|
HC SUTURE VICRYL 1 BLUNT JB947
|
Facility
|
IP
|
$23.23
|
|
| Hospital Charge Code |
41601565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.07
|
| Rate for Payer: Cash Price |
$14.40
|
| 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: Lutheran Preferred All Commercial |
$20.91
|
| Rate for Payer: PHCS All Commercial |
$17.42
|
| Rate for Payer: PHP All Commercial |
$17.62
|
| 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: United Healthcare Commercial |
$18.31
|
|
|
HC SUTURE VICRYL 1 CTX
|
Facility
|
IP
|
$13.38
|
|
| Hospital Charge Code |
41605573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: Aetna Commercial |
$11.56
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cigna All Commercial |
$11.55
|
| Rate for Payer: CORVEL All Commercial |
$12.44
|
| Rate for Payer: Coventry All Commercial |
$11.77
|
| Rate for Payer: Encore All Commercial |
$12.32
|
| Rate for Payer: Frontpath All Commercial |
$12.31
|
| Rate for Payer: Humana ChoiceCare |
$11.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.04
|
| Rate for Payer: PHCS All Commercial |
$10.04
|
| Rate for Payer: PHP All Commercial |
$10.15
|
| Rate for Payer: Sagamore Health Network All Products |
$10.33
|
| Rate for Payer: Signature Care EPO |
$11.11
|
| Rate for Payer: Signature Care PPO |
$11.77
|
| Rate for Payer: United Healthcare Commercial |
$10.54
|
|
|
HC SUTURE VICRYL 1 CTX
|
Facility
|
OP
|
$13.38
|
|
| Hospital Charge Code |
41605573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.29
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Centivo All Commercial |
$6.82
|
| Rate for Payer: Cigna All Commercial |
$11.55
|
| Rate for Payer: CORVEL All Commercial |
$12.44
|
| Rate for Payer: Coventry All Commercial |
$11.77
|
| Rate for Payer: Encore All Commercial |
$12.32
|
| Rate for Payer: Frontpath All Commercial |
$12.31
|
| Rate for Payer: Humana ChoiceCare |
$11.56
|
| Rate for Payer: Humana Medicare |
$6.82
|
| Rate for Payer: Lucent All Commercial |
$6.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.04
|
| Rate for Payer: PHP All Commercial |
$10.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.22
|
| Rate for Payer: Sagamore Health Network All Products |
$10.33
|
| Rate for Payer: Signature Care EPO |
$11.11
|
| Rate for Payer: Signature Care PPO |
$11.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.37
|
| Rate for Payer: United Healthcare Commercial |
$10.54
|
| Rate for Payer: United Healthcare Medicare |
$4.42
|
|
|
HC SUTURE VICRYL 1 J347H
|
Facility
|
IP
|
$10.63
|
|
| Hospital Charge Code |
41601578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
|
|
HC SUTURE VICRYL 1 J347H
|
Facility
|
OP
|
$10.63
|
|
| Hospital Charge Code |
41601578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.97
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.86
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Centivo All Commercial |
$5.42
|
| Rate for Payer: Cigna All Commercial |
$9.17
|
| Rate for Payer: CORVEL All Commercial |
$9.89
|
| Rate for Payer: Coventry All Commercial |
$9.35
|
| Rate for Payer: Encore All Commercial |
$9.78
|
| Rate for Payer: Frontpath All Commercial |
$9.78
|
| Rate for Payer: Humana ChoiceCare |
$9.18
|
| Rate for Payer: Humana Medicare |
$5.42
|
| Rate for Payer: Lucent All Commercial |
$5.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.97
|
| Rate for Payer: PHP All Commercial |
$8.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.15
|
| Rate for Payer: Sagamore Health Network All Products |
$8.21
|
| Rate for Payer: Signature Care EPO |
$8.82
|
| Rate for Payer: Signature Care PPO |
$9.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$8.38
|
| Rate for Payer: United Healthcare Medicare |
$3.51
|
|
|
HC SUTURE VICRYL 1 J959H
|
Facility
|
IP
|
$18.67
|
|
| Hospital Charge Code |
41601160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cigna All Commercial |
$16.11
|
| Rate for Payer: CORVEL All Commercial |
$17.36
|
| Rate for Payer: Coventry All Commercial |
$16.43
|
| Rate for Payer: Encore All Commercial |
$17.19
|
| Rate for Payer: Frontpath All Commercial |
$17.18
|
| Rate for Payer: Humana ChoiceCare |
$16.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$14.00
|
| Rate for Payer: PHP All Commercial |
$14.16
|
| Rate for Payer: Sagamore Health Network All Products |
$14.41
|
| Rate for Payer: Signature Care EPO |
$15.50
|
| Rate for Payer: Signature Care PPO |
$16.43
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
|
|
HC SUTURE VICRYL 1 J959H
|
Facility
|
OP
|
$18.67
|
|
| Hospital Charge Code |
41601160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Cash Price |
$11.58
|
| Rate for Payer: Centivo All Commercial |
$9.52
|
| Rate for Payer: Cigna All Commercial |
$16.11
|
| Rate for Payer: CORVEL All Commercial |
$17.36
|
| Rate for Payer: Coventry All Commercial |
$16.43
|
| Rate for Payer: Encore All Commercial |
$17.19
|
| Rate for Payer: Frontpath All Commercial |
$17.18
|
| Rate for Payer: Humana ChoiceCare |
$16.13
|
| Rate for Payer: Humana Medicare |
$9.52
|
| Rate for Payer: Lucent All Commercial |
$9.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$14.00
|
| Rate for Payer: PHP All Commercial |
$14.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.28
|
| Rate for Payer: Sagamore Health Network All Products |
$14.41
|
| Rate for Payer: Signature Care EPO |
$15.50
|
| Rate for Payer: Signature Care PPO |
$16.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.87
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$6.16
|
|
|
HC SUTURE VICRYL 2-0 417H
|
Facility
|
IP
|
$12.58
|
|
| Hospital Charge Code |
41607490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna All Commercial |
$10.86
|
| Rate for Payer: CORVEL All Commercial |
$11.70
|
| Rate for Payer: Coventry All Commercial |
$11.07
|
| Rate for Payer: Encore All Commercial |
$11.58
|
| Rate for Payer: Frontpath All Commercial |
$11.57
|
| Rate for Payer: Humana ChoiceCare |
$10.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.32
|
| Rate for Payer: PHCS All Commercial |
$9.44
|
| Rate for Payer: PHP All Commercial |
$9.54
|
| Rate for Payer: Sagamore Health Network All Products |
$9.71
|
| Rate for Payer: Signature Care EPO |
$10.44
|
| Rate for Payer: Signature Care PPO |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$9.91
|
|
|
HC SUTURE VICRYL 2-0 417H
|
Facility
|
OP
|
$12.58
|
|
| Hospital Charge Code |
41607490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.62
|
| Rate for Payer: Aetna Medicare |
$4.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.57
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Centivo All Commercial |
$6.42
|
| Rate for Payer: Cigna All Commercial |
$10.86
|
| Rate for Payer: CORVEL All Commercial |
$11.70
|
| Rate for Payer: Coventry All Commercial |
$11.07
|
| Rate for Payer: Encore All Commercial |
$11.58
|
| Rate for Payer: Frontpath All Commercial |
$11.57
|
| Rate for Payer: Humana ChoiceCare |
$10.87
|
| Rate for Payer: Humana Medicare |
$6.42
|
| Rate for Payer: Lucent All Commercial |
$6.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.32
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.44
|
| Rate for Payer: PHP All Commercial |
$9.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.91
|
| Rate for Payer: Sagamore Health Network All Products |
$9.71
|
| Rate for Payer: Signature Care EPO |
$10.44
|
| Rate for Payer: Signature Care PPO |
$11.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.69
|
| Rate for Payer: United Healthcare Commercial |
$9.91
|
| Rate for Payer: United Healthcare Medicare |
$4.15
|
|
|
HC SUTURE VICRYL 2-0 BLUNT JB417
|
Facility
|
OP
|
$15.21
|
|
| Hospital Charge Code |
41601572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.84
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.52
|
| Rate for Payer: Cash Price |
$9.43
|
| Rate for Payer: Cash Price |
$9.43
|
| Rate for Payer: Centivo All Commercial |
$7.76
|
| Rate for Payer: Cigna All Commercial |
$13.13
|
| Rate for Payer: CORVEL All Commercial |
$14.15
|
| Rate for Payer: Coventry All Commercial |
$13.38
|
| Rate for Payer: Encore All Commercial |
$14.00
|
| Rate for Payer: Frontpath All Commercial |
$13.99
|
| Rate for Payer: Humana ChoiceCare |
$13.14
|
| Rate for Payer: Humana Medicare |
$7.76
|
| Rate for Payer: Lucent All Commercial |
$7.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.69
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.41
|
| Rate for Payer: PHP All Commercial |
$11.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.93
|
| Rate for Payer: Sagamore Health Network All Products |
$11.74
|
| Rate for Payer: Signature Care EPO |
$12.62
|
| Rate for Payer: Signature Care PPO |
$13.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$11.99
|
| Rate for Payer: United Healthcare Medicare |
$5.02
|
|
|
HC SUTURE VICRYL 2-0 BLUNT JB417
|
Facility
|
IP
|
$15.21
|
|
| Hospital Charge Code |
41601572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$14.15 |
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$9.43
|
| Rate for Payer: Cigna All Commercial |
$13.13
|
| Rate for Payer: CORVEL All Commercial |
$14.15
|
| Rate for Payer: Coventry All Commercial |
$13.38
|
| Rate for Payer: Encore All Commercial |
$14.00
|
| Rate for Payer: Frontpath All Commercial |
$13.99
|
| Rate for Payer: Humana ChoiceCare |
$13.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.69
|
| Rate for Payer: PHCS All Commercial |
$11.41
|
| Rate for Payer: PHP All Commercial |
$11.54
|
| Rate for Payer: Sagamore Health Network All Products |
$11.74
|
| Rate for Payer: Signature Care EPO |
$12.62
|
| Rate for Payer: Signature Care PPO |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$11.99
|
|
|
HC SUTURE VICRYL 2-0 CP-1 27IN
|
Facility
|
IP
|
$5.98
|
|
| Hospital Charge Code |
41607166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna All Commercial |
$5.16
|
| Rate for Payer: CORVEL All Commercial |
$5.56
|
| Rate for Payer: Coventry All Commercial |
$5.26
|
| Rate for Payer: Encore All Commercial |
$5.50
|
| Rate for Payer: Frontpath All Commercial |
$5.50
|
| Rate for Payer: Humana ChoiceCare |
$5.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.38
|
| Rate for Payer: PHCS All Commercial |
$4.48
|
| Rate for Payer: PHP All Commercial |
$4.54
|
| Rate for Payer: Sagamore Health Network All Products |
$4.62
|
| Rate for Payer: Signature Care EPO |
$4.96
|
| Rate for Payer: Signature Care PPO |
$5.26
|
| Rate for Payer: United Healthcare Commercial |
$4.71
|
|
|
HC SUTURE VICRYL 2-0 CP-1 27IN
|
Facility
|
OP
|
$5.98
|
|
| Hospital Charge Code |
41607166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$5.05
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.17
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Centivo All Commercial |
$3.05
|
| Rate for Payer: Cigna All Commercial |
$5.16
|
| Rate for Payer: CORVEL All Commercial |
$5.56
|
| Rate for Payer: Coventry All Commercial |
$5.26
|
| Rate for Payer: Encore All Commercial |
$5.50
|
| Rate for Payer: Frontpath All Commercial |
$5.50
|
| Rate for Payer: Humana ChoiceCare |
$5.16
|
| Rate for Payer: Humana Medicare |
$3.05
|
| Rate for Payer: Lucent All Commercial |
$3.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4.48
|
| Rate for Payer: PHP All Commercial |
$4.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.33
|
| Rate for Payer: Sagamore Health Network All Products |
$4.62
|
| Rate for Payer: Signature Care EPO |
$4.96
|
| Rate for Payer: Signature Care PPO |
$5.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$4.71
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
|
|
HC SUTURE VICRYL 2-0 CT-1
|
Facility
|
IP
|
$77.72
|
|
| Hospital Charge Code |
41605571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.29 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Aetna Commercial |
$67.15
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cigna All Commercial |
$67.07
|
| Rate for Payer: CORVEL All Commercial |
$72.28
|
| Rate for Payer: Coventry All Commercial |
$68.39
|
| Rate for Payer: Encore All Commercial |
$71.54
|
| Rate for Payer: Frontpath All Commercial |
$71.50
|
| Rate for Payer: Humana ChoiceCare |
$67.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.95
|
| Rate for Payer: PHCS All Commercial |
$58.29
|
| Rate for Payer: PHP All Commercial |
$58.94
|
| Rate for Payer: Sagamore Health Network All Products |
$60.00
|
| Rate for Payer: Signature Care EPO |
$64.51
|
| Rate for Payer: Signature Care PPO |
$68.39
|
| Rate for Payer: United Healthcare Commercial |
$61.24
|
|
|
HC SUTURE VICRYL 2-0 CT-1
|
Facility
|
OP
|
$77.72
|
|
| Hospital Charge Code |
41605571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$65.60
|
| Rate for Payer: Aetna Medicare |
$25.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$44.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.21
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Centivo All Commercial |
$39.64
|
| Rate for Payer: Cigna All Commercial |
$67.07
|
| Rate for Payer: CORVEL All Commercial |
$72.28
|
| Rate for Payer: Coventry All Commercial |
$68.39
|
| Rate for Payer: Encore All Commercial |
$71.54
|
| Rate for Payer: Frontpath All Commercial |
$71.50
|
| Rate for Payer: Humana ChoiceCare |
$67.13
|
| Rate for Payer: Humana Medicare |
$39.64
|
| Rate for Payer: Lucent All Commercial |
$39.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$58.29
|
| Rate for Payer: PHP All Commercial |
$58.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.31
|
| Rate for Payer: Sagamore Health Network All Products |
$60.00
|
| Rate for Payer: Signature Care EPO |
$64.51
|
| Rate for Payer: Signature Care PPO |
$68.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$66.06
|
| Rate for Payer: United Healthcare Commercial |
$61.24
|
| Rate for Payer: United Healthcare Medicare |
$25.65
|
|
|
HC SUTURE VICRYL 2-0 J105T
|
Facility
|
IP
|
$95.84
|
|
| Hospital Charge Code |
41601163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$89.13 |
| Rate for Payer: Aetna Commercial |
$82.81
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cigna All Commercial |
$82.71
|
| Rate for Payer: CORVEL All Commercial |
$89.13
|
| Rate for Payer: Coventry All Commercial |
$84.34
|
| Rate for Payer: Encore All Commercial |
$88.22
|
| Rate for Payer: Frontpath All Commercial |
$88.17
|
| Rate for Payer: Humana ChoiceCare |
$82.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.26
|
| Rate for Payer: PHCS All Commercial |
$71.88
|
| Rate for Payer: PHP All Commercial |
$72.69
|
| Rate for Payer: Sagamore Health Network All Products |
$73.99
|
| Rate for Payer: Signature Care EPO |
$79.55
|
| Rate for Payer: Signature Care PPO |
$84.34
|
| Rate for Payer: United Healthcare Commercial |
$75.52
|
|
|
HC SUTURE VICRYL 2-0 J105T
|
Facility
|
OP
|
$95.84
|
|
| Hospital Charge Code |
41601163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Aetna Medicare |
$31.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.79
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Centivo All Commercial |
$48.88
|
| Rate for Payer: Cigna All Commercial |
$82.71
|
| Rate for Payer: CORVEL All Commercial |
$89.13
|
| Rate for Payer: Coventry All Commercial |
$84.34
|
| Rate for Payer: Encore All Commercial |
$88.22
|
| Rate for Payer: Frontpath All Commercial |
$88.17
|
| Rate for Payer: Humana ChoiceCare |
$82.78
|
| Rate for Payer: Humana Medicare |
$48.88
|
| Rate for Payer: Lucent All Commercial |
$48.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$71.88
|
| Rate for Payer: PHP All Commercial |
$72.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.38
|
| Rate for Payer: Sagamore Health Network All Products |
$73.99
|
| Rate for Payer: Signature Care EPO |
$79.55
|
| Rate for Payer: Signature Care PPO |
$84.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$75.52
|
| Rate for Payer: United Healthcare Medicare |
$31.63
|
|
|
HC SUTURE VICRYL 2-0 J 259H
|
Facility
|
OP
|
$9.70
|
|
| Hospital Charge Code |
41601162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Centivo All Commercial |
$4.95
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Lucent All Commercial |
$4.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
|
|
HC SUTURE VICRYL 2-0 J 259H
|
Facility
|
IP
|
$9.70
|
|
| Hospital Charge Code |
41601162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC SUTURE VICRYL 2-0 J317H
|
Facility
|
IP
|
$11.42
|
|
| Hospital Charge Code |
41601552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cigna All Commercial |
$9.86
|
| Rate for Payer: CORVEL All Commercial |
$10.62
|
| Rate for Payer: Coventry All Commercial |
$10.05
|
| Rate for Payer: Encore All Commercial |
$10.51
|
| Rate for Payer: Frontpath All Commercial |
$10.51
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.28
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.66
|
| Rate for Payer: Sagamore Health Network All Products |
$8.82
|
| Rate for Payer: Signature Care EPO |
$9.48
|
| Rate for Payer: Signature Care PPO |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$9.00
|
|
|
HC SUTURE VICRYL 2-0 J317H
|
Facility
|
OP
|
$11.42
|
|
| Hospital Charge Code |
41601552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.14
|
| 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 |
$4.15
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Centivo All Commercial |
$5.82
|
| Rate for Payer: Cigna All Commercial |
$9.86
|
| Rate for Payer: CORVEL All Commercial |
$10.62
|
| Rate for Payer: Coventry All Commercial |
$10.05
|
| Rate for Payer: Encore All Commercial |
$10.51
|
| Rate for Payer: Frontpath All Commercial |
$10.51
|
| Rate for Payer: Humana ChoiceCare |
$9.86
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Lucent All Commercial |
$5.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.28
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.56
|
| Rate for Payer: PHP All Commercial |
$8.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.45
|
| Rate for Payer: Sagamore Health Network All Products |
$8.82
|
| Rate for Payer: Signature Care EPO |
$9.48
|
| Rate for Payer: Signature Care PPO |
$10.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$9.00
|
| Rate for Payer: United Healthcare Medicare |
$3.77
|
|
|
HC SUTURE VICRYL 2-0 J339H
|
Facility
|
OP
|
$9.70
|
|
| Hospital Charge Code |
41601164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Centivo All Commercial |
$4.95
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Lucent All Commercial |
$4.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.78
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.24
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
|
|
HC SUTURE VICRYL 2-0 J339H
|
Facility
|
IP
|
$9.70
|
|
| Hospital Charge Code |
41601164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Cash Price |
$6.01
|
| Rate for Payer: Cigna All Commercial |
$8.37
|
| Rate for Payer: CORVEL All Commercial |
$9.02
|
| Rate for Payer: Coventry All Commercial |
$8.54
|
| Rate for Payer: Encore All Commercial |
$8.93
|
| Rate for Payer: Frontpath All Commercial |
$8.92
|
| Rate for Payer: Humana ChoiceCare |
$8.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.73
|
| Rate for Payer: PHCS All Commercial |
$7.28
|
| Rate for Payer: PHP All Commercial |
$7.36
|
| Rate for Payer: Sagamore Health Network All Products |
$7.49
|
| Rate for Payer: Signature Care EPO |
$8.05
|
| Rate for Payer: Signature Care PPO |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$7.64
|
|
|
HC SUTURE VICRYL 2-0 J375H
|
Facility
|
OP
|
$12.23
|
|
| Hospital Charge Code |
41603563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.44
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Centivo All Commercial |
$6.24
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Humana Medicare |
$6.24
|
| Rate for Payer: Lucent All Commercial |
$6.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.77
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
| Rate for Payer: United Healthcare Medicare |
$4.04
|
|
|
HC SUTURE VICRYL 2-0 J375H
|
Facility
|
IP
|
$12.23
|
|
| Hospital Charge Code |
41603563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cigna All Commercial |
$10.55
|
| Rate for Payer: CORVEL All Commercial |
$11.37
|
| Rate for Payer: Coventry All Commercial |
$10.76
|
| Rate for Payer: Encore All Commercial |
$11.26
|
| Rate for Payer: Frontpath All Commercial |
$11.25
|
| Rate for Payer: Humana ChoiceCare |
$10.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.01
|
| Rate for Payer: PHCS All Commercial |
$9.17
|
| Rate for Payer: PHP All Commercial |
$9.28
|
| Rate for Payer: Sagamore Health Network All Products |
$9.44
|
| Rate for Payer: Signature Care EPO |
$10.15
|
| Rate for Payer: Signature Care PPO |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$9.64
|
|
