|
HC SUTURE VICRYL 6-0 J492G
|
Facility
|
IP
|
$30.62
|
|
| Hospital Charge Code |
41601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.46
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna All Commercial |
$26.43
|
| Rate for Payer: CORVEL All Commercial |
$28.48
|
| Rate for Payer: Coventry All Commercial |
$26.95
|
| Rate for Payer: Encore All Commercial |
$28.19
|
| Rate for Payer: Frontpath All Commercial |
$28.17
|
| Rate for Payer: Humana ChoiceCare |
$26.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.56
|
| Rate for Payer: PHCS All Commercial |
$22.96
|
| Rate for Payer: PHP All Commercial |
$23.22
|
| Rate for Payer: Sagamore Health Network All Products |
$23.64
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.95
|
| Rate for Payer: United Healthcare Commercial |
$24.13
|
|
|
HC SUTURE VICRYL 6-0 J492G
|
Facility
|
OP
|
$30.62
|
|
| Hospital Charge Code |
41601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$25.84
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.12
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Centivo All Commercial |
$15.62
|
| Rate for Payer: Cigna All Commercial |
$26.43
|
| Rate for Payer: CORVEL All Commercial |
$28.48
|
| Rate for Payer: Coventry All Commercial |
$26.95
|
| Rate for Payer: Encore All Commercial |
$28.19
|
| Rate for Payer: Frontpath All Commercial |
$28.17
|
| Rate for Payer: Humana ChoiceCare |
$26.45
|
| Rate for Payer: Humana Medicare |
$15.62
|
| Rate for Payer: Lucent All Commercial |
$15.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$22.96
|
| Rate for Payer: PHP All Commercial |
$23.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.94
|
| Rate for Payer: Sagamore Health Network All Products |
$23.64
|
| Rate for Payer: Signature Care EPO |
$25.41
|
| Rate for Payer: Signature Care PPO |
$26.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.03
|
| Rate for Payer: United Healthcare Commercial |
$24.13
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
|
|
HC SUTURE VICRYL 6-0 J544G
|
Facility
|
IP
|
$115.18
|
|
| Hospital Charge Code |
41601560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.38 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cigna All Commercial |
$99.40
|
| Rate for Payer: CORVEL All Commercial |
$107.12
|
| Rate for Payer: Coventry All Commercial |
$101.36
|
| Rate for Payer: Encore All Commercial |
$106.02
|
| Rate for Payer: Frontpath All Commercial |
$105.97
|
| Rate for Payer: Humana ChoiceCare |
$99.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.66
|
| Rate for Payer: PHCS All Commercial |
$86.38
|
| Rate for Payer: PHP All Commercial |
$87.35
|
| Rate for Payer: Sagamore Health Network All Products |
$88.92
|
| Rate for Payer: Signature Care EPO |
$95.60
|
| Rate for Payer: Signature Care PPO |
$101.36
|
| Rate for Payer: United Healthcare Commercial |
$90.76
|
|
|
HC SUTURE VICRYL 6-0 J544G
|
Facility
|
OP
|
$115.18
|
|
| Hospital Charge Code |
41601560
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$97.21
|
| Rate for Payer: Aetna Medicare |
$38.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.81
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Centivo All Commercial |
$58.74
|
| Rate for Payer: Cigna All Commercial |
$99.40
|
| Rate for Payer: CORVEL All Commercial |
$107.12
|
| Rate for Payer: Coventry All Commercial |
$101.36
|
| Rate for Payer: Encore All Commercial |
$106.02
|
| Rate for Payer: Frontpath All Commercial |
$105.97
|
| Rate for Payer: Humana ChoiceCare |
$99.48
|
| Rate for Payer: Humana Medicare |
$58.74
|
| Rate for Payer: Lucent All Commercial |
$58.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$86.38
|
| Rate for Payer: PHP All Commercial |
$87.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.92
|
| Rate for Payer: Sagamore Health Network All Products |
$88.92
|
| Rate for Payer: Signature Care EPO |
$95.60
|
| Rate for Payer: Signature Care PPO |
$101.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$97.90
|
| Rate for Payer: United Healthcare Commercial |
$90.76
|
| Rate for Payer: United Healthcare Medicare |
$38.01
|
|
|
HC SUTURE VICRYL 6-0 J555G
|
Facility
|
OP
|
$91.85
|
|
| Hospital Charge Code |
41601559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.52
|
| Rate for Payer: Aetna Medicare |
$30.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.34
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Centivo All Commercial |
$46.84
|
| Rate for Payer: Cigna All Commercial |
$79.27
|
| Rate for Payer: CORVEL All Commercial |
$85.42
|
| Rate for Payer: Coventry All Commercial |
$80.83
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$84.50
|
| Rate for Payer: Humana ChoiceCare |
$79.33
|
| Rate for Payer: Humana Medicare |
$46.84
|
| Rate for Payer: Lucent All Commercial |
$46.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.66
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$68.89
|
| Rate for Payer: PHP All Commercial |
$69.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.82
|
| Rate for Payer: Sagamore Health Network All Products |
$70.91
|
| Rate for Payer: Signature Care EPO |
$76.24
|
| Rate for Payer: Signature Care PPO |
$80.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.07
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
| Rate for Payer: United Healthcare Medicare |
$30.31
|
|
|
HC SUTURE VICRYL 6-0 J555G
|
Facility
|
IP
|
$91.85
|
|
| Hospital Charge Code |
41601559
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna Commercial |
$79.36
|
| Rate for Payer: Cash Price |
$56.95
|
| Rate for Payer: Cigna All Commercial |
$79.27
|
| Rate for Payer: CORVEL All Commercial |
$85.42
|
| Rate for Payer: Coventry All Commercial |
$80.83
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$84.50
|
| Rate for Payer: Humana ChoiceCare |
$79.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.66
|
| Rate for Payer: PHCS All Commercial |
$68.89
|
| Rate for Payer: PHP All Commercial |
$69.66
|
| Rate for Payer: Sagamore Health Network All Products |
$70.91
|
| Rate for Payer: Signature Care EPO |
$76.24
|
| Rate for Payer: Signature Care PPO |
$80.83
|
| Rate for Payer: United Healthcare Commercial |
$72.38
|
|
|
HC SUTURE VICRYL 8-0 J405G
|
Facility
|
IP
|
$123.75
|
|
| Hospital Charge Code |
41601568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.81 |
| Max. Negotiated Rate |
$115.09 |
| Rate for Payer: Aetna Commercial |
$106.92
|
| Rate for Payer: Cash Price |
$76.73
|
| Rate for Payer: Cigna All Commercial |
$106.80
|
| Rate for Payer: CORVEL All Commercial |
$115.09
|
| Rate for Payer: Coventry All Commercial |
$108.90
|
| Rate for Payer: Encore All Commercial |
$113.91
|
| Rate for Payer: Frontpath All Commercial |
$113.85
|
| Rate for Payer: Humana ChoiceCare |
$106.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.38
|
| Rate for Payer: PHCS All Commercial |
$92.81
|
| Rate for Payer: PHP All Commercial |
$93.85
|
| Rate for Payer: Sagamore Health Network All Products |
$95.54
|
| Rate for Payer: Signature Care EPO |
$102.71
|
| Rate for Payer: Signature Care PPO |
$108.90
|
| Rate for Payer: United Healthcare Commercial |
$97.52
|
|
|
HC SUTURE VICRYL 8-0 J405G
|
Facility
|
OP
|
$123.75
|
|
| Hospital Charge Code |
41601568
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$104.44
|
| Rate for Payer: Aetna Medicare |
$40.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$71.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.92
|
| Rate for Payer: Cash Price |
$76.73
|
| Rate for Payer: Cash Price |
$76.73
|
| Rate for Payer: Centivo All Commercial |
$63.11
|
| Rate for Payer: Cigna All Commercial |
$106.80
|
| Rate for Payer: CORVEL All Commercial |
$115.09
|
| Rate for Payer: Coventry All Commercial |
$108.90
|
| Rate for Payer: Encore All Commercial |
$113.91
|
| Rate for Payer: Frontpath All Commercial |
$113.85
|
| Rate for Payer: Humana ChoiceCare |
$106.88
|
| Rate for Payer: Humana Medicare |
$63.11
|
| Rate for Payer: Lucent All Commercial |
$63.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$92.81
|
| Rate for Payer: PHP All Commercial |
$93.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.26
|
| Rate for Payer: Sagamore Health Network All Products |
$95.54
|
| Rate for Payer: Signature Care EPO |
$102.71
|
| Rate for Payer: Signature Care PPO |
$108.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.19
|
| Rate for Payer: United Healthcare Commercial |
$97.52
|
| Rate for Payer: United Healthcare Medicare |
$40.84
|
|
|
HC SUTURE VICRYL 8-0 J547G
|
Facility
|
OP
|
$132.01
|
|
| Hospital Charge Code |
41601569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.56 |
| Max. Negotiated Rate |
$122.77 |
| Rate for Payer: Aetna Commercial |
$111.42
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.92
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Centivo All Commercial |
$67.33
|
| Rate for Payer: Cigna All Commercial |
$113.92
|
| Rate for Payer: CORVEL All Commercial |
$122.77
|
| Rate for Payer: Coventry All Commercial |
$116.17
|
| Rate for Payer: Encore All Commercial |
$121.52
|
| Rate for Payer: Frontpath All Commercial |
$121.45
|
| Rate for Payer: Humana ChoiceCare |
$114.02
|
| Rate for Payer: Humana Medicare |
$67.33
|
| Rate for Payer: Lucent All Commercial |
$67.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.81
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$99.01
|
| Rate for Payer: PHP All Commercial |
$100.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.48
|
| Rate for Payer: Sagamore Health Network All Products |
$101.91
|
| Rate for Payer: Signature Care EPO |
$109.57
|
| Rate for Payer: Signature Care PPO |
$116.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.21
|
| Rate for Payer: United Healthcare Commercial |
$104.02
|
| Rate for Payer: United Healthcare Medicare |
$43.56
|
|
|
HC SUTURE VICRYL 8-0 J547G
|
Facility
|
IP
|
$132.01
|
|
| Hospital Charge Code |
41601569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$122.77 |
| Rate for Payer: Aetna Commercial |
$114.06
|
| Rate for Payer: Cash Price |
$81.85
|
| Rate for Payer: Cigna All Commercial |
$113.92
|
| Rate for Payer: CORVEL All Commercial |
$122.77
|
| Rate for Payer: Coventry All Commercial |
$116.17
|
| Rate for Payer: Encore All Commercial |
$121.52
|
| Rate for Payer: Frontpath All Commercial |
$121.45
|
| Rate for Payer: Humana ChoiceCare |
$114.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$118.81
|
| Rate for Payer: PHCS All Commercial |
$99.01
|
| Rate for Payer: PHP All Commercial |
$100.12
|
| Rate for Payer: Sagamore Health Network All Products |
$101.91
|
| Rate for Payer: Signature Care EPO |
$109.57
|
| Rate for Payer: Signature Care PPO |
$116.17
|
| Rate for Payer: United Healthcare Commercial |
$104.02
|
|
|
HC SUTURE VICRYL 8-0 J974G
|
Facility
|
OP
|
$154.12
|
|
| Hospital Charge Code |
41601608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$143.33 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: Aetna Medicare |
$50.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.95
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Centivo All Commercial |
$78.60
|
| Rate for Payer: Cigna All Commercial |
$133.01
|
| Rate for Payer: CORVEL All Commercial |
$143.33
|
| Rate for Payer: Coventry All Commercial |
$135.63
|
| Rate for Payer: Encore All Commercial |
$141.87
|
| Rate for Payer: Frontpath All Commercial |
$141.79
|
| Rate for Payer: Humana ChoiceCare |
$133.11
|
| Rate for Payer: Humana Medicare |
$78.60
|
| Rate for Payer: Lucent All Commercial |
$78.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$115.59
|
| Rate for Payer: PHP All Commercial |
$116.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.11
|
| Rate for Payer: Sagamore Health Network All Products |
$118.98
|
| Rate for Payer: Signature Care EPO |
$127.92
|
| Rate for Payer: Signature Care PPO |
$135.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.00
|
| Rate for Payer: United Healthcare Commercial |
$121.45
|
| Rate for Payer: United Healthcare Medicare |
$50.86
|
|
|
HC SUTURE VICRYL 8-0 J974G
|
Facility
|
IP
|
$154.12
|
|
| Hospital Charge Code |
41601608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.59 |
| Max. Negotiated Rate |
$143.33 |
| Rate for Payer: Aetna Commercial |
$133.16
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Cigna All Commercial |
$133.01
|
| Rate for Payer: CORVEL All Commercial |
$143.33
|
| Rate for Payer: Coventry All Commercial |
$135.63
|
| Rate for Payer: Encore All Commercial |
$141.87
|
| Rate for Payer: Frontpath All Commercial |
$141.79
|
| Rate for Payer: Humana ChoiceCare |
$133.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.71
|
| Rate for Payer: PHCS All Commercial |
$115.59
|
| Rate for Payer: PHP All Commercial |
$116.88
|
| Rate for Payer: Sagamore Health Network All Products |
$118.98
|
| Rate for Payer: Signature Care EPO |
$127.92
|
| Rate for Payer: Signature Care PPO |
$135.63
|
| Rate for Payer: United Healthcare Commercial |
$121.45
|
|
|
HC SUTURE VICRYL 9-0 V402G
|
Facility
|
IP
|
$199.58
|
|
| Hospital Charge Code |
41601561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Aetna Commercial |
$172.44
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Cigna All Commercial |
$172.24
|
| Rate for Payer: CORVEL All Commercial |
$185.61
|
| Rate for Payer: Coventry All Commercial |
$175.63
|
| Rate for Payer: Encore All Commercial |
$183.71
|
| Rate for Payer: Frontpath All Commercial |
$183.61
|
| Rate for Payer: Humana ChoiceCare |
$172.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.62
|
| Rate for Payer: PHCS All Commercial |
$149.68
|
| Rate for Payer: PHP All Commercial |
$151.36
|
| Rate for Payer: Sagamore Health Network All Products |
$154.08
|
| Rate for Payer: Signature Care EPO |
$165.65
|
| Rate for Payer: Signature Care PPO |
$175.63
|
| Rate for Payer: United Healthcare Commercial |
$157.27
|
|
|
HC SUTURE VICRYL 9-0 V402G
|
Facility
|
OP
|
$199.58
|
|
| Hospital Charge Code |
41601561
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.86 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Aetna Commercial |
$168.45
|
| Rate for Payer: Aetna Medicare |
$65.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$114.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.45
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Centivo All Commercial |
$101.79
|
| Rate for Payer: Cigna All Commercial |
$172.24
|
| Rate for Payer: CORVEL All Commercial |
$185.61
|
| Rate for Payer: Coventry All Commercial |
$175.63
|
| Rate for Payer: Encore All Commercial |
$183.71
|
| Rate for Payer: Frontpath All Commercial |
$183.61
|
| Rate for Payer: Humana ChoiceCare |
$172.38
|
| Rate for Payer: Humana Medicare |
$101.79
|
| Rate for Payer: Lucent All Commercial |
$101.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$179.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$149.68
|
| Rate for Payer: PHP All Commercial |
$151.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.84
|
| Rate for Payer: Sagamore Health Network All Products |
$154.08
|
| Rate for Payer: Signature Care EPO |
$165.65
|
| Rate for Payer: Signature Care PPO |
$175.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$169.64
|
| Rate for Payer: United Healthcare Commercial |
$157.27
|
| Rate for Payer: United Healthcare Medicare |
$65.86
|
|
|
HC SUTURE VICRYL PLUS 2-0 VCP917H
|
Facility
|
IP
|
$29.06
|
|
| Hospital Charge Code |
41601471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$25.08
|
| Rate for Payer: CORVEL All Commercial |
$27.03
|
| Rate for Payer: Coventry All Commercial |
$25.57
|
| Rate for Payer: Encore All Commercial |
$26.75
|
| Rate for Payer: Frontpath All Commercial |
$26.74
|
| Rate for Payer: Humana ChoiceCare |
$25.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.15
|
| Rate for Payer: PHCS All Commercial |
$21.80
|
| Rate for Payer: PHP All Commercial |
$22.04
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Signature Care EPO |
$24.12
|
| Rate for Payer: Signature Care PPO |
$25.57
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
|
|
HC SUTURE VICRYL PLUS 2-0 VCP917H
|
Facility
|
OP
|
$29.06
|
|
| Hospital Charge Code |
41601471
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.55
|
| Rate for Payer: Cash Price |
$18.02
|
| Rate for Payer: Cash Price |
$18.02
|
| Rate for Payer: Centivo All Commercial |
$14.82
|
| Rate for Payer: Cigna All Commercial |
$25.08
|
| Rate for Payer: CORVEL All Commercial |
$27.03
|
| Rate for Payer: Coventry All Commercial |
$25.57
|
| Rate for Payer: Encore All Commercial |
$26.75
|
| Rate for Payer: Frontpath All Commercial |
$26.74
|
| Rate for Payer: Humana ChoiceCare |
$25.10
|
| Rate for Payer: Humana Medicare |
$14.82
|
| Rate for Payer: Lucent All Commercial |
$14.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.15
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.80
|
| Rate for Payer: PHP All Commercial |
$22.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.33
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Signature Care EPO |
$24.12
|
| Rate for Payer: Signature Care PPO |
$25.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.70
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
| Rate for Payer: United Healthcare Medicare |
$9.59
|
|
|
HC SUTURE VICRYL PLUS 2 VCP195H
|
Facility
|
OP
|
$21.07
|
|
| Hospital Charge Code |
41601470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.65
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Centivo All Commercial |
$10.75
|
| Rate for Payer: Cigna All Commercial |
$18.18
|
| Rate for Payer: CORVEL All Commercial |
$19.60
|
| Rate for Payer: Coventry All Commercial |
$18.54
|
| Rate for Payer: Encore All Commercial |
$19.39
|
| Rate for Payer: Frontpath All Commercial |
$19.38
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Humana Medicare |
$10.75
|
| Rate for Payer: Lucent All Commercial |
$10.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$15.80
|
| Rate for Payer: PHP All Commercial |
$15.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.22
|
| Rate for Payer: Sagamore Health Network All Products |
$16.27
|
| Rate for Payer: Signature Care EPO |
$17.49
|
| Rate for Payer: Signature Care PPO |
$18.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.91
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Medicare |
$6.95
|
|
|
HC SUTURE VICRYL PLUS 2 VCP195H
|
Facility
|
IP
|
$21.07
|
|
| Hospital Charge Code |
41601470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cigna All Commercial |
$18.18
|
| Rate for Payer: CORVEL All Commercial |
$19.60
|
| Rate for Payer: Coventry All Commercial |
$18.54
|
| Rate for Payer: Encore All Commercial |
$19.39
|
| Rate for Payer: Frontpath All Commercial |
$19.38
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.96
|
| Rate for Payer: PHCS All Commercial |
$15.80
|
| Rate for Payer: PHP All Commercial |
$15.98
|
| Rate for Payer: Sagamore Health Network All Products |
$16.27
|
| Rate for Payer: Signature Care EPO |
$17.49
|
| Rate for Payer: Signature Care PPO |
$18.54
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH-1
|
Facility
|
OP
|
$36.97
|
|
| Hospital Charge Code |
41602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Centivo All Commercial |
$18.85
|
| Rate for Payer: Cigna All Commercial |
$31.91
|
| Rate for Payer: CORVEL All Commercial |
$34.38
|
| Rate for Payer: Coventry All Commercial |
$32.53
|
| Rate for Payer: Encore All Commercial |
$34.03
|
| Rate for Payer: Frontpath All Commercial |
$34.01
|
| Rate for Payer: Humana ChoiceCare |
$31.93
|
| Rate for Payer: Humana Medicare |
$18.85
|
| Rate for Payer: Lucent All Commercial |
$18.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$27.73
|
| Rate for Payer: PHP All Commercial |
$28.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.42
|
| Rate for Payer: Sagamore Health Network All Products |
$28.54
|
| Rate for Payer: Signature Care EPO |
$30.69
|
| Rate for Payer: Signature Care PPO |
$32.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$29.13
|
| Rate for Payer: United Healthcare Medicare |
$12.20
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH-1
|
Facility
|
IP
|
$36.97
|
|
| Hospital Charge Code |
41602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$31.94
|
| Rate for Payer: Cash Price |
$22.92
|
| Rate for Payer: Cigna All Commercial |
$31.91
|
| Rate for Payer: CORVEL All Commercial |
$34.38
|
| Rate for Payer: Coventry All Commercial |
$32.53
|
| Rate for Payer: Encore All Commercial |
$34.03
|
| Rate for Payer: Frontpath All Commercial |
$34.01
|
| Rate for Payer: Humana ChoiceCare |
$31.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.27
|
| Rate for Payer: PHCS All Commercial |
$27.73
|
| Rate for Payer: PHP All Commercial |
$28.04
|
| Rate for Payer: Sagamore Health Network All Products |
$28.54
|
| Rate for Payer: Signature Care EPO |
$30.69
|
| Rate for Payer: Signature Care PPO |
$32.53
|
| Rate for Payer: United Healthcare Commercial |
$29.13
|
|
|
HC SUTURE VICRYL PLUS 3-0 VCP427H
|
Facility
|
OP
|
$39.12
|
|
| Hospital Charge Code |
41601614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.02
|
| Rate for Payer: Aetna Medicare |
$12.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.20
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Centivo All Commercial |
$19.95
|
| Rate for Payer: Cigna All Commercial |
$33.76
|
| Rate for Payer: CORVEL All Commercial |
$36.38
|
| Rate for Payer: Coventry All Commercial |
$34.43
|
| Rate for Payer: Encore All Commercial |
$36.01
|
| Rate for Payer: Frontpath All Commercial |
$35.99
|
| Rate for Payer: Humana ChoiceCare |
$33.79
|
| Rate for Payer: Humana Medicare |
$19.95
|
| Rate for Payer: Lucent All Commercial |
$19.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.21
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.34
|
| Rate for Payer: PHP All Commercial |
$29.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.26
|
| Rate for Payer: Sagamore Health Network All Products |
$30.20
|
| Rate for Payer: Signature Care EPO |
$32.47
|
| Rate for Payer: Signature Care PPO |
$34.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.25
|
| Rate for Payer: United Healthcare Commercial |
$30.83
|
| Rate for Payer: United Healthcare Medicare |
$12.91
|
|
|
HC SUTURE VICRYL PLUS 3-0 VCP427H
|
Facility
|
IP
|
$39.12
|
|
| Hospital Charge Code |
41601614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$36.38 |
| Rate for Payer: Aetna Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cigna All Commercial |
$33.76
|
| Rate for Payer: CORVEL All Commercial |
$36.38
|
| Rate for Payer: Coventry All Commercial |
$34.43
|
| Rate for Payer: Encore All Commercial |
$36.01
|
| Rate for Payer: Frontpath All Commercial |
$35.99
|
| Rate for Payer: Humana ChoiceCare |
$33.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.21
|
| Rate for Payer: PHCS All Commercial |
$29.34
|
| Rate for Payer: PHP All Commercial |
$29.67
|
| Rate for Payer: Sagamore Health Network All Products |
$30.20
|
| Rate for Payer: Signature Care EPO |
$32.47
|
| Rate for Payer: Signature Care PPO |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$30.83
|
|
|
HC SUTURE VICRYL PLUS 4-0 PS-4
|
Facility
|
IP
|
$24.70
|
|
| Hospital Charge Code |
41602407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.34
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cigna All Commercial |
$21.32
|
| Rate for Payer: CORVEL All Commercial |
$22.97
|
| Rate for Payer: Coventry All Commercial |
$21.74
|
| Rate for Payer: Encore All Commercial |
$22.74
|
| Rate for Payer: Frontpath All Commercial |
$22.72
|
| Rate for Payer: Humana ChoiceCare |
$21.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.23
|
| Rate for Payer: PHCS All Commercial |
$18.52
|
| Rate for Payer: PHP All Commercial |
$18.73
|
| Rate for Payer: Sagamore Health Network All Products |
$19.07
|
| Rate for Payer: Signature Care EPO |
$20.50
|
| Rate for Payer: Signature Care PPO |
$21.74
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
|
|
HC SUTURE VICRYL PLUS 4-0 PS-4
|
Facility
|
OP
|
$24.70
|
|
| Hospital Charge Code |
41602407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.85
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.97
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Centivo All Commercial |
$12.60
|
| Rate for Payer: Cigna All Commercial |
$21.32
|
| Rate for Payer: CORVEL All Commercial |
$22.97
|
| Rate for Payer: Coventry All Commercial |
$21.74
|
| Rate for Payer: Encore All Commercial |
$22.74
|
| Rate for Payer: Frontpath All Commercial |
$22.72
|
| Rate for Payer: Humana ChoiceCare |
$21.33
|
| Rate for Payer: Humana Medicare |
$12.60
|
| Rate for Payer: Lucent All Commercial |
$12.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.23
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.52
|
| Rate for Payer: PHP All Commercial |
$18.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.63
|
| Rate for Payer: Sagamore Health Network All Products |
$19.07
|
| Rate for Payer: Signature Care EPO |
$20.50
|
| Rate for Payer: Signature Care PPO |
$21.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$19.46
|
| Rate for Payer: United Healthcare Medicare |
$8.15
|
|
|
HC SUTURE VICRYL PLUS 4-0 VCP426H
|
Facility
|
OP
|
$39.31
|
|
| Hospital Charge Code |
41601613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: Centivo All Commercial |
$20.05
|
| Rate for Payer: Cigna All Commercial |
$33.92
|
| Rate for Payer: CORVEL All Commercial |
$36.56
|
| Rate for Payer: Coventry All Commercial |
$34.59
|
| Rate for Payer: Encore All Commercial |
$36.18
|
| Rate for Payer: Frontpath All Commercial |
$36.17
|
| Rate for Payer: Humana ChoiceCare |
$33.95
|
| Rate for Payer: Humana Medicare |
$20.05
|
| Rate for Payer: Lucent All Commercial |
$20.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.38
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$29.48
|
| Rate for Payer: PHP All Commercial |
$29.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.33
|
| Rate for Payer: Sagamore Health Network All Products |
$30.35
|
| Rate for Payer: Signature Care EPO |
$32.63
|
| Rate for Payer: Signature Care PPO |
$34.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.41
|
| Rate for Payer: United Healthcare Commercial |
$30.98
|
| Rate for Payer: United Healthcare Medicare |
$12.97
|
|
