|
SPONGE GAUZE 4X4 X-RAY
|
None
|
Both
|
$3.00
|
|
| Hospital Charge Code |
100592
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
SPONGE GAUZE FLUFF TRAY
|
None
|
Both
|
$3.00
|
|
| Hospital Charge Code |
100278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
SPONGE LAP STERILE 18 X 18
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100585
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
SPONGE LAP STERILE 4X18
|
None
|
Both
|
$4.00
|
|
| Hospital Charge Code |
100586
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
-$1.00 |
|
|
SPONGE TONSIL MEDIUM
|
None
|
Both
|
$50.00
|
|
| Hospital Charge Code |
100825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$45.00 |
|
|
STABILIZATION DEVICE PICC PLUS
|
None
|
Both
|
$26.00
|
|
| Hospital Charge Code |
100222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$21.00 |
|
|
STAPLER CRVD ENDO ECS25A
|
None
|
Both
|
$678.00
|
|
| Hospital Charge Code |
100146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$673.00 |
|
|
STAPLER FLEX PLEE60A
|
None
|
Both
|
$842.00
|
|
| Hospital Charge Code |
100157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$837.00 |
|
|
STAPLER HERNIA VERSATEC DLU 4.
|
None
|
Both
|
$176.00
|
|
| Hospital Charge Code |
100676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$171.00 |
|
|
STAPLER INTRALUMINAL CURVED 29MM
|
None
|
Both
|
$590.00
|
|
| Hospital Charge Code |
100938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$526.00 |
| Max. Negotiated Rate |
$585.00 |
|
|
STAPLER INTRALUMINAL CURVED 33MM
|
None
|
Both
|
$590.00
|
|
| Hospital Charge Code |
100939
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$526.00 |
| Max. Negotiated Rate |
$585.00 |
|
|
STAPLER LINEAR 55MM TLC55
|
None
|
Both
|
$258.00
|
|
| Hospital Charge Code |
100942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$253.00 |
|
|
STAPLER LINEAR 60MM 3.5 TX60B
|
None
|
Both
|
$457.00
|
|
| Hospital Charge Code |
100334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$406.00 |
| Max. Negotiated Rate |
$452.00 |
|
|
STAPLER RELOAD ECR60D
|
None
|
Both
|
$271.00
|
|
| Hospital Charge Code |
100151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$266.00 |
|
|
STAPLER RELOAD ENDO ECR60B
|
None
|
Both
|
$313.00
|
|
| Hospital Charge Code |
100150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$308.00 |
|
|
STAPLER RELOAD ENDO GST60W
|
None
|
Both
|
$305.00
|
|
| Hospital Charge Code |
100148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$300.00 |
|
|
STAPLER SKIN
|
None
|
Both
|
$38.00
|
|
| Hospital Charge Code |
100472
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$33.00 |
|
|
STAPLER SKIN DISPOSABLE
|
None
|
Both
|
$30.00
|
|
| Hospital Charge Code |
100336
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$25.00 |
|
|
STAPLER SKIN PRECISE 15
|
None
|
Both
|
$28.00
|
|
| Hospital Charge Code |
100335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$23.00 |
|
|
STERI STRIP 1/2
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100195
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
STERI STRIP 1/4
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100196
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
STOCKINETTE BIAS CUT 4
|
None
|
Both
|
$22.00
|
|
| Hospital Charge Code |
100637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$17.00 |
|
|
STOCKINETTE IMPERVIOUS LGE 9
|
None
|
Both
|
$18.00
|
|
| Hospital Charge Code |
100580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$13.00 |
|
|
STOCKINETTE IMPERVIOUS LRG
|
None
|
Both
|
$32.00
|
|
| Hospital Charge Code |
100835
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$27.00 |
|
|
STOCKINETTE IMPERVIOUS MED
|
None
|
Both
|
$16.00
|
|
| Hospital Charge Code |
100804
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$11.00 |
|