|
SHOE POST OP FEMALE MEDIUM
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100471
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SHOE POST OP FEMALE SMALL
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SHOE POST OP MALE LRG
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SHOE POST OP MALE MED
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100701
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SHOE POST OP MALE SMALL
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SHOE POST OP MALE XLG
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SIMPLE PULM STRESS TEST ( INIT EVAL )
|
None
|
Both
|
$297.00
|
|
|
Service Code
|
None 94620 None
|
| Hospital Charge Code |
100025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$292.00 |
|
|
SKIN PROTECTANT CALAZIME
|
None
|
Both
|
$22.00
|
|
| Hospital Charge Code |
100137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$17.00 |
|
|
SKIN PROTECTANT LIQUID MARATHON
|
None
|
Both
|
$32.00
|
|
| Hospital Charge Code |
100932
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$27.00 |
|
|
SKIN PROTECTIVE BARRIER WAND 1 ML
|
None
|
Both
|
$13.00
|
|
| Hospital Charge Code |
100933
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$8.00 |
|
|
SLEEVE DISP STERILE
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100593
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
SLEEVE SCD KNEE MEDIUM
|
None
|
Both
|
$107.00
|
|
| Hospital Charge Code |
100301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$102.00 |
|
|
SLEEVE SCD THIGH LARGE
|
None
|
Both
|
$162.00
|
|
| Hospital Charge Code |
100302
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$157.00 |
|
|
SLEEVE SCD THIGH LARGE-REPROCESSED
|
None
|
Both
|
$89.00
|
|
| Hospital Charge Code |
100307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$84.00 |
|
|
SLEEVE SCD THIGH MEDIUM
|
None
|
Both
|
$185.00
|
|
| Hospital Charge Code |
100303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$180.00 |
|
|
SLEEVE SCD THIGH MED-REPROCESSED
|
None
|
Both
|
$89.00
|
|
| Hospital Charge Code |
100306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$84.00 |
|
|
SLEEVE SCD THIGH SMALL
|
None
|
Both
|
$179.00
|
|
| Hospital Charge Code |
100304
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$174.00 |
|
|
SLEEVE SCD THIGH SMALL-REPROCESSED
|
None
|
Both
|
$89.00
|
|
| Hospital Charge Code |
100305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$84.00 |
|
|
SLEEVE STABILITY 5MM CB5LT-REPROCESSED
|
None
|
Both
|
$87.00
|
|
| Hospital Charge Code |
100599
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$82.00 |
|
|
SNAP CARTRIDGE 125MMHG
|
None
|
Both
|
$288.00
|
|
| Hospital Charge Code |
100768
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$254.00 |
| Max. Negotiated Rate |
$283.00 |
|
|
SNAP DRESSING FOAM 10X10
|
None
|
Both
|
$186.00
|
|
| Hospital Charge Code |
100767
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$181.00 |
|
|
SNAP STRAP WOUND CARE LGE
|
None
|
Both
|
$68.00
|
|
| Hospital Charge Code |
100766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$63.00 |
|
|
SNARE ELECTOSURGICAL 15MM DISPOSABLE
|
None
|
Both
|
$52.00
|
|
| Hospital Charge Code |
100284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$47.00 |
|
|
SPECULUM VAGINAL LARGE
|
None
|
Both
|
$11.00
|
|
| Hospital Charge Code |
100309
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$6.00 |
|
|
SPECULUM VAGINAL MED
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100492
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|