|
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
|
|
|
HC SUTURE TAPE UMBILICAL 1/16X30
|
Facility
|
IP
|
$0.52
|
|
| Hospital Charge Code |
41607736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna All Commercial |
$0.45
|
| Rate for Payer: CORVEL All Commercial |
$0.48
|
| Rate for Payer: Coventry All Commercial |
$0.46
|
| Rate for Payer: Encore All Commercial |
$0.48
|
| Rate for Payer: Frontpath All Commercial |
$0.48
|
| Rate for Payer: Humana ChoiceCare |
$0.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.47
|
| Rate for Payer: PHCS All Commercial |
$0.39
|
| Rate for Payer: PHP All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.40
|
| Rate for Payer: Signature Care EPO |
$0.43
|
| Rate for Payer: Signature Care PPO |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.41
|
|
|
HC SUTURE TAPE UMBILICAL 1/16X30
|
Facility
|
OP
|
$0.52
|
|
| Hospital Charge Code |
41607736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$0.44
|
| Rate for Payer: Aetna Medicare |
$0.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.19
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Centivo All Commercial |
$0.27
|
| Rate for Payer: Cigna All Commercial |
$0.45
|
| Rate for Payer: CORVEL All Commercial |
$0.48
|
| Rate for Payer: Coventry All Commercial |
$0.46
|
| Rate for Payer: Encore All Commercial |
$0.48
|
| Rate for Payer: Frontpath All Commercial |
$0.48
|
| Rate for Payer: Humana ChoiceCare |
$0.45
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Lucent All Commercial |
$0.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$0.39
|
| Rate for Payer: PHP All Commercial |
$0.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.20
|
| Rate for Payer: Sagamore Health Network All Products |
$0.40
|
| Rate for Payer: Signature Care EPO |
$0.43
|
| Rate for Payer: Signature Care PPO |
$0.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.41
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
|
|
HC SUTURE TAPE UMBILICAL U11T
|
Facility
|
IP
|
$11.70
|
|
| Hospital Charge Code |
41601544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cigna All Commercial |
$10.10
|
| Rate for Payer: CORVEL All Commercial |
$10.88
|
| Rate for Payer: Coventry All Commercial |
$10.30
|
| Rate for Payer: Encore All Commercial |
$10.77
|
| Rate for Payer: Frontpath All Commercial |
$10.76
|
| Rate for Payer: Humana ChoiceCare |
$10.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.53
|
| Rate for Payer: PHCS All Commercial |
$8.78
|
| Rate for Payer: PHP All Commercial |
$8.87
|
| Rate for Payer: Sagamore Health Network All Products |
$9.03
|
| Rate for Payer: Signature Care EPO |
$9.71
|
| Rate for Payer: Signature Care PPO |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$9.22
|
|
|
HC SUTURE TAPE UMBILICAL U11T
|
Facility
|
OP
|
$11.70
|
|
| Hospital Charge Code |
41601544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.25
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Centivo All Commercial |
$5.97
|
| Rate for Payer: Cigna All Commercial |
$10.10
|
| Rate for Payer: CORVEL All Commercial |
$10.88
|
| Rate for Payer: Coventry All Commercial |
$10.30
|
| Rate for Payer: Encore All Commercial |
$10.77
|
| Rate for Payer: Frontpath All Commercial |
$10.76
|
| Rate for Payer: Humana ChoiceCare |
$10.11
|
| Rate for Payer: Humana Medicare |
$5.97
|
| Rate for Payer: Lucent All Commercial |
$5.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.78
|
| Rate for Payer: PHP All Commercial |
$8.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.56
|
| Rate for Payer: Sagamore Health Network All Products |
$9.03
|
| Rate for Payer: Signature Care EPO |
$9.71
|
| Rate for Payer: Signature Care PPO |
$10.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.94
|
| Rate for Payer: United Healthcare Commercial |
$9.22
|
| Rate for Payer: United Healthcare Medicare |
$3.86
|
|
|
HC SUTURE TICRON 2 HOS-10
|
Facility
|
OP
|
$42.57
|
|
| Hospital Charge Code |
41603280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$35.93
|
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$24.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.45
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Centivo All Commercial |
$21.71
|
| Rate for Payer: Cigna All Commercial |
$36.74
|
| Rate for Payer: CORVEL All Commercial |
$39.59
|
| Rate for Payer: Coventry All Commercial |
$37.46
|
| Rate for Payer: Encore All Commercial |
$39.19
|
| Rate for Payer: Frontpath All Commercial |
$39.16
|
| Rate for Payer: Humana ChoiceCare |
$36.77
|
| Rate for Payer: Humana Medicare |
$21.71
|
| Rate for Payer: Lucent All Commercial |
$21.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.31
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$31.93
|
| Rate for Payer: PHP All Commercial |
$32.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.60
|
| Rate for Payer: Sagamore Health Network All Products |
$32.86
|
| Rate for Payer: Signature Care EPO |
$35.33
|
| Rate for Payer: Signature Care PPO |
$37.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.18
|
| Rate for Payer: United Healthcare Commercial |
$33.55
|
| Rate for Payer: United Healthcare Medicare |
$14.05
|
|
|
HC SUTURE TICRON 2 HOS-10
|
Facility
|
IP
|
$42.57
|
|
| Hospital Charge Code |
41603280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Aetna Commercial |
$36.78
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cigna All Commercial |
$36.74
|
| Rate for Payer: CORVEL All Commercial |
$39.59
|
| Rate for Payer: Coventry All Commercial |
$37.46
|
| Rate for Payer: Encore All Commercial |
$39.19
|
| Rate for Payer: Frontpath All Commercial |
$39.16
|
| Rate for Payer: Humana ChoiceCare |
$36.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.31
|
| Rate for Payer: PHCS All Commercial |
$31.93
|
| Rate for Payer: PHP All Commercial |
$32.29
|
| Rate for Payer: Sagamore Health Network All Products |
$32.86
|
| Rate for Payer: Signature Care EPO |
$35.33
|
| Rate for Payer: Signature Care PPO |
$37.46
|
| Rate for Payer: United Healthcare Commercial |
$33.55
|
|
|
HC SUTURE TICRON 3-0 3109-43
|
Facility
|
OP
|
$73.98
|
|
| Hospital Charge Code |
41601545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$62.44
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.85
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$63.84
|
| Rate for Payer: CORVEL All Commercial |
$68.80
|
| Rate for Payer: Coventry All Commercial |
$65.10
|
| Rate for Payer: Encore All Commercial |
$68.10
|
| Rate for Payer: Frontpath All Commercial |
$68.06
|
| Rate for Payer: Humana ChoiceCare |
$63.90
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.58
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$55.48
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.85
|
| Rate for Payer: Sagamore Health Network All Products |
$57.11
|
| Rate for Payer: Signature Care EPO |
$61.40
|
| Rate for Payer: Signature Care PPO |
$65.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.88
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$24.41
|
|
|
HC SUTURE TICRON 3-0 3109-43
|
Facility
|
IP
|
$73.98
|
|
| Hospital Charge Code |
41601545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$68.80 |
| Rate for Payer: Aetna Commercial |
$63.92
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna All Commercial |
$63.84
|
| Rate for Payer: CORVEL All Commercial |
$68.80
|
| Rate for Payer: Coventry All Commercial |
$65.10
|
| Rate for Payer: Encore All Commercial |
$68.10
|
| Rate for Payer: Frontpath All Commercial |
$68.06
|
| Rate for Payer: Humana ChoiceCare |
$63.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.58
|
| Rate for Payer: PHCS All Commercial |
$55.48
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.11
|
| Rate for Payer: Signature Care EPO |
$61.40
|
| Rate for Payer: Signature Care PPO |
$65.10
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC SUTURE TICRON 3-0 3256-41
|
Facility
|
OP
|
$72.63
|
|
| Hospital Charge Code |
41601548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$61.30
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.36
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Centivo All Commercial |
$37.04
|
| Rate for Payer: Cigna All Commercial |
$62.68
|
| Rate for Payer: CORVEL All Commercial |
$67.55
|
| Rate for Payer: Coventry All Commercial |
$63.91
|
| Rate for Payer: Encore All Commercial |
$66.86
|
| Rate for Payer: Frontpath All Commercial |
$66.82
|
| Rate for Payer: Humana ChoiceCare |
$62.73
|
| Rate for Payer: Humana Medicare |
$37.04
|
| Rate for Payer: Lucent All Commercial |
$37.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.37
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$54.47
|
| Rate for Payer: PHP All Commercial |
$55.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.33
|
| Rate for Payer: Sagamore Health Network All Products |
$56.07
|
| Rate for Payer: Signature Care EPO |
$60.28
|
| Rate for Payer: Signature Care PPO |
$63.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$61.74
|
| Rate for Payer: United Healthcare Commercial |
$57.23
|
| Rate for Payer: United Healthcare Medicare |
$23.97
|
|
|
HC SUTURE TICRON 3-0 3256-41
|
Facility
|
IP
|
$72.63
|
|
| Hospital Charge Code |
41601548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.47 |
| Max. Negotiated Rate |
$67.55 |
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Cigna All Commercial |
$62.68
|
| Rate for Payer: CORVEL All Commercial |
$67.55
|
| Rate for Payer: Coventry All Commercial |
$63.91
|
| Rate for Payer: Encore All Commercial |
$66.86
|
| Rate for Payer: Frontpath All Commercial |
$66.82
|
| Rate for Payer: Humana ChoiceCare |
$62.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.37
|
| Rate for Payer: PHCS All Commercial |
$54.47
|
| Rate for Payer: PHP All Commercial |
$55.08
|
| Rate for Payer: Sagamore Health Network All Products |
$56.07
|
| Rate for Payer: Signature Care EPO |
$60.28
|
| Rate for Payer: Signature Care PPO |
$63.91
|
| Rate for Payer: United Healthcare Commercial |
$57.23
|
|
|
HC SUTURE TICRON 4-0 SCD3059G
|
Facility
|
IP
|
$70.22
|
|
| Hospital Charge Code |
41601546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.66 |
| Max. Negotiated Rate |
$65.30 |
| Rate for Payer: Aetna Commercial |
$60.67
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cigna All Commercial |
$60.60
|
| Rate for Payer: CORVEL All Commercial |
$65.30
|
| Rate for Payer: Coventry All Commercial |
$61.79
|
| Rate for Payer: Encore All Commercial |
$64.64
|
| Rate for Payer: Frontpath All Commercial |
$64.60
|
| Rate for Payer: Humana ChoiceCare |
$60.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.20
|
| Rate for Payer: PHCS All Commercial |
$52.66
|
| Rate for Payer: PHP All Commercial |
$53.25
|
| Rate for Payer: Sagamore Health Network All Products |
$54.21
|
| Rate for Payer: Signature Care EPO |
$58.28
|
| Rate for Payer: Signature Care PPO |
$61.79
|
| Rate for Payer: United Healthcare Commercial |
$55.33
|
|
|
HC SUTURE TICRON 4-0 SCD3059G
|
Facility
|
OP
|
$70.22
|
|
| Hospital Charge Code |
41601546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$59.27
|
| Rate for Payer: Aetna Medicare |
$23.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.49
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Centivo All Commercial |
$35.81
|
| Rate for Payer: Cigna All Commercial |
$60.60
|
| Rate for Payer: CORVEL All Commercial |
$65.30
|
| Rate for Payer: Coventry All Commercial |
$61.79
|
| Rate for Payer: Encore All Commercial |
$64.64
|
| Rate for Payer: Frontpath All Commercial |
$64.60
|
| Rate for Payer: Humana ChoiceCare |
$60.65
|
| Rate for Payer: Humana Medicare |
$35.81
|
| Rate for Payer: Lucent All Commercial |
$35.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$52.66
|
| Rate for Payer: PHP All Commercial |
$53.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.39
|
| Rate for Payer: Sagamore Health Network All Products |
$54.21
|
| Rate for Payer: Signature Care EPO |
$58.28
|
| Rate for Payer: Signature Care PPO |
$61.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$59.69
|
| Rate for Payer: United Healthcare Commercial |
$55.33
|
| Rate for Payer: United Healthcare Medicare |
$23.17
|
|
|
HC SUTURE TICRON #5 3027-79
|
Facility
|
OP
|
$61.25
|
|
| Hospital Charge Code |
41601547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$51.70
|
| Rate for Payer: Aetna Medicare |
$20.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.23
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Centivo All Commercial |
$31.24
|
| Rate for Payer: Cigna All Commercial |
$52.86
|
| Rate for Payer: CORVEL All Commercial |
$56.96
|
| Rate for Payer: Coventry All Commercial |
$53.90
|
| Rate for Payer: Encore All Commercial |
$56.38
|
| Rate for Payer: Frontpath All Commercial |
$56.35
|
| Rate for Payer: Humana ChoiceCare |
$52.90
|
| Rate for Payer: Humana Medicare |
$31.24
|
| Rate for Payer: Lucent All Commercial |
$31.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$45.94
|
| Rate for Payer: PHP All Commercial |
$46.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.89
|
| Rate for Payer: Sagamore Health Network All Products |
$47.28
|
| Rate for Payer: Signature Care EPO |
$50.84
|
| Rate for Payer: Signature Care PPO |
$53.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.06
|
| Rate for Payer: United Healthcare Commercial |
$48.26
|
| Rate for Payer: United Healthcare Medicare |
$20.21
|
|
|
HC SUTURE TICRON #5 3027-79
|
Facility
|
IP
|
$61.25
|
|
| Hospital Charge Code |
41601547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$56.96 |
| Rate for Payer: Aetna Commercial |
$52.92
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna All Commercial |
$52.86
|
| Rate for Payer: CORVEL All Commercial |
$56.96
|
| Rate for Payer: Coventry All Commercial |
$53.90
|
| Rate for Payer: Encore All Commercial |
$56.38
|
| Rate for Payer: Frontpath All Commercial |
$56.35
|
| Rate for Payer: Humana ChoiceCare |
$52.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.12
|
| Rate for Payer: PHCS All Commercial |
$45.94
|
| Rate for Payer: PHP All Commercial |
$46.45
|
| Rate for Payer: Sagamore Health Network All Products |
$47.28
|
| Rate for Payer: Signature Care EPO |
$50.84
|
| Rate for Payer: Signature Care PPO |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$48.26
|
|
|
HC SUTURE VESSEL LOOP BLUE
|
Facility
|
OP
|
$8.06
|
|
| Hospital Charge Code |
41602417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.93
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Centivo All Commercial |
$4.11
|
| Rate for Payer: Cigna All Commercial |
$6.96
|
| Rate for Payer: CORVEL All Commercial |
$7.50
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.42
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Humana Medicare |
$4.11
|
| Rate for Payer: Lucent All Commercial |
$4.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.14
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare |
$2.66
|
|
|
HC SUTURE VESSEL LOOP BLUE
|
Facility
|
IP
|
$8.06
|
|
| Hospital Charge Code |
41602417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna All Commercial |
$6.96
|
| Rate for Payer: CORVEL All Commercial |
$7.50
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.42
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
|
|
HC SUTURE VESSEL LOOP RED
|
Facility
|
OP
|
$9.38
|
|
| Hospital Charge Code |
41601577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna Medicare |
$3.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.40
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Centivo All Commercial |
$4.78
|
| Rate for Payer: Cigna All Commercial |
$8.09
|
| Rate for Payer: CORVEL All Commercial |
$8.72
|
| Rate for Payer: Coventry All Commercial |
$8.25
|
| Rate for Payer: Encore All Commercial |
$8.63
|
| Rate for Payer: Frontpath All Commercial |
$8.63
|
| Rate for Payer: Humana ChoiceCare |
$8.10
|
| Rate for Payer: Humana Medicare |
$4.78
|
| Rate for Payer: Lucent All Commercial |
$4.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.44
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.04
|
| Rate for Payer: PHP All Commercial |
$7.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.66
|
| Rate for Payer: Sagamore Health Network All Products |
$7.24
|
| Rate for Payer: Signature Care EPO |
$7.79
|
| Rate for Payer: Signature Care PPO |
$8.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.97
|
| Rate for Payer: United Healthcare Commercial |
$7.39
|
| Rate for Payer: United Healthcare Medicare |
$3.10
|
|
|
HC SUTURE VESSEL LOOP RED
|
Facility
|
IP
|
$9.38
|
|
| Hospital Charge Code |
41601577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$8.09
|
| Rate for Payer: CORVEL All Commercial |
$8.72
|
| Rate for Payer: Coventry All Commercial |
$8.25
|
| Rate for Payer: Encore All Commercial |
$8.63
|
| Rate for Payer: Frontpath All Commercial |
$8.63
|
| Rate for Payer: Humana ChoiceCare |
$8.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.44
|
| Rate for Payer: PHCS All Commercial |
$7.04
|
| Rate for Payer: PHP All Commercial |
$7.11
|
| Rate for Payer: Sagamore Health Network All Products |
$7.24
|
| Rate for Payer: Signature Care EPO |
$7.79
|
| Rate for Payer: Signature Care PPO |
$8.25
|
| Rate for Payer: United Healthcare Commercial |
$7.39
|
|
|
HC SUTURE VESSEL LOOP WHITE
|
Facility
|
IP
|
$8.06
|
|
| Hospital Charge Code |
41602416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna All Commercial |
$6.96
|
| Rate for Payer: CORVEL All Commercial |
$7.50
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.42
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
|
|
HC SUTURE VESSEL LOOP WHITE
|
Facility
|
OP
|
$8.06
|
|
| Hospital Charge Code |
41602416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.93
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Centivo All Commercial |
$4.11
|
| Rate for Payer: Cigna All Commercial |
$6.96
|
| Rate for Payer: CORVEL All Commercial |
$7.50
|
| Rate for Payer: Coventry All Commercial |
$7.09
|
| Rate for Payer: Encore All Commercial |
$7.42
|
| Rate for Payer: Frontpath All Commercial |
$7.42
|
| Rate for Payer: Humana ChoiceCare |
$6.96
|
| Rate for Payer: Humana Medicare |
$4.11
|
| Rate for Payer: Lucent All Commercial |
$4.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$6.04
|
| Rate for Payer: PHP All Commercial |
$6.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.14
|
| Rate for Payer: Sagamore Health Network All Products |
$6.22
|
| Rate for Payer: Signature Care EPO |
$6.69
|
| Rate for Payer: Signature Care PPO |
$7.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$6.35
|
| Rate for Payer: United Healthcare Medicare |
$2.66
|
|
|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
IP
|
$14.15
|
|
| Hospital Charge Code |
41602404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$13.16 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cigna All Commercial |
$12.21
|
| Rate for Payer: CORVEL All Commercial |
$13.16
|
| Rate for Payer: Coventry All Commercial |
$12.45
|
| Rate for Payer: Encore All Commercial |
$13.03
|
| Rate for Payer: Frontpath All Commercial |
$13.02
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.74
|
| Rate for Payer: PHCS All Commercial |
$10.61
|
| Rate for Payer: PHP All Commercial |
$10.73
|
| Rate for Payer: Sagamore Health Network All Products |
$10.92
|
| Rate for Payer: Signature Care EPO |
$11.74
|
| Rate for Payer: Signature Care PPO |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$11.15
|
|
|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
OP
|
$14.15
|
|
| Hospital Charge Code |
41602404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.14
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Cash Price |
$8.77
|
| Rate for Payer: Centivo All Commercial |
$7.22
|
| Rate for Payer: Cigna All Commercial |
$12.21
|
| Rate for Payer: CORVEL All Commercial |
$13.16
|
| Rate for Payer: Coventry All Commercial |
$12.45
|
| Rate for Payer: Encore All Commercial |
$13.03
|
| Rate for Payer: Frontpath All Commercial |
$13.02
|
| Rate for Payer: Humana ChoiceCare |
$12.22
|
| Rate for Payer: Humana Medicare |
$7.22
|
| Rate for Payer: Lucent All Commercial |
$7.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.74
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.61
|
| Rate for Payer: PHP All Commercial |
$10.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.52
|
| Rate for Payer: Sagamore Health Network All Products |
$10.92
|
| Rate for Payer: Signature Care EPO |
$11.74
|
| Rate for Payer: Signature Care PPO |
$12.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.03
|
| Rate for Payer: United Healthcare Commercial |
$11.15
|
| Rate for Payer: United Healthcare Medicare |
$4.67
|
|
|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
IP
|
$40.37
|
|
| Hospital Charge Code |
41602403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$34.88
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cigna All Commercial |
$34.84
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.53
|
| Rate for Payer: Encore All Commercial |
$37.16
|
| Rate for Payer: Frontpath All Commercial |
$37.14
|
| Rate for Payer: Humana ChoiceCare |
$34.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: PHCS All Commercial |
$30.28
|
| Rate for Payer: PHP All Commercial |
$30.62
|
| Rate for Payer: Sagamore Health Network All Products |
$31.17
|
| Rate for Payer: Signature Care EPO |
$33.51
|
| Rate for Payer: Signature Care PPO |
$35.53
|
| Rate for Payer: United Healthcare Commercial |
$31.81
|
|
|
HC SUTURE VICRYL 0 CT-1
|
Facility
|
OP
|
$40.37
|
|
| Hospital Charge Code |
41602403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$23.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.65
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Centivo All Commercial |
$20.59
|
| Rate for Payer: Cigna All Commercial |
$34.84
|
| Rate for Payer: CORVEL All Commercial |
$37.54
|
| Rate for Payer: Coventry All Commercial |
$35.53
|
| Rate for Payer: Encore All Commercial |
$37.16
|
| Rate for Payer: Frontpath All Commercial |
$37.14
|
| Rate for Payer: Humana ChoiceCare |
$34.87
|
| Rate for Payer: Humana Medicare |
$20.59
|
| Rate for Payer: Lucent All Commercial |
$20.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.33
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$30.28
|
| Rate for Payer: PHP All Commercial |
$30.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.74
|
| Rate for Payer: Sagamore Health Network All Products |
$31.17
|
| Rate for Payer: Signature Care EPO |
$33.51
|
| Rate for Payer: Signature Care PPO |
$35.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.31
|
| Rate for Payer: United Healthcare Commercial |
$31.81
|
| Rate for Payer: United Healthcare Medicare |
$13.32
|
|
