|
SUTURE VICRYL 4-0 PS2 J426H
|
None
|
Both
|
$21.00
|
|
| Hospital Charge Code |
100811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$16.00 |
|
|
SUTURE VICRYL CTD 3-0 ETCVP316H
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
SUTURE VICRYL RAPIDE 4.0 VR496
|
None
|
Both
|
$20.00
|
|
| Hospital Charge Code |
100554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$15.00 |
|
|
SUTURE VICRYL VIL 3 0 J634H
|
None
|
Both
|
$10.00
|
|
| Hospital Charge Code |
100552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.00 |
|
|
SYNTHES 1.25 MM GUIDEWIRE
|
None
|
Both
|
$179.00
|
|
|
Service Code
|
None C1769 None
|
| Hospital Charge Code |
100046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$174.00 |
|
|
SYNTHES 1.25 MM GUIDEWIRE
|
None
|
Both
|
$179.00
|
|
|
Service Code
|
None C1769 None
|
| Hospital Charge Code |
100082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$174.00 |
|
|
SYNTHES 5 HOLE PLATE
|
None
|
Both
|
$233.00
|
|
| Hospital Charge Code |
100077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$228.00 |
|
|
SYNTHES PLATE TUBULAR
|
None
|
Both
|
$290.00
|
|
| Hospital Charge Code |
100090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.00 |
| Max. Negotiated Rate |
$285.00 |
|
|
SYNTHES SCREW
|
None
|
Both
|
$287.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$282.00 |
|
|
SYNTHES SCREW 2.7X10MM
|
None
|
Both
|
$134.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$129.00 |
|
|
SYNTHES SCREW 2.7X12MM
|
None
|
Both
|
$134.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$129.00 |
|
|
SYNTHES SCREW 2.7X14MM
|
None
|
Both
|
$134.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$129.00 |
|
|
SYNTHES SCREW 2.7X16MM
|
None
|
Both
|
$134.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$129.00 |
|
|
SYNTHES SCREW 4.0
|
None
|
Both
|
$567.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$562.00 |
|
|
SYNTHES SCREW 4.0 LONG THREAD 46MM
|
None
|
Both
|
$588.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.00 |
| Max. Negotiated Rate |
$583.00 |
|
|
SYNTHES SCREW 4.0MM LONG THREAD 50MM
|
None
|
Both
|
$588.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.00 |
| Max. Negotiated Rate |
$583.00 |
|
|
SYNTHES SCREW 4.0 SHORT THREAD 40MM
|
None
|
Both
|
$588.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.00 |
| Max. Negotiated Rate |
$583.00 |
|
|
SYNTHES SCREW CANCELLOUS
|
None
|
Both
|
$120.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$115.00 |
|
|
SYNTHES SCREW CANCELLOUS
|
None
|
Both
|
$120.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$115.00 |
|
|
SYNTHES SCREW CANNCELLOUS
|
None
|
Both
|
$120.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$115.00 |
|
|
SYNTHES SCREW CANNCELLOUS
|
None
|
Both
|
$120.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$115.00 |
|
|
SYNTHES SCREW CANN PART THREADED
|
None
|
Both
|
$119.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$114.00 |
|
|
SYNTHES SCREW CANN PART THREADED
|
None
|
Both
|
$119.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$114.00 |
|
|
SYNTHES SCREW CANN PART THREADED
|
None
|
Both
|
$120.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$115.00 |
|
|
SYNTHES SCREW CANNULATED
|
None
|
Both
|
$568.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$563.00 |
|