|
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
|
|
|
HC SUTURE PROLENE 2-0 8685H
|
Facility
|
IP
|
$30.62
|
|
| Hospital Charge Code |
41601526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.46
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna All Commercial |
$26.43
|
| Rate for Payer: CORVEL All Commercial |
$28.48
|
| Rate for Payer: Coventry All Commercial |
$26.95
|
| Rate for Payer: Encore All Commercial |
$28.19
|
| Rate for Payer: Frontpath All Commercial |
$28.17
|
| Rate for Payer: Humana ChoiceCare |
$26.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.56
|
| Rate for Payer: PHCS All Commercial |
$22.96
|
| Rate for Payer: PHP All Commercial |
$23.22
|
| Rate for Payer: Sagamore Health Network All Products |
$23.64
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.95
|
| Rate for Payer: United Healthcare Commercial |
$24.13
|
|
|
HC SUTURE PROLENE 2-0 8685H
|
Facility
|
OP
|
$30.62
|
|
| Hospital Charge Code |
41601526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.84
|
| 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 |
$17.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.14
|
| 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 |
$11.12
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Centivo All Commercial |
$15.62
|
| Rate for Payer: Cigna All Commercial |
$26.43
|
| Rate for Payer: CORVEL All Commercial |
$28.48
|
| Rate for Payer: Coventry All Commercial |
$26.95
|
| Rate for Payer: Encore All Commercial |
$28.19
|
| Rate for Payer: Frontpath All Commercial |
$28.17
|
| Rate for Payer: Humana ChoiceCare |
$26.45
|
| Rate for Payer: Humana Medicare |
$15.62
|
| Rate for Payer: Lucent All Commercial |
$15.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.56
|
| 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 |
$23.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.94
|
| Rate for Payer: Sagamore Health Network All Products |
$23.64
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.03
|
| Rate for Payer: United Healthcare Commercial |
$24.13
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
|
|
HC SUTURE PROLENE 2-0 8689H
|
Facility
|
OP
|
$23.83
|
|
| Hospital Charge Code |
41601468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.65
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Centivo All Commercial |
$12.15
|
| Rate for Payer: Cigna All Commercial |
$20.57
|
| Rate for Payer: CORVEL All Commercial |
$22.16
|
| Rate for Payer: Coventry All Commercial |
$20.97
|
| Rate for Payer: Encore All Commercial |
$21.94
|
| Rate for Payer: Frontpath All Commercial |
$21.92
|
| Rate for Payer: Humana ChoiceCare |
$20.58
|
| Rate for Payer: Humana Medicare |
$12.15
|
| Rate for Payer: Lucent All Commercial |
$12.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.87
|
| Rate for Payer: PHP All Commercial |
$18.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.29
|
| Rate for Payer: Sagamore Health Network All Products |
$18.40
|
| Rate for Payer: Signature Care EPO |
$19.78
|
| Rate for Payer: Signature Care PPO |
$20.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.26
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
| Rate for Payer: United Healthcare Medicare |
$7.86
|
|
|
HC SUTURE PROLENE 2-0 8689H
|
Facility
|
IP
|
$23.83
|
|
| Hospital Charge Code |
41601468
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cigna All Commercial |
$20.57
|
| Rate for Payer: CORVEL All Commercial |
$22.16
|
| Rate for Payer: Coventry All Commercial |
$20.97
|
| Rate for Payer: Encore All Commercial |
$21.94
|
| Rate for Payer: Frontpath All Commercial |
$21.92
|
| Rate for Payer: Humana ChoiceCare |
$20.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.45
|
| Rate for Payer: PHCS All Commercial |
$17.87
|
| Rate for Payer: PHP All Commercial |
$18.07
|
| Rate for Payer: Sagamore Health Network All Products |
$18.40
|
| Rate for Payer: Signature Care EPO |
$19.78
|
| Rate for Payer: Signature Care PPO |
$20.97
|
| Rate for Payer: United Healthcare Commercial |
$18.78
|
|
|
HC SUTURE PROLENE 2-0 8825G
|
Facility
|
IP
|
$40.82
|
|
| Hospital Charge Code |
41601466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$37.96 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cigna All Commercial |
$35.23
|
| Rate for Payer: CORVEL All Commercial |
$37.96
|
| Rate for Payer: Coventry All Commercial |
$35.92
|
| Rate for Payer: Encore All Commercial |
$37.57
|
| Rate for Payer: Frontpath All Commercial |
$37.55
|
| Rate for Payer: Humana ChoiceCare |
$35.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.74
|
| Rate for Payer: PHCS All Commercial |
$30.62
|
| Rate for Payer: PHP All Commercial |
$30.96
|
| Rate for Payer: Sagamore Health Network All Products |
$31.51
|
| Rate for Payer: Signature Care EPO |
$33.88
|
| Rate for Payer: Signature Care PPO |
$35.92
|
| Rate for Payer: United Healthcare Commercial |
$32.17
|
|
|
HC SUTURE PROLENE 2-0 8825G
|
Facility
|
OP
|
$40.82
|
|
| Hospital Charge Code |
41601466
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$34.45
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.82
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Centivo All Commercial |
$20.82
|
| Rate for Payer: Cigna All Commercial |
$35.23
|
| Rate for Payer: CORVEL All Commercial |
$37.96
|
| Rate for Payer: Coventry All Commercial |
$35.92
|
| Rate for Payer: Encore All Commercial |
$37.57
|
| Rate for Payer: Frontpath All Commercial |
$37.55
|
| Rate for Payer: Humana ChoiceCare |
$35.26
|
| Rate for Payer: Humana Medicare |
$20.82
|
| Rate for Payer: Lucent All Commercial |
$20.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$30.62
|
| Rate for Payer: PHP All Commercial |
$30.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.92
|
| Rate for Payer: Sagamore Health Network All Products |
$31.51
|
| Rate for Payer: Signature Care EPO |
$33.88
|
| Rate for Payer: Signature Care PPO |
$35.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.70
|
| Rate for Payer: United Healthcare Commercial |
$32.17
|
| Rate for Payer: United Healthcare Medicare |
$13.47
|
|
|
HC SUTURE PROLENE 2-0 8833H
|
Facility
|
OP
|
$23.13
|
|
| Hospital Charge Code |
41601579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.52
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Centivo All Commercial |
$11.80
|
| Rate for Payer: Cigna All Commercial |
$19.96
|
| Rate for Payer: CORVEL All Commercial |
$21.51
|
| Rate for Payer: Coventry All Commercial |
$20.35
|
| Rate for Payer: Encore All Commercial |
$21.29
|
| Rate for Payer: Frontpath All Commercial |
$21.28
|
| Rate for Payer: Humana ChoiceCare |
$19.98
|
| Rate for Payer: Humana Medicare |
$11.80
|
| Rate for Payer: Lucent All Commercial |
$11.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.82
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.35
|
| Rate for Payer: PHP All Commercial |
$17.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.02
|
| Rate for Payer: Sagamore Health Network All Products |
$17.86
|
| Rate for Payer: Signature Care EPO |
$19.20
|
| Rate for Payer: Signature Care PPO |
$20.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare |
$7.63
|
|
|
HC SUTURE PROLENE 2-0 8833H
|
Facility
|
IP
|
$23.13
|
|
| Hospital Charge Code |
41601579
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cigna All Commercial |
$19.96
|
| Rate for Payer: CORVEL All Commercial |
$21.51
|
| Rate for Payer: Coventry All Commercial |
$20.35
|
| Rate for Payer: Encore All Commercial |
$21.29
|
| Rate for Payer: Frontpath All Commercial |
$21.28
|
| Rate for Payer: Humana ChoiceCare |
$19.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.82
|
| Rate for Payer: PHCS All Commercial |
$17.35
|
| Rate for Payer: PHP All Commercial |
$17.54
|
| Rate for Payer: Sagamore Health Network All Products |
$17.86
|
| Rate for Payer: Signature Care EPO |
$19.20
|
| Rate for Payer: Signature Care PPO |
$20.35
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
|
|
HC SUTURE PROLENE 3-0 36 IN
|
Facility
|
OP
|
$66.91
|
|
| Hospital Charge Code |
41602426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.29
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Centivo All Commercial |
$34.12
|
| Rate for Payer: Cigna All Commercial |
$57.74
|
| Rate for Payer: CORVEL All Commercial |
$62.23
|
| Rate for Payer: Coventry All Commercial |
$58.88
|
| Rate for Payer: Encore All Commercial |
$61.59
|
| Rate for Payer: Frontpath All Commercial |
$61.56
|
| Rate for Payer: Humana ChoiceCare |
$57.79
|
| Rate for Payer: Humana Medicare |
$34.12
|
| Rate for Payer: Lucent All Commercial |
$34.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$50.18
|
| Rate for Payer: PHP All Commercial |
$50.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.09
|
| Rate for Payer: Sagamore Health Network All Products |
$51.65
|
| Rate for Payer: Signature Care EPO |
$55.54
|
| Rate for Payer: Signature Care PPO |
$58.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.87
|
| Rate for Payer: United Healthcare Commercial |
$52.73
|
| Rate for Payer: United Healthcare Medicare |
$22.08
|
|
|
HC SUTURE PROLENE 3-0 36 IN
|
Facility
|
IP
|
$66.91
|
|
| Hospital Charge Code |
41602426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$57.81
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna All Commercial |
$57.74
|
| Rate for Payer: CORVEL All Commercial |
$62.23
|
| Rate for Payer: Coventry All Commercial |
$58.88
|
| Rate for Payer: Encore All Commercial |
$61.59
|
| Rate for Payer: Frontpath All Commercial |
$61.56
|
| Rate for Payer: Humana ChoiceCare |
$57.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$60.22
|
| Rate for Payer: PHCS All Commercial |
$50.18
|
| Rate for Payer: PHP All Commercial |
$50.74
|
| Rate for Payer: Sagamore Health Network All Products |
$51.65
|
| Rate for Payer: Signature Care EPO |
$55.54
|
| Rate for Payer: Signature Care PPO |
$58.88
|
| Rate for Payer: United Healthcare Commercial |
$52.73
|
|
|
HC SUTURE PROLENE 3-0 8675H
|
Facility
|
IP
|
$22.28
|
|
| Hospital Charge Code |
41601482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$20.72 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cigna All Commercial |
$19.23
|
| Rate for Payer: CORVEL All Commercial |
$20.72
|
| Rate for Payer: Coventry All Commercial |
$19.61
|
| Rate for Payer: Encore All Commercial |
$20.51
|
| Rate for Payer: Frontpath All Commercial |
$20.50
|
| Rate for Payer: Humana ChoiceCare |
$19.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.05
|
| Rate for Payer: PHCS All Commercial |
$16.71
|
| Rate for Payer: PHP All Commercial |
$16.90
|
| Rate for Payer: Sagamore Health Network All Products |
$17.20
|
| Rate for Payer: Signature Care EPO |
$18.49
|
| Rate for Payer: Signature Care PPO |
$19.61
|
| Rate for Payer: United Healthcare Commercial |
$17.56
|
|
|
HC SUTURE PROLENE 3-0 8675H
|
Facility
|
OP
|
$22.28
|
|
| Hospital Charge Code |
41601482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.80
|
| Rate for Payer: Aetna Medicare |
$7.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.09
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Centivo All Commercial |
$11.36
|
| Rate for Payer: Cigna All Commercial |
$19.23
|
| Rate for Payer: CORVEL All Commercial |
$20.72
|
| Rate for Payer: Coventry All Commercial |
$19.61
|
| Rate for Payer: Encore All Commercial |
$20.51
|
| Rate for Payer: Frontpath All Commercial |
$20.50
|
| Rate for Payer: Humana ChoiceCare |
$19.24
|
| Rate for Payer: Humana Medicare |
$11.36
|
| Rate for Payer: Lucent All Commercial |
$11.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.71
|
| Rate for Payer: PHP All Commercial |
$16.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.69
|
| Rate for Payer: Sagamore Health Network All Products |
$17.20
|
| Rate for Payer: Signature Care EPO |
$18.49
|
| Rate for Payer: Signature Care PPO |
$19.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.94
|
| Rate for Payer: United Healthcare Commercial |
$17.56
|
| Rate for Payer: United Healthcare Medicare |
$7.35
|
|
|
HC SUTURE PROLENE 3-0 8687H
|
Facility
|
OP
|
$38.39
|
|
| Hospital Charge Code |
41601528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Medicare |
$12.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.94
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Centivo All Commercial |
$19.58
|
| Rate for Payer: Cigna All Commercial |
$33.13
|
| Rate for Payer: CORVEL All Commercial |
$35.70
|
| Rate for Payer: Coventry All Commercial |
$33.78
|
| Rate for Payer: Encore All Commercial |
$35.34
|
| Rate for Payer: Frontpath All Commercial |
$35.32
|
| Rate for Payer: Humana ChoiceCare |
$33.16
|
| Rate for Payer: Humana Medicare |
$19.58
|
| Rate for Payer: Lucent All Commercial |
$19.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.79
|
| Rate for Payer: PHP All Commercial |
$29.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.97
|
| Rate for Payer: Sagamore Health Network All Products |
$29.64
|
| Rate for Payer: Signature Care EPO |
$31.86
|
| Rate for Payer: Signature Care PPO |
$33.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.63
|
| Rate for Payer: United Healthcare Commercial |
$30.25
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
|
|
HC SUTURE PROLENE 3-0 8687H
|
Facility
|
IP
|
$38.39
|
|
| Hospital Charge Code |
41601528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Cigna All Commercial |
$33.13
|
| Rate for Payer: CORVEL All Commercial |
$35.70
|
| Rate for Payer: Coventry All Commercial |
$33.78
|
| Rate for Payer: Encore All Commercial |
$35.34
|
| Rate for Payer: Frontpath All Commercial |
$35.32
|
| Rate for Payer: Humana ChoiceCare |
$33.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.55
|
| Rate for Payer: PHCS All Commercial |
$28.79
|
| Rate for Payer: PHP All Commercial |
$29.11
|
| Rate for Payer: Sagamore Health Network All Products |
$29.64
|
| Rate for Payer: Signature Care EPO |
$31.86
|
| Rate for Payer: Signature Care PPO |
$33.78
|
| Rate for Payer: United Healthcare Commercial |
$30.25
|
|
|
HC SUTURE PROLENE 4-0 8521H
|
Facility
|
IP
|
$38.04
|
|
| Hospital Charge Code |
41601527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$32.87
|
| Rate for Payer: Cash Price |
$23.59
|
| Rate for Payer: Cigna All Commercial |
$32.83
|
| Rate for Payer: CORVEL All Commercial |
$35.38
|
| Rate for Payer: Coventry All Commercial |
$33.48
|
| Rate for Payer: Encore All Commercial |
$35.02
|
| Rate for Payer: Frontpath All Commercial |
$35.00
|
| Rate for Payer: Humana ChoiceCare |
$32.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.24
|
| Rate for Payer: PHCS All Commercial |
$28.53
|
| Rate for Payer: PHP All Commercial |
$28.85
|
| Rate for Payer: Sagamore Health Network All Products |
$29.37
|
| Rate for Payer: Signature Care EPO |
$31.57
|
| Rate for Payer: Signature Care PPO |
$33.48
|
| Rate for Payer: United Healthcare Commercial |
$29.98
|
|
|
HC SUTURE PROLENE 4-0 8521H
|
Facility
|
OP
|
$38.04
|
|
| Hospital Charge Code |
41601527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.81
|
| Rate for Payer: Cash Price |
$23.59
|
| Rate for Payer: Cash Price |
$23.59
|
| Rate for Payer: Centivo All Commercial |
$19.40
|
| Rate for Payer: Cigna All Commercial |
$32.83
|
| Rate for Payer: CORVEL All Commercial |
$35.38
|
| Rate for Payer: Coventry All Commercial |
$33.48
|
| Rate for Payer: Encore All Commercial |
$35.02
|
| Rate for Payer: Frontpath All Commercial |
$35.00
|
| Rate for Payer: Humana ChoiceCare |
$32.86
|
| Rate for Payer: Humana Medicare |
$19.40
|
| Rate for Payer: Lucent All Commercial |
$19.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$28.53
|
| Rate for Payer: PHP All Commercial |
$28.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.84
|
| Rate for Payer: Sagamore Health Network All Products |
$29.37
|
| Rate for Payer: Signature Care EPO |
$31.57
|
| Rate for Payer: Signature Care PPO |
$33.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.33
|
| Rate for Payer: United Healthcare Commercial |
$29.98
|
| Rate for Payer: United Healthcare Medicare |
$12.55
|
|
|
HC SUTURE PROLENE 4-0 8682H
|
Facility
|
OP
|
$39.18
|
|
| Hospital Charge Code |
41601153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.07
|
| Rate for Payer: Aetna Medicare |
$12.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.22
|
| Rate for Payer: Cash Price |
$24.29
|
| Rate for Payer: Cash Price |
$24.29
|
| Rate for Payer: Centivo All Commercial |
$19.98
|
| Rate for Payer: Cigna All Commercial |
$33.81
|
| Rate for Payer: CORVEL All Commercial |
$36.44
|
| Rate for Payer: Coventry All Commercial |
$34.48
|
| Rate for Payer: Encore All Commercial |
$36.07
|
| Rate for Payer: Frontpath All Commercial |
$36.05
|
| Rate for Payer: Humana ChoiceCare |
$33.84
|
| Rate for Payer: Humana Medicare |
$19.98
|
| Rate for Payer: Lucent All Commercial |
$19.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.38
|
| Rate for Payer: PHP All Commercial |
$29.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.28
|
| Rate for Payer: Sagamore Health Network All Products |
$30.25
|
| Rate for Payer: Signature Care EPO |
$32.52
|
| Rate for Payer: Signature Care PPO |
$34.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.30
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Medicare |
$12.93
|
|
|
HC SUTURE PROLENE 4-0 8682H
|
Facility
|
IP
|
$39.18
|
|
| Hospital Charge Code |
41601153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$36.44 |
| Rate for Payer: Aetna Commercial |
$33.85
|
| Rate for Payer: Cash Price |
$24.29
|
| Rate for Payer: Cigna All Commercial |
$33.81
|
| Rate for Payer: CORVEL All Commercial |
$36.44
|
| Rate for Payer: Coventry All Commercial |
$34.48
|
| Rate for Payer: Encore All Commercial |
$36.07
|
| Rate for Payer: Frontpath All Commercial |
$36.05
|
| Rate for Payer: Humana ChoiceCare |
$33.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.26
|
| Rate for Payer: PHCS All Commercial |
$29.38
|
| Rate for Payer: PHP All Commercial |
$29.71
|
| Rate for Payer: Sagamore Health Network All Products |
$30.25
|
| Rate for Payer: Signature Care EPO |
$32.52
|
| Rate for Payer: Signature Care PPO |
$34.48
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
|
|
HC SUTURE PROLENE 4-0 8881H
|
Facility
|
IP
|
$21.97
|
|
| Hospital Charge Code |
41601533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Aetna Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cigna All Commercial |
$18.96
|
| Rate for Payer: CORVEL All Commercial |
$20.43
|
| Rate for Payer: Coventry All Commercial |
$19.33
|
| Rate for Payer: Encore All Commercial |
$20.22
|
| Rate for Payer: Frontpath All Commercial |
$20.21
|
| Rate for Payer: Humana ChoiceCare |
$18.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.77
|
| Rate for Payer: PHCS All Commercial |
$16.48
|
| Rate for Payer: PHP All Commercial |
$16.66
|
| Rate for Payer: Sagamore Health Network All Products |
$16.96
|
| Rate for Payer: Signature Care EPO |
$18.24
|
| Rate for Payer: Signature Care PPO |
$19.33
|
| Rate for Payer: United Healthcare Commercial |
$17.31
|
|
|
HC SUTURE PROLENE 4-0 8881H
|
Facility
|
OP
|
$21.97
|
|
| Hospital Charge Code |
41601533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.54
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.98
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Centivo All Commercial |
$11.20
|
| Rate for Payer: Cigna All Commercial |
$18.96
|
| Rate for Payer: CORVEL All Commercial |
$20.43
|
| Rate for Payer: Coventry All Commercial |
$19.33
|
| Rate for Payer: Encore All Commercial |
$20.22
|
| Rate for Payer: Frontpath All Commercial |
$20.21
|
| Rate for Payer: Humana ChoiceCare |
$18.98
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Lucent All Commercial |
$11.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.77
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.48
|
| Rate for Payer: PHP All Commercial |
$16.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.57
|
| Rate for Payer: Sagamore Health Network All Products |
$16.96
|
| Rate for Payer: Signature Care EPO |
$18.24
|
| Rate for Payer: Signature Care PPO |
$19.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$17.31
|
| Rate for Payer: United Healthcare Medicare |
$7.25
|
|
|
HC SUTURE PROLENE 5-0 7740G
|
Facility
|
OP
|
$100.35
|
|
| Hospital Charge Code |
41601594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Aetna Medicare |
$33.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.43
|
| Rate for Payer: Cash Price |
$62.22
|
| Rate for Payer: Cash Price |
$62.22
|
| Rate for Payer: Centivo All Commercial |
$51.18
|
| Rate for Payer: Cigna All Commercial |
$86.60
|
| Rate for Payer: CORVEL All Commercial |
$93.33
|
| Rate for Payer: Coventry All Commercial |
$88.31
|
| Rate for Payer: Encore All Commercial |
$92.37
|
| Rate for Payer: Frontpath All Commercial |
$92.32
|
| Rate for Payer: Humana ChoiceCare |
$86.67
|
| Rate for Payer: Humana Medicare |
$51.18
|
| Rate for Payer: Lucent All Commercial |
$51.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$75.26
|
| Rate for Payer: PHP All Commercial |
$76.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.14
|
| Rate for Payer: Sagamore Health Network All Products |
$77.47
|
| Rate for Payer: Signature Care EPO |
$83.29
|
| Rate for Payer: Signature Care PPO |
$88.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.30
|
| Rate for Payer: United Healthcare Commercial |
$79.08
|
| Rate for Payer: United Healthcare Medicare |
$33.12
|
|
|
HC SUTURE PROLENE 5-0 7740G
|
Facility
|
IP
|
$100.35
|
|
| Hospital Charge Code |
41601594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$93.33 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Cash Price |
$62.22
|
| Rate for Payer: Cigna All Commercial |
$86.60
|
| Rate for Payer: CORVEL All Commercial |
$93.33
|
| Rate for Payer: Coventry All Commercial |
$88.31
|
| Rate for Payer: Encore All Commercial |
$92.37
|
| Rate for Payer: Frontpath All Commercial |
$92.32
|
| Rate for Payer: Humana ChoiceCare |
$86.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.32
|
| Rate for Payer: PHCS All Commercial |
$75.26
|
| Rate for Payer: PHP All Commercial |
$76.11
|
| Rate for Payer: Sagamore Health Network All Products |
$77.47
|
| Rate for Payer: Signature Care EPO |
$83.29
|
| Rate for Payer: Signature Care PPO |
$88.31
|
| Rate for Payer: United Healthcare Commercial |
$79.08
|
|
|
HC SUTURE PROLENE 5-0 8556H
|
Facility
|
IP
|
$41.66
|
|
| Hospital Charge Code |
41601469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$35.99
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cigna All Commercial |
$35.95
|
| Rate for Payer: CORVEL All Commercial |
$38.74
|
| Rate for Payer: Coventry All Commercial |
$36.66
|
| Rate for Payer: Encore All Commercial |
$38.35
|
| Rate for Payer: Frontpath All Commercial |
$38.33
|
| Rate for Payer: Humana ChoiceCare |
$35.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.49
|
| Rate for Payer: PHCS All Commercial |
$31.24
|
| Rate for Payer: PHP All Commercial |
$31.59
|
| Rate for Payer: Sagamore Health Network All Products |
$32.16
|
| Rate for Payer: Signature Care EPO |
$34.58
|
| Rate for Payer: Signature Care PPO |
$36.66
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
|
|
HC SUTURE PROLENE 5-0 8556H
|
Facility
|
OP
|
$41.66
|
|
| Hospital Charge Code |
41601469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$35.16
|
| Rate for Payer: Aetna Medicare |
$13.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.12
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Centivo All Commercial |
$21.25
|
| Rate for Payer: Cigna All Commercial |
$35.95
|
| Rate for Payer: CORVEL All Commercial |
$38.74
|
| Rate for Payer: Coventry All Commercial |
$36.66
|
| Rate for Payer: Encore All Commercial |
$38.35
|
| Rate for Payer: Frontpath All Commercial |
$38.33
|
| Rate for Payer: Humana ChoiceCare |
$35.98
|
| Rate for Payer: Humana Medicare |
$21.25
|
| Rate for Payer: Lucent All Commercial |
$21.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$31.24
|
| Rate for Payer: PHP All Commercial |
$31.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.25
|
| Rate for Payer: Sagamore Health Network All Products |
$32.16
|
| Rate for Payer: Signature Care EPO |
$34.58
|
| Rate for Payer: Signature Care PPO |
$36.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.41
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Medicare |
$13.75
|
|
