|
TROCAR W/SLEEVE 12MM/150MM B12XT
|
None
|
Both
|
$208.00
|
|
| Hospital Charge Code |
100506
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$203.00 |
|
|
TROCAR W/SLEEVE 5MM/100MM B5LT
|
None
|
Both
|
$163.00
|
|
| Hospital Charge Code |
100584
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$158.00 |
|
|
TUBE ENDOTRACH 3.0 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100686
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 3.5 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100687
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 4.0 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100688
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 4.5 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 5.0 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100689
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 5.5 UNCUFFED
|
None
|
Both
|
$7.00
|
|
| Hospital Charge Code |
100690
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.00 |
|
|
TUBE ENDOTRACH 6.0 HILO CUFF
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100491
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
TUBE ENDOTRACH 8.5 HILO CUFF
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
TUBE ENDOTRACH 9.0 HILO CUFF
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100455
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
TUBE ENDOTRACH 9.5 HILO CUFF
|
None
|
Both
|
$9.00
|
|
| Hospital Charge Code |
100454
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.00 |
|
|
TUBE FEEDING 8FR W STYLT
|
None
|
Both
|
$87.00
|
|
| Hospital Charge Code |
100394
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$82.00 |
|
|
TUBE FEEDING INFANT 5FR 15IN
|
None
|
Both
|
$3.00
|
|
| Hospital Charge Code |
100697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
-$1.00 |
| Max. Negotiated Rate |
-$2.00 |
|
|
TUBE FEEDING INFANT 8FR 15IN
|
None
|
Both
|
$4.00
|
|
| Hospital Charge Code |
100393
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
-$1.00 |
|
|
TUBE GASTROSTOMY 20FR
|
None
|
Both
|
$65.00
|
|
| Hospital Charge Code |
100569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$60.00 |
|
|
TUBE GASTROSTOMY 22 FR
|
None
|
Both
|
$65.00
|
|
| Hospital Charge Code |
100570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$60.00 |
|
|
TUBE GASTROSTOMY 24 FR
|
None
|
Both
|
$65.00
|
|
| Hospital Charge Code |
100571
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$60.00 |
|
|
TUBE NASOGASTRIC SUMP 10FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100456
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TUBE NASOGASTRIC SUMP 12FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100698
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TUBE NASOGASTRIC SUMP 14FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100699
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TUBE NASOGASTRIC SUMP 16FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100396
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TUBE NASOGASTRIC SUMP 18FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100503
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|
|
TUBE SALEM SUMP 16FR
|
None
|
Both
|
$43.00
|
|
| Hospital Charge Code |
100813
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.00 |
|
|
TUBE SUCTION FRAZIER 10FR
|
None
|
Both
|
$6.00
|
|
| Hospital Charge Code |
100458
|
|
Hospital Revenue Code
|
270
|
| Max. Negotiated Rate |
$1.00 |
|