|
HC SUTURE PROLENE 5-0 8630G
|
Facility
|
IP
|
$42.48
|
|
| Hospital Charge Code |
41601154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$39.51 |
| Rate for Payer: Aetna Commercial |
$36.70
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cigna All Commercial |
$36.66
|
| Rate for Payer: CORVEL All Commercial |
$39.51
|
| Rate for Payer: Coventry All Commercial |
$37.38
|
| Rate for Payer: Encore All Commercial |
$39.10
|
| Rate for Payer: Frontpath All Commercial |
$39.08
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.23
|
| Rate for Payer: PHCS All Commercial |
$31.86
|
| Rate for Payer: PHP All Commercial |
$32.22
|
| Rate for Payer: Sagamore Health Network All Products |
$32.79
|
| Rate for Payer: Signature Care EPO |
$35.26
|
| Rate for Payer: Signature Care PPO |
$37.38
|
| Rate for Payer: United Healthcare Commercial |
$33.47
|
|
|
HC SUTURE PROLENE 5-0 8630G
|
Facility
|
OP
|
$42.48
|
|
| Hospital Charge Code |
41601154
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$35.85
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.42
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Centivo All Commercial |
$21.66
|
| Rate for Payer: Cigna All Commercial |
$36.66
|
| Rate for Payer: CORVEL All Commercial |
$39.51
|
| Rate for Payer: Coventry All Commercial |
$37.38
|
| Rate for Payer: Encore All Commercial |
$39.10
|
| Rate for Payer: Frontpath All Commercial |
$39.08
|
| Rate for Payer: Humana ChoiceCare |
$36.69
|
| Rate for Payer: Humana Medicare |
$21.66
|
| Rate for Payer: Lucent All Commercial |
$21.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$31.86
|
| Rate for Payer: PHP All Commercial |
$32.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.57
|
| Rate for Payer: Sagamore Health Network All Products |
$32.79
|
| Rate for Payer: Signature Care EPO |
$35.26
|
| Rate for Payer: Signature Care PPO |
$37.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.11
|
| Rate for Payer: United Healthcare Commercial |
$33.47
|
| Rate for Payer: United Healthcare Medicare |
$14.02
|
|
|
HC SUTURE PROLENE 5-0 8698G
|
Facility
|
IP
|
$38.73
|
|
| Hospital Charge Code |
41601531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$36.02 |
| Rate for Payer: Aetna Commercial |
$33.46
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cigna All Commercial |
$33.42
|
| Rate for Payer: CORVEL All Commercial |
$36.02
|
| Rate for Payer: Coventry All Commercial |
$34.08
|
| Rate for Payer: Encore All Commercial |
$35.65
|
| Rate for Payer: Frontpath All Commercial |
$35.63
|
| Rate for Payer: Humana ChoiceCare |
$33.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.86
|
| Rate for Payer: PHCS All Commercial |
$29.05
|
| Rate for Payer: PHP All Commercial |
$29.37
|
| Rate for Payer: Sagamore Health Network All Products |
$29.90
|
| Rate for Payer: Signature Care EPO |
$32.15
|
| Rate for Payer: Signature Care PPO |
$34.08
|
| Rate for Payer: United Healthcare Commercial |
$30.52
|
|
|
HC SUTURE PROLENE 5-0 8698G
|
Facility
|
OP
|
$38.73
|
|
| Hospital Charge Code |
41601531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$32.69
|
| Rate for Payer: Aetna Medicare |
$12.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.06
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Centivo All Commercial |
$19.75
|
| Rate for Payer: Cigna All Commercial |
$33.42
|
| Rate for Payer: CORVEL All Commercial |
$36.02
|
| Rate for Payer: Coventry All Commercial |
$34.08
|
| Rate for Payer: Encore All Commercial |
$35.65
|
| Rate for Payer: Frontpath All Commercial |
$35.63
|
| Rate for Payer: Humana ChoiceCare |
$33.45
|
| Rate for Payer: Humana Medicare |
$19.75
|
| Rate for Payer: Lucent All Commercial |
$19.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.05
|
| Rate for Payer: PHP All Commercial |
$29.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.10
|
| Rate for Payer: Sagamore Health Network All Products |
$29.90
|
| Rate for Payer: Signature Care EPO |
$32.15
|
| Rate for Payer: Signature Care PPO |
$34.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.92
|
| Rate for Payer: United Healthcare Commercial |
$30.52
|
| Rate for Payer: United Healthcare Medicare |
$12.78
|
|
|
HC SUTURE PROLENE 5-0 9702H
|
Facility
|
IP
|
$167.99
|
|
| Hospital Charge Code |
41601532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$156.23 |
| Rate for Payer: Aetna Commercial |
$145.14
|
| Rate for Payer: Cash Price |
$104.15
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.23
|
| Rate for Payer: Coventry All Commercial |
$147.83
|
| Rate for Payer: Encore All Commercial |
$154.63
|
| Rate for Payer: Frontpath All Commercial |
$154.55
|
| Rate for Payer: Humana ChoiceCare |
$145.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.19
|
| Rate for Payer: PHCS All Commercial |
$125.99
|
| Rate for Payer: PHP All Commercial |
$127.40
|
| Rate for Payer: Sagamore Health Network All Products |
$129.69
|
| Rate for Payer: Signature Care EPO |
$139.43
|
| Rate for Payer: Signature Care PPO |
$147.83
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
|
|
HC SUTURE PROLENE 5-0 9702H
|
Facility
|
OP
|
$167.99
|
|
| Hospital Charge Code |
41601532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$156.23 |
| Rate for Payer: Aetna Commercial |
$141.78
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.98
|
| Rate for Payer: Cash Price |
$104.15
|
| Rate for Payer: Cash Price |
$104.15
|
| Rate for Payer: Centivo All Commercial |
$85.67
|
| Rate for Payer: Cigna All Commercial |
$144.98
|
| Rate for Payer: CORVEL All Commercial |
$156.23
|
| Rate for Payer: Coventry All Commercial |
$147.83
|
| Rate for Payer: Encore All Commercial |
$154.63
|
| Rate for Payer: Frontpath All Commercial |
$154.55
|
| Rate for Payer: Humana ChoiceCare |
$145.09
|
| Rate for Payer: Humana Medicare |
$85.67
|
| Rate for Payer: Lucent All Commercial |
$85.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$125.99
|
| Rate for Payer: PHP All Commercial |
$127.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.52
|
| Rate for Payer: Sagamore Health Network All Products |
$129.69
|
| Rate for Payer: Signature Care EPO |
$139.43
|
| Rate for Payer: Signature Care PPO |
$147.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.79
|
| Rate for Payer: United Healthcare Commercial |
$132.38
|
| Rate for Payer: United Healthcare Medicare |
$55.44
|
|
|
HC SUTURE PROLENE 6-0 8680G
|
Facility
|
OP
|
$40.63
|
|
| Hospital Charge Code |
41601524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$34.29
|
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.75
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Centivo All Commercial |
$20.72
|
| Rate for Payer: Cigna All Commercial |
$35.06
|
| Rate for Payer: CORVEL All Commercial |
$37.79
|
| Rate for Payer: Coventry All Commercial |
$35.75
|
| Rate for Payer: Encore All Commercial |
$37.40
|
| Rate for Payer: Frontpath All Commercial |
$37.38
|
| Rate for Payer: Humana ChoiceCare |
$35.09
|
| Rate for Payer: Humana Medicare |
$20.72
|
| Rate for Payer: Lucent All Commercial |
$20.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$30.47
|
| Rate for Payer: PHP All Commercial |
$30.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.85
|
| Rate for Payer: Sagamore Health Network All Products |
$31.37
|
| Rate for Payer: Signature Care EPO |
$33.72
|
| Rate for Payer: Signature Care PPO |
$35.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.54
|
| Rate for Payer: United Healthcare Commercial |
$32.02
|
| Rate for Payer: United Healthcare Medicare |
$13.41
|
|
|
HC SUTURE PROLENE 6-0 8680G
|
Facility
|
IP
|
$40.63
|
|
| Hospital Charge Code |
41601524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$37.79 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cigna All Commercial |
$35.06
|
| Rate for Payer: CORVEL All Commercial |
$37.79
|
| Rate for Payer: Coventry All Commercial |
$35.75
|
| Rate for Payer: Encore All Commercial |
$37.40
|
| Rate for Payer: Frontpath All Commercial |
$37.38
|
| Rate for Payer: Humana ChoiceCare |
$35.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.57
|
| Rate for Payer: PHCS All Commercial |
$30.47
|
| Rate for Payer: PHP All Commercial |
$30.81
|
| Rate for Payer: Sagamore Health Network All Products |
$31.37
|
| Rate for Payer: Signature Care EPO |
$33.72
|
| Rate for Payer: Signature Care PPO |
$35.75
|
| Rate for Payer: United Healthcare Commercial |
$32.02
|
|
|
HC SUTURE PROLENE 7-0 8648G
|
Facility
|
IP
|
$44.54
|
|
| Hospital Charge Code |
41601530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$41.42 |
| Rate for Payer: Aetna Commercial |
$38.48
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cigna All Commercial |
$38.44
|
| Rate for Payer: CORVEL All Commercial |
$41.42
|
| Rate for Payer: Coventry All Commercial |
$39.20
|
| Rate for Payer: Encore All Commercial |
$41.00
|
| Rate for Payer: Frontpath All Commercial |
$40.98
|
| Rate for Payer: Humana ChoiceCare |
$38.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.09
|
| Rate for Payer: PHCS All Commercial |
$33.40
|
| Rate for Payer: PHP All Commercial |
$33.78
|
| Rate for Payer: Sagamore Health Network All Products |
$34.38
|
| Rate for Payer: Signature Care EPO |
$36.97
|
| Rate for Payer: Signature Care PPO |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
|
|
HC SUTURE PROLENE 7-0 8648G
|
Facility
|
OP
|
$44.54
|
|
| Hospital Charge Code |
41601530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.17
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Cash Price |
$27.62
|
| Rate for Payer: Centivo All Commercial |
$22.72
|
| Rate for Payer: Cigna All Commercial |
$38.44
|
| Rate for Payer: CORVEL All Commercial |
$41.42
|
| Rate for Payer: Coventry All Commercial |
$39.20
|
| Rate for Payer: Encore All Commercial |
$41.00
|
| Rate for Payer: Frontpath All Commercial |
$40.98
|
| Rate for Payer: Humana ChoiceCare |
$38.47
|
| Rate for Payer: Humana Medicare |
$22.72
|
| Rate for Payer: Lucent All Commercial |
$22.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$33.40
|
| Rate for Payer: PHP All Commercial |
$33.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.37
|
| Rate for Payer: Sagamore Health Network All Products |
$34.38
|
| Rate for Payer: Signature Care EPO |
$36.97
|
| Rate for Payer: Signature Care PPO |
$39.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.86
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
| Rate for Payer: United Healthcare Medicare |
$14.70
|
|
|
HC SUTURE QUILL 3-0 VLM1012
|
Facility
|
IP
|
$91.88
|
|
| Hospital Charge Code |
41603247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.91 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cigna All Commercial |
$79.29
|
| Rate for Payer: CORVEL All Commercial |
$85.45
|
| Rate for Payer: Coventry All Commercial |
$80.85
|
| Rate for Payer: Encore All Commercial |
$84.58
|
| Rate for Payer: Frontpath All Commercial |
$84.53
|
| Rate for Payer: Humana ChoiceCare |
$79.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.69
|
| Rate for Payer: PHCS All Commercial |
$68.91
|
| Rate for Payer: PHP All Commercial |
$69.68
|
| Rate for Payer: Sagamore Health Network All Products |
$70.93
|
| Rate for Payer: Signature Care EPO |
$76.26
|
| Rate for Payer: Signature Care PPO |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$72.40
|
|
|
HC SUTURE QUILL 3-0 VLM1012
|
Facility
|
OP
|
$91.88
|
|
| Hospital Charge Code |
41603247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.55
|
| Rate for Payer: Aetna Medicare |
$30.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.35
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Centivo All Commercial |
$46.86
|
| Rate for Payer: Cigna All Commercial |
$79.29
|
| Rate for Payer: CORVEL All Commercial |
$85.45
|
| Rate for Payer: Coventry All Commercial |
$80.85
|
| Rate for Payer: Encore All Commercial |
$84.58
|
| Rate for Payer: Frontpath All Commercial |
$84.53
|
| Rate for Payer: Humana ChoiceCare |
$79.36
|
| Rate for Payer: Humana Medicare |
$46.86
|
| Rate for Payer: Lucent All Commercial |
$46.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$68.91
|
| Rate for Payer: PHP All Commercial |
$69.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.83
|
| Rate for Payer: Sagamore Health Network All Products |
$70.93
|
| Rate for Payer: Signature Care EPO |
$76.26
|
| Rate for Payer: Signature Care PPO |
$80.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.10
|
| Rate for Payer: United Healthcare Commercial |
$72.40
|
| Rate for Payer: United Healthcare Medicare |
$30.32
|
|
|
HC SUTURE QUILL MONODERM 2-0
|
Facility
|
IP
|
$151.11
|
|
| Hospital Charge Code |
41602386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.33 |
| Max. Negotiated Rate |
$140.53 |
| Rate for Payer: Aetna Commercial |
$130.56
|
| Rate for Payer: Cash Price |
$93.69
|
| Rate for Payer: Cigna All Commercial |
$130.41
|
| Rate for Payer: CORVEL All Commercial |
$140.53
|
| Rate for Payer: Coventry All Commercial |
$132.98
|
| Rate for Payer: Encore All Commercial |
$139.10
|
| Rate for Payer: Frontpath All Commercial |
$139.02
|
| Rate for Payer: Humana ChoiceCare |
$130.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: PHCS All Commercial |
$113.33
|
| Rate for Payer: PHP All Commercial |
$114.60
|
| Rate for Payer: Sagamore Health Network All Products |
$116.66
|
| Rate for Payer: Signature Care EPO |
$125.42
|
| Rate for Payer: Signature Care PPO |
$132.98
|
| Rate for Payer: United Healthcare Commercial |
$119.07
|
|
|
HC SUTURE QUILL MONODERM 2-0
|
Facility
|
OP
|
$151.11
|
|
| Hospital Charge Code |
41602386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$140.53 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$49.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$86.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.85
|
| Rate for Payer: Cash Price |
$93.69
|
| Rate for Payer: Cash Price |
$93.69
|
| Rate for Payer: Centivo All Commercial |
$77.07
|
| Rate for Payer: Cigna All Commercial |
$130.41
|
| Rate for Payer: CORVEL All Commercial |
$140.53
|
| Rate for Payer: Coventry All Commercial |
$132.98
|
| Rate for Payer: Encore All Commercial |
$139.10
|
| Rate for Payer: Frontpath All Commercial |
$139.02
|
| Rate for Payer: Humana ChoiceCare |
$130.51
|
| Rate for Payer: Humana Medicare |
$77.07
|
| Rate for Payer: Lucent All Commercial |
$77.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$113.33
|
| Rate for Payer: PHP All Commercial |
$114.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.93
|
| Rate for Payer: Sagamore Health Network All Products |
$116.66
|
| Rate for Payer: Signature Care EPO |
$125.42
|
| Rate for Payer: Signature Care PPO |
$132.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.44
|
| Rate for Payer: United Healthcare Commercial |
$119.07
|
| Rate for Payer: United Healthcare Medicare |
$49.87
|
|
|
HC SUTURE QUILL MONODERM 2-0 YA-2022Q
|
Facility
|
OP
|
$194.28
|
|
| Hospital Charge Code |
41601606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$163.97
|
| Rate for Payer: Aetna Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.52
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Centivo All Commercial |
$99.08
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Humana Medicare |
$99.08
|
| Rate for Payer: Lucent All Commercial |
$99.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.77
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.14
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
| Rate for Payer: United Healthcare Medicare |
$64.11
|
|
|
HC SUTURE QUILL MONODERM 2-0 YA-2022Q
|
Facility
|
IP
|
$194.28
|
|
| Hospital Charge Code |
41601606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
|
|
HC SUTURE QUILL MONODERM 3-0 YA-2021Q
|
Facility
|
OP
|
$194.28
|
|
| Hospital Charge Code |
41601609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$163.97
|
| Rate for Payer: Aetna Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.52
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Centivo All Commercial |
$99.08
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Humana Medicare |
$99.08
|
| Rate for Payer: Lucent All Commercial |
$99.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.77
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.14
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
| Rate for Payer: United Healthcare Medicare |
$64.11
|
|
|
HC SUTURE QUILL MONODERM 3-0 YA-2021Q
|
Facility
|
IP
|
$194.28
|
|
| Hospital Charge Code |
41601609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
|
|
HC SUTURE QUILL MONO VLM-2003
|
Facility
|
OP
|
$91.88
|
|
| Hospital Charge Code |
41603377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.55
|
| Rate for Payer: Aetna Medicare |
$30.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.35
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Centivo All Commercial |
$46.86
|
| Rate for Payer: Cigna All Commercial |
$79.29
|
| Rate for Payer: CORVEL All Commercial |
$85.45
|
| Rate for Payer: Coventry All Commercial |
$80.85
|
| Rate for Payer: Encore All Commercial |
$84.58
|
| Rate for Payer: Frontpath All Commercial |
$84.53
|
| Rate for Payer: Humana ChoiceCare |
$79.36
|
| Rate for Payer: Humana Medicare |
$46.86
|
| Rate for Payer: Lucent All Commercial |
$46.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$68.91
|
| Rate for Payer: PHP All Commercial |
$69.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.83
|
| Rate for Payer: Sagamore Health Network All Products |
$70.93
|
| Rate for Payer: Signature Care EPO |
$76.26
|
| Rate for Payer: Signature Care PPO |
$80.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.10
|
| Rate for Payer: United Healthcare Commercial |
$72.40
|
| Rate for Payer: United Healthcare Medicare |
$30.32
|
|
|
HC SUTURE QUILL MONO VLM-2003
|
Facility
|
IP
|
$91.88
|
|
| Hospital Charge Code |
41603377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.91 |
| Max. Negotiated Rate |
$85.45 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Cash Price |
$56.97
|
| Rate for Payer: Cigna All Commercial |
$79.29
|
| Rate for Payer: CORVEL All Commercial |
$85.45
|
| Rate for Payer: Coventry All Commercial |
$80.85
|
| Rate for Payer: Encore All Commercial |
$84.58
|
| Rate for Payer: Frontpath All Commercial |
$84.53
|
| Rate for Payer: Humana ChoiceCare |
$79.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.69
|
| Rate for Payer: PHCS All Commercial |
$68.91
|
| Rate for Payer: PHP All Commercial |
$69.68
|
| Rate for Payer: Sagamore Health Network All Products |
$70.93
|
| Rate for Payer: Signature Care EPO |
$76.26
|
| Rate for Payer: Signature Care PPO |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$72.40
|
|
|
HC SUTURE QUILL PDO #2 RX-1066Q
|
Facility
|
OP
|
$194.28
|
|
| Hospital Charge Code |
41601607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$163.97
|
| Rate for Payer: Aetna Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$111.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$121.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$73.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$70.52
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Centivo All Commercial |
$99.08
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Humana Medicare |
$99.08
|
| Rate for Payer: Lucent All Commercial |
$99.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$75.77
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$165.14
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
| Rate for Payer: United Healthcare Medicare |
$64.11
|
|
|
HC SUTURE QUILL PDO #2 RX-1066Q
|
Facility
|
IP
|
$194.28
|
|
| Hospital Charge Code |
41601607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$180.68 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cigna All Commercial |
$167.66
|
| Rate for Payer: CORVEL All Commercial |
$180.68
|
| Rate for Payer: Coventry All Commercial |
$170.97
|
| Rate for Payer: Encore All Commercial |
$178.83
|
| Rate for Payer: Frontpath All Commercial |
$178.74
|
| Rate for Payer: Humana ChoiceCare |
$167.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$174.85
|
| Rate for Payer: PHCS All Commercial |
$145.71
|
| Rate for Payer: PHP All Commercial |
$147.34
|
| Rate for Payer: Sagamore Health Network All Products |
$149.98
|
| Rate for Payer: Signature Care EPO |
$161.25
|
| Rate for Payer: Signature Care PPO |
$170.97
|
| Rate for Payer: United Healthcare Commercial |
$153.09
|
|
|
HC SUTURE QUILL PDO 2 VLP 2011
|
Facility
|
OP
|
$112.29
|
|
| Hospital Charge Code |
41602938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$94.77
|
| Rate for Payer: Aetna Medicare |
$37.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.76
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Centivo All Commercial |
$57.27
|
| Rate for Payer: Cigna All Commercial |
$96.91
|
| Rate for Payer: CORVEL All Commercial |
$104.43
|
| Rate for Payer: Coventry All Commercial |
$98.82
|
| Rate for Payer: Encore All Commercial |
$103.36
|
| Rate for Payer: Frontpath All Commercial |
$103.31
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Humana Medicare |
$57.27
|
| Rate for Payer: Lucent All Commercial |
$57.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.06
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$84.22
|
| Rate for Payer: PHP All Commercial |
$85.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.79
|
| Rate for Payer: Sagamore Health Network All Products |
$86.69
|
| Rate for Payer: Signature Care EPO |
$93.20
|
| Rate for Payer: Signature Care PPO |
$98.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.45
|
| Rate for Payer: United Healthcare Commercial |
$88.48
|
| Rate for Payer: United Healthcare Medicare |
$37.06
|
|
|
HC SUTURE QUILL PDO 2 VLP 2011
|
Facility
|
IP
|
$112.29
|
|
| Hospital Charge Code |
41602938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.22 |
| Max. Negotiated Rate |
$104.43 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Cash Price |
$69.62
|
| Rate for Payer: Cigna All Commercial |
$96.91
|
| Rate for Payer: CORVEL All Commercial |
$104.43
|
| Rate for Payer: Coventry All Commercial |
$98.82
|
| Rate for Payer: Encore All Commercial |
$103.36
|
| Rate for Payer: Frontpath All Commercial |
$103.31
|
| Rate for Payer: Humana ChoiceCare |
$96.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.06
|
| Rate for Payer: PHCS All Commercial |
$84.22
|
| Rate for Payer: PHP All Commercial |
$85.16
|
| Rate for Payer: Sagamore Health Network All Products |
$86.69
|
| Rate for Payer: Signature Care EPO |
$93.20
|
| Rate for Payer: Signature Care PPO |
$98.82
|
| Rate for Payer: United Healthcare Commercial |
$88.48
|
|
|
HC SUTURE REMOVAL KIT
|
Facility
|
IP
|
$8.15
|
|
| Hospital Charge Code |
41608324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna All Commercial |
$7.03
|
| Rate for Payer: CORVEL All Commercial |
$7.58
|
| Rate for Payer: Coventry All Commercial |
$7.17
|
| Rate for Payer: Encore All Commercial |
$7.50
|
| Rate for Payer: Frontpath All Commercial |
$7.50
|
| Rate for Payer: Humana ChoiceCare |
$7.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.34
|
| Rate for Payer: PHCS All Commercial |
$6.11
|
| Rate for Payer: PHP All Commercial |
$6.18
|
| Rate for Payer: Sagamore Health Network All Products |
$6.29
|
| Rate for Payer: Signature Care EPO |
$6.76
|
| Rate for Payer: Signature Care PPO |
$7.17
|
| Rate for Payer: United Healthcare Commercial |
$6.42
|
|
