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Billing Information Billing Information- Please understand that the prices included in our list of charges are not what your insurance will pay and not reflective of what your actual financial responsibility will be. The amount collected may be less than the amount listed based on our contractual agreements with payers such as Medicare, Medicaid, commercial insurance companies and eligibility for our financial assistance program. SERVICE CHARGE CODE SERVICE DESCRIPTION PRICE1 111 AIRSPLINT FULL 107.50 112 AIRSPLINT 1/2 L 77.05 121 ARM SLING CRADLE XL 22.20 123 ARM SLING POUCH XL 19.65 124 ARM SLING MED 19.65 125 ARM SLING LG 19.65 128 WRIST & FOREARM SM L 30.40 145 ELASTIC WRIST P 39.90 152 CAST BOOT EX SMALL 59.00 160 FLEX CUFF ELBOW ORTH 304.15 162 FOOT ORTHO WEDGE 92.40 163 TIB FIB SM CHILD 128.90 310 PRIVATE ROOM 770.00 311 SEMI PRIVATE 770.00 400 BREAST BIOPSY 622.15 412 EKG 90.60 413 EKG SCREENING FOR MC 90.60 430 PREMARIN 0.3 TAB 12.10 439 SPEECH TX INDIVIDUAL 162.65 440 SPEECH TX GROUP 66.70 441 TX SWALLOW DYSFUNCTI 186.50 582 PREDNISONE TAB 5MG 1.95 790 CHOLECYSTECTOMY CRNA 1,174.95 810 COLONOSCOPY CRNA 691.00 840 APPENDECTOMY CRNA 1,036.85 50140 IV BL SET NEEDLELESS 12.95 58661 LAP OVARIAN ECT 6,800.30 60745 SI LOC PELVIC SUPPOR 105.80 100049 SENSOR DISP BED 65.70 103184 NOVASOURCE RENAL FOR 12.20 150006 PULSE OXI 1 PER DAY 18.55 150010 OBSERVATION ROOM 1HR 32.00 150128 COUDE INSERTED 370.85 150129 VAGINAL DELIVERY 4,440.00 150130 DELIVERY OF PLACENTA 4,424.95 150131 LUMBAR PUNCTURE 1,075.15 150135 GASTRIC INTUBATION 554.60 150137 I&D PERINEAL ABSCESS 585.20 150138 I&D BARTHOLINS GLAND 403.70 150139 TEMP TRANSCUTANEOUS 1,021.25 150140 CARDIOVERSION EXTERN 1,021.35 150141 THROMBOLYSIS COR IV 914.45 150142 VENTILATOR INITIAL D 899.55 150143 EPISIOTOMY 4,429.90 150145 DENTAL BLOCK 551.40 150146 REGIONAL NERVE BLOCK 1,355.75 150147 DIGITAL NERVE BLOCK 1,076.20 150148 REMOVAL FB EMBEDDED 555.55 150149 REMOVAL FB CORNEA 558.65 150150 BLOOD GLUCOSE 10.25 150191 THROMBOLYSIS CVA 820.45 150200 LACERATION REPAIR 406.10 150201 REMOVAL FB SUBCUTANE 617.95 150202 SHAVING OF LES 0.6-1 397.85 150203 EXC BENIGN LES 1.1-2 1,143.90 150204 I&D BREAST 2,623.85 150205 WOUND EXPLOR CHEST 3,029.50 150206 APPLY SHORT ARM SPLI 291.75 150207 APPL SPLNT SHORT ARM 169.40 150208 APPLY FINGER SPLINT 176.95 150209 APPLICAT FINGER SPLI 169.40 150210 APPLY SHORT LEG SPLI 331.95 150211 TRACH TUBE CHANGE 467.30 150212 NASOTRACH CATH ASPIR 429.85 150213 BLOOD TRANSFUSION 752.25 150214 SIMPLE LAC 402.80 150215 CATHETERIZATION SIMP 271.30 150216 REMOVAL IMPACT CERUM 171.20 150217 REMOVAL IMPACT CERUM 101.30 150218 REMOVAL FB EAR 291.90 150219 DEBRIDE SKIN & TISSU 590.15 150220 IV ADM INITIAL 476.85 150221 ANTIBIOTIC INJECTION 183.75 150222 D T INJ < 7YR 74.35 150223 D T INJ > 7 YR 112.90 150224 PULSE OXI CONTIN >6H 182.80 150225 PULSE OXI MULTI/EXER 72.30 150226 T T INJ 167.00 150227 IV HYDRATION </= 1HR 453.15 150228 IV INFUS FOR THERAPY 1 449.45 150229 APPLY LONG LEG SPLIN 365.15 150230 STRAPPING OF CLAVICL 527.75 150231 REMOVAL FB EXT EYE 298.50 150232 EXC ABD MASS 1,193.30 150233 REMOVAL FB FOOT 1,180.05 150301 APPLICATION LEG SPLI 106.05 150303 T T INJ IM OR JET 12.40 150307 FACIAL INTERMEDIATE 620.90 150308 TRUNK COMPLEX 962.40 150309 COMPLEX SCALP/EXT 961.40 150310 FACIAL COMPLEX 960.90 150311 VERMILLION LACERATIO 939.15 150312 TONGUE LACERATION 624.75 150330 IV ADM ADDITIONAL 183.75 150331 IV HYDRATION ADD HR 110.70 150332 I&D FINGER ABSCESS 435.05 150400 IV INFUS FOR THERAPY 2 107.95 150401 IV SEQUENTIAL THERAP 169.35 150403 I&D 406.10 150404 I&D PILONIDAL CYST 1,140.45 150405 PUNCTURE ASPIRATION 413.75 150407 DEBRIDEMANT OF NAIL 169.75 150408 NAIL AVULSION SINGLE 408.45 150409 NAIL AVULSION MULTIP 204.20 150410 SUBUNGUAL HEMATOMA 173.70 150411 EXCISION OF NAIL 620.90 150412 INGROWN TONAIL 615.30 150413 SIMP REPAIR WOUND DI 961.40 150414 REPAIR WOUND DEHISCE 620.60 150415 ARTHROCENTESIS ASP/I 490.10 150416 ARTHROCENTESIS INTER 551.40 150417 ARTHROCENTESIS LARGE 612.65 150418 TMJ DISLOCATION 530.05 150419 REDUCTION CLAVICLE 2,583.15 150420 REDUCTION ELBOW 529.10 150421 REDUCTION NURSEMAID 526.75 150422 WRIST DISLOCATION 522.45 150423 THUMB DISLOCATION 528.65 150424 REDUCTION INTERPHALA 529.95 150425 REDUCTION TRAUMATIC 525.40 150426 REDUCTION NONTRAUMAT 527.50 150427 REDUCTION OF KNEE 528.50 150428 REDUCTION/DISLOCAT P 527.00 150429 REDUCTION ANKLE 524.90 150430 REDUCTION TOES 524.20 150431 SUGAR TONG SPLINT 363.05 150432 KNEE IMMOBILIZER 172.65 150433 RIB BELT 365.20 150434 CLAVICLE/SHOULDER IM 173.70 150435 WRIST SPLINT 90.70 150436 AIR STIRRUP 331.95 150437 STRAPPING TOES 175.30 150439 CAST REMOVAL 526.95 150440 REMOVAL NARE 270.25 150441 EPISTAXIS CONTROL AN 291.85 150442 EPITAXIS CONTROL COM 304.70 150443 EPITAXIS CONTROL POS 318.35 150444 LARYNGOSCOPY 426.50 150446 CRICOTHYROTOMY 939.15 150447 THORACENTESIS 1,448.90 150448 CHEST TUBE INSERTION 1,453.95 150449 PERICARDIOCENTESIS 1,451.85 150450 TRIAGE 61.40 150451 IV INSERTION 26.50 150452 WOUND EXPLOR EXTREM 1,143.90 150453 LABS DRAWN 9.25 150454 CENTRAL LINE PLACEME 1 1,451.65 150455 CENTRAL LINE PLACEME 2 1,459.70 150457 BLOOD GASES 173.60 150458 INTRAOSSEOUS 559.35 150459 FB REMOVAL PHARYNX 559.35 150460 I&D PERIRECTAL AREA 1,862.10 150461 I&D PERIANAL AREA 1,419.25 150462 I&D THOMOBOSED EXT H 515.70 150463 ANOSCOPE 292.00 150464 FB REMOVAL RECTUM 1,416.65 150465 PARACENTESIS 1,485.00 150466 ASPIRATION BLADDER/N 1,165.80 150467 BLADDER IRRIGATION 515.70 150468 STRAIGHT CATH INSERT 293.00 150469 MODERATE SEDATION <5 73.80 150470 MODERATE SEDATION >5 38.45 150471 MODERATE SED ADD 30 30.95 150472 MOD SED OTHER PHY <5 288.70 150473 MOD SED OTHER PHY >5 237.30 150474 NEWBORN RESUSCITATIO 1,021.35 150500 I&D VULVA/PERINEUM 691.00 160001 FLU SHOT ADMINISTRAT 11.15 160003 H1N1 VAC ADMISTRATIO 12.40 161405 EMPTY VAC BOTTLES 38.25 200042 SURG ROOM BASE AMT 2,705.70 200043 CATARACT CRNA 256.90 200115 SURG PROC TREAT ROOM 198.65 200116 EXC MAL LESION 2.1-3 1,216.10 200117 SURGICAL PROCEDURE 155.05 200118 US GUIDE THYROID BX 247.85 200119 US GUIDE BREAST BX 1 3,554.20 200120 US GUIDE BREAST BX 2 1,772.65 200131 ESOPHAGOSCOPY 817.40 200166 CYSTOSCOPY 899.85 200204 RECOVERY RM 30MIN 288.40 200205 RECTAL DILATION 3,369.75 200206 RECTAL DILATION CRNA 321.30 200239 SURG ROOM ADD 15 MIN 676.40 200500 ENSURE CHOCOLATE 4.80 200502 1698-G ETHILON SUTUR 16.30 220000 RECOVERY RM EA ADD15 74.00 230331 TENDON EXTENS TOE 2,989.35 230335 I&D ULCERS LOWER EXT 2,942.05 230336 I & D DEEP ABCESS 3,090.85 230337 I & D DEEP ABCESS CR 218.55 260001 LOCAL ANESTHESIA 164.85 260002 ANES/EXTREME AGE CRN 76.25 260003 ANES/EMERGENCY CRNA 153.35 260004 ANES CRNA 15 MIN 76.25 260005 P3 PHYSICAL STA CRNA 76.25 260006 P4 PHYSICAL STA CRNA 153.35 260007 P5 PHYSICAL STA CRNA 229.60 260008 EXCIS BREA MASS CRNA 229.60 260009 DEBRIDEMENT KNEE 231.85 260010 OOPHORECTOMY CRNA 459.75 260012 ANES MAT ADD 15 MIN 63.35 260013 TONSILECTOMY CRNA 459.75 260014 COLONOSCOPY SCR CRNA 383.20 260015 EGD CRNA 383.20 260016 APPENDECTOMY CRNA 459.75 260017 TUBAL CRNA 459.75 260018 AXILLARY CRNA 229.60 260019 UMBILICAL HERN CRNA 306.10 260020 GANGLION CYST CRNA 229.60 260021 PEG CRNA 383.20 260022 TAH CRNA 459.75 260023 GALL BLADDER CRNA 536.55 260024 HEMORRHOIDECTOM CRNA 383.20 260025 COLECTOMY CRNA 459.75 260026 INGUINAL HERNIA CRNA 306.10 260027 BMT CRNA 383.20 260028 CYSTOCELE CRNA 229.60 260029 ANES MATERIAL BASE C 402.30 260030 TONSILECTOMY 2,419.85 260031 OMENTUMECTOMY 2,849.20 260032 MASTECTOMY CRNA 383.20 260033 APPENDECTOMY 3,295.50 260034 TUBAL 2,369.95 260035 AXILLARY 845.80 260036 UMBILICAL HERNIA 2,914.75 260037 SPINAL ANES TRAY 139.00 260038 GANGLION CYST 1,471.05 260039 PEG 929.05 260040 HEMORRHOIDS 2,297.70 260041 INGUINAL HERNIA 5,143.80 260042 BMT 1,561.95 260043 CYSTOCELE 2,272.65 260044 INTEGUMENT I/D CRNA 229.60 260045 BIER BLOCK 383.20 260046 EXCISION BREAST MASS 1,607.50 260047 LAP CHOLECYSTECTOMY 5,432.80 260048 VENTRAL HERNIA 4,556.10 260049 PROCTOPLASTY 2,297.70 260050 FISTULECTOMY 2,297.70 260051 TAH 10,814.70 260052 COLECTOMY 12,066.00 260053 OOPHORECTOMY 1,047.50 260054 VENTRAL HERNIA CRNA 459.75 260055 OMENTUMECTOMY CRNA 536.55 260056 MASTECTOMY 3,066.45 260057 PROCTOPLASTY CRNA 383.20 260058 D & C CRNA 229.60 260059 THYROIDECTOMY CRNA 459.75 260060 INTUBATION EMER CRNA 459.75 260061 TIB FIB ADULT K 191.05 260062 DIAG SPINAL CRNA 383.20 260063 CIRCUMCISION CRNA 229.60 260064 EXPLORATORY LAP CRNA 459.75 260065 EXP LAP ENTEROADHES 3,995.25 260066 LAP CYSTECTOMY 3,995.25 260067 FISTULECTOMY CRNA 383.20 260068 PILONIDAL CYSTECTOMY 1,161.80 260069 PILONIDAL CYST CRNA 383.20 260070 EXCISION CYST CHEST 1,002.25 260071 EXC CYST CHEST CRNA 459.75 260072 HYDROCELECTOMY CRNA 229.60 260073 HYDROCELECTOMY 1,744.80 260074 EXCIS ABD MASS CRNA 229.60 260075 VEIN STRIPPING CRNA 229.60 260076 VEIN STRIPPING 1,930.80 260077 EXC ELBOW BURSA 1,556.60 260078 EXC ELBOW BURSA CRNA 229.60 260079 BRONCHOSCOPY CRNA 459.75 260080 AMP BELOW KNEE EXT CRNA 306.10 260081 EXC ABD WALL MASS 1,105.50 260082 FEMORAL HERNIA 3,086.40 260083 FEMORAL HERNIA CRNA 306.10 260084 EXC NECK MASS 414.70 260085 EXC NECK MASS CRNA 383.20 260086 REMOVAL NEUROMA 414.70 260087 REMOVAL NEUROMA CRNA 383.20 260088 AMP BELOW KNEE EXT 5,792.40 260089 EXC NECK MASS NERVE 1,503.95 260090 CONIZATION OF CERVIX 2,078.80 260091 D & C 2,692.45 260092 VASECTOMY 2,473.30 260093 VASECTOMY CRNA 229.60 260094 REMOVAL FB FINGER 1,532.05 260095 REMOVAL FB FINGER CR 229.60 260096 EXC LESION EYELID 760.25 260097 EXC MALIG LES 1.1-2 553.20 260098 SKIN GRAFT 1,507.00 260099 EXC MAL LESION > 4CM 1,822.80 260100 EXC BASAL CELL TEMPL 553.45 260101 EXC BASAL CELL TEMPL CRNA 383.20 260102 REVISION OF AMP FING 1,531.80 260103 ANES OPEN FINGER HAN 229.60 260104 EXP FINGER W EXCISIO 884.65 260105 SIGMOID RESECT COLOS 14,737.95 260106 EXC TONSIL CYST CRNA 459.75 260107 REPAIR SIGMOID DIV C 383.20 260108 EXC TONSIL CYST 974.70 260109 REPAIR SIGMOID DIVER 14,737.95 260110 REPAIR SIGMOID CRNA 383.20 260111 HEMICOLECTOMY W ILEO 14,737.95 260112 COLOSTOMY CRNA 459.75 260113 FLEX SIGMOIDOSCOPY C 383.20 260114 EXCISION THIGH CYST 1,548.95 260115 EXC CYST THIGH CRNA 229.60 260116 EXPLORATION TOE MASS 553.20 260117 EXC BENIGN LESION>4.
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