|
HC SUTURE VICRYL 2-0 J417H
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
41601165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$14.26
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.13
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Centivo All Commercial |
$8.61
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Lucent All Commercial |
$8.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.59
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.36
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
| Rate for Payer: United Healthcare Medicare |
$5.57
|
|
|
HC SUTURE VICRYL 2-0 J417H
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
41601165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.59
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna All Commercial |
$14.58
|
| Rate for Payer: CORVEL All Commercial |
$15.71
|
| Rate for Payer: Coventry All Commercial |
$14.86
|
| Rate for Payer: Encore All Commercial |
$15.55
|
| Rate for Payer: Frontpath All Commercial |
$15.54
|
| Rate for Payer: Humana ChoiceCare |
$14.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.20
|
| Rate for Payer: PHCS All Commercial |
$12.67
|
| Rate for Payer: PHP All Commercial |
$12.81
|
| Rate for Payer: Sagamore Health Network All Products |
$13.04
|
| Rate for Payer: Signature Care EPO |
$14.02
|
| Rate for Payer: Signature Care PPO |
$14.86
|
| Rate for Payer: United Healthcare Commercial |
$13.31
|
|
|
HC SUTURE VICRYL 2-0 J443H
|
Facility
|
IP
|
$20.96
|
|
| Hospital Charge Code |
41601563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.11
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna All Commercial |
$18.09
|
| Rate for Payer: CORVEL All Commercial |
$19.49
|
| Rate for Payer: Coventry All Commercial |
$18.44
|
| Rate for Payer: Encore All Commercial |
$19.29
|
| Rate for Payer: Frontpath All Commercial |
$19.28
|
| Rate for Payer: Humana ChoiceCare |
$18.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.86
|
| Rate for Payer: PHCS All Commercial |
$15.72
|
| Rate for Payer: PHP All Commercial |
$15.90
|
| Rate for Payer: Sagamore Health Network All Products |
$16.18
|
| Rate for Payer: Signature Care EPO |
$17.40
|
| Rate for Payer: Signature Care PPO |
$18.44
|
| Rate for Payer: United Healthcare Commercial |
$16.52
|
|
|
HC SUTURE VICRYL 2-0 J443H
|
Facility
|
OP
|
$20.96
|
|
| Hospital Charge Code |
41601563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$6.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.61
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Centivo All Commercial |
$10.69
|
| Rate for Payer: Cigna All Commercial |
$18.09
|
| Rate for Payer: CORVEL All Commercial |
$19.49
|
| Rate for Payer: Coventry All Commercial |
$18.44
|
| Rate for Payer: Encore All Commercial |
$19.29
|
| Rate for Payer: Frontpath All Commercial |
$19.28
|
| Rate for Payer: Humana ChoiceCare |
$18.10
|
| Rate for Payer: Humana Medicare |
$10.69
|
| Rate for Payer: Lucent All Commercial |
$10.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.86
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.72
|
| Rate for Payer: PHP All Commercial |
$15.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.17
|
| Rate for Payer: Sagamore Health Network All Products |
$16.18
|
| Rate for Payer: Signature Care EPO |
$17.40
|
| Rate for Payer: Signature Care PPO |
$18.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.82
|
| Rate for Payer: United Healthcare Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare |
$6.92
|
|
|
HC SUTURE VICRYL 3-0 J104T
|
Facility
|
IP
|
$66.14
|
|
| Hospital Charge Code |
41601553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$57.14
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cigna All Commercial |
$57.08
|
| Rate for Payer: CORVEL All Commercial |
$61.51
|
| Rate for Payer: Coventry All Commercial |
$58.20
|
| Rate for Payer: Encore All Commercial |
$60.88
|
| Rate for Payer: Frontpath All Commercial |
$60.85
|
| Rate for Payer: Humana ChoiceCare |
$57.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.53
|
| Rate for Payer: PHCS All Commercial |
$49.60
|
| Rate for Payer: PHP All Commercial |
$50.16
|
| Rate for Payer: Sagamore Health Network All Products |
$51.06
|
| Rate for Payer: Signature Care EPO |
$54.90
|
| Rate for Payer: Signature Care PPO |
$58.20
|
| Rate for Payer: United Healthcare Commercial |
$52.12
|
|
|
HC SUTURE VICRYL 3-0 J104T
|
Facility
|
OP
|
$66.14
|
|
| Hospital Charge Code |
41601553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$55.82
|
| Rate for Payer: Aetna Medicare |
$21.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.01
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Centivo All Commercial |
$33.73
|
| Rate for Payer: Cigna All Commercial |
$57.08
|
| Rate for Payer: CORVEL All Commercial |
$61.51
|
| Rate for Payer: Coventry All Commercial |
$58.20
|
| Rate for Payer: Encore All Commercial |
$60.88
|
| Rate for Payer: Frontpath All Commercial |
$60.85
|
| Rate for Payer: Humana ChoiceCare |
$57.13
|
| Rate for Payer: Humana Medicare |
$33.73
|
| Rate for Payer: Lucent All Commercial |
$33.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$49.60
|
| Rate for Payer: PHP All Commercial |
$50.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.79
|
| Rate for Payer: Sagamore Health Network All Products |
$51.06
|
| Rate for Payer: Signature Care EPO |
$54.90
|
| Rate for Payer: Signature Care PPO |
$58.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.22
|
| Rate for Payer: United Healthcare Commercial |
$52.12
|
| Rate for Payer: United Healthcare Medicare |
$21.83
|
|
|
HC SUTURE VICRYL 3-0 J205G
|
Facility
|
OP
|
$14.69
|
|
| Hospital Charge Code |
41601167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.40
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.33
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Centivo All Commercial |
$7.49
|
| Rate for Payer: Cigna All Commercial |
$12.68
|
| Rate for Payer: CORVEL All Commercial |
$13.66
|
| Rate for Payer: Coventry All Commercial |
$12.93
|
| Rate for Payer: Encore All Commercial |
$13.52
|
| Rate for Payer: Frontpath All Commercial |
$13.51
|
| Rate for Payer: Humana ChoiceCare |
$12.69
|
| Rate for Payer: Humana Medicare |
$7.49
|
| Rate for Payer: Lucent All Commercial |
$7.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.02
|
| Rate for Payer: PHP All Commercial |
$11.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.73
|
| Rate for Payer: Sagamore Health Network All Products |
$11.34
|
| Rate for Payer: Signature Care EPO |
$12.19
|
| Rate for Payer: Signature Care PPO |
$12.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.49
|
| Rate for Payer: United Healthcare Commercial |
$11.58
|
| Rate for Payer: United Healthcare Medicare |
$4.85
|
|
|
HC SUTURE VICRYL 3-0 J205G
|
Facility
|
IP
|
$14.69
|
|
| Hospital Charge Code |
41601167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: Aetna Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cigna All Commercial |
$12.68
|
| Rate for Payer: CORVEL All Commercial |
$13.66
|
| Rate for Payer: Coventry All Commercial |
$12.93
|
| Rate for Payer: Encore All Commercial |
$13.52
|
| Rate for Payer: Frontpath All Commercial |
$13.51
|
| Rate for Payer: Humana ChoiceCare |
$12.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.22
|
| Rate for Payer: PHCS All Commercial |
$11.02
|
| Rate for Payer: PHP All Commercial |
$11.14
|
| Rate for Payer: Sagamore Health Network All Products |
$11.34
|
| Rate for Payer: Signature Care EPO |
$12.19
|
| Rate for Payer: Signature Care PPO |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$11.58
|
|
|
HC SUTURE VICRYL 3-0 J232H
|
Facility
|
OP
|
$16.57
|
|
| Hospital Charge Code |
41601472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.99
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Centivo All Commercial |
$8.45
|
| Rate for Payer: Cigna All Commercial |
$14.30
|
| Rate for Payer: CORVEL All Commercial |
$15.41
|
| Rate for Payer: Coventry All Commercial |
$14.58
|
| Rate for Payer: Encore All Commercial |
$15.25
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.31
|
| Rate for Payer: Humana Medicare |
$8.45
|
| Rate for Payer: Lucent All Commercial |
$8.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.91
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.43
|
| Rate for Payer: PHP All Commercial |
$12.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.46
|
| Rate for Payer: Sagamore Health Network All Products |
$12.79
|
| Rate for Payer: Signature Care EPO |
$13.75
|
| Rate for Payer: Signature Care PPO |
$14.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
| Rate for Payer: United Healthcare Medicare |
$5.47
|
|
|
HC SUTURE VICRYL 3-0 J232H
|
Facility
|
IP
|
$16.57
|
|
| Hospital Charge Code |
41601472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Cash Price |
$10.27
|
| Rate for Payer: Cigna All Commercial |
$14.30
|
| Rate for Payer: CORVEL All Commercial |
$15.41
|
| Rate for Payer: Coventry All Commercial |
$14.58
|
| Rate for Payer: Encore All Commercial |
$15.25
|
| Rate for Payer: Frontpath All Commercial |
$15.24
|
| Rate for Payer: Humana ChoiceCare |
$14.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.91
|
| Rate for Payer: PHCS All Commercial |
$12.43
|
| Rate for Payer: PHP All Commercial |
$12.57
|
| Rate for Payer: Sagamore Health Network All Products |
$12.79
|
| Rate for Payer: Signature Care EPO |
$13.75
|
| Rate for Payer: Signature Care PPO |
$14.58
|
| Rate for Payer: United Healthcare Commercial |
$13.06
|
|
|
HC SUTURE VICRYL 3-0 J285G
|
Facility
|
IP
|
$13.65
|
|
| Hospital Charge Code |
41601593
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cigna All Commercial |
$11.78
|
| Rate for Payer: CORVEL All Commercial |
$12.69
|
| Rate for Payer: Coventry All Commercial |
$12.01
|
| Rate for Payer: Encore All Commercial |
$12.56
|
| Rate for Payer: Frontpath All Commercial |
$12.56
|
| Rate for Payer: Humana ChoiceCare |
$11.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.28
|
| Rate for Payer: PHCS All Commercial |
$10.24
|
| Rate for Payer: PHP All Commercial |
$10.35
|
| Rate for Payer: Sagamore Health Network All Products |
$10.54
|
| Rate for Payer: Signature Care EPO |
$11.33
|
| Rate for Payer: Signature Care PPO |
$12.01
|
| Rate for Payer: United Healthcare Commercial |
$10.76
|
|
|
HC SUTURE VICRYL 3-0 J285G
|
Facility
|
OP
|
$13.65
|
|
| Hospital Charge Code |
41601593
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$11.52
|
| Rate for Payer: Aetna Medicare |
$4.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.95
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Centivo All Commercial |
$6.96
|
| Rate for Payer: Cigna All Commercial |
$11.78
|
| Rate for Payer: CORVEL All Commercial |
$12.69
|
| Rate for Payer: Coventry All Commercial |
$12.01
|
| Rate for Payer: Encore All Commercial |
$12.56
|
| Rate for Payer: Frontpath All Commercial |
$12.56
|
| Rate for Payer: Humana ChoiceCare |
$11.79
|
| Rate for Payer: Humana Medicare |
$6.96
|
| Rate for Payer: Lucent All Commercial |
$6.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.28
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$10.24
|
| Rate for Payer: PHP All Commercial |
$10.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.32
|
| Rate for Payer: Sagamore Health Network All Products |
$10.54
|
| Rate for Payer: Signature Care EPO |
$11.33
|
| Rate for Payer: Signature Care PPO |
$12.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.60
|
| Rate for Payer: United Healthcare Commercial |
$10.76
|
| Rate for Payer: United Healthcare Medicare |
$4.50
|
|
|
HC SUTURE VICRYL 3-0 J316H
|
Facility
|
IP
|
$31.57
|
|
| Hospital Charge Code |
41601554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
|
|
HC SUTURE VICRYL 3-0 J316H
|
Facility
|
OP
|
$31.57
|
|
| Hospital Charge Code |
41601554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.46
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Centivo All Commercial |
$16.10
|
| Rate for Payer: Cigna All Commercial |
$27.24
|
| Rate for Payer: CORVEL All Commercial |
$29.36
|
| Rate for Payer: Coventry All Commercial |
$27.78
|
| Rate for Payer: Encore All Commercial |
$29.06
|
| Rate for Payer: Frontpath All Commercial |
$29.04
|
| Rate for Payer: Humana ChoiceCare |
$27.27
|
| Rate for Payer: Humana Medicare |
$16.10
|
| Rate for Payer: Lucent All Commercial |
$16.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$23.68
|
| Rate for Payer: PHP All Commercial |
$23.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.31
|
| Rate for Payer: Sagamore Health Network All Products |
$24.37
|
| Rate for Payer: Signature Care EPO |
$26.20
|
| Rate for Payer: Signature Care PPO |
$27.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.83
|
| Rate for Payer: United Healthcare Commercial |
$24.88
|
| Rate for Payer: United Healthcare Medicare |
$10.42
|
|
|
HC SUTURE VICRYL 3-0 SH
|
Facility
|
OP
|
$241.12
|
|
| Hospital Charge Code |
41602405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$224.24 |
| Rate for Payer: Aetna Commercial |
$203.51
|
| Rate for Payer: Aetna Medicare |
$79.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$138.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$150.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.53
|
| Rate for Payer: Cash Price |
$149.49
|
| Rate for Payer: Cash Price |
$149.49
|
| Rate for Payer: Centivo All Commercial |
$122.97
|
| Rate for Payer: Cigna All Commercial |
$208.09
|
| Rate for Payer: CORVEL All Commercial |
$224.24
|
| Rate for Payer: Coventry All Commercial |
$212.19
|
| Rate for Payer: Encore All Commercial |
$221.95
|
| Rate for Payer: Frontpath All Commercial |
$221.83
|
| Rate for Payer: Humana ChoiceCare |
$208.26
|
| Rate for Payer: Humana Medicare |
$122.97
|
| Rate for Payer: Lucent All Commercial |
$122.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.01
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$180.84
|
| Rate for Payer: PHP All Commercial |
$182.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$94.04
|
| Rate for Payer: Sagamore Health Network All Products |
$186.14
|
| Rate for Payer: Signature Care EPO |
$200.13
|
| Rate for Payer: Signature Care PPO |
$212.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$204.95
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
| Rate for Payer: United Healthcare Medicare |
$79.57
|
|
|
HC SUTURE VICRYL 3-0 SH
|
Facility
|
IP
|
$241.12
|
|
| Hospital Charge Code |
41602405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.84 |
| Max. Negotiated Rate |
$224.24 |
| Rate for Payer: Aetna Commercial |
$208.33
|
| Rate for Payer: Cash Price |
$149.49
|
| Rate for Payer: Cigna All Commercial |
$208.09
|
| Rate for Payer: CORVEL All Commercial |
$224.24
|
| Rate for Payer: Coventry All Commercial |
$212.19
|
| Rate for Payer: Encore All Commercial |
$221.95
|
| Rate for Payer: Frontpath All Commercial |
$221.83
|
| Rate for Payer: Humana ChoiceCare |
$208.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$217.01
|
| Rate for Payer: PHCS All Commercial |
$180.84
|
| Rate for Payer: PHP All Commercial |
$182.87
|
| Rate for Payer: Sagamore Health Network All Products |
$186.14
|
| Rate for Payer: Signature Care EPO |
$200.13
|
| Rate for Payer: Signature Care PPO |
$212.19
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
|
|
HC SUTURE VICRYL 3-0 UNDYED J416H
|
Facility
|
OP
|
$10.33
|
|
| Hospital Charge Code |
41601168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.75
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Centivo All Commercial |
$5.27
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Humana Medicare |
$5.27
|
| Rate for Payer: Lucent All Commercial |
$5.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.03
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
| Rate for Payer: United Healthcare Medicare |
$3.41
|
|
|
HC SUTURE VICRYL 3-0 UNDYED J416H
|
Facility
|
IP
|
$10.33
|
|
| Hospital Charge Code |
41601168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cigna All Commercial |
$8.91
|
| Rate for Payer: CORVEL All Commercial |
$9.61
|
| Rate for Payer: Coventry All Commercial |
$9.09
|
| Rate for Payer: Encore All Commercial |
$9.51
|
| Rate for Payer: Frontpath All Commercial |
$9.50
|
| Rate for Payer: Humana ChoiceCare |
$8.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.30
|
| Rate for Payer: PHCS All Commercial |
$7.75
|
| Rate for Payer: PHP All Commercial |
$7.83
|
| Rate for Payer: Sagamore Health Network All Products |
$7.97
|
| Rate for Payer: Signature Care EPO |
$8.57
|
| Rate for Payer: Signature Care PPO |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$8.14
|
|
|
HC SUTURE VICRYL 3-0 UNDYED PS2 J497H
|
Facility
|
IP
|
$27.09
|
|
| Hospital Charge Code |
41601169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
|
|
HC SUTURE VICRYL 3-0 UNDYED PS2 J497H
|
Facility
|
OP
|
$27.09
|
|
| Hospital Charge Code |
41601169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.83
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centivo All Commercial |
$13.82
|
| Rate for Payer: Cigna All Commercial |
$23.38
|
| Rate for Payer: CORVEL All Commercial |
$25.19
|
| Rate for Payer: Coventry All Commercial |
$23.84
|
| Rate for Payer: Encore All Commercial |
$24.94
|
| Rate for Payer: Frontpath All Commercial |
$24.92
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Lucent All Commercial |
$13.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.32
|
| Rate for Payer: PHP All Commercial |
$20.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.57
|
| Rate for Payer: Sagamore Health Network All Products |
$20.91
|
| Rate for Payer: Signature Care EPO |
$22.48
|
| Rate for Payer: Signature Care PPO |
$23.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$21.35
|
| Rate for Payer: United Healthcare Medicare |
$8.94
|
|
|
HC SUTURE VICRYL 3-0 UNDYED VR497
|
Facility
|
IP
|
$74.67
|
|
| Hospital Charge Code |
41601567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$69.44 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Cash Price |
$46.30
|
| Rate for Payer: Cigna All Commercial |
$64.44
|
| Rate for Payer: CORVEL All Commercial |
$69.44
|
| Rate for Payer: Coventry All Commercial |
$65.71
|
| Rate for Payer: Encore All Commercial |
$68.73
|
| Rate for Payer: Frontpath All Commercial |
$68.70
|
| Rate for Payer: Humana ChoiceCare |
$64.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.20
|
| Rate for Payer: PHCS All Commercial |
$56.00
|
| Rate for Payer: PHP All Commercial |
$56.63
|
| Rate for Payer: Sagamore Health Network All Products |
$57.65
|
| Rate for Payer: Signature Care EPO |
$61.98
|
| Rate for Payer: Signature Care PPO |
$65.71
|
| Rate for Payer: United Healthcare Commercial |
$58.84
|
|
|
HC SUTURE VICRYL 3-0 UNDYED VR497
|
Facility
|
OP
|
$74.67
|
|
| Hospital Charge Code |
41601567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$63.02
|
| Rate for Payer: Aetna Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.11
|
| Rate for Payer: Cash Price |
$46.30
|
| Rate for Payer: Cash Price |
$46.30
|
| Rate for Payer: Centivo All Commercial |
$38.08
|
| Rate for Payer: Cigna All Commercial |
$64.44
|
| Rate for Payer: CORVEL All Commercial |
$69.44
|
| Rate for Payer: Coventry All Commercial |
$65.71
|
| Rate for Payer: Encore All Commercial |
$68.73
|
| Rate for Payer: Frontpath All Commercial |
$68.70
|
| Rate for Payer: Humana ChoiceCare |
$64.49
|
| Rate for Payer: Humana Medicare |
$38.08
|
| Rate for Payer: Lucent All Commercial |
$38.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$56.00
|
| Rate for Payer: PHP All Commercial |
$56.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.12
|
| Rate for Payer: Sagamore Health Network All Products |
$57.65
|
| Rate for Payer: Signature Care EPO |
$61.98
|
| Rate for Payer: Signature Care PPO |
$65.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.47
|
| Rate for Payer: United Healthcare Commercial |
$58.84
|
| Rate for Payer: United Healthcare Medicare |
$24.64
|
|
|
HC SUTURE VICRYL 3-0 V34 J516H
|
Facility
|
IP
|
$17.20
|
|
| Hospital Charge Code |
41601166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cigna All Commercial |
$14.84
|
| Rate for Payer: CORVEL All Commercial |
$16.00
|
| Rate for Payer: Coventry All Commercial |
$15.14
|
| Rate for Payer: Encore All Commercial |
$15.83
|
| Rate for Payer: Frontpath All Commercial |
$15.82
|
| Rate for Payer: Humana ChoiceCare |
$14.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.48
|
| Rate for Payer: PHCS All Commercial |
$12.90
|
| Rate for Payer: PHP All Commercial |
$13.04
|
| Rate for Payer: Sagamore Health Network All Products |
$13.28
|
| Rate for Payer: Signature Care EPO |
$14.28
|
| Rate for Payer: Signature Care PPO |
$15.14
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
|
|
HC SUTURE VICRYL 3-0 V34 J516H
|
Facility
|
OP
|
$17.20
|
|
| Hospital Charge Code |
41601166
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$14.52
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.24
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Centivo All Commercial |
$8.77
|
| Rate for Payer: Cigna All Commercial |
$14.84
|
| Rate for Payer: CORVEL All Commercial |
$16.00
|
| Rate for Payer: Coventry All Commercial |
$15.14
|
| Rate for Payer: Encore All Commercial |
$15.83
|
| Rate for Payer: Frontpath All Commercial |
$15.82
|
| Rate for Payer: Humana ChoiceCare |
$14.86
|
| Rate for Payer: Humana Medicare |
$8.77
|
| Rate for Payer: Lucent All Commercial |
$8.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.48
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$12.90
|
| Rate for Payer: PHP All Commercial |
$13.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.71
|
| Rate for Payer: Sagamore Health Network All Products |
$13.28
|
| Rate for Payer: Signature Care EPO |
$14.28
|
| Rate for Payer: Signature Care PPO |
$15.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.62
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
| Rate for Payer: United Healthcare Medicare |
$5.68
|
|
|
HC SUTURE VICRYL 4-0 J218H
|
Facility
|
OP
|
$9.54
|
|
| Hospital Charge Code |
41601571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$8.05
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.46
|
| Rate for Payer: Cash Price |
$5.92
|
| Rate for Payer: Cash Price |
$5.92
|
| Rate for Payer: Centivo All Commercial |
$4.87
|
| Rate for Payer: Cigna All Commercial |
$8.23
|
| Rate for Payer: CORVEL All Commercial |
$8.87
|
| Rate for Payer: Coventry All Commercial |
$8.40
|
| Rate for Payer: Encore All Commercial |
$8.78
|
| Rate for Payer: Frontpath All Commercial |
$8.78
|
| Rate for Payer: Humana ChoiceCare |
$8.24
|
| Rate for Payer: Humana Medicare |
$4.87
|
| Rate for Payer: Lucent All Commercial |
$4.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$7.16
|
| Rate for Payer: PHP All Commercial |
$7.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.72
|
| Rate for Payer: Sagamore Health Network All Products |
$7.36
|
| Rate for Payer: Signature Care EPO |
$7.92
|
| Rate for Payer: Signature Care PPO |
$8.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$7.52
|
| Rate for Payer: United Healthcare Medicare |
$3.15
|
|
