|
THER PROC 2 OR MORE IND KX MODIFIER
|
None
None
|
$88.00
|
|
|
Service Code
|
None G0239,59,KX None
|
| Hospital Charge Code |
100033
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$83.00 |
|
|
THER PROC DIRECT 1 EA 15 MIN
|
None
None
|
$131.00
|
|
|
Service Code
|
None G0238,59 None
|
| Hospital Charge Code |
100030
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$126.00 |
|
|
THER PROC DIRECT 1 EA 15 MIN KX MODIFIER
|
None
None
|
$131.00
|
|
|
Service Code
|
None G0238,59,KX None
|
| Hospital Charge Code |
100031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$126.00 |
|
|
THER PROC STR/ END IND EA 15 MIN KX MOD
|
None
None
|
$131.00
|
|
|
Service Code
|
None G0237,59,KX None
|
| Hospital Charge Code |
100029
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$126.00 |
|
|
THER PROC STRENGTH/ ENDUR IND. EA 15 MIN
|
None
None
|
$131.00
|
|
|
Service Code
|
None G0237,59 None
|
| Hospital Charge Code |
100028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$126.00 |
|
|
TRAP MUCUS SPECIMEN DELEE
|
None
None
|
$22.00
|
|
| Hospital Charge Code |
100370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$17.00 |
|
|
TRAP POLYP SUCTION IN-LINE
|
None
None
|
$15.00
|
|
| Hospital Charge Code |
100707
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$10.00 |
|
|
TRAP SPECIMEN 40 CC
|
None
None
|
$4.00
|
|
| Hospital Charge Code |
100373
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
-$1.00 |
|
|
TRAY 7FR 20CM MULTILUMEN C/VNS
|
None
None
|
$202.00
|
|
| Hospital Charge Code |
100602
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$197.00 |
|
|
TRAY ARTHROGRAM 22GX3.5
|
None
None
|
$69.00
|
|
| Hospital Charge Code |
100374
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$64.00 |
|
|
TRAY BIOPSY SOFT TISSUE
|
None
None
|
$88.00
|
|
| Hospital Charge Code |
100375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$83.00 |
|
|
TRAY BONE MARROW BIOPSY
|
None
None
|
$76.00
|
|
| Hospital Charge Code |
100516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$71.00 |
|
|
TRAY BONE MARROW JAMSHIDI 11GA X 4
|
None
None
|
$123.00
|
|
| Hospital Charge Code |
100376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$118.00 |
|
|
TRAY CATH PERCU INTRODUCER 8
|
None
None
|
$161.00
|
|
| Hospital Charge Code |
100605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$156.00 |
|
|
TRAY EPIDURAL STEROID
|
None
None
|
$135.00
|
|
| Hospital Charge Code |
100517
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$130.00 |
|
|
TRAY FOLEY CATH 18FR
|
None
None
|
$68.00
|
|
| Hospital Charge Code |
100377
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$63.00 |
|
|
TRAY IRRIGATION PISTON
|
None
None
|
$6.00
|
|
| Hospital Charge Code |
100378
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TRAY LUMBAR PUNCTURE ADULT
|
None
None
|
$91.00
|
|
| Hospital Charge Code |
100382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$86.00 |
|
|
TRAY LUMBAR PUNCTURE INFANT
|
None
None
|
$89.00
|
|
| Hospital Charge Code |
100870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$84.00 |
|
|
TRAY LUMBAR PUNCTURE INFANT
|
None
None
|
$55.00
|
|
| Hospital Charge Code |
100383
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$50.00 |
|
|
TRAY MULTILUMEN 7FR 20CM C/VNS
|
None
None
|
$129.00
|
|
| Hospital Charge Code |
100604
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$124.00 |
|
|
TRAY MULTILUMEN 7 FR 30CM C/VENOUS
|
None
None
|
$242.00
|
|
| Hospital Charge Code |
100603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$237.00 |
|
|
TRAY MULTILUMEN 7 FR 30CM C/VENOUS
|
None
None
|
$242.00
|
|
| Hospital Charge Code |
100944
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$237.00 |
|
|
TRAY MULTI LUMEN CENTRAL VENOUS
|
None
None
|
$236.00
|
|
| Hospital Charge Code |
100728
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$231.00 |
|
|
TRAY MYELOGRAM 22GA X 3.5
|
None
None
|
$90.00
|
|
| Hospital Charge Code |
100384
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$85.00 |
|