|
CUTTER RESECTOR 5.5MM
|
None
|
Both
|
$122.00
|
|
| Hospital Charge Code |
100575
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$117.00 |
|
|
CUTTER RESECTOR ANGLED 5.0MM
|
None
|
Both
|
$122.00
|
|
| Hospital Charge Code |
100577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$117.00 |
|
|
DETECTOR CARBON DIOXIDE
|
None
|
Both
|
$48.00
|
|
| Hospital Charge Code |
100494
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$43.00 |
|
|
DIALATOR 7MM MULTI SINUS
|
None
|
Both
|
$0.00
|
|
|
Service Code
|
None C1726 None
|
| Hospital Charge Code |
100105
|
|
Hospital Revenue Code
|
270
|
|
|
DILATOR ESOPHAGEAL BALLOON 15-16,5-18
|
None
|
Both
|
$430.00
|
|
| Hospital Charge Code |
100709
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$382.00 |
| Max. Negotiated Rate |
$425.00 |
|
|
DILATOR ESOPHAGEAL BALLOON 18-19-20
|
None
|
Both
|
$430.00
|
|
| Hospital Charge Code |
100710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$382.00 |
| Max. Negotiated Rate |
$425.00 |
|
|
DISSECTOR ENDO
|
None
|
Both
|
$106.00
|
|
| Hospital Charge Code |
100283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$101.00 |
|
|
DRAIN BLAKE 10FR W/TROCAR
|
None
|
Both
|
$91.00
|
|
| Hospital Charge Code |
100523
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$86.00 |
|
|
DRAIN BLAKE 15FR W/TROCAR
|
None
|
Both
|
$219.00
|
|
| Hospital Charge Code |
100514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$214.00 |
|
|
DRAIN BLAKE 19FR ROUND
|
None
|
Both
|
$189.00
|
|
| Hospital Charge Code |
100730
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$184.00 |
|
|
DRAIN BLAKE 19FR W/TROCAR
|
None
|
Both
|
$90.00
|
|
| Hospital Charge Code |
100263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$85.00 |
|
|
DRAIN MALECOT 20FR
|
None
|
Both
|
$51.00
|
|
| Hospital Charge Code |
100654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$46.00 |
|
|
DRAIN MALECOT 24FR
|
None
|
Both
|
$56.00
|
|
| Hospital Charge Code |
100655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$51.00 |
|
|
DRAIN PENROSE 1/2 X 12
|
None
|
Both
|
$18.00
|
|
| Hospital Charge Code |
100391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$13.00 |
|
|
DRAIN RELIVAC 400 CLOSED WOUND
|
None
|
Both
|
$203.00
|
|
| Hospital Charge Code |
100407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$198.00 |
|
|
DRAPE IOBAN 6617
|
None
|
Both
|
$98.00
|
|
| Hospital Charge Code |
100359
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$93.00 |
|
|
DRAPE IOBAN 6650EZ
|
None
|
Both
|
$33.00
|
|
| Hospital Charge Code |
100363
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$28.00 |
|
|
DRAPE IOBAN 6651
|
None
|
Both
|
$62.00
|
|
| Hospital Charge Code |
100364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$57.00 |
|
|
DRAPE STERI 1000
|
None
|
Both
|
$5.00
|
|
| Hospital Charge Code |
100361
|
|
Hospital Revenue Code
|
270
|
|
|
DRAPE STERI 1015
|
None
|
Both
|
$19.00
|
|
| Hospital Charge Code |
100360
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$14.00 |
|
|
DRAPE STERI 1016
|
None
|
Both
|
$22.00
|
|
| Hospital Charge Code |
100765
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$17.00 |
|
|
DRAPE STERI 1018
|
None
|
Both
|
$8.00
|
|
| Hospital Charge Code |
100153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.00 |
|
|
DRAPE STERI 1040
|
None
|
Both
|
$13.00
|
|
| Hospital Charge Code |
100362
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$8.00 |
|
|
DRAPE STERI 1092
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100763
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
DRESSING ABDOMINAL PAD 5X9
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|