|
HC SUTURE REMOVAL KIT
|
Facility
|
OP
|
$18.97
|
|
| Hospital Charge Code |
41601215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Centivo All Commercial |
$9.67
|
| Rate for Payer: Cigna All Commercial |
$16.37
|
| Rate for Payer: CORVEL All Commercial |
$17.64
|
| Rate for Payer: Coventry All Commercial |
$16.69
|
| Rate for Payer: Encore All Commercial |
$17.46
|
| Rate for Payer: Frontpath All Commercial |
$17.45
|
| Rate for Payer: Humana ChoiceCare |
$16.38
|
| Rate for Payer: Humana Medicare |
$9.67
|
| Rate for Payer: Lucent All Commercial |
$9.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.23
|
| Rate for Payer: PHP All Commercial |
$14.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.40
|
| Rate for Payer: Sagamore Health Network All Products |
$14.64
|
| Rate for Payer: Signature Care EPO |
$15.75
|
| Rate for Payer: Signature Care PPO |
$16.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
| Rate for Payer: United Healthcare Medicare |
$6.26
|
|
|
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
|
|
|
HC SUTURE REMOVAL KIT
|
Facility
|
IP
|
$18.97
|
|
| Hospital Charge Code |
41601215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cigna All Commercial |
$16.37
|
| Rate for Payer: CORVEL All Commercial |
$17.64
|
| Rate for Payer: Coventry All Commercial |
$16.69
|
| Rate for Payer: Encore All Commercial |
$17.46
|
| Rate for Payer: Frontpath All Commercial |
$17.45
|
| Rate for Payer: Humana ChoiceCare |
$16.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.07
|
| Rate for Payer: PHCS All Commercial |
$14.23
|
| Rate for Payer: PHP All Commercial |
$14.39
|
| Rate for Payer: Sagamore Health Network All Products |
$14.64
|
| Rate for Payer: Signature Care EPO |
$15.75
|
| Rate for Payer: Signature Care PPO |
$16.69
|
| Rate for Payer: United Healthcare Commercial |
$14.95
|
|
|
HC SUTURE RETENTION BOLSTER 450G
|
Facility
|
IP
|
$14.96
|
|
| Hospital Charge Code |
41601611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cigna All Commercial |
$12.91
|
| Rate for Payer: CORVEL All Commercial |
$13.91
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Encore All Commercial |
$13.77
|
| Rate for Payer: Frontpath All Commercial |
$13.76
|
| Rate for Payer: Humana ChoiceCare |
$12.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: PHCS All Commercial |
$11.22
|
| Rate for Payer: PHP All Commercial |
$11.35
|
| Rate for Payer: Sagamore Health Network All Products |
$11.55
|
| Rate for Payer: Signature Care EPO |
$12.42
|
| Rate for Payer: Signature Care PPO |
$13.16
|
| Rate for Payer: United Healthcare Commercial |
$11.79
|
|
|
HC SUTURE RETENTION BOLSTER 450G
|
Facility
|
OP
|
$14.96
|
|
| Hospital Charge Code |
41601611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.43
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Centivo All Commercial |
$7.63
|
| Rate for Payer: Cigna All Commercial |
$12.91
|
| Rate for Payer: CORVEL All Commercial |
$13.91
|
| Rate for Payer: Coventry All Commercial |
$13.16
|
| Rate for Payer: Encore All Commercial |
$13.77
|
| Rate for Payer: Frontpath All Commercial |
$13.76
|
| Rate for Payer: Humana ChoiceCare |
$12.92
|
| Rate for Payer: Humana Medicare |
$7.63
|
| Rate for Payer: Lucent All Commercial |
$7.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.46
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.22
|
| Rate for Payer: PHP All Commercial |
$11.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.83
|
| Rate for Payer: Sagamore Health Network All Products |
$11.55
|
| Rate for Payer: Signature Care EPO |
$12.42
|
| Rate for Payer: Signature Care PPO |
$13.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.72
|
| Rate for Payer: United Healthcare Commercial |
$11.79
|
| Rate for Payer: United Healthcare Medicare |
$4.94
|
|
|
HC SUTURE RETRIEVER
|
Facility
|
IP
|
$278.87
|
|
| Hospital Charge Code |
41601488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.15 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$240.94
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cigna All Commercial |
$240.66
|
| Rate for Payer: CORVEL All Commercial |
$259.35
|
| Rate for Payer: Coventry All Commercial |
$245.41
|
| Rate for Payer: Encore All Commercial |
$256.70
|
| Rate for Payer: Frontpath All Commercial |
$256.56
|
| Rate for Payer: Humana ChoiceCare |
$240.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.98
|
| Rate for Payer: PHCS All Commercial |
$209.15
|
| Rate for Payer: PHP All Commercial |
$211.50
|
| Rate for Payer: Sagamore Health Network All Products |
$215.29
|
| Rate for Payer: Signature Care EPO |
$231.46
|
| Rate for Payer: Signature Care PPO |
$245.41
|
| Rate for Payer: United Healthcare Commercial |
$219.75
|
|
|
HC SUTURE RETRIEVER
|
Facility
|
OP
|
$278.87
|
|
| Hospital Charge Code |
41601488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.03 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Aetna Commercial |
$235.37
|
| Rate for Payer: Aetna Medicare |
$92.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$160.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$174.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.23
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Cash Price |
$172.90
|
| Rate for Payer: Centivo All Commercial |
$142.22
|
| Rate for Payer: Cigna All Commercial |
$240.66
|
| Rate for Payer: CORVEL All Commercial |
$259.35
|
| Rate for Payer: Coventry All Commercial |
$245.41
|
| Rate for Payer: Encore All Commercial |
$256.70
|
| Rate for Payer: Frontpath All Commercial |
$256.56
|
| Rate for Payer: Humana ChoiceCare |
$240.86
|
| Rate for Payer: Humana Medicare |
$142.22
|
| Rate for Payer: Lucent All Commercial |
$142.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$209.15
|
| Rate for Payer: PHP All Commercial |
$211.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.76
|
| Rate for Payer: Sagamore Health Network All Products |
$215.29
|
| Rate for Payer: Signature Care EPO |
$231.46
|
| Rate for Payer: Signature Care PPO |
$245.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$237.04
|
| Rate for Payer: United Healthcare Commercial |
$219.75
|
| Rate for Payer: United Healthcare Medicare |
$92.03
|
|
|
HC SUTURE SILK 0 424H
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
41601483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna All Commercial |
$6.90
|
| Rate for Payer: CORVEL All Commercial |
$7.44
|
| Rate for Payer: Coventry All Commercial |
$7.04
|
| Rate for Payer: Encore All Commercial |
$7.36
|
| Rate for Payer: Frontpath All Commercial |
$7.36
|
| Rate for Payer: Humana ChoiceCare |
$6.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.20
|
| Rate for Payer: PHCS All Commercial |
$6.00
|
| Rate for Payer: PHP All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$6.18
|
| Rate for Payer: Signature Care EPO |
$6.64
|
| Rate for Payer: Signature Care PPO |
$7.04
|
| Rate for Payer: United Healthcare Commercial |
$6.30
|
|
|
HC SUTURE SILK 0 424H
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41601483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.90
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Centivo All Commercial |
$4.08
|
| Rate for Payer: Cigna All Commercial |
$6.90
|
| Rate for Payer: CORVEL All Commercial |
$7.44
|
| Rate for Payer: Coventry All Commercial |
$7.04
|
| Rate for Payer: Encore All Commercial |
$7.36
|
| Rate for Payer: Frontpath All Commercial |
$7.36
|
| Rate for Payer: Humana ChoiceCare |
$6.91
|
| Rate for Payer: Humana Medicare |
$4.08
|
| Rate for Payer: Lucent All Commercial |
$4.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.00
|
| Rate for Payer: PHP All Commercial |
$6.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.12
|
| Rate for Payer: Sagamore Health Network All Products |
$6.18
|
| Rate for Payer: Signature Care EPO |
$6.64
|
| Rate for Payer: Signature Care PPO |
$7.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.80
|
| Rate for Payer: United Healthcare Commercial |
$6.30
|
| Rate for Payer: United Healthcare Medicare |
$2.64
|
|
|
HC SUTURE SILK 0 680H
|
Facility
|
OP
|
$10.50
|
|
| Hospital Charge Code |
41601155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Centivo All Commercial |
$5.36
|
| Rate for Payer: Cigna All Commercial |
$9.06
|
| Rate for Payer: CORVEL All Commercial |
$9.76
|
| Rate for Payer: Coventry All Commercial |
$9.24
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Frontpath All Commercial |
$9.66
|
| Rate for Payer: Humana ChoiceCare |
$9.07
|
| Rate for Payer: Humana Medicare |
$5.36
|
| Rate for Payer: Lucent All Commercial |
$5.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.88
|
| Rate for Payer: PHP All Commercial |
$7.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.10
|
| Rate for Payer: Sagamore Health Network All Products |
$8.11
|
| Rate for Payer: Signature Care EPO |
$8.72
|
| Rate for Payer: Signature Care PPO |
$9.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.92
|
| Rate for Payer: United Healthcare Commercial |
$8.27
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
|
|
HC SUTURE SILK 0 680H
|
Facility
|
IP
|
$10.50
|
|
| Hospital Charge Code |
41601155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: Aetna Commercial |
$9.07
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cigna All Commercial |
$9.06
|
| Rate for Payer: CORVEL All Commercial |
$9.76
|
| Rate for Payer: Coventry All Commercial |
$9.24
|
| Rate for Payer: Encore All Commercial |
$9.67
|
| Rate for Payer: Frontpath All Commercial |
$9.66
|
| Rate for Payer: Humana ChoiceCare |
$9.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.45
|
| Rate for Payer: PHCS All Commercial |
$7.88
|
| Rate for Payer: PHP All Commercial |
$7.96
|
| Rate for Payer: Sagamore Health Network All Products |
$8.11
|
| Rate for Payer: Signature Care EPO |
$8.72
|
| Rate for Payer: Signature Care PPO |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$8.27
|
|
|
HC SUTURE SILK 0 A306H
|
Facility
|
IP
|
$8.84
|
|
| Hospital Charge Code |
41601541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: Aetna Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cigna All Commercial |
$7.63
|
| Rate for Payer: CORVEL All Commercial |
$8.22
|
| Rate for Payer: Coventry All Commercial |
$7.78
|
| Rate for Payer: Encore All Commercial |
$8.14
|
| Rate for Payer: Frontpath All Commercial |
$8.13
|
| Rate for Payer: Humana ChoiceCare |
$7.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.96
|
| Rate for Payer: PHCS All Commercial |
$6.63
|
| Rate for Payer: PHP All Commercial |
$6.70
|
| Rate for Payer: Sagamore Health Network All Products |
$6.82
|
| Rate for Payer: Signature Care EPO |
$7.34
|
| Rate for Payer: Signature Care PPO |
$7.78
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
|
|
HC SUTURE SILK 0 A306H
|
Facility
|
OP
|
$8.84
|
|
| Hospital Charge Code |
41601541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Aetna Medicare |
$2.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.21
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Cash Price |
$5.48
|
| Rate for Payer: Centivo All Commercial |
$4.51
|
| Rate for Payer: Cigna All Commercial |
$7.63
|
| Rate for Payer: CORVEL All Commercial |
$8.22
|
| Rate for Payer: Coventry All Commercial |
$7.78
|
| Rate for Payer: Encore All Commercial |
$8.14
|
| Rate for Payer: Frontpath All Commercial |
$8.13
|
| Rate for Payer: Humana ChoiceCare |
$7.64
|
| Rate for Payer: Humana Medicare |
$4.51
|
| Rate for Payer: Lucent All Commercial |
$4.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.63
|
| Rate for Payer: PHP All Commercial |
$6.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.45
|
| Rate for Payer: Sagamore Health Network All Products |
$6.82
|
| Rate for Payer: Signature Care EPO |
$7.34
|
| Rate for Payer: Signature Care PPO |
$7.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.51
|
| Rate for Payer: United Healthcare Commercial |
$6.97
|
| Rate for Payer: United Healthcare Medicare |
$2.92
|
|
|
HC SUTURE SILK 0 K834H
|
Facility
|
OP
|
$8.87
|
|
| Hospital Charge Code |
41601592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.22
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Centivo All Commercial |
$4.52
|
| Rate for Payer: Cigna All Commercial |
$7.65
|
| Rate for Payer: CORVEL All Commercial |
$8.25
|
| Rate for Payer: Coventry All Commercial |
$7.81
|
| Rate for Payer: Encore All Commercial |
$8.16
|
| Rate for Payer: Frontpath All Commercial |
$8.16
|
| Rate for Payer: Humana ChoiceCare |
$7.66
|
| Rate for Payer: Humana Medicare |
$4.52
|
| Rate for Payer: Lucent All Commercial |
$4.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.65
|
| Rate for Payer: PHP All Commercial |
$6.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.46
|
| Rate for Payer: Sagamore Health Network All Products |
$6.85
|
| Rate for Payer: Signature Care EPO |
$7.36
|
| Rate for Payer: Signature Care PPO |
$7.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.54
|
| Rate for Payer: United Healthcare Commercial |
$6.99
|
| Rate for Payer: United Healthcare Medicare |
$2.93
|
|
|
HC SUTURE SILK 0 K834H
|
Facility
|
IP
|
$8.87
|
|
| Hospital Charge Code |
41601592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Aetna Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna All Commercial |
$7.65
|
| Rate for Payer: CORVEL All Commercial |
$8.25
|
| Rate for Payer: Coventry All Commercial |
$7.81
|
| Rate for Payer: Encore All Commercial |
$8.16
|
| Rate for Payer: Frontpath All Commercial |
$8.16
|
| Rate for Payer: Humana ChoiceCare |
$7.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.98
|
| Rate for Payer: PHCS All Commercial |
$6.65
|
| Rate for Payer: PHP All Commercial |
$6.73
|
| Rate for Payer: Sagamore Health Network All Products |
$6.85
|
| Rate for Payer: Signature Care EPO |
$7.36
|
| Rate for Payer: Signature Care PPO |
$7.81
|
| Rate for Payer: United Healthcare Commercial |
$6.99
|
|
|
HC SUTURE SILK 1-0 A187H
|
Facility
|
IP
|
$7.32
|
|
| Hospital Charge Code |
41601537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna All Commercial |
$6.32
|
| Rate for Payer: CORVEL All Commercial |
$6.81
|
| Rate for Payer: Coventry All Commercial |
$6.44
|
| Rate for Payer: Encore All Commercial |
$6.74
|
| Rate for Payer: Frontpath All Commercial |
$6.73
|
| Rate for Payer: Humana ChoiceCare |
$6.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.59
|
| Rate for Payer: PHCS All Commercial |
$5.49
|
| Rate for Payer: PHP All Commercial |
$5.55
|
| Rate for Payer: Sagamore Health Network All Products |
$5.65
|
| Rate for Payer: Signature Care EPO |
$6.08
|
| Rate for Payer: Signature Care PPO |
$6.44
|
| Rate for Payer: United Healthcare Commercial |
$5.77
|
|
|
HC SUTURE SILK 1-0 A187H
|
Facility
|
OP
|
$7.32
|
|
| Hospital Charge Code |
41601537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.18
|
| Rate for Payer: Aetna Medicare |
$2.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.66
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Centivo All Commercial |
$3.73
|
| Rate for Payer: Cigna All Commercial |
$6.32
|
| Rate for Payer: CORVEL All Commercial |
$6.81
|
| Rate for Payer: Coventry All Commercial |
$6.44
|
| Rate for Payer: Encore All Commercial |
$6.74
|
| Rate for Payer: Frontpath All Commercial |
$6.73
|
| Rate for Payer: Humana ChoiceCare |
$6.32
|
| Rate for Payer: Humana Medicare |
$3.73
|
| Rate for Payer: Lucent All Commercial |
$3.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$5.49
|
| Rate for Payer: PHP All Commercial |
$5.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.85
|
| Rate for Payer: Sagamore Health Network All Products |
$5.65
|
| Rate for Payer: Signature Care EPO |
$6.08
|
| Rate for Payer: Signature Care PPO |
$6.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.22
|
| Rate for Payer: United Healthcare Commercial |
$5.77
|
| Rate for Payer: United Healthcare Medicare |
$2.42
|
|
|
HC SUTURE SILK 2-0 A305H
|
Facility
|
OP
|
$15.94
|
|
| Hospital Charge Code |
41601538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.45
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.79
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Centivo All Commercial |
$8.13
|
| Rate for Payer: Cigna All Commercial |
$13.76
|
| Rate for Payer: CORVEL All Commercial |
$14.82
|
| Rate for Payer: Coventry All Commercial |
$14.03
|
| Rate for Payer: Encore All Commercial |
$14.67
|
| Rate for Payer: Frontpath All Commercial |
$14.66
|
| Rate for Payer: Humana ChoiceCare |
$13.77
|
| Rate for Payer: Humana Medicare |
$8.13
|
| Rate for Payer: Lucent All Commercial |
$8.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.35
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.96
|
| Rate for Payer: PHP All Commercial |
$12.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.22
|
| Rate for Payer: Sagamore Health Network All Products |
$12.31
|
| Rate for Payer: Signature Care EPO |
$13.23
|
| Rate for Payer: Signature Care PPO |
$14.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.55
|
| Rate for Payer: United Healthcare Commercial |
$12.56
|
| Rate for Payer: United Healthcare Medicare |
$5.26
|
|
|
HC SUTURE SILK 2-0 A305H
|
Facility
|
IP
|
$15.94
|
|
| Hospital Charge Code |
41601538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$14.82 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cigna All Commercial |
$13.76
|
| Rate for Payer: CORVEL All Commercial |
$14.82
|
| Rate for Payer: Coventry All Commercial |
$14.03
|
| Rate for Payer: Encore All Commercial |
$14.67
|
| Rate for Payer: Frontpath All Commercial |
$14.66
|
| Rate for Payer: Humana ChoiceCare |
$13.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.35
|
| Rate for Payer: PHCS All Commercial |
$11.96
|
| Rate for Payer: PHP All Commercial |
$12.09
|
| Rate for Payer: Sagamore Health Network All Products |
$12.31
|
| Rate for Payer: Signature Care EPO |
$13.23
|
| Rate for Payer: Signature Care PPO |
$14.03
|
| Rate for Payer: United Healthcare Commercial |
$12.56
|
|
|
HC SUTURE SILK 2-0 K833H
|
Facility
|
IP
|
$8.71
|
|
| Hospital Charge Code |
41601534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna All Commercial |
$7.52
|
| Rate for Payer: CORVEL All Commercial |
$8.10
|
| Rate for Payer: Coventry All Commercial |
$7.66
|
| Rate for Payer: Encore All Commercial |
$8.02
|
| Rate for Payer: Frontpath All Commercial |
$8.01
|
| Rate for Payer: Humana ChoiceCare |
$7.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.84
|
| Rate for Payer: PHCS All Commercial |
$6.53
|
| Rate for Payer: PHP All Commercial |
$6.61
|
| Rate for Payer: Sagamore Health Network All Products |
$6.72
|
| Rate for Payer: Signature Care EPO |
$7.23
|
| Rate for Payer: Signature Care PPO |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$6.86
|
|
|
HC SUTURE SILK 2-0 K833H
|
Facility
|
OP
|
$8.71
|
|
| Hospital Charge Code |
41601534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.16
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Centivo All Commercial |
$4.44
|
| Rate for Payer: Cigna All Commercial |
$7.52
|
| Rate for Payer: CORVEL All Commercial |
$8.10
|
| Rate for Payer: Coventry All Commercial |
$7.66
|
| Rate for Payer: Encore All Commercial |
$8.02
|
| Rate for Payer: Frontpath All Commercial |
$8.01
|
| Rate for Payer: Humana ChoiceCare |
$7.52
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Lucent All Commercial |
$4.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.53
|
| Rate for Payer: PHP All Commercial |
$6.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.40
|
| Rate for Payer: Sagamore Health Network All Products |
$6.72
|
| Rate for Payer: Signature Care EPO |
$7.23
|
| Rate for Payer: Signature Care PPO |
$7.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.40
|
| Rate for Payer: United Healthcare Commercial |
$6.86
|
| Rate for Payer: United Healthcare Medicare |
$2.87
|
|
|
HC SUTURE SILK 2-0 M12T
|
Facility
|
OP
|
$60.16
|
|
| Hospital Charge Code |
41601506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Aetna Medicare |
$19.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.84
|
| Rate for Payer: Cash Price |
$37.30
|
| Rate for Payer: Cash Price |
$37.30
|
| Rate for Payer: Centivo All Commercial |
$30.68
|
| Rate for Payer: Cigna All Commercial |
$51.92
|
| Rate for Payer: CORVEL All Commercial |
$55.95
|
| Rate for Payer: Coventry All Commercial |
$52.94
|
| Rate for Payer: Encore All Commercial |
$55.38
|
| Rate for Payer: Frontpath All Commercial |
$55.35
|
| Rate for Payer: Humana ChoiceCare |
$51.96
|
| Rate for Payer: Humana Medicare |
$30.68
|
| Rate for Payer: Lucent All Commercial |
$30.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$45.12
|
| Rate for Payer: PHP All Commercial |
$45.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.46
|
| Rate for Payer: Sagamore Health Network All Products |
$46.44
|
| Rate for Payer: Signature Care EPO |
$49.93
|
| Rate for Payer: Signature Care PPO |
$52.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.14
|
| Rate for Payer: United Healthcare Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare |
$19.85
|
|
|
HC SUTURE SILK 2-0 M12T
|
Facility
|
IP
|
$60.16
|
|
| Hospital Charge Code |
41601506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.12 |
| Max. Negotiated Rate |
$55.95 |
| Rate for Payer: Aetna Commercial |
$51.98
|
| Rate for Payer: Cash Price |
$37.30
|
| Rate for Payer: Cigna All Commercial |
$51.92
|
| Rate for Payer: CORVEL All Commercial |
$55.95
|
| Rate for Payer: Coventry All Commercial |
$52.94
|
| Rate for Payer: Encore All Commercial |
$55.38
|
| Rate for Payer: Frontpath All Commercial |
$55.35
|
| Rate for Payer: Humana ChoiceCare |
$51.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.14
|
| Rate for Payer: PHCS All Commercial |
$45.12
|
| Rate for Payer: PHP All Commercial |
$45.63
|
| Rate for Payer: Sagamore Health Network All Products |
$46.44
|
| Rate for Payer: Signature Care EPO |
$49.93
|
| Rate for Payer: Signature Care PPO |
$52.94
|
| Rate for Payer: United Healthcare Commercial |
$47.41
|
|
|
HC SUTURE SILK 3-0 1684G
|
Facility
|
IP
|
$25.29
|
|
| Hospital Charge Code |
41601535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna All Commercial |
$21.83
|
| Rate for Payer: CORVEL All Commercial |
$23.52
|
| Rate for Payer: Coventry All Commercial |
$22.26
|
| Rate for Payer: Encore All Commercial |
$23.28
|
| Rate for Payer: Frontpath All Commercial |
$23.27
|
| Rate for Payer: Humana ChoiceCare |
$21.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.76
|
| Rate for Payer: PHCS All Commercial |
$18.97
|
| Rate for Payer: PHP All Commercial |
$19.18
|
| Rate for Payer: Sagamore Health Network All Products |
$19.52
|
| Rate for Payer: Signature Care EPO |
$20.99
|
| Rate for Payer: Signature Care PPO |
$22.26
|
| Rate for Payer: United Healthcare Commercial |
$19.93
|
|
|
HC SUTURE SILK 3-0 1684G
|
Facility
|
OP
|
$25.29
|
|
| Hospital Charge Code |
41601535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.18
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Centivo All Commercial |
$12.90
|
| Rate for Payer: Cigna All Commercial |
$21.83
|
| Rate for Payer: CORVEL All Commercial |
$23.52
|
| Rate for Payer: Coventry All Commercial |
$22.26
|
| Rate for Payer: Encore All Commercial |
$23.28
|
| Rate for Payer: Frontpath All Commercial |
$23.27
|
| Rate for Payer: Humana ChoiceCare |
$21.84
|
| Rate for Payer: Humana Medicare |
$12.90
|
| Rate for Payer: Lucent All Commercial |
$12.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.97
|
| Rate for Payer: PHP All Commercial |
$19.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.86
|
| Rate for Payer: Sagamore Health Network All Products |
$19.52
|
| Rate for Payer: Signature Care EPO |
$20.99
|
| Rate for Payer: Signature Care PPO |
$22.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.50
|
| Rate for Payer: United Healthcare Commercial |
$19.93
|
| Rate for Payer: United Healthcare Medicare |
$8.35
|
|
