|
N95 MAKRITE 9500
|
Facility
|
IP
|
$33.98
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$16.99 |
| Rate for Payer: SELF PAY |
$16.99
|
|
|
NAIL BRUSH
|
Facility
|
IP
|
$0.50
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: SELF PAY |
$0.25
|
|
|
NASAL CANNULA ADULT W/7' TUBIN
|
Facility
|
IP
|
$0.58
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: SELF PAY |
$0.29
|
|
|
NASAL CANNULA INF. W/7FT TUBIN
|
Facility
|
IP
|
$3.68
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: SELF PAY |
$1.84
|
|
|
NASAL CANNULA PED. W/7FT TUBIN
|
Facility
|
IP
|
$2.16
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: SELF PAY |
$1.08
|
|
|
Nasal Tube Retaining System 10
|
Facility
|
IP
|
$333.98
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.99 |
| Max. Negotiated Rate |
$166.99 |
| Rate for Payer: SELF PAY |
$166.99
|
|
|
Na (Sodium)
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
CPT 84295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: SELF PAY |
$2.40
|
|
|
Nasopharyngeal Airway 20FR
|
Facility
|
IP
|
$10.38
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$5.19 |
| Rate for Payer: SELF PAY |
$5.19
|
|
|
Nasopharyngeal Airway 22FR
|
Facility
|
IP
|
$7.32
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: SELF PAY |
$3.66
|
|
|
Nasopharyngeal Airway 24FR
|
Facility
|
IP
|
$18.36
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: SELF PAY |
$9.18
|
|
|
Nasopharyngeal Airway 26FR
|
Facility
|
IP
|
$18.36
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: SELF PAY |
$9.18
|
|
|
Nasopharyngeal Airway 28FR
|
Facility
|
IP
|
$7.52
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: SELF PAY |
$3.76
|
|
|
Nasopharyngeal Airway 30FR
|
Facility
|
IP
|
$18.66
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: SELF PAY |
$9.33
|
|
|
Nasopharyngeal Airway 32FR
|
Facility
|
IP
|
$7.52
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: SELF PAY |
$3.76
|
|
|
Nasopharyngeal Airway 34FR
|
Facility
|
IP
|
$8.64
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: SELF PAY |
$4.32
|
|
|
Nasopharyngeal Airway 36FR
|
Facility
|
IP
|
$8.64
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: SELF PAY |
$4.32
|
|
|
Nasopharyngeal Airway 60 mm
|
Facility
|
IP
|
$7.30
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: SELF PAY |
$3.65
|
|
|
NEB CUP
|
Facility
|
IP
|
$0.84
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: SELF PAY |
$0.42
|
|
|
NEB CUP WP
|
Facility
|
IP
|
$0.84
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: SELF PAY |
$0.42
|
|
|
Nebulizer Heater/Day
|
Facility
|
IP
|
$5.50
|
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: SELF PAY |
$2.75
|
|
|
Nebulizer Machine
|
Facility
|
IP
|
$1.84
|
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: SELF PAY |
$0.92
|
|
|
NELLCOR SPo2 ADULT SENSOR/TELE
|
Facility
|
IP
|
$127.32
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$63.66 |
| Rate for Payer: SELF PAY |
$63.66
|
|
|
Neocate Infant
|
Facility
|
IP
|
$109.40
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$54.70 |
| Rate for Payer: SELF PAY |
$54.70
|
|
|
Neocate JR
|
Facility
|
IP
|
$97.82
|
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.91 |
| Max. Negotiated Rate |
$48.91 |
| Rate for Payer: SELF PAY |
$48.91
|
|
|
Neonates, died or transferred to another acute care facility
|
Facility
|
IP
|
$51,200.00
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$18,346.93 |
| Max. Negotiated Rate |
$20,385.48 |
| Rate for Payer: AETNA-COVENTRY-COFINITY(First Health) MCR ADVANTAGE and GOVERNMENT PLANS |
$20,385.48
|
| Rate for Payer: American Health Plans Medicare Advantage |
$20,385.48
|
| Rate for Payer: BLUE CROSS OF UTAH/BLUE CARD Medicare Advantage |
$20,385.48
|
| Rate for Payer: CIGNA Medicare Advantage |
$20,385.48
|
| Rate for Payer: HealthChoice Utah Medicare Advantage |
$20,385.48
|
| Rate for Payer: Humana Medicare Advantage |
$20,385.48
|
| Rate for Payer: Medicare |
$20,385.48
|
| Rate for Payer: MOLINA (MARKETPLACE) COMMERCIAL |
$20,385.48
|
| Rate for Payer: MOLINA MEDICARE |
$20,385.48
|
| Rate for Payer: Pacific Source Medicare Advantage |
$20,385.48
|
| Rate for Payer: Select Health Medicare Advantage |
$20,385.48
|
| Rate for Payer: SELF PAY |
$25,600.00
|
| Rate for Payer: Tricare West Military |
$18,346.93
|
|
