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Faith Regional Health Services List of Charges Note: Any Items with an '*' Do Not Have a Fixed Charge. the Charge Is Manually A

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Faith Regional Health Services List of Charges Note: Any Items with an '*' Do Not Have a Fixed Charge. the Charge Is Manually A Faith Regional Health Services List of Charges Note: Any items with an '*' do not have a fixed charge. The charge is manually adjusted for patient-specific items. Charge# Pricing Transparency Description 2019 Price 17517 NEWBORN NURSERY $ 821.00 22004 INTENSIVE CARE ROOM 3,456.00 25304 PEDIATRICS INTERMEDIATE (LEVEL 2) 1,931.00 27516 NEWBORN INTERMEDIATE 1,931.00 32011 INTENSIVE CARE STEP DOWN ROOM 2,279.00 34819 MEDICAL SURGICAL ROOM 1,500.00 35311 WOMEN'S SURGERY 1,500.00 36509 BEHAVORIAL HEALTH ROOM 2,224.00 37515 NEWBORN INTENSIVE CARE (NICU) 2,673.00 38000 ACUTE REHAB INTERRUPTED STAY * 42010 MEDICAL SURGICAL ROOM 1,500.00 45310 PEDIATRICS LEVEL 1 1,500.00 46425 PROGRESSIVE PSYCH ROOM 2,224.00 46524 BEHAVORIAL HEALTH ROOM 2,224.00 48009 ACUTE REHAB PRIVATE ROOM 1,662.00 55004 POST-PARTUM 1,532.00 56424 PROGRESSIVE PSYCH ROOM 2,224.00 56523 BEHAVORIAL HEALTH ROOM 2,224.00 99002 RM AMS SAME DAY SURG BED * 101394 CAR SEAT TESTING 60MIN. 101.00 101410 CAR SEAT TESTING +30 101.00 105510 OBSERVATION INTENSIVE CARE DIRECT ADMIT 621.00 105528 OBSERVATION INTENSIVE CARE FIRST 6 HOURS 1,252.00 105536 OBSERVATION INTENSIVE CARE HOURS 7 THROUGH 12 124.00 105544 OBSERVATION INTENSIVE CARE HOURS 13 THROUGH 18 62.00 105551 OBSERVATION INTENSIVE CARE HOURS 19 THROUGH 24 62.00 OBSERVATION INTENSIVE CARE OVER 24 HOURS (PER HOUR 105569 62.00 CHARGE) 105577 OBSERVATION MEDICAL SURGICAL DIRECT ADMIT 621.00 105585 OBSERVATION MEDICAL SURGICAL FIRST 6 HOURS 1,252.00 105593 OBSERVATION MEDICAL SURGICAL HOURS 7 THROUGH 12 124.00 105601 OBSERVATION MEDICAL SURGICAL HOURS 13 THROUGH 18 62.00 105619 OBSERVATION MEDICAL SURGICAL HOURS 19 THROUGH 24 62.00 OBSERVATION MEDICAL SURGICAL OVER 24 HOURS (PER HOUR 105627 62.00 CHARGE) 105635 OB OBSERVATION DIRECT ADMIN. 621.00 105643 OB OBSERVATION 1 THRU 6HRS. 1,252.00 105650 OB OBSERVATION 7 THRU 12HRS. 124.00 105668 OB OBSERVATION 13 THRU 18HRS. 62.00 105676 OB OBSERVATION 19 THRU 24HRS. 62.00 105684 OB OBSERVATION >24HRS. 62.00 105692 PEDS OBSERVATION DIRECT ADMIN. 621.00 105700 PEDS OBSERVATION 1 THRU 6HRS. 1,252.00 105718 PEDS OBSERVATION 7 THRU 12HRS. 124.00 105726 PEDS OBSERVATION 13 THRU 18HRS. 62.00 105734 PEDS OBSERVATION 19 THRU 24HRS. 62.00 105742 PEDS OBSERVATION >24HRS. 62.00 105759 CDU OBSERVATIONDIRECT ADMISSION 621.00 105767 CDU OBSERVATION HOURS 1 THRU 6 1,252.00 105775 CDU OBSERVATION HOURS 7 THRU 12 124.00 105783 CDU OBSERVATION HOURS 13 THRU 18 62.00 105791 CDU OBSERVATION HOURS 19 THRU 24 62.00 105809 CDU OBSERVATION HOURS OVER 24 62.00 200022 OR MINOR PROCEDURE/LVL 1 476.00 200030 OR ARCH BARS 159.00 200048 OR ARTHROSCOPE 766.00 200063 OR BRONCHOSCOPE 1,085.00 200071 OR CAST SAW 131.00 200097 OR COLONSCOPE 1,085.00 200147 OR CYSTOSCOPE FLEXIBLE 789.00 200212 OR ERCP 1,094.00 200329 OR FLEX VIDEO URETEROSCOP 1,850.00 200337 OR FORCEP 168.00 200345 OR GASTROSCOPE 1,032.00 200352 OR HALL/STRYKER DRILL/SAW 864.00 200360 OR HYSTERSCOPE RIGID 746.00 200394 OR PURPLE LAPAROSCOPE 30 746.00 200402 OR LARYNGOSCOPE RIGID 834.00 200451 OR LASER/CO2/KTP 1,465.00 200485 OR MICROSCOPE 473.00 200535 OR OPERATING ROOM LEVEL 2 32.00 200543 OR OPERATING ROOM LEVEL 3 35.00 200550 OR OPERATING ROOM LEVEL 4 38.00 200568 OR OPERATING ROOM LEVEL 5 53.00 200618 OR PRINTER PICTURES 90.00 200642 OR SAVARY GILLIARD 419.00 200667 OR SIGMOIDOSCOPE RIGID 725.00 200675 OR SINUSCOPE 617.00 200725 OR ULTRASONIC DOPPLER 46.00 200741 OR VIDEO IMAGING 1,267.00 200774 OR SPINAL PUNCTURE LUMBAR 675.00 200808 OR OPERATING ROOM LEVEL 6 56.00 200824 OR HEART/LUNG MACHINE ON 2,014.00 200873 OR HEART/LUNG MACHINE OFF 1,018.00 200972 OR COMBINE ROLL STERILIZE 86.00 200980 OR AUTOLOGOUS CELL SAVER 622.00 201152 OR STORZ 30 DEGREE SCOPE 794.00 201160 OR STORZ 70 DEGREE SCOPE 794.00 201194 OR STORZ 0 DEGREE SCOP/LE 617.00 201202 OR 11 FR PEDS CYSTO 30 DE 617.00 201228 OR URETEROSCOPE DUR 8 1,772.00 201244 OR 6.9 FR SEMI RIGID URET 1,981.00 201251 OR 10 FR SEMI RIGID URETE 1,772.00 201293 OR LAPAROSCOPE 10MM 30 DE 617.00 201319 OR LAPAROSCOPE 10MM 0 DEG 712.00 201327 OR LAPAROSCOPE 5MM 0 DEGR 794.00 201343 OR LAPAROSCOPE 5MM 0 DEG 794.00 201350 OR LAPAROSCOPE 5MM 30 DEG 794.00 201368 OR LAPAROSCOPE 5MM 30 DEG 794.00 201426 OR LAPAROSCOPE VEIN HARVE 794.00 201558 OR EMG <5 SITES + ABDOMEN 125.00 201574 OR NEEDLE EMG 2 LIMBS 245.00 201640 OR BILATERAL CRANIAL NERV 245.00 201731 OR XR ABDOMEN COMPLETE SU 535.00 201749 OR XR UROGRAPHY RETROGRAD 1,547.00 201806 OR WRIST NERVE BLOCK 675.00 201814 OR SUPRACLAVICULAR 675.00 201822 OR INFRACLAVICULAR NRV BL 675.00 201848 OR INTERSCALENE 675.00 201855 OR MEDIAN NERVE BLOCK 675.00 201863 OR POPLITEAL NERVE BLOCK 675.00 201871 OR N BLOCK CONT INFUSE B 1,276.00 201889 OR IONM IN OPERATING ROOM 403.00 201897 OR FEMORAL NERVE BLOCK SG 675.00 201905 OR SCIATIC NERVE BLOCK SG 1,276.00 202002 OR SOMATOSENSORY TESTING 827.00 202028 OR BRONCHOSCOPE 180 OLYMP 1,464.00 202036 OR BRONCHOSCOPE 180 OLYMP 1,464.00 202044 OR ENDOSCOPE PENTAX CURVE 1,464.00 202051 OR ENDOSCOPE US PENTAX 1,464.00 202069 OR EBUS ULTRASOUND PROBE 341.00 202077 OR OLYMPUS 180 COLONOSCOP 1,421.00 202085 OR US GUIDANCE FOR VASCUL 803.00 202119 OR USE OF MINI-C ARM W/I * 202127 OR TCEMEP UPPER & LOWER L 1,050.00 202135 OR TAP BLOCK BILATERAL 1,654.00 202143 OR TAP BLOCK SINGLE 1,433.00 202150 OR ADULT PERCUTANEOUS W/F 1,989.00 202168 OR ADULT OPEN 1,989.00 202184 OR INITIATION VENO-VENO 8,448.00 202192 OR INITIATION VENO-ART 8,448.00 202200 OR DAILY MANAGEMENT VENO- 1,133.00 202226 OR ULTRASONIC GUIDANCE IN 709.00 300053 RR POST ANES CARE LVL I I 22.00 300079 RR POST ANES CARE LVL I 16.00 300111 RR PACU MONITOR 117.00 400010 SU EST PT CARE LEVEL I 152.00 400051 SU POST PROCEDURE CARE/RO 137.00 400069 SU PRE-PROCEDURE CARE/ROO 378.00 400143 SU LUMBAR PUNCTURE DIAGNO 675.00 400325 SU INJ EPI BLOOD PATCH 1,276.00 400473 SU SEDATION 5YRS+ INITIAL 245.00 400630 SU SIJ ANESTH/STERIOD INJ 1,276.00 500017 DL CERVICAL RIPENING 325.00 500025 DL CIRCUMSION 477.00 500033 DL DELIVERY VAGINAL 1,566.00 500041 DL EPIDURAL PER 30 MINS 66.00 500066 DL INDUCTION PER 30 MINS 123.00 500074 DL LABOR TIME PER 30 MINS 92.00 500082 DL MGSO4 ADMIN PER 30 MIN 126.00 500090 DL PITOCIN AUGMENTATION/3 122.00 500116 DL PP RECOVERY PER 30 MIN 143.00 500124 DL CERVIDIL PER 30 MIN 62.00 500132 DL NON STRESS TEST - FETA 287.00 500157 DL ANTEPARTUM MANI EXTERN 2,993.00 500173 DL LACTATION CONSULT PER 38.00 500348 DL HEARING SCREEN EOE LTD 152.00 700021 AN ANSETHESIA VENT 249.00 700070 AN EPIDURAL SETUP 418.00 700104 AN MASK GENERAL ANESTHESI 636.00 700120 AN IV SED MAC TIVA 205.00 700138 AN NITROUS OXIDE/AIR 54.00 700161 AN SPINAL SETUP 624.00 700203 AN ETT GENERAL ANESTHESIA 684.00 700211 AN LMA GENERAL ANESTHESIA 684.00 700229 AN ORAL RAE GENERAL ANEST 727.00 700237 AN NASAL RAE GENERAL ANES 638.00 700245 AN LABOR EPIDURAL SETUP 395.00 700344 AN SUPRANE PER 30' 232.00 700351 AN ULTANE PER 30' 232.00 700369 AN FORANE PER 30' 232.00 700377 AN US GUIDED NEEDLE PLACE 1,905.00 700385 AN GENERAL ANESTHESIA NO 585.00 700401 AN ADDUCTOR CANAL BLOCK 406.00 700419 AN OTHER PERIPHERAL NERVE 992.00 700427 AN SINGLE INJ PEC REGIONA 900.00 700435 AN MULTIPLE INJ PEC REGIO 1,134.00 900118 XR GALLBLADDER 2,027.00 900126 XR GALLBLADDER 2,002.00 900134 XR SMALL INTESTINE WITH TUBE 1,667.00 900167 XR FLUOROSCOPY UP TO 1 HR 636.00 900175 XR FLUOROSCOPY > 1 HOUR 2,138.00 900209 XR STOMACH TUBE PLACEMENT 1,585.00 900282 XR CONTRAST IN UTERUS AND OVARIES 690.00 900316 XR INTRODUCE GI TUBE 864.00 900670 XR SURGICAL PROCEDURE * 900746 XR KIDNEYS WITH CONTRAST 1,473.00 900753 XR KIDNEYS WITH CONTRAST 1,010.00 900761 XR BLADDER EMPTYING STUDY 738.00 900852 XR EYE FOREIGN BODY 245.00 900860 XR FACIAL BONES 3 VIEWS 410.00 900878 XR JAW 410.00 900886 XR NASAL BONES 3+ VIEWS 325.00 900902 XR EYE 366.00 900910 XR SOFT TISSUE NECK 282.00 900928 XR SKULL <4 VWS 325.00 900944 XR ABDOMEN COMPLETE SUPIN 509.00 900977 XR AC JOINTS BILATERAL 287.00 900993 XR ANKLE COMPLETE 325.00 901009 XR ANKLE 2 VW 245.00 901017 XR ANKLE COMP 3 VW/EA BIL 489.00 901025 XR ANKLE 2 VW BILATERAL 428.00 901041 XR C-SPINE 4+ VIEWS 501.00 901058 XR C-SPINE COMPLETE 549.00 901066 XR C-SPINE 2-3 VIEWS 366.00 901074 XR HEEL 245.00 901140 XR CHOLANGIOGRAPHY OPERAT 683.00 901165 XR COLLARBONE 277.00 901173 XR COLON AIR CONTRAST BAR 1,852.00 901181 XR COLON BARIUM ENEMA 1,331.00 901199 XR ELBOW MIN 3 VW 325.00 901207 XR ELBOW WITH CONTRAST 763.00 901215 XR ELBOW 2 VW 277.00 901223 XR ELBOW MIN 3 VW BILATER 489.00 901231 XR ELBOW 2 VW BILATERAL 428.00 901264 XR ESOPHAGUS 549.00 901272 XR FOOT COMPLETE BILATERA 489.00 901280 XR FOOT 2 VW BILATERAL 428.00 901306 XR FEMUR 2 VW BILAT 428.00 901314 XR FINGER 2+ VIEWS 245.00 901330 XR FOOT COMPLETE 306.00 901348 XR FOOT 2 VW 245.00 901355 XR FOREARM 2 VW 245.00 901363 XR FOREARM 2 VW BILATERAL 428.00 901371 XR HAND MIN 3 VW 306.00 901389 XR HAND 2 VW 306.00 901397 XR HAND MIN 3 VW BILATERA 489.00 901405 XR HAND 2 VW BILATERAL 489.00 901413 XR HIP WITH CONTRAST 616.00 901421 XR HUMERUS 2 VIEWS 306.00 901439 XR CONTRAST IN UTERUS AND OVARIES 428.00 901470 XR CONTRAST INJECTED INTO BLADDER 428.00 901496 XR INJECTION ELBOW WITH CONTRAST 366.00 901512 XR INJECTION HIP WITH CONTRAST 366.00 901520 XR INJECTION KNEE WITH CONTRAST 366.00 901546 XR INJECTION SHOULDER WITH CONTRAST 366.00 901579 XR INJECTION WRIST WITH CONTRAST 366.00 901587 XR INJECTION KNEE WITH CONTRAST 642.00 901595 XR KNEE COMPLETE 4+VW 397.00 901603 XR KNEE 1 OR 2 VW 306.00 901611 XR KNEE 3 VW 306.00 901629 XR KNEE COMPLETE 4+VW BIL 585.00 901637 XR KNEE 1 OR 2 VW BILATER 458.00 901645 XR KNEE 3 VW BILATERAL 458.00 901652
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