|
SPECULUM VAGINAL SM
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100493
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
SPIROMETER INCENTIVE
|
None
|
Both
|
$12.00
|
|
| Hospital Charge Code |
100799
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$7.00 |
|
|
SPLINT FINGER ALUMAFOAM 3/4X18
|
None
|
Both
|
$8.00
|
|
| Hospital Charge Code |
100887
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.00 |
|
|
SPLINT FINGER TOAD LGE
|
None
|
Both
|
$13.00
|
|
| Hospital Charge Code |
100853
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$8.00 |
|
|
SPLINT FOREARM L-L
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100427
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM L-M
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100426
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM L-S
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100425
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM L-XS
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100424
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM R-L
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100431
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM R-M
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM R-S
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100429
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT FOREARM R-XS
|
None
|
Both
|
$27.00
|
|
| Hospital Charge Code |
100428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$22.00 |
|
|
SPLINT PATELLA LG
|
None
|
Both
|
$125.00
|
|
| Hospital Charge Code |
100886
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$120.00 |
|
|
SPLINT PATELLA MED
|
None
|
Both
|
$125.00
|
|
| Hospital Charge Code |
100885
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$120.00 |
|
|
SPLINT POSTERIOR BOOT LARGE
|
None
|
Both
|
$114.00
|
|
|
Service Code
|
None L4386 None
|
| Hospital Charge Code |
100131
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SPLINT POSTERIOR BOOT MEDIUM
|
None
|
Both
|
$114.00
|
|
| Hospital Charge Code |
100369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SPLINT POSTERIOR BOOT SMALL
|
None
|
Both
|
$115.00
|
|
| Hospital Charge Code |
100368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$110.00 |
|
|
SPLINT WRIST LT-LG FOREARM
|
None
|
Both
|
$29.00
|
|
| Hospital Charge Code |
100891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$24.00 |
|
|
SPLINT WRIST LT-MED FOREARM
|
None
|
Both
|
$32.00
|
|
| Hospital Charge Code |
100890
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$27.00 |
|
|
SPLINT WRIST RT-LG FOREARM
|
None
|
Both
|
$26.00
|
|
| Hospital Charge Code |
100893
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$21.00 |
|
|
SPLINT WRIST RT-MED COCK-UP
|
None
|
Both
|
$36.00
|
|
| Hospital Charge Code |
100889
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$31.00 |
|
|
SPLINT WRIST RT-MED FOREARM
|
None
|
Both
|
$32.00
|
|
| Hospital Charge Code |
100892
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$27.00 |
|
|
SPLINT WRIST RT-SM COCK-UP
|
None
|
Both
|
$63.00
|
|
| Hospital Charge Code |
100888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$58.00 |
|
|
SPONGE DRAIN 4X4
|
None
|
Both
|
$2.00
|
|
| Hospital Charge Code |
100650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
SPONGE GAUZE 4X4 TRAY 10'S
|
None
|
Both
|
$3.00
|
|
| Hospital Charge Code |
100277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|