|
HC SUTURE SILK 3-0 675H
|
Facility
|
OP
|
$11.86
|
|
| Hospital Charge Code |
41601432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Aetna Medicare |
$3.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Centivo All Commercial |
$6.05
|
| Rate for Payer: Cigna All Commercial |
$10.24
|
| Rate for Payer: CORVEL All Commercial |
$11.03
|
| Rate for Payer: Coventry All Commercial |
$10.44
|
| Rate for Payer: Encore All Commercial |
$10.92
|
| Rate for Payer: Frontpath All Commercial |
$10.91
|
| Rate for Payer: Humana ChoiceCare |
$10.24
|
| Rate for Payer: Humana Medicare |
$6.05
|
| Rate for Payer: Lucent All Commercial |
$6.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.90
|
| Rate for Payer: PHP All Commercial |
$8.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.63
|
| Rate for Payer: Sagamore Health Network All Products |
$9.16
|
| Rate for Payer: Signature Care EPO |
$9.84
|
| Rate for Payer: Signature Care PPO |
$10.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$9.35
|
| Rate for Payer: United Healthcare Medicare |
$3.91
|
|
|
HC SUTURE SILK 3-0 675H
|
Facility
|
IP
|
$11.86
|
|
| Hospital Charge Code |
41601432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$10.25
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Cigna All Commercial |
$10.24
|
| Rate for Payer: CORVEL All Commercial |
$11.03
|
| Rate for Payer: Coventry All Commercial |
$10.44
|
| Rate for Payer: Encore All Commercial |
$10.92
|
| Rate for Payer: Frontpath All Commercial |
$10.91
|
| Rate for Payer: Humana ChoiceCare |
$10.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.67
|
| Rate for Payer: PHCS All Commercial |
$8.90
|
| Rate for Payer: PHP All Commercial |
$8.99
|
| Rate for Payer: Sagamore Health Network All Products |
$9.16
|
| Rate for Payer: Signature Care EPO |
$9.84
|
| Rate for Payer: Signature Care PPO |
$10.44
|
| Rate for Payer: United Healthcare Commercial |
$9.35
|
|
|
HC SUTURE SILK 3-0 A184H
|
Facility
|
OP
|
$20.01
|
|
| Hospital Charge Code |
41601543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.26
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Centivo All Commercial |
$10.21
|
| Rate for Payer: Cigna All Commercial |
$17.27
|
| Rate for Payer: CORVEL All Commercial |
$18.61
|
| Rate for Payer: Coventry All Commercial |
$17.61
|
| Rate for Payer: Encore All Commercial |
$18.42
|
| Rate for Payer: Frontpath All Commercial |
$18.41
|
| Rate for Payer: Humana ChoiceCare |
$17.28
|
| Rate for Payer: Humana Medicare |
$10.21
|
| Rate for Payer: Lucent All Commercial |
$10.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.01
|
| Rate for Payer: PHP All Commercial |
$15.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.80
|
| Rate for Payer: Sagamore Health Network All Products |
$15.45
|
| Rate for Payer: Signature Care EPO |
$16.61
|
| Rate for Payer: Signature Care PPO |
$17.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.01
|
| Rate for Payer: United Healthcare Commercial |
$15.77
|
| Rate for Payer: United Healthcare Medicare |
$6.60
|
|
|
HC SUTURE SILK 3-0 A184H
|
Facility
|
IP
|
$20.01
|
|
| Hospital Charge Code |
41601543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cigna All Commercial |
$17.27
|
| Rate for Payer: CORVEL All Commercial |
$18.61
|
| Rate for Payer: Coventry All Commercial |
$17.61
|
| Rate for Payer: Encore All Commercial |
$18.42
|
| Rate for Payer: Frontpath All Commercial |
$18.41
|
| Rate for Payer: Humana ChoiceCare |
$17.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.01
|
| Rate for Payer: PHCS All Commercial |
$15.01
|
| Rate for Payer: PHP All Commercial |
$15.18
|
| Rate for Payer: Sagamore Health Network All Products |
$15.45
|
| Rate for Payer: Signature Care EPO |
$16.61
|
| Rate for Payer: Signature Care PPO |
$17.61
|
| Rate for Payer: United Healthcare Commercial |
$15.77
|
|
|
HC SUTURE SILK 3-0 K832H
|
Facility
|
OP
|
$8.72
|
|
| Hospital Charge Code |
41601542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.36
|
| Rate for Payer: Aetna Medicare |
$2.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.45
|
| 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 |
$3.17
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Centivo All Commercial |
$4.45
|
| Rate for Payer: Cigna All Commercial |
$7.53
|
| Rate for Payer: CORVEL All Commercial |
$8.11
|
| Rate for Payer: Coventry All Commercial |
$7.67
|
| Rate for Payer: Encore All Commercial |
$8.03
|
| Rate for Payer: Frontpath All Commercial |
$8.02
|
| Rate for Payer: Humana ChoiceCare |
$7.53
|
| Rate for Payer: Humana Medicare |
$4.45
|
| Rate for Payer: Lucent All Commercial |
$4.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.85
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.54
|
| 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 |
$6.73
|
| Rate for Payer: Signature Care EPO |
$7.24
|
| Rate for Payer: Signature Care PPO |
$7.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.41
|
| Rate for Payer: United Healthcare Commercial |
$6.87
|
| Rate for Payer: United Healthcare Medicare |
$2.88
|
|
|
HC SUTURE SILK 3-0 K832H
|
Facility
|
IP
|
$8.72
|
|
| Hospital Charge Code |
41601542
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Cash Price |
$5.41
|
| Rate for Payer: Cigna All Commercial |
$7.53
|
| Rate for Payer: CORVEL All Commercial |
$8.11
|
| Rate for Payer: Coventry All Commercial |
$7.67
|
| Rate for Payer: Encore All Commercial |
$8.03
|
| Rate for Payer: Frontpath All Commercial |
$8.02
|
| Rate for Payer: Humana ChoiceCare |
$7.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.85
|
| Rate for Payer: PHCS All Commercial |
$6.54
|
| Rate for Payer: PHP All Commercial |
$6.61
|
| Rate for Payer: Sagamore Health Network All Products |
$6.73
|
| Rate for Payer: Signature Care EPO |
$7.24
|
| Rate for Payer: Signature Care PPO |
$7.67
|
| Rate for Payer: United Healthcare Commercial |
$6.87
|
|
|
HC SUTURE SILK 4-0 683G
|
Facility
|
IP
|
$15.16
|
|
| Hospital Charge Code |
41601464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$14.10 |
| Rate for Payer: Aetna Commercial |
$13.10
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cigna All Commercial |
$13.08
|
| Rate for Payer: CORVEL All Commercial |
$14.10
|
| Rate for Payer: Coventry All Commercial |
$13.34
|
| Rate for Payer: Encore All Commercial |
$13.95
|
| Rate for Payer: Frontpath All Commercial |
$13.95
|
| Rate for Payer: Humana ChoiceCare |
$13.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.64
|
| Rate for Payer: PHCS All Commercial |
$11.37
|
| Rate for Payer: PHP All Commercial |
$11.50
|
| Rate for Payer: Sagamore Health Network All Products |
$11.70
|
| Rate for Payer: Signature Care EPO |
$12.58
|
| Rate for Payer: Signature Care PPO |
$13.34
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
|
|
HC SUTURE SILK 4-0 683G
|
Facility
|
OP
|
$15.16
|
|
| Hospital Charge Code |
41601464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.50
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Centivo All Commercial |
$7.73
|
| Rate for Payer: Cigna All Commercial |
$13.08
|
| Rate for Payer: CORVEL All Commercial |
$14.10
|
| Rate for Payer: Coventry All Commercial |
$13.34
|
| Rate for Payer: Encore All Commercial |
$13.95
|
| Rate for Payer: Frontpath All Commercial |
$13.95
|
| Rate for Payer: Humana ChoiceCare |
$13.09
|
| Rate for Payer: Humana Medicare |
$7.73
|
| Rate for Payer: Lucent All Commercial |
$7.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.37
|
| Rate for Payer: PHP All Commercial |
$11.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.91
|
| Rate for Payer: Sagamore Health Network All Products |
$11.70
|
| Rate for Payer: Signature Care EPO |
$12.58
|
| Rate for Payer: Signature Care PPO |
$13.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.89
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
| Rate for Payer: United Healthcare Medicare |
$5.00
|
|
|
HC SUTURE SILK 4-0 789G
|
Facility
|
OP
|
$41.20
|
|
| Hospital Charge Code |
41601590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: Aetna Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.96
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Centivo All Commercial |
$21.01
|
| Rate for Payer: Cigna All Commercial |
$35.56
|
| Rate for Payer: CORVEL All Commercial |
$38.32
|
| Rate for Payer: Coventry All Commercial |
$36.26
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Frontpath All Commercial |
$37.90
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana Medicare |
$21.01
|
| Rate for Payer: Lucent All Commercial |
$21.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$30.90
|
| Rate for Payer: PHP All Commercial |
$31.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.07
|
| Rate for Payer: Sagamore Health Network All Products |
$31.81
|
| Rate for Payer: Signature Care EPO |
$34.20
|
| Rate for Payer: Signature Care PPO |
$36.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.02
|
| Rate for Payer: United Healthcare Commercial |
$32.47
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
|
|
HC SUTURE SILK 4-0 789G
|
Facility
|
IP
|
$41.20
|
|
| Hospital Charge Code |
41601590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$38.32 |
| Rate for Payer: Aetna Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cigna All Commercial |
$35.56
|
| Rate for Payer: CORVEL All Commercial |
$38.32
|
| Rate for Payer: Coventry All Commercial |
$36.26
|
| Rate for Payer: Encore All Commercial |
$37.92
|
| Rate for Payer: Frontpath All Commercial |
$37.90
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.08
|
| Rate for Payer: PHCS All Commercial |
$30.90
|
| Rate for Payer: PHP All Commercial |
$31.25
|
| Rate for Payer: Sagamore Health Network All Products |
$31.81
|
| Rate for Payer: Signature Care EPO |
$34.20
|
| Rate for Payer: Signature Care PPO |
$36.26
|
| Rate for Payer: United Healthcare Commercial |
$32.47
|
|
|
HC SUTURE SILK 4-0 K831H
|
Facility
|
OP
|
$8.37
|
|
| Hospital Charge Code |
41601536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Centivo All Commercial |
$4.27
|
| Rate for Payer: Cigna All Commercial |
$7.22
|
| Rate for Payer: CORVEL All Commercial |
$7.78
|
| Rate for Payer: Coventry All Commercial |
$7.37
|
| Rate for Payer: Encore All Commercial |
$7.70
|
| Rate for Payer: Frontpath All Commercial |
$7.70
|
| Rate for Payer: Humana ChoiceCare |
$7.23
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Lucent All Commercial |
$4.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.28
|
| Rate for Payer: PHP All Commercial |
$6.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.26
|
| Rate for Payer: Sagamore Health Network All Products |
$6.46
|
| Rate for Payer: Signature Care EPO |
$6.95
|
| Rate for Payer: Signature Care PPO |
$7.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.11
|
| Rate for Payer: United Healthcare Commercial |
$6.60
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
|
|
HC SUTURE SILK 4-0 K831H
|
Facility
|
IP
|
$8.37
|
|
| Hospital Charge Code |
41601536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cigna All Commercial |
$7.22
|
| Rate for Payer: CORVEL All Commercial |
$7.78
|
| Rate for Payer: Coventry All Commercial |
$7.37
|
| Rate for Payer: Encore All Commercial |
$7.70
|
| Rate for Payer: Frontpath All Commercial |
$7.70
|
| Rate for Payer: Humana ChoiceCare |
$7.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.53
|
| Rate for Payer: PHCS All Commercial |
$6.28
|
| Rate for Payer: PHP All Commercial |
$6.35
|
| Rate for Payer: Sagamore Health Network All Products |
$6.46
|
| Rate for Payer: Signature Care EPO |
$6.95
|
| Rate for Payer: Signature Care PPO |
$7.37
|
| Rate for Payer: United Healthcare Commercial |
$6.60
|
|
|
HC SUTURE SILK 4-0 K871H
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41601584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.82
|
| Rate for Payer: Aetna Medicare |
$4.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Centivo All Commercial |
$7.14
|
| Rate for Payer: Cigna All Commercial |
$12.08
|
| Rate for Payer: CORVEL All Commercial |
$13.02
|
| Rate for Payer: Coventry All Commercial |
$12.32
|
| Rate for Payer: Encore All Commercial |
$12.89
|
| Rate for Payer: Frontpath All Commercial |
$12.88
|
| Rate for Payer: Humana ChoiceCare |
$12.09
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Lucent All Commercial |
$7.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.50
|
| Rate for Payer: PHP All Commercial |
$10.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.46
|
| Rate for Payer: Sagamore Health Network All Products |
$10.81
|
| Rate for Payer: Signature Care EPO |
$11.62
|
| Rate for Payer: Signature Care PPO |
$12.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.90
|
| Rate for Payer: United Healthcare Commercial |
$11.03
|
| Rate for Payer: United Healthcare Medicare |
$4.62
|
|
|
HC SUTURE SILK 4-0 K871H
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
41601584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$13.02 |
| Rate for Payer: Aetna Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cigna All Commercial |
$12.08
|
| Rate for Payer: CORVEL All Commercial |
$13.02
|
| Rate for Payer: Coventry All Commercial |
$12.32
|
| Rate for Payer: Encore All Commercial |
$12.89
|
| Rate for Payer: Frontpath All Commercial |
$12.88
|
| Rate for Payer: Humana ChoiceCare |
$12.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.60
|
| Rate for Payer: PHCS All Commercial |
$10.50
|
| Rate for Payer: PHP All Commercial |
$10.62
|
| Rate for Payer: Sagamore Health Network All Products |
$10.81
|
| Rate for Payer: Signature Care EPO |
$11.62
|
| Rate for Payer: Signature Care PPO |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$11.03
|
|
|
HC SUTURE SILK 6-0 780G
|
Facility
|
OP
|
$80.76
|
|
| Hospital Charge Code |
41601540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$68.16
|
| Rate for Payer: Aetna Medicare |
$26.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.32
|
| Rate for Payer: Cash Price |
$50.07
|
| Rate for Payer: Cash Price |
$50.07
|
| Rate for Payer: Centivo All Commercial |
$41.19
|
| Rate for Payer: Cigna All Commercial |
$69.70
|
| Rate for Payer: CORVEL All Commercial |
$75.11
|
| Rate for Payer: Coventry All Commercial |
$71.07
|
| Rate for Payer: Encore All Commercial |
$74.34
|
| Rate for Payer: Frontpath All Commercial |
$74.30
|
| Rate for Payer: Humana ChoiceCare |
$69.75
|
| Rate for Payer: Humana Medicare |
$41.19
|
| Rate for Payer: Lucent All Commercial |
$41.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$60.57
|
| Rate for Payer: PHP All Commercial |
$61.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.50
|
| Rate for Payer: Sagamore Health Network All Products |
$62.35
|
| Rate for Payer: Signature Care EPO |
$67.03
|
| Rate for Payer: Signature Care PPO |
$71.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.65
|
| Rate for Payer: United Healthcare Commercial |
$63.64
|
| Rate for Payer: United Healthcare Medicare |
$26.65
|
|
|
HC SUTURE SILK 6-0 780G
|
Facility
|
IP
|
$80.76
|
|
| Hospital Charge Code |
41601540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.57 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: Aetna Commercial |
$69.78
|
| Rate for Payer: Cash Price |
$50.07
|
| Rate for Payer: Cigna All Commercial |
$69.70
|
| Rate for Payer: CORVEL All Commercial |
$75.11
|
| Rate for Payer: Coventry All Commercial |
$71.07
|
| Rate for Payer: Encore All Commercial |
$74.34
|
| Rate for Payer: Frontpath All Commercial |
$74.30
|
| Rate for Payer: Humana ChoiceCare |
$69.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.68
|
| Rate for Payer: PHCS All Commercial |
$60.57
|
| Rate for Payer: PHP All Commercial |
$61.25
|
| Rate for Payer: Sagamore Health Network All Products |
$62.35
|
| Rate for Payer: Signature Care EPO |
$67.03
|
| Rate for Payer: Signature Care PPO |
$71.07
|
| Rate for Payer: United Healthcare Commercial |
$63.64
|
|
|
HC SUTURE SILK 7-0 768G
|
Facility
|
IP
|
$266.46
|
|
| Hospital Charge Code |
41601539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.84 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$230.22
|
| Rate for Payer: Cash Price |
$165.21
|
| Rate for Payer: Cigna All Commercial |
$229.95
|
| Rate for Payer: CORVEL All Commercial |
$247.81
|
| Rate for Payer: Coventry All Commercial |
$234.48
|
| Rate for Payer: Encore All Commercial |
$245.28
|
| Rate for Payer: Frontpath All Commercial |
$245.14
|
| Rate for Payer: Humana ChoiceCare |
$230.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.81
|
| Rate for Payer: PHCS All Commercial |
$199.84
|
| Rate for Payer: PHP All Commercial |
$202.08
|
| Rate for Payer: Sagamore Health Network All Products |
$205.71
|
| Rate for Payer: Signature Care EPO |
$221.16
|
| Rate for Payer: Signature Care PPO |
$234.48
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
|
|
HC SUTURE SILK 7-0 768G
|
Facility
|
OP
|
$266.46
|
|
| Hospital Charge Code |
41601539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$224.89
|
| Rate for Payer: Aetna Medicare |
$87.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$153.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$166.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.72
|
| Rate for Payer: Cash Price |
$165.21
|
| Rate for Payer: Cash Price |
$165.21
|
| Rate for Payer: Centivo All Commercial |
$135.89
|
| Rate for Payer: Cigna All Commercial |
$229.95
|
| Rate for Payer: CORVEL All Commercial |
$247.81
|
| Rate for Payer: Coventry All Commercial |
$234.48
|
| Rate for Payer: Encore All Commercial |
$245.28
|
| Rate for Payer: Frontpath All Commercial |
$245.14
|
| Rate for Payer: Humana ChoiceCare |
$230.14
|
| Rate for Payer: Humana Medicare |
$135.89
|
| Rate for Payer: Lucent All Commercial |
$135.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$239.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$199.84
|
| Rate for Payer: PHP All Commercial |
$202.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.92
|
| Rate for Payer: Sagamore Health Network All Products |
$205.71
|
| Rate for Payer: Signature Care EPO |
$221.16
|
| Rate for Payer: Signature Care PPO |
$234.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$226.49
|
| Rate for Payer: United Healthcare Commercial |
$209.97
|
| Rate for Payer: United Healthcare Medicare |
$87.93
|
|
|
HC SUTURE SMART STITCH
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
41601257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,296.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cigna All Commercial |
$1,294.50
|
| Rate for Payer: CORVEL All Commercial |
$1,395.00
|
| Rate for Payer: Coventry All Commercial |
$1,320.00
|
| Rate for Payer: Encore All Commercial |
$1,380.75
|
| Rate for Payer: Frontpath All Commercial |
$1,380.00
|
| Rate for Payer: Humana ChoiceCare |
$1,295.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,350.00
|
| Rate for Payer: PHCS All Commercial |
$1,125.00
|
| Rate for Payer: PHP All Commercial |
$1,137.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,158.00
|
| Rate for Payer: Signature Care EPO |
$1,245.00
|
| Rate for Payer: Signature Care PPO |
$1,320.00
|
| Rate for Payer: United Healthcare Commercial |
$1,182.00
|
|
|
HC SUTURE SMART STITCH
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
41601257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$1,266.00
|
| Rate for Payer: Aetna Medicare |
$495.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$495.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$861.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$937.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$569.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$544.50
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Cash Price |
$930.00
|
| Rate for Payer: Centivo All Commercial |
$765.00
|
| Rate for Payer: Cigna All Commercial |
$1,294.50
|
| Rate for Payer: CORVEL All Commercial |
$1,395.00
|
| Rate for Payer: Coventry All Commercial |
$1,320.00
|
| Rate for Payer: Encore All Commercial |
$1,380.75
|
| Rate for Payer: Frontpath All Commercial |
$1,380.00
|
| Rate for Payer: Humana ChoiceCare |
$1,295.55
|
| Rate for Payer: Humana Medicare |
$765.00
|
| Rate for Payer: Lucent All Commercial |
$765.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,350.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,125.00
|
| Rate for Payer: PHP All Commercial |
$1,137.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$585.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,158.00
|
| Rate for Payer: Signature Care EPO |
$1,245.00
|
| Rate for Payer: Signature Care PPO |
$1,320.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare Commercial |
$1,182.00
|
| Rate for Payer: United Healthcare Medicare |
$495.00
|
|
|
HC SUTURE SPEEDSTITCH MINI MAG
|
Facility
|
OP
|
$865.00
|
|
| Hospital Charge Code |
41601258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$804.45 |
| Rate for Payer: Aetna Commercial |
$730.06
|
| Rate for Payer: Aetna Medicare |
$285.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$285.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$496.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$540.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$328.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$314.00
|
| Rate for Payer: Cash Price |
$536.30
|
| Rate for Payer: Cash Price |
$536.30
|
| Rate for Payer: Centivo All Commercial |
$441.15
|
| Rate for Payer: Cigna All Commercial |
$746.50
|
| Rate for Payer: CORVEL All Commercial |
$804.45
|
| Rate for Payer: Coventry All Commercial |
$761.20
|
| Rate for Payer: Encore All Commercial |
$796.23
|
| Rate for Payer: Frontpath All Commercial |
$795.80
|
| Rate for Payer: Humana ChoiceCare |
$747.10
|
| Rate for Payer: Humana Medicare |
$441.15
|
| Rate for Payer: Lucent All Commercial |
$441.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$648.75
|
| Rate for Payer: PHP All Commercial |
$656.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$337.35
|
| Rate for Payer: Sagamore Health Network All Products |
$667.78
|
| Rate for Payer: Signature Care EPO |
$717.95
|
| Rate for Payer: Signature Care PPO |
$761.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$735.25
|
| Rate for Payer: United Healthcare Commercial |
$681.62
|
| Rate for Payer: United Healthcare Medicare |
$285.45
|
|
|
HC SUTURE SPEEDSTITCH MINI MAG
|
Facility
|
IP
|
$865.00
|
|
| Hospital Charge Code |
41601258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$648.75 |
| Max. Negotiated Rate |
$804.45 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Cash Price |
$536.30
|
| Rate for Payer: Cigna All Commercial |
$746.50
|
| Rate for Payer: CORVEL All Commercial |
$804.45
|
| Rate for Payer: Coventry All Commercial |
$761.20
|
| Rate for Payer: Encore All Commercial |
$796.23
|
| Rate for Payer: Frontpath All Commercial |
$795.80
|
| Rate for Payer: Humana ChoiceCare |
$747.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$778.50
|
| Rate for Payer: PHCS All Commercial |
$648.75
|
| Rate for Payer: PHP All Commercial |
$656.02
|
| Rate for Payer: Sagamore Health Network All Products |
$667.78
|
| Rate for Payer: Signature Care EPO |
$717.95
|
| Rate for Payer: Signature Care PPO |
$761.20
|
| Rate for Payer: United Healthcare Commercial |
$681.62
|
|
|
HC SUTURE STEEL 2-0 SS28G
|
Facility
|
OP
|
$162.32
|
|
| Hospital Charge Code |
41601156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$137.00
|
| Rate for Payer: Aetna Medicare |
$53.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$93.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$101.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.92
|
| Rate for Payer: Cash Price |
$100.64
|
| Rate for Payer: Cash Price |
$100.64
|
| Rate for Payer: Centivo All Commercial |
$82.78
|
| Rate for Payer: Cigna All Commercial |
$140.08
|
| Rate for Payer: CORVEL All Commercial |
$150.96
|
| Rate for Payer: Coventry All Commercial |
$142.84
|
| Rate for Payer: Encore All Commercial |
$149.42
|
| Rate for Payer: Frontpath All Commercial |
$149.33
|
| Rate for Payer: Humana ChoiceCare |
$140.20
|
| Rate for Payer: Humana Medicare |
$82.78
|
| Rate for Payer: Lucent All Commercial |
$82.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$121.74
|
| Rate for Payer: PHP All Commercial |
$123.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.30
|
| Rate for Payer: Sagamore Health Network All Products |
$125.31
|
| Rate for Payer: Signature Care EPO |
$134.73
|
| Rate for Payer: Signature Care PPO |
$142.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137.97
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
| Rate for Payer: United Healthcare Medicare |
$53.57
|
|
|
HC SUTURE STEEL 2-0 SS28G
|
Facility
|
IP
|
$162.32
|
|
| Hospital Charge Code |
41601156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.74 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$140.24
|
| Rate for Payer: Cash Price |
$100.64
|
| Rate for Payer: Cigna All Commercial |
$140.08
|
| Rate for Payer: CORVEL All Commercial |
$150.96
|
| Rate for Payer: Coventry All Commercial |
$142.84
|
| Rate for Payer: Encore All Commercial |
$149.42
|
| Rate for Payer: Frontpath All Commercial |
$149.33
|
| Rate for Payer: Humana ChoiceCare |
$140.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.09
|
| Rate for Payer: PHCS All Commercial |
$121.74
|
| Rate for Payer: PHP All Commercial |
$123.10
|
| Rate for Payer: Sagamore Health Network All Products |
$125.31
|
| Rate for Payer: Signature Care EPO |
$134.73
|
| Rate for Payer: Signature Care PPO |
$142.84
|
| Rate for Payer: United Healthcare Commercial |
$127.91
|
|
|
HC SUTURE SUPRAMID 3-0 HEA-30
|
Facility
|
OP
|
$126.88
|
|
| Hospital Charge Code |
41606248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$107.09
|
| Rate for Payer: Aetna Medicare |
$41.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.06
|
| Rate for Payer: Cash Price |
$78.67
|
| Rate for Payer: Cash Price |
$78.67
|
| Rate for Payer: Centivo All Commercial |
$64.71
|
| Rate for Payer: Cigna All Commercial |
$109.50
|
| Rate for Payer: CORVEL All Commercial |
$118.00
|
| Rate for Payer: Coventry All Commercial |
$111.65
|
| Rate for Payer: Encore All Commercial |
$116.79
|
| Rate for Payer: Frontpath All Commercial |
$116.73
|
| Rate for Payer: Humana ChoiceCare |
$109.59
|
| Rate for Payer: Humana Medicare |
$64.71
|
| Rate for Payer: Lucent All Commercial |
$64.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.19
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$95.16
|
| Rate for Payer: PHP All Commercial |
$96.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.48
|
| Rate for Payer: Sagamore Health Network All Products |
$97.95
|
| Rate for Payer: Signature Care EPO |
$105.31
|
| Rate for Payer: Signature Care PPO |
$111.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.85
|
| Rate for Payer: United Healthcare Commercial |
$99.98
|
| Rate for Payer: United Healthcare Medicare |
$41.87
|
|
