|
HC SUTURE VICRYL 0 J207G
|
Facility
|
IP
|
$17.53
|
|
| Hospital Charge Code |
41601585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$16.30 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cigna All Commercial |
$15.13
|
| Rate for Payer: CORVEL All Commercial |
$16.30
|
| Rate for Payer: Coventry All Commercial |
$15.43
|
| Rate for Payer: Encore All Commercial |
$16.14
|
| Rate for Payer: Frontpath All Commercial |
$16.13
|
| Rate for Payer: Humana ChoiceCare |
$15.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.78
|
| Rate for Payer: PHCS All Commercial |
$13.15
|
| Rate for Payer: PHP All Commercial |
$13.29
|
| Rate for Payer: Sagamore Health Network All Products |
$13.53
|
| Rate for Payer: Signature Care EPO |
$14.55
|
| Rate for Payer: Signature Care PPO |
$15.43
|
| Rate for Payer: United Healthcare Commercial |
$13.81
|
|
|
HC SUTURE VICRYL 0 J207G
|
Facility
|
OP
|
$17.53
|
|
| Hospital Charge Code |
41601585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.80
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.36
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: Centivo All Commercial |
$8.94
|
| Rate for Payer: Cigna All Commercial |
$15.13
|
| Rate for Payer: CORVEL All Commercial |
$16.30
|
| Rate for Payer: Coventry All Commercial |
$15.43
|
| Rate for Payer: Encore All Commercial |
$16.14
|
| Rate for Payer: Frontpath All Commercial |
$16.13
|
| Rate for Payer: Humana ChoiceCare |
$15.14
|
| Rate for Payer: Humana Medicare |
$8.94
|
| Rate for Payer: Lucent All Commercial |
$8.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.78
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$13.15
|
| Rate for Payer: PHP All Commercial |
$13.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.84
|
| Rate for Payer: Sagamore Health Network All Products |
$13.53
|
| Rate for Payer: Signature Care EPO |
$14.55
|
| Rate for Payer: Signature Care PPO |
$15.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.90
|
| Rate for Payer: United Healthcare Commercial |
$13.81
|
| Rate for Payer: United Healthcare Medicare |
$5.78
|
|
|
HC SUTURE VICRYL 0 J287G UNDYED
|
Facility
|
OP
|
$14.47
|
|
| Hospital Charge Code |
41601566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.25
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Centivo All Commercial |
$7.38
|
| Rate for Payer: Cigna All Commercial |
$12.49
|
| Rate for Payer: CORVEL All Commercial |
$13.46
|
| Rate for Payer: Coventry All Commercial |
$12.73
|
| Rate for Payer: Encore All Commercial |
$13.32
|
| Rate for Payer: Frontpath All Commercial |
$13.31
|
| Rate for Payer: Humana ChoiceCare |
$12.50
|
| Rate for Payer: Humana Medicare |
$7.38
|
| Rate for Payer: Lucent All Commercial |
$7.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.85
|
| Rate for Payer: PHP All Commercial |
$10.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.64
|
| Rate for Payer: Sagamore Health Network All Products |
$11.17
|
| Rate for Payer: Signature Care EPO |
$12.01
|
| Rate for Payer: Signature Care PPO |
$12.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.30
|
| Rate for Payer: United Healthcare Commercial |
$11.40
|
| Rate for Payer: United Healthcare Medicare |
$4.78
|
|
|
HC SUTURE VICRYL 0 J287G UNDYED
|
Facility
|
IP
|
$14.47
|
|
| Hospital Charge Code |
41601566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: Aetna Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cigna All Commercial |
$12.49
|
| Rate for Payer: CORVEL All Commercial |
$13.46
|
| Rate for Payer: Coventry All Commercial |
$12.73
|
| Rate for Payer: Encore All Commercial |
$13.32
|
| Rate for Payer: Frontpath All Commercial |
$13.31
|
| Rate for Payer: Humana ChoiceCare |
$12.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.02
|
| Rate for Payer: PHCS All Commercial |
$10.85
|
| Rate for Payer: PHP All Commercial |
$10.97
|
| Rate for Payer: Sagamore Health Network All Products |
$11.17
|
| Rate for Payer: Signature Care EPO |
$12.01
|
| Rate for Payer: Signature Care PPO |
$12.73
|
| Rate for Payer: United Healthcare Commercial |
$11.40
|
|
|
HC SUTURE VICRYL 0 J346H
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
41601549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.27
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Centivo All Commercial |
$7.41
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Humana Medicare |
$7.41
|
| Rate for Payer: Lucent All Commercial |
$7.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.67
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
| Rate for Payer: United Healthcare Medicare |
$4.79
|
|
|
HC SUTURE VICRYL 0 J346H
|
Facility
|
IP
|
$14.53
|
|
| Hospital Charge Code |
41601549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$9.01
|
| Rate for Payer: Cigna All Commercial |
$12.54
|
| Rate for Payer: CORVEL All Commercial |
$13.51
|
| Rate for Payer: Coventry All Commercial |
$12.79
|
| Rate for Payer: Encore All Commercial |
$13.37
|
| Rate for Payer: Frontpath All Commercial |
$13.37
|
| Rate for Payer: Humana ChoiceCare |
$12.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.08
|
| Rate for Payer: PHCS All Commercial |
$10.90
|
| Rate for Payer: PHP All Commercial |
$11.02
|
| Rate for Payer: Sagamore Health Network All Products |
$11.22
|
| Rate for Payer: Signature Care EPO |
$12.06
|
| Rate for Payer: Signature Care PPO |
$12.79
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
|
|
HC SUTURE VICRYL 0 J370H
|
Facility
|
IP
|
$11.40
|
|
| Hospital Charge Code |
41603246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cigna All Commercial |
$9.84
|
| Rate for Payer: CORVEL All Commercial |
$10.60
|
| Rate for Payer: Coventry All Commercial |
$10.03
|
| Rate for Payer: Encore All Commercial |
$10.49
|
| Rate for Payer: Frontpath All Commercial |
$10.49
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.26
|
| Rate for Payer: PHCS All Commercial |
$8.55
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Sagamore Health Network All Products |
$8.80
|
| Rate for Payer: Signature Care EPO |
$9.46
|
| Rate for Payer: Signature Care PPO |
$10.03
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
|
|
HC SUTURE VICRYL 0 J370H
|
Facility
|
OP
|
$11.40
|
|
| Hospital Charge Code |
41603246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Aetna Medicare |
$3.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.14
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Centivo All Commercial |
$5.81
|
| Rate for Payer: Cigna All Commercial |
$9.84
|
| Rate for Payer: CORVEL All Commercial |
$10.60
|
| Rate for Payer: Coventry All Commercial |
$10.03
|
| Rate for Payer: Encore All Commercial |
$10.49
|
| Rate for Payer: Frontpath All Commercial |
$10.49
|
| Rate for Payer: Humana ChoiceCare |
$9.85
|
| Rate for Payer: Humana Medicare |
$5.81
|
| Rate for Payer: Lucent All Commercial |
$5.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.55
|
| Rate for Payer: PHP All Commercial |
$8.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.45
|
| Rate for Payer: Sagamore Health Network All Products |
$8.80
|
| Rate for Payer: Signature Care EPO |
$9.46
|
| Rate for Payer: Signature Care PPO |
$10.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.69
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
| Rate for Payer: United Healthcare Medicare |
$3.76
|
|
|
HC SUTURE VICRYL 0 J376H
|
Facility
|
OP
|
$12.99
|
|
| Hospital Charge Code |
41601158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$8.05
|
| Rate for Payer: Cash Price |
$8.05
|
| Rate for Payer: Centivo All Commercial |
$6.62
|
| Rate for Payer: Cigna All Commercial |
$11.21
|
| Rate for Payer: CORVEL All Commercial |
$12.08
|
| Rate for Payer: Coventry All Commercial |
$11.43
|
| Rate for Payer: Encore All Commercial |
$11.96
|
| Rate for Payer: Frontpath All Commercial |
$11.95
|
| Rate for Payer: Humana ChoiceCare |
$11.22
|
| Rate for Payer: Humana Medicare |
$6.62
|
| Rate for Payer: Lucent All Commercial |
$6.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.74
|
| Rate for Payer: PHP All Commercial |
$9.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.07
|
| Rate for Payer: Sagamore Health Network All Products |
$10.03
|
| Rate for Payer: Signature Care EPO |
$10.78
|
| Rate for Payer: Signature Care PPO |
$11.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.04
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
|
|
HC SUTURE VICRYL 0 J376H
|
Facility
|
IP
|
$12.99
|
|
| Hospital Charge Code |
41601158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Cash Price |
$8.05
|
| Rate for Payer: Cigna All Commercial |
$11.21
|
| Rate for Payer: CORVEL All Commercial |
$12.08
|
| Rate for Payer: Coventry All Commercial |
$11.43
|
| Rate for Payer: Encore All Commercial |
$11.96
|
| Rate for Payer: Frontpath All Commercial |
$11.95
|
| Rate for Payer: Humana ChoiceCare |
$11.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.69
|
| Rate for Payer: PHCS All Commercial |
$9.74
|
| Rate for Payer: PHP All Commercial |
$9.85
|
| Rate for Payer: Sagamore Health Network All Products |
$10.03
|
| Rate for Payer: Signature Care EPO |
$10.78
|
| Rate for Payer: Signature Care PPO |
$11.43
|
| Rate for Payer: United Healthcare Commercial |
$10.24
|
|
|
HC SUTURE VICRYL 0 J727D
|
Facility
|
IP
|
$128.44
|
|
| Hospital Charge Code |
41601159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Aetna Commercial |
$110.97
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cigna All Commercial |
$110.84
|
| Rate for Payer: CORVEL All Commercial |
$119.45
|
| Rate for Payer: Coventry All Commercial |
$113.03
|
| Rate for Payer: Encore All Commercial |
$118.23
|
| Rate for Payer: Frontpath All Commercial |
$118.16
|
| Rate for Payer: Humana ChoiceCare |
$110.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.60
|
| Rate for Payer: PHCS All Commercial |
$96.33
|
| Rate for Payer: PHP All Commercial |
$97.41
|
| Rate for Payer: Sagamore Health Network All Products |
$99.16
|
| Rate for Payer: Signature Care EPO |
$106.61
|
| Rate for Payer: Signature Care PPO |
$113.03
|
| Rate for Payer: United Healthcare Commercial |
$101.21
|
|
|
HC SUTURE VICRYL 0 J727D
|
Facility
|
OP
|
$128.44
|
|
| Hospital Charge Code |
41601159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$108.40
|
| Rate for Payer: Aetna Medicare |
$42.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.62
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Centivo All Commercial |
$65.50
|
| Rate for Payer: Cigna All Commercial |
$110.84
|
| Rate for Payer: CORVEL All Commercial |
$119.45
|
| Rate for Payer: Coventry All Commercial |
$113.03
|
| Rate for Payer: Encore All Commercial |
$118.23
|
| Rate for Payer: Frontpath All Commercial |
$118.16
|
| Rate for Payer: Humana ChoiceCare |
$110.93
|
| Rate for Payer: Humana Medicare |
$65.50
|
| Rate for Payer: Lucent All Commercial |
$65.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$96.33
|
| Rate for Payer: PHP All Commercial |
$97.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.09
|
| Rate for Payer: Sagamore Health Network All Products |
$99.16
|
| Rate for Payer: Signature Care EPO |
$106.61
|
| Rate for Payer: Signature Care PPO |
$113.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.17
|
| Rate for Payer: United Healthcare Commercial |
$101.21
|
| Rate for Payer: United Healthcare Medicare |
$42.39
|
|
|
HC SUTURE VICRYL 0 J906G
|
Facility
|
IP
|
$169.44
|
|
| Hospital Charge Code |
41601550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.08 |
| Max. Negotiated Rate |
$157.58 |
| Rate for Payer: Aetna Commercial |
$146.40
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna All Commercial |
$146.23
|
| Rate for Payer: CORVEL All Commercial |
$157.58
|
| Rate for Payer: Coventry All Commercial |
$149.11
|
| Rate for Payer: Encore All Commercial |
$155.97
|
| Rate for Payer: Frontpath All Commercial |
$155.88
|
| Rate for Payer: Humana ChoiceCare |
$146.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.50
|
| Rate for Payer: PHCS All Commercial |
$127.08
|
| Rate for Payer: PHP All Commercial |
$128.50
|
| Rate for Payer: Sagamore Health Network All Products |
$130.81
|
| Rate for Payer: Signature Care EPO |
$140.64
|
| Rate for Payer: Signature Care PPO |
$149.11
|
| Rate for Payer: United Healthcare Commercial |
$133.52
|
|
|
HC SUTURE VICRYL 0 J906G
|
Facility
|
OP
|
$169.44
|
|
| Hospital Charge Code |
41601550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$157.58 |
| Rate for Payer: Aetna Commercial |
$143.01
|
| Rate for Payer: Aetna Medicare |
$55.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$97.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$64.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$61.51
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Centivo All Commercial |
$86.41
|
| Rate for Payer: Cigna All Commercial |
$146.23
|
| Rate for Payer: CORVEL All Commercial |
$157.58
|
| Rate for Payer: Coventry All Commercial |
$149.11
|
| Rate for Payer: Encore All Commercial |
$155.97
|
| Rate for Payer: Frontpath All Commercial |
$155.88
|
| Rate for Payer: Humana ChoiceCare |
$146.35
|
| Rate for Payer: Humana Medicare |
$86.41
|
| Rate for Payer: Lucent All Commercial |
$86.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$127.08
|
| Rate for Payer: PHP All Commercial |
$128.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.08
|
| Rate for Payer: Sagamore Health Network All Products |
$130.81
|
| Rate for Payer: Signature Care EPO |
$140.64
|
| Rate for Payer: Signature Care PPO |
$149.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$144.02
|
| Rate for Payer: United Healthcare Commercial |
$133.52
|
| Rate for Payer: United Healthcare Medicare |
$55.92
|
|
|
HC SUTURE VICRYL 0 J946H
|
Facility
|
OP
|
$10.89
|
|
| Hospital Charge Code |
41601564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Aetna Medicare |
$3.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.95
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Centivo All Commercial |
$5.55
|
| Rate for Payer: Cigna All Commercial |
$9.40
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: Coventry All Commercial |
$9.58
|
| Rate for Payer: Encore All Commercial |
$10.02
|
| Rate for Payer: Frontpath All Commercial |
$10.02
|
| Rate for Payer: Humana ChoiceCare |
$9.41
|
| Rate for Payer: Humana Medicare |
$5.55
|
| Rate for Payer: Lucent All Commercial |
$5.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.17
|
| Rate for Payer: PHP All Commercial |
$8.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.25
|
| Rate for Payer: Sagamore Health Network All Products |
$8.41
|
| Rate for Payer: Signature Care EPO |
$9.04
|
| Rate for Payer: Signature Care PPO |
$9.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
| Rate for Payer: United Healthcare Medicare |
$3.59
|
|
|
HC SUTURE VICRYL 0 J946H
|
Facility
|
IP
|
$10.89
|
|
| Hospital Charge Code |
41601564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna All Commercial |
$9.40
|
| Rate for Payer: CORVEL All Commercial |
$10.13
|
| Rate for Payer: Coventry All Commercial |
$9.58
|
| Rate for Payer: Encore All Commercial |
$10.02
|
| Rate for Payer: Frontpath All Commercial |
$10.02
|
| Rate for Payer: Humana ChoiceCare |
$9.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.80
|
| Rate for Payer: PHCS All Commercial |
$8.17
|
| Rate for Payer: PHP All Commercial |
$8.26
|
| Rate for Payer: Sagamore Health Network All Products |
$8.41
|
| Rate for Payer: Signature Care EPO |
$9.04
|
| Rate for Payer: Signature Care PPO |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$8.58
|
|
|
HC SUTURE VICRYL 0 J958H
|
Facility
|
OP
|
$16.84
|
|
| Hospital Charge Code |
41601604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.11
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Centivo All Commercial |
$8.59
|
| Rate for Payer: Cigna All Commercial |
$14.53
|
| Rate for Payer: CORVEL All Commercial |
$15.66
|
| Rate for Payer: Coventry All Commercial |
$14.82
|
| Rate for Payer: Encore All Commercial |
$15.50
|
| Rate for Payer: Frontpath All Commercial |
$15.49
|
| Rate for Payer: Humana ChoiceCare |
$14.54
|
| Rate for Payer: Humana Medicare |
$8.59
|
| Rate for Payer: Lucent All Commercial |
$8.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.16
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.63
|
| Rate for Payer: PHP All Commercial |
$12.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.57
|
| Rate for Payer: Sagamore Health Network All Products |
$13.00
|
| Rate for Payer: Signature Care EPO |
$13.98
|
| Rate for Payer: Signature Care PPO |
$14.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.31
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Medicare |
$5.56
|
|
|
HC SUTURE VICRYL 0 J958H
|
Facility
|
IP
|
$16.84
|
|
| Hospital Charge Code |
41601604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna Commercial |
$14.55
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cigna All Commercial |
$14.53
|
| Rate for Payer: CORVEL All Commercial |
$15.66
|
| Rate for Payer: Coventry All Commercial |
$14.82
|
| Rate for Payer: Encore All Commercial |
$15.50
|
| Rate for Payer: Frontpath All Commercial |
$15.49
|
| Rate for Payer: Humana ChoiceCare |
$14.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.16
|
| Rate for Payer: PHCS All Commercial |
$12.63
|
| Rate for Payer: PHP All Commercial |
$12.77
|
| Rate for Payer: Sagamore Health Network All Products |
$13.00
|
| Rate for Payer: Signature Care EPO |
$13.98
|
| Rate for Payer: Signature Care PPO |
$14.82
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
|
|
HC SUTURE VICRYL 0 JB946
|
Facility
|
OP
|
$22.31
|
|
| Hospital Charge Code |
41601157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Centivo All Commercial |
$11.38
|
| Rate for Payer: Cigna All Commercial |
$19.25
|
| Rate for Payer: CORVEL All Commercial |
$20.75
|
| Rate for Payer: Coventry All Commercial |
$19.63
|
| Rate for Payer: Encore All Commercial |
$20.54
|
| Rate for Payer: Frontpath All Commercial |
$20.53
|
| Rate for Payer: Humana ChoiceCare |
$19.27
|
| Rate for Payer: Humana Medicare |
$11.38
|
| Rate for Payer: Lucent All Commercial |
$11.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.73
|
| Rate for Payer: PHP All Commercial |
$16.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.70
|
| Rate for Payer: Sagamore Health Network All Products |
$17.22
|
| Rate for Payer: Signature Care EPO |
$18.52
|
| Rate for Payer: Signature Care PPO |
$19.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare |
$7.36
|
|
|
HC SUTURE VICRYL 0 JB946
|
Facility
|
IP
|
$22.31
|
|
| Hospital Charge Code |
41601157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna All Commercial |
$19.25
|
| Rate for Payer: CORVEL All Commercial |
$20.75
|
| Rate for Payer: Coventry All Commercial |
$19.63
|
| Rate for Payer: Encore All Commercial |
$20.54
|
| Rate for Payer: Frontpath All Commercial |
$20.53
|
| Rate for Payer: Humana ChoiceCare |
$19.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.08
|
| Rate for Payer: PHCS All Commercial |
$16.73
|
| Rate for Payer: PHP All Commercial |
$16.92
|
| Rate for Payer: Sagamore Health Network All Products |
$17.22
|
| Rate for Payer: Signature Care EPO |
$18.52
|
| Rate for Payer: Signature Care PPO |
$19.63
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
|
|
HC SUTURE VICRYL 1-0 J335H
|
Facility
|
IP
|
$9.72
|
|
| Hospital Charge Code |
41601161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Aetna Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cigna All Commercial |
$8.39
|
| Rate for Payer: CORVEL All Commercial |
$9.04
|
| Rate for Payer: Coventry All Commercial |
$8.55
|
| Rate for Payer: Encore All Commercial |
$8.95
|
| Rate for Payer: Frontpath All Commercial |
$8.94
|
| Rate for Payer: Humana ChoiceCare |
$8.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.75
|
| Rate for Payer: PHCS All Commercial |
$7.29
|
| Rate for Payer: PHP All Commercial |
$7.37
|
| Rate for Payer: Sagamore Health Network All Products |
$7.50
|
| Rate for Payer: Signature Care EPO |
$8.07
|
| Rate for Payer: Signature Care PPO |
$8.55
|
| Rate for Payer: United Healthcare Commercial |
$7.66
|
|
|
HC SUTURE VICRYL 1-0 J335H
|
Facility
|
OP
|
$9.72
|
|
| Hospital Charge Code |
41601161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.20
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.53
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Centivo All Commercial |
$4.96
|
| Rate for Payer: Cigna All Commercial |
$8.39
|
| Rate for Payer: CORVEL All Commercial |
$9.04
|
| Rate for Payer: Coventry All Commercial |
$8.55
|
| Rate for Payer: Encore All Commercial |
$8.95
|
| Rate for Payer: Frontpath All Commercial |
$8.94
|
| Rate for Payer: Humana ChoiceCare |
$8.40
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Lucent All Commercial |
$4.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.29
|
| Rate for Payer: PHP All Commercial |
$7.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.79
|
| Rate for Payer: Sagamore Health Network All Products |
$7.50
|
| Rate for Payer: Signature Care EPO |
$8.07
|
| Rate for Payer: Signature Care PPO |
$8.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.26
|
| Rate for Payer: United Healthcare Commercial |
$7.66
|
| Rate for Payer: United Healthcare Medicare |
$3.21
|
|
|
HC SUTURE VICRYL 1-0 J371H
|
Facility
|
IP
|
$15.75
|
|
| Hospital Charge Code |
41601551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Aetna Commercial |
$13.61
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cigna All Commercial |
$13.59
|
| Rate for Payer: CORVEL All Commercial |
$14.65
|
| Rate for Payer: Coventry All Commercial |
$13.86
|
| Rate for Payer: Encore All Commercial |
$14.50
|
| Rate for Payer: Frontpath All Commercial |
$14.49
|
| Rate for Payer: Humana ChoiceCare |
$13.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$11.81
|
| Rate for Payer: PHP All Commercial |
$11.94
|
| Rate for Payer: Sagamore Health Network All Products |
$12.16
|
| Rate for Payer: Signature Care EPO |
$13.07
|
| Rate for Payer: Signature Care PPO |
$13.86
|
| Rate for Payer: United Healthcare Commercial |
$12.41
|
|
|
HC SUTURE VICRYL 1-0 J371H
|
Facility
|
OP
|
$15.75
|
|
| Hospital Charge Code |
41601551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.72
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Centivo All Commercial |
$8.03
|
| Rate for Payer: Cigna All Commercial |
$13.59
|
| Rate for Payer: CORVEL All Commercial |
$14.65
|
| Rate for Payer: Coventry All Commercial |
$13.86
|
| Rate for Payer: Encore All Commercial |
$14.50
|
| Rate for Payer: Frontpath All Commercial |
$14.49
|
| Rate for Payer: Humana ChoiceCare |
$13.60
|
| Rate for Payer: Humana Medicare |
$8.03
|
| Rate for Payer: Lucent All Commercial |
$8.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.81
|
| Rate for Payer: PHP All Commercial |
$11.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.14
|
| Rate for Payer: Sagamore Health Network All Products |
$12.16
|
| Rate for Payer: Signature Care EPO |
$13.07
|
| Rate for Payer: Signature Care PPO |
$13.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$12.41
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
|
|
HC SUTURE VICRYL 1 BLUNT JB947
|
Facility
|
OP
|
$23.23
|
|
| Hospital Charge Code |
41601565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.61
|
| Rate for Payer: Aetna Medicare |
$7.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.43
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Centivo All Commercial |
$11.85
|
| Rate for Payer: Cigna All Commercial |
$20.05
|
| Rate for Payer: CORVEL All Commercial |
$21.60
|
| Rate for Payer: Coventry All Commercial |
$20.44
|
| Rate for Payer: Encore All Commercial |
$21.38
|
| Rate for Payer: Frontpath All Commercial |
$21.37
|
| Rate for Payer: Humana ChoiceCare |
$20.06
|
| Rate for Payer: Humana Medicare |
$11.85
|
| Rate for Payer: Lucent All Commercial |
$11.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$17.42
|
| Rate for Payer: PHP All Commercial |
$17.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.06
|
| Rate for Payer: Sagamore Health Network All Products |
$17.93
|
| Rate for Payer: Signature Care EPO |
$19.28
|
| Rate for Payer: Signature Care PPO |
$20.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.75
|
| Rate for Payer: United Healthcare Commercial |
$18.31
|
| Rate for Payer: United Healthcare Medicare |
$7.67
|
|
