|
HC SUTURE VICRYL 4-0 J218H
|
Facility
|
IP
|
$9.54
|
|
| Hospital Charge Code |
41601571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$5.92
|
| 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: Lutheran Preferred All Commercial |
$8.59
|
| Rate for Payer: PHCS All Commercial |
$7.16
|
| Rate for Payer: PHP All Commercial |
$7.24
|
| 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: United Healthcare Commercial |
$7.52
|
|
|
HC SUTURE VICRYL 4-0 J315H
|
Facility
|
OP
|
$10.72
|
|
| Hospital Charge Code |
41601484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$3.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.89
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Centivo All Commercial |
$5.47
|
| Rate for Payer: Cigna All Commercial |
$9.25
|
| Rate for Payer: CORVEL All Commercial |
$9.97
|
| Rate for Payer: Coventry All Commercial |
$9.43
|
| Rate for Payer: Encore All Commercial |
$9.87
|
| Rate for Payer: Frontpath All Commercial |
$9.86
|
| Rate for Payer: Humana ChoiceCare |
$9.26
|
| Rate for Payer: Humana Medicare |
$5.47
|
| Rate for Payer: Lucent All Commercial |
$5.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.04
|
| Rate for Payer: PHP All Commercial |
$8.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.18
|
| Rate for Payer: Sagamore Health Network All Products |
$8.28
|
| Rate for Payer: Signature Care EPO |
$8.90
|
| Rate for Payer: Signature Care PPO |
$9.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.11
|
| Rate for Payer: United Healthcare Commercial |
$8.45
|
| Rate for Payer: United Healthcare Medicare |
$3.54
|
|
|
HC SUTURE VICRYL 4-0 J315H
|
Facility
|
IP
|
$10.72
|
|
| Hospital Charge Code |
41601484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cigna All Commercial |
$9.25
|
| Rate for Payer: CORVEL All Commercial |
$9.97
|
| Rate for Payer: Coventry All Commercial |
$9.43
|
| Rate for Payer: Encore All Commercial |
$9.87
|
| Rate for Payer: Frontpath All Commercial |
$9.86
|
| Rate for Payer: Humana ChoiceCare |
$9.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.65
|
| Rate for Payer: PHCS All Commercial |
$8.04
|
| Rate for Payer: PHP All Commercial |
$8.13
|
| Rate for Payer: Sagamore Health Network All Products |
$8.28
|
| Rate for Payer: Signature Care EPO |
$8.90
|
| Rate for Payer: Signature Care PPO |
$9.43
|
| Rate for Payer: United Healthcare Commercial |
$8.45
|
|
|
HC SUTURE VICRYL 4-0 J392H
|
Facility
|
OP
|
$13.92
|
|
| Hospital Charge Code |
41601485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$11.75
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.05
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Centivo All Commercial |
$7.10
|
| Rate for Payer: Cigna All Commercial |
$12.01
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.25
|
| Rate for Payer: Encore All Commercial |
$12.81
|
| Rate for Payer: Frontpath All Commercial |
$12.81
|
| Rate for Payer: Humana ChoiceCare |
$12.02
|
| Rate for Payer: Humana Medicare |
$7.10
|
| Rate for Payer: Lucent All Commercial |
$7.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.53
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$10.44
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.43
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.55
|
| Rate for Payer: Signature Care PPO |
$12.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.83
|
| Rate for Payer: United Healthcare Commercial |
$10.97
|
| Rate for Payer: United Healthcare Medicare |
$4.59
|
|
|
HC SUTURE VICRYL 4-0 J392H
|
Facility
|
IP
|
$13.92
|
|
| Hospital Charge Code |
41601485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cigna All Commercial |
$12.01
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.25
|
| Rate for Payer: Encore All Commercial |
$12.81
|
| Rate for Payer: Frontpath All Commercial |
$12.81
|
| Rate for Payer: Humana ChoiceCare |
$12.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.53
|
| Rate for Payer: PHCS All Commercial |
$10.44
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.55
|
| Rate for Payer: Signature Care PPO |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$10.97
|
|
|
HC SUTURE VICRYL 4-0 J422H
|
Facility
|
OP
|
$22.51
|
|
| Hospital Charge Code |
41601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Centivo All Commercial |
$11.48
|
| Rate for Payer: Cigna All Commercial |
$19.43
|
| Rate for Payer: CORVEL All Commercial |
$20.93
|
| Rate for Payer: Coventry All Commercial |
$19.81
|
| Rate for Payer: Encore All Commercial |
$20.72
|
| Rate for Payer: Frontpath All Commercial |
$20.71
|
| Rate for Payer: Humana ChoiceCare |
$19.44
|
| Rate for Payer: Humana Medicare |
$11.48
|
| Rate for Payer: Lucent All Commercial |
$11.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.88
|
| Rate for Payer: PHP All Commercial |
$17.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.78
|
| Rate for Payer: Sagamore Health Network All Products |
$17.38
|
| Rate for Payer: Signature Care EPO |
$18.68
|
| Rate for Payer: Signature Care PPO |
$19.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.13
|
| Rate for Payer: United Healthcare Commercial |
$17.74
|
| Rate for Payer: United Healthcare Medicare |
$7.43
|
|
|
HC SUTURE VICRYL 4-0 J422H
|
Facility
|
IP
|
$22.51
|
|
| Hospital Charge Code |
41601473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cigna All Commercial |
$19.43
|
| Rate for Payer: CORVEL All Commercial |
$20.93
|
| Rate for Payer: Coventry All Commercial |
$19.81
|
| Rate for Payer: Encore All Commercial |
$20.72
|
| Rate for Payer: Frontpath All Commercial |
$20.71
|
| Rate for Payer: Humana ChoiceCare |
$19.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.26
|
| Rate for Payer: PHCS All Commercial |
$16.88
|
| Rate for Payer: PHP All Commercial |
$17.07
|
| Rate for Payer: Sagamore Health Network All Products |
$17.38
|
| Rate for Payer: Signature Care EPO |
$18.68
|
| Rate for Payer: Signature Care PPO |
$19.81
|
| Rate for Payer: United Healthcare Commercial |
$17.74
|
|
|
HC SUTURE VICRYL 4-0 J441H
|
Facility
|
IP
|
$14.78
|
|
| Hospital Charge Code |
41601555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cigna All Commercial |
$12.76
|
| Rate for Payer: CORVEL All Commercial |
$13.75
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Encore All Commercial |
$13.60
|
| Rate for Payer: Frontpath All Commercial |
$13.60
|
| Rate for Payer: Humana ChoiceCare |
$12.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.30
|
| Rate for Payer: PHCS All Commercial |
$11.08
|
| Rate for Payer: PHP All Commercial |
$11.21
|
| Rate for Payer: Sagamore Health Network All Products |
$11.41
|
| Rate for Payer: Signature Care EPO |
$12.27
|
| Rate for Payer: Signature Care PPO |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$11.65
|
|
|
HC SUTURE VICRYL 4-0 J441H
|
Facility
|
OP
|
$14.78
|
|
| Hospital Charge Code |
41601555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.47
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.37
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Centivo All Commercial |
$7.54
|
| Rate for Payer: Cigna All Commercial |
$12.76
|
| Rate for Payer: CORVEL All Commercial |
$13.75
|
| Rate for Payer: Coventry All Commercial |
$13.01
|
| Rate for Payer: Encore All Commercial |
$13.60
|
| Rate for Payer: Frontpath All Commercial |
$13.60
|
| Rate for Payer: Humana ChoiceCare |
$12.77
|
| Rate for Payer: Humana Medicare |
$7.54
|
| Rate for Payer: Lucent All Commercial |
$7.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.08
|
| Rate for Payer: PHP All Commercial |
$11.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.76
|
| Rate for Payer: Sagamore Health Network All Products |
$11.41
|
| Rate for Payer: Signature Care EPO |
$12.27
|
| Rate for Payer: Signature Care PPO |
$13.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$11.65
|
| Rate for Payer: United Healthcare Medicare |
$4.88
|
|
|
HC SUTURE VICRYL 4-0 J494G
|
Facility
|
OP
|
$29.96
|
|
| Hospital Charge Code |
41601558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.29
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.88
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Centivo All Commercial |
$15.28
|
| Rate for Payer: Cigna All Commercial |
$25.86
|
| Rate for Payer: CORVEL All Commercial |
$27.86
|
| Rate for Payer: Coventry All Commercial |
$26.36
|
| Rate for Payer: Encore All Commercial |
$27.58
|
| Rate for Payer: Frontpath All Commercial |
$27.56
|
| Rate for Payer: Humana ChoiceCare |
$25.88
|
| Rate for Payer: Humana Medicare |
$15.28
|
| Rate for Payer: Lucent All Commercial |
$15.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.47
|
| Rate for Payer: PHP All Commercial |
$22.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.68
|
| Rate for Payer: Sagamore Health Network All Products |
$23.13
|
| Rate for Payer: Signature Care EPO |
$24.87
|
| Rate for Payer: Signature Care PPO |
$26.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$23.61
|
| Rate for Payer: United Healthcare Medicare |
$9.89
|
|
|
HC SUTURE VICRYL 4-0 J494G
|
Facility
|
IP
|
$29.96
|
|
| Hospital Charge Code |
41601558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$27.86 |
| Rate for Payer: Aetna Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cigna All Commercial |
$25.86
|
| Rate for Payer: CORVEL All Commercial |
$27.86
|
| Rate for Payer: Coventry All Commercial |
$26.36
|
| Rate for Payer: Encore All Commercial |
$27.58
|
| Rate for Payer: Frontpath All Commercial |
$27.56
|
| Rate for Payer: Humana ChoiceCare |
$25.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.96
|
| Rate for Payer: PHCS All Commercial |
$22.47
|
| Rate for Payer: PHP All Commercial |
$22.72
|
| Rate for Payer: Sagamore Health Network All Products |
$23.13
|
| Rate for Payer: Signature Care EPO |
$24.87
|
| Rate for Payer: Signature Care PPO |
$26.36
|
| Rate for Payer: United Healthcare Commercial |
$23.61
|
|
|
HC SUTURE VICRYL 4-0 J662H
|
Facility
|
IP
|
$14.94
|
|
| Hospital Charge Code |
41605570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$13.89 |
| Rate for Payer: Aetna Commercial |
$12.91
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cigna All Commercial |
$12.89
|
| Rate for Payer: CORVEL All Commercial |
$13.89
|
| Rate for Payer: Coventry All Commercial |
$13.15
|
| Rate for Payer: Encore All Commercial |
$13.75
|
| Rate for Payer: Frontpath All Commercial |
$13.74
|
| Rate for Payer: Humana ChoiceCare |
$12.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.45
|
| Rate for Payer: PHCS All Commercial |
$11.20
|
| Rate for Payer: PHP All Commercial |
$11.33
|
| Rate for Payer: Sagamore Health Network All Products |
$11.53
|
| Rate for Payer: Signature Care EPO |
$12.40
|
| Rate for Payer: Signature Care PPO |
$13.15
|
| Rate for Payer: United Healthcare Commercial |
$11.77
|
|
|
HC SUTURE VICRYL 4-0 J662H
|
Facility
|
OP
|
$14.94
|
|
| Hospital Charge Code |
41605570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.42
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Centivo All Commercial |
$7.62
|
| Rate for Payer: Cigna All Commercial |
$12.89
|
| Rate for Payer: CORVEL All Commercial |
$13.89
|
| Rate for Payer: Coventry All Commercial |
$13.15
|
| Rate for Payer: Encore All Commercial |
$13.75
|
| Rate for Payer: Frontpath All Commercial |
$13.74
|
| Rate for Payer: Humana ChoiceCare |
$12.90
|
| Rate for Payer: Humana Medicare |
$7.62
|
| Rate for Payer: Lucent All Commercial |
$7.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.20
|
| Rate for Payer: PHP All Commercial |
$11.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.83
|
| Rate for Payer: Sagamore Health Network All Products |
$11.53
|
| Rate for Payer: Signature Care EPO |
$12.40
|
| Rate for Payer: Signature Care PPO |
$13.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.70
|
| Rate for Payer: United Healthcare Commercial |
$11.77
|
| Rate for Payer: United Healthcare Medicare |
$4.93
|
|
|
HC SUTURE VICRYL 4-0 J714D
|
Facility
|
IP
|
$85.84
|
|
| Hospital Charge Code |
41603426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$79.83 |
| Rate for Payer: Aetna Commercial |
$74.17
|
| Rate for Payer: Cash Price |
$53.22
|
| Rate for Payer: Cigna All Commercial |
$74.08
|
| Rate for Payer: CORVEL All Commercial |
$79.83
|
| Rate for Payer: Coventry All Commercial |
$75.54
|
| Rate for Payer: Encore All Commercial |
$79.02
|
| Rate for Payer: Frontpath All Commercial |
$78.97
|
| Rate for Payer: Humana ChoiceCare |
$74.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.26
|
| Rate for Payer: PHCS All Commercial |
$64.38
|
| Rate for Payer: PHP All Commercial |
$65.10
|
| Rate for Payer: Sagamore Health Network All Products |
$66.27
|
| Rate for Payer: Signature Care EPO |
$71.25
|
| Rate for Payer: Signature Care PPO |
$75.54
|
| Rate for Payer: United Healthcare Commercial |
$67.64
|
|
|
HC SUTURE VICRYL 4-0 J714D
|
Facility
|
OP
|
$85.84
|
|
| Hospital Charge Code |
41603426
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$72.45
|
| Rate for Payer: Aetna Medicare |
$28.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.16
|
| Rate for Payer: Cash Price |
$53.22
|
| Rate for Payer: Cash Price |
$53.22
|
| Rate for Payer: Centivo All Commercial |
$43.78
|
| Rate for Payer: Cigna All Commercial |
$74.08
|
| Rate for Payer: CORVEL All Commercial |
$79.83
|
| Rate for Payer: Coventry All Commercial |
$75.54
|
| Rate for Payer: Encore All Commercial |
$79.02
|
| Rate for Payer: Frontpath All Commercial |
$78.97
|
| Rate for Payer: Humana ChoiceCare |
$74.14
|
| Rate for Payer: Humana Medicare |
$43.78
|
| Rate for Payer: Lucent All Commercial |
$43.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$64.38
|
| Rate for Payer: PHP All Commercial |
$65.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.48
|
| Rate for Payer: Sagamore Health Network All Products |
$66.27
|
| Rate for Payer: Signature Care EPO |
$71.25
|
| Rate for Payer: Signature Care PPO |
$75.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.96
|
| Rate for Payer: United Healthcare Commercial |
$67.64
|
| Rate for Payer: United Healthcare Medicare |
$28.33
|
|
|
HC SUTURE VICRYL 4-0 UNDYED PS2 J496H
|
Facility
|
IP
|
$27.28
|
|
| Hospital Charge Code |
41601170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
|
|
HC SUTURE VICRYL 4-0 UNDYED PS2 J496H
|
Facility
|
OP
|
$27.28
|
|
| Hospital Charge Code |
41601170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.90
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Centivo All Commercial |
$13.91
|
| Rate for Payer: Cigna All Commercial |
$23.54
|
| Rate for Payer: CORVEL All Commercial |
$25.37
|
| Rate for Payer: Coventry All Commercial |
$24.01
|
| Rate for Payer: Encore All Commercial |
$25.11
|
| Rate for Payer: Frontpath All Commercial |
$25.10
|
| Rate for Payer: Humana ChoiceCare |
$23.56
|
| Rate for Payer: Humana Medicare |
$13.91
|
| Rate for Payer: Lucent All Commercial |
$13.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.55
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$20.46
|
| Rate for Payer: PHP All Commercial |
$20.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.64
|
| Rate for Payer: Sagamore Health Network All Products |
$21.06
|
| Rate for Payer: Signature Care EPO |
$22.64
|
| Rate for Payer: Signature Care PPO |
$24.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.19
|
| Rate for Payer: United Healthcare Commercial |
$21.50
|
| Rate for Payer: United Healthcare Medicare |
$9.00
|
|
|
HC SUTURE VICRYL 5-0 J213H
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
41601570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.98
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Centivo All Commercial |
$8.40
|
| Rate for Payer: Cigna All Commercial |
$14.22
|
| Rate for Payer: CORVEL All Commercial |
$15.33
|
| Rate for Payer: Coventry All Commercial |
$14.50
|
| Rate for Payer: Encore All Commercial |
$15.17
|
| Rate for Payer: Frontpath All Commercial |
$15.16
|
| Rate for Payer: Humana ChoiceCare |
$14.23
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Lucent All Commercial |
$8.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.83
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.36
|
| Rate for Payer: PHP All Commercial |
$12.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.43
|
| Rate for Payer: Sagamore Health Network All Products |
$12.72
|
| Rate for Payer: Signature Care EPO |
$13.68
|
| Rate for Payer: Signature Care PPO |
$14.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$12.99
|
| Rate for Payer: United Healthcare Medicare |
$5.44
|
|
|
HC SUTURE VICRYL 5-0 J213H
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
41601570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cigna All Commercial |
$14.22
|
| Rate for Payer: CORVEL All Commercial |
$15.33
|
| Rate for Payer: Coventry All Commercial |
$14.50
|
| Rate for Payer: Encore All Commercial |
$15.17
|
| Rate for Payer: Frontpath All Commercial |
$15.16
|
| Rate for Payer: Humana ChoiceCare |
$14.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.83
|
| Rate for Payer: PHCS All Commercial |
$12.36
|
| Rate for Payer: PHP All Commercial |
$12.50
|
| Rate for Payer: Sagamore Health Network All Products |
$12.72
|
| Rate for Payer: Signature Care EPO |
$13.68
|
| Rate for Payer: Signature Care PPO |
$14.50
|
| Rate for Payer: United Healthcare Commercial |
$12.99
|
|
|
HC SUTURE VICRYL 5-0 J303H
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
41601556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Aetna Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cigna All Commercial |
$14.22
|
| Rate for Payer: CORVEL All Commercial |
$15.33
|
| Rate for Payer: Coventry All Commercial |
$14.50
|
| Rate for Payer: Encore All Commercial |
$15.17
|
| Rate for Payer: Frontpath All Commercial |
$15.16
|
| Rate for Payer: Humana ChoiceCare |
$14.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.83
|
| Rate for Payer: PHCS All Commercial |
$12.36
|
| Rate for Payer: PHP All Commercial |
$12.50
|
| Rate for Payer: Sagamore Health Network All Products |
$12.72
|
| Rate for Payer: Signature Care EPO |
$13.68
|
| Rate for Payer: Signature Care PPO |
$14.50
|
| Rate for Payer: United Healthcare Commercial |
$12.99
|
|
|
HC SUTURE VICRYL 5-0 J303H
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
41601556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.98
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Centivo All Commercial |
$8.40
|
| Rate for Payer: Cigna All Commercial |
$14.22
|
| Rate for Payer: CORVEL All Commercial |
$15.33
|
| Rate for Payer: Coventry All Commercial |
$14.50
|
| Rate for Payer: Encore All Commercial |
$15.17
|
| Rate for Payer: Frontpath All Commercial |
$15.16
|
| Rate for Payer: Humana ChoiceCare |
$14.23
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Lucent All Commercial |
$8.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.83
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.36
|
| Rate for Payer: PHP All Commercial |
$12.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.43
|
| Rate for Payer: Sagamore Health Network All Products |
$12.72
|
| Rate for Payer: Signature Care EPO |
$13.68
|
| Rate for Payer: Signature Care PPO |
$14.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$12.99
|
| Rate for Payer: United Healthcare Medicare |
$5.44
|
|
|
HC SUTURE VICRYL 5-0 J493G
|
Facility
|
OP
|
$28.48
|
|
| Hospital Charge Code |
41601171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.34
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Centivo All Commercial |
$14.52
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Humana Medicare |
$14.52
|
| Rate for Payer: Lucent All Commercial |
$14.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.11
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.21
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
|
|
HC SUTURE VICRYL 5-0 J493G
|
Facility
|
IP
|
$28.48
|
|
| Hospital Charge Code |
41601171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
|
|
HC SUTURE VICRYL 5-0 J553G
|
Facility
|
OP
|
$160.13
|
|
| Hospital Charge Code |
41601562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$148.92 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$91.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.13
|
| Rate for Payer: Cash Price |
$99.28
|
| Rate for Payer: Cash Price |
$99.28
|
| Rate for Payer: Centivo All Commercial |
$81.67
|
| Rate for Payer: Cigna All Commercial |
$138.19
|
| Rate for Payer: CORVEL All Commercial |
$148.92
|
| Rate for Payer: Coventry All Commercial |
$140.91
|
| Rate for Payer: Encore All Commercial |
$147.40
|
| Rate for Payer: Frontpath All Commercial |
$147.32
|
| Rate for Payer: Humana ChoiceCare |
$138.30
|
| Rate for Payer: Humana Medicare |
$81.67
|
| Rate for Payer: Lucent All Commercial |
$81.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$120.10
|
| Rate for Payer: PHP All Commercial |
$121.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.45
|
| Rate for Payer: Sagamore Health Network All Products |
$123.62
|
| Rate for Payer: Signature Care EPO |
$132.91
|
| Rate for Payer: Signature Care PPO |
$140.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.11
|
| Rate for Payer: United Healthcare Commercial |
$126.18
|
| Rate for Payer: United Healthcare Medicare |
$52.84
|
|
|
HC SUTURE VICRYL 5-0 J553G
|
Facility
|
IP
|
$160.13
|
|
| Hospital Charge Code |
41601562
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.10 |
| Max. Negotiated Rate |
$148.92 |
| Rate for Payer: Aetna Commercial |
$138.35
|
| Rate for Payer: Cash Price |
$99.28
|
| Rate for Payer: Cigna All Commercial |
$138.19
|
| Rate for Payer: CORVEL All Commercial |
$148.92
|
| Rate for Payer: Coventry All Commercial |
$140.91
|
| Rate for Payer: Encore All Commercial |
$147.40
|
| Rate for Payer: Frontpath All Commercial |
$147.32
|
| Rate for Payer: Humana ChoiceCare |
$138.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.12
|
| Rate for Payer: PHCS All Commercial |
$120.10
|
| Rate for Payer: PHP All Commercial |
$121.44
|
| Rate for Payer: Sagamore Health Network All Products |
$123.62
|
| Rate for Payer: Signature Care EPO |
$132.91
|
| Rate for Payer: Signature Care PPO |
$140.91
|
| Rate for Payer: United Healthcare Commercial |
$126.18
|
|
