercial |
$58.93
|
| Rate for Payer: Encore All Commercial |
$61.65
|
| Rate for Payer: Frontpath All Commercial |
$61.61
|
| Rate for Payer: Humana ChoiceCare |
$57.84
|
| Rate for Payer: Humana Medicare |
$34.15
|
| Rate for Payer: Lucent All Commercial |
$34.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$50.23
|
| Rate for Payer: PHP All Commercial |
$50.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.12
|
| Rate for Payer: Sagamore Health Network All Products |
$51.70
|
| Rate for Payer: Signature Care EPO |
$55.59
|
| Rate for Payer: Signature Care PPO |
$58.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicare |
$22.10
|
|
|
HC SUTURE PROLENE 1 8190G
|
Facility
|
IP
|
$66.97
|
|
| Hospital Charge Code |
41601529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: Aetna Commercial |
$57.86
|
| Rate for Payer: Cash Price |
$41.52
|
| Rate for Payer: Cigna All Commercial |
$57.80
|
| Rate for Payer: CORVEL All Commercial |
$62.28
|
| Rate for Payer: Coventry All Commercial |
$58.93
|
| Rate for Payer: Encore All Commercial |
$61.65
|
| Rate for Payer: Frontpath All Commercial |
$61.61
|
| Rate for Payer: Humana ChoiceCare |
$57.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.27
|
| Rate for Payer: PHCS All Commercial |
$50.23
|
| Rate for Payer: PHP All Commercial |
$50.79
|
| Rate for Payer: Sagamore Health Network All Products |
$51.70
|
| Rate for Payer: Signature Care EPO |
$55.59
|
| Rate for Payer: Signature Care PPO |
$58.93
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
|
|
HC SUTURE PROLENE 1 8824G
|
Facility
|
OP
|
$43.21
|
|
| Hospital Charge Code |
41601602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$36.47
|
| Rate for Payer: Aetna Medicare |
$14.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.69
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Centivo All Commercial |
$22.04
|
| Rate for Payer: Cigna All Commercial |
$37.29
|
| Rate for Payer: CORVEL All Commercial |
$40.19
|
| Rate for Payer: Coventry All Commercial |
$38.02
|
| Rate for Payer: Encore All Commercial |
$39.77
|
| Rate for Payer: Frontpath All Commercial |
$39.75
|
| Rate for Payer: Humana ChoiceCare |
$37.32
|
| Rate for Payer: Humana Medicare |
$22.04
|
| Rate for Payer: Lucent All Commercial |
$22.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.89
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$32.41
|
| Rate for Payer: PHP All Commercial |
$32.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.85
|
| Rate for Payer: Sagamore Health Network All Products |
$33.36
|
| Rate for Payer: Signature Care EPO |
$35.86
|
| Rate for Payer: Signature Care PPO |
$38.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.73
|
| Rate for Payer: United Healthcare Commercial |
$34.05
|
| Rate for Payer: United Healthcare Medicare |
$14.26
|
|
|
HC SUTURE PROLENE 1 8824G
|
Facility
|
IP
|
$43.21
|
|
| Hospital Charge Code |
41601602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.41 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.33
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Cigna All Commercial |
$37.29
|
| Rate for Payer: CORVEL All Commercial |
$40.19
|
| Rate for Payer: Coventry All Commercial |
$38.02
|
| Rate for Payer: Encore All Commercial |
$39.77
|
| Rate for Payer: Frontpath All Commercial |
$39.75
|
| Rate for Payer: Humana ChoiceCare |
$37.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.89
|
| Rate for Payer: PHCS All Commercial |
$32.41
|
| Rate for Payer: PHP All Commercial |
$32.77
|
| Rate for Payer: Sagamore Health Network All Products |
$33.36
|
| Rate for Payer: Signature Care EPO |
$35.86
|
| Rate for Payer: Signature Care PPO |
$38.02
|
| Rate for Payer: United Healthcare Commercial |
$34.05
|
|
|
HC SUTURE PROLENE 2-0 36 IN
|
Facility
|
OP
|
$65.81
|
|
| Hospital Charge Code |
41602425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$55.54
|
| Rate for Payer: Aetna Medicare |
$21.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.89
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Centivo All Commercial |
$33.56
|
| Rate for Payer: Cigna All Commercial |
$56.79
|
| Rate for Payer: CORVEL All Commercial |
$61.20
|
| Rate for Payer: Coventry All Commercial |
$57.91
|
| Rate for Payer: Encore All Commercial |
$60.58
|
| Rate for Payer: Frontpath All Commercial |
$60.55
|
| Rate for Payer: Humana ChoiceCare |
$56.84
|
| Rate for Payer: Humana Medicare |
$33.56
|
| Rate for Payer: Lucent All Commercial |
$33.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$49.36
|
| Rate for Payer: PHP All Commercial |
$49.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.67
|
| Rate for Payer: Sagamore Health Network All Products |
$50.81
|
| Rate for Payer: Signature Care EPO |
$54.62
|
| Rate for Payer: Signature Care PPO |
$57.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.94
|
| Rate for Payer: United Healthcare Commercial |
$51.86
|
| Rate for Payer: United Healthcare Medicare |
$21.72
|
|
