|
DRESSING ABDOMINAL PAD 8X10
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|
|
DRESSING ADHESIVE 2X3 TELFA
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|
|
DRESSING ADHESIVE 3X4 TELFA
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$2.00 |
| Max. Negotiated Rate |
-$3.00 |
|
|
DRESSING ALLEVYN SACRUM 6X6
|
None
|
Both
|
$41.00
|
|
| Hospital Charge Code |
100409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$36.00 |
|
|
DRESSING AQUACEL 4X5
|
None
|
Both
|
$52.00
|
|
| Hospital Charge Code |
100737
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$47.00 |
|
|
DRESSING AQUACEL 6X6
|
None
|
Both
|
$101.00
|
|
| Hospital Charge Code |
100741
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$96.00 |
|
|
DRESSING BIOPATCH 4MM DISK
|
None
|
Both
|
$20.00
|
|
| Hospital Charge Code |
100158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$15.00 |
|
|
DRESSING BORDERED GAUZE 2X2
|
None
|
Both
|
$3.00
|
|
|
Service Code
|
None A6219 None
|
| Hospital Charge Code |
100160
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
DRESSING BORDERED GAUZE 4X4
|
None
|
Both
|
$8.00
|
|
|
Service Code
|
None A6219 None
|
| Hospital Charge Code |
100161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.00 |
|
|
DRESSING BORDERED GAUZE 6X6
|
None
|
Both
|
$3.00
|
|
|
Service Code
|
None A6220 None
|
| Hospital Charge Code |
100162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
DRESSING CHANGE W/BIOPATCH
|
None
|
Both
|
$82.00
|
|
| Hospital Charge Code |
100490
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$77.00 |
|
|
DRESSING DUODERM 4 X 4
|
None
|
Both
|
$13.00
|
|
| Hospital Charge Code |
100508
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$8.00 |
|
|
DRESSING DUODERM 6 X 8
|
None
|
Both
|
$40.00
|
|
| Hospital Charge Code |
100507
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$35.00 |
|
|
DRESSING GELFILM BARRIER
|
None
|
Both
|
$301.00
|
|
| Hospital Charge Code |
100159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$296.00 |
|
|
DRESSING GRANUFOAM LARGE
|
None
|
Both
|
$284.00
|
|
| Hospital Charge Code |
100943
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$279.00 |
|
|
DRESSING GRANUFOAM MED BLACK
|
None
|
Both
|
$178.00
|
|
| Hospital Charge Code |
100748
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$173.00 |
|
|
DRESSING MEDIHONEY 2X2
|
None
|
Both
|
$24.00
|
|
| Hospital Charge Code |
100718
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.00 |
|
|
DRESSING MEPILEX 3X3
|
None
|
Both
|
$15.00
|
|
| Hospital Charge Code |
100739
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$10.00 |
|
|
DRESSING MEPILEX 4X4
|
None
|
Both
|
$20.00
|
|
| Hospital Charge Code |
100573
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$15.00 |
|
|
DRESSING MEPILEX 7X7
|
None
|
Both
|
$15.00
|
|
| Hospital Charge Code |
100740
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$10.00 |
|
|
DRESSING MEPITEL ONE 3INX4IN
|
None
|
Both
|
$15.00
|
|
| Hospital Charge Code |
100754
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$10.00 |
|
|
DRESSING NON-ADHERENT 2X3
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100790
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|
|
DRESSING NON-ADHERENT 3X4
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|
|
DRESSING NON-ADHERENT 3X8
|
None
|
Both
|
$1.00
|
|
| Hospital Charge Code |
100626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$3.00 |
| Max. Negotiated Rate |
-$4.00 |
|
|
DRESSING OASIS TRILEVEL 5X7
|
None
|
Both
|
$0.00
|
|
| Hospital Charge Code |
100682
|
|
Hospital Revenue Code
|
270
|
|