|
SYNTHES SCREW CANNULATED 4.0
|
None
|
Both
|
$529.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.00 |
| Max. Negotiated Rate |
$524.00 |
|
|
SYNTHES SCREW CANNULATED 4.5X40
|
None
|
Both
|
$475.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$470.00 |
|
|
SYNTHES SCREW CANNULATED 4.5X50
|
None
|
Both
|
$475.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$470.00 |
|
|
SYNTHES SCREW CORTEX
|
None
|
Both
|
$114.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SYNTHES SCREW CORTEX 3.5X10
|
None
|
Both
|
$155.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$150.00 |
|
|
SYNTHES SCREW CORTEX 3.5X10
|
None
|
Both
|
$113.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$108.00 |
|
|
SYNTHES SCREW CORTEX 3.5X12
|
None
|
Both
|
$155.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$150.00 |
|
|
SYNTHES SCREW CORTEX 3.5X12
|
None
|
Both
|
$114.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SYNTHES SCREW CORTEX 3.5X12
|
None
|
Both
|
$155.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100071
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$150.00 |
|
|
SYNTHES SCREW CORTEX 3.5X14
|
None
|
Both
|
$114.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SYNTHES SCREW CORTEX 3.5X16
|
None
|
Both
|
$114.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$109.00 |
|
|
SYNTHES SCREW CORTEX 3.5X18
|
None
|
Both
|
$91.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$86.00 |
|
|
SYNTHES SCREW CORTEX 3.5X50
|
None
|
Both
|
$117.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$112.00 |
|
|
SYNTHES SCREW MALLEOLAR 70MM
|
None
|
Both
|
$170.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100068
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$165.00 |
|
|
SYNTHES SHAFT 3.5
|
None
|
Both
|
$133.00
|
|
| Hospital Charge Code |
100086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$128.00 |
|
|
SYNTHES SHAFT 3.5
|
None
|
Both
|
$133.00
|
|
| Hospital Charge Code |
100087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$128.00 |
|
|
SYNTHES TAP 5MM
|
None
|
Both
|
$321.00
|
|
|
Service Code
|
None C1713 None
|
| Hospital Charge Code |
100084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$316.00 |
|
|
SYNTHES WIRE GUIDE
|
None
|
Both
|
$161.00
|
|
|
Service Code
|
None C1769 None
|
| Hospital Charge Code |
100061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$156.00 |
|
|
SYSTEM TROCAR CONVERTIBLE 5MM
|
None
|
Both
|
$12.00
|
|
| Hospital Charge Code |
100546
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$7.00 |
|
|
SYSTEM TROCAR CONVERTIBLE 5MM
|
None
|
Both
|
$14.00
|
|
| Hospital Charge Code |
100547
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$9.00 |
|
|
TAPE ELASTIC 4
|
None
|
Both
|
$35.00
|
|
| Hospital Charge Code |
100357
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$30.00 |
|
|
TAPE SURGICAL CLOTH 2 MEDIPORE
|
None
|
Both
|
$21.00
|
|
| Hospital Charge Code |
100489
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$16.00 |
|
|
TAPE SURGICAL CLOTH 4 MEDIPORE
|
None
|
Both
|
$42.00
|
|
| Hospital Charge Code |
100434
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$37.00 |
|
|
THER EXRC 1 EA 15 MIN
|
None
|
Both
|
$30.00
|
|
|
Service Code
|
None 97110,GP None
|
| Hospital Charge Code |
100027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$25.00 |
|
|
THER PROC 2 OR MORE IND
|
None
|
Both
|
$88.00
|
|
|
Service Code
|
None G0239,59 None
|
| Hospital Charge Code |
100032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$83.00 |
|