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Hospital Charges As of 2018 3 2018 ALL HOSPITAL CHARGES 2018 Charge Description CPT-4 code Price "L" PLATES - LEFT C1713 $ 645.47 (PT) CONTACT PRODUCT 85730 $ 16.32 (TB) DIRECT SMEAR 87206 $ 14.63 **FB REMOVAL RECTUM 45307 $ 6,123.85 .062 X 7 LONG GUIDE WIRE C1713 $ 86.25 .99MM TURBO ELITE LASER CATH C1885 $ 3,150.00 .99MM TURBO ELITE LASER CATHETER C1887 $ 2,200.00 0 27 GUT CHROMIC SH $ 14.87 0 30 ETHIBOND BRAIDED CT-1 $ 103.50 0 30 PROLENE MONO CTX $ 105.10 0 36 ETHIBOND BRAIDED V-7 $ 310.52 0 54 COATED VICRYL $ 33.80 0 54 GUT CHROMIC $ 33.02 0 54 GUT CHROMIC PLAIN $ 54.98 0 8-18 ETHIBOND EXTRA GRN MO-7 $ 240.30 0 8-18ETHIBOND EXTRA GRN CT-2 $ 206.51 0 PROLENE BL SH $ 129.30 0 SILK SUTUPAK 13 STRANDS 24 C1713 $ 35.55 0.8MM OFFSET PLATE C1713 $ 636.00 0.9MM CATH RAPD-EXCHANGE 150CM C1885 $ 3,150.00 0.9MM CATH X-80, CONT.ON RAPID-EXCHG 150 C1885 $ 3,150.00 02 SATURATION DIRECT 82810 $ 23.69 1 25-OH2D 82652 $ 104.57 1 27 GUT CHROMIC CT-1 $ 155.71 1 30 ETHIBOND BRAIDED DS-8 $ 157.52 1 30ETHIBOND BRAIDED CT-1 $ 87.92 1 36 GUT CHROMIC CTX $ 120.57 1 36 IN COATED VICRYL CTX $ 96.06 1 36 PDS II MONO CT $ 85.41 1 PDS II MONON TP-1 $ 72.48 1 PROLENE CTX $ 103.46 1 VERT MUSCLE 67314 $ 4,790.26 1 VICRYL 27CTB-1 $ 143.21 1.0MM 4 HOLE LARGE XLONG GAP C1713 $ 1,006.50 1.0MM 7HOLE PLATE STRGHT PLATE C1713 $ 1,158.00 1.1MM GUIDE WIRE C1713 $ 43.04 1.2 GUIDEWIRE C1713 $ 322.50 1.3 GUIDE PIN C1713 $ 30.12 1.3MM DRILL BIT MINI QC 55MM X C1713 $ 169.50 1.3MM TI T-PLATE C1713 $ 469.50 1.3MMTPLATE4HOLEHEAD/8HOLESHFT C1713 $ 562.50 1.4MM CATH 80HZ, CONT.ON RAPID-EX 150CM C1885 $ 4,200.00 1.4MM CATH OTW LASER 157L C1885 $ 3,150.00 1.4MM CATH RAPD-EXCHANGE 150CM C1885 $ 4,200.00 1.4MM CATHETER OTW LASER 157L C1885 $ 3,150.00 1.5 MM X50MM 5MM STOP BIT C1713 $ 78.75 1.6x150MM WIRE C1713 $ 469.50 1.7 SUTUREFIX DISPOS DRILL BIT C1713 $ 338.34 1.7MM CATH 80HZ CONT.ON RAPID-EX RX 150C C1885 $ 3,150.00 1.7MM CATH 80HZ, CONT.ON OTW 150CM C1885 $ 3,150.00 1.7MM CATH OVER THE WIRE 150CM C1885 $ 3,150.00 Page 1 2018 1.7MM CATH RAPD-EXCHANGE 150CM C1885 $ 3,150.00 1.8M OLIVE WIRES C1713 $ 44.00 1.8MM SMOOTH WIRE 3/PK C1713 $ 111.00 1/2 CIRCLE TAPER NEEDLE MALE C2618 $ 494.96 1/2 CIRCLE VICRYL#1 SUTURE C1713 $ 225.92 1/2 CYLINDER 5MM-SILICONE SPONGE IMPLANT C1784 $ 75.90 1/2 NORMAL SALINE 250ML IV Acquisition cost 1/2 NS+D5%W+K.PO420MEQ+K.ACETATE20MEQ Acquisition cost 1/3 RING - LARGE C1713 $ 1,228.50 1/8 X3 GEN TROCER PINS C1713 $ 34.92 1-0 30" ETHIBOND BRAIDED DS C1713 $ 157.52 10 HOLE CLAMP C1713 $ 1,263.38 10 X 20 WALL STENT Acquisition cost 10 X 39 WALL STENT Acquisition cost 10-0 PROLENE BL MONO SUTURE C1713 $ 63.07 100MM CURVED CANNULA 10/BX A4615 $ 531.00 10CC SLS 21G 1 1/2 $ 0.99 10CC SLS ONLY $ 0.38 10CC VITOSS C1713 $ 7,110.45 10F NEPH CATHETER C1726 $ 114.98 10FR 97CM TRIPLE LUMEN CATH C1757 $ 656.93 10FR PINN INTRO SHEATH W/POUCH C1769 $ 321.75 10FR24CM DBLE PIGTAIL STNT SET C2617 $ 191.40 10FR26CM DBLE PIGTAIL STNT SET C2617 $ 167.64 10MM HUMERAL STEM Acquisition cost 10MM X 285 CANNULATED TIBIA Acquisition cost 10MM X 300 CANNULATED TIBIA Acquisition cost 10MM/130 LEFT TROCH FIXATION NAIL C1713 $ 1,959.00 10MM/130 X 360MM TROCH NAIL Acquisition cost 10MMX20MMX75 UNISTEP PLUS Acquisition cost 10MMX42MM/75CM/100CM WALL STEN Acquisition cost 10MMX68MM/75CM/100CM Acquisition cost 10x23 BIO INT SCREW C1713 $ 346.50 1-131 NAI ORAL SOLN EACH ADL 1 MCI A9529 $ 107.25 11MM TI CANN TROCH FIXATION NAIL C1713 $ 2,124.00 11MM/130 CANNUL TROCHANTERIC FIX NAIL Acquisition cost 11MM/130 X 170MM TROCH FIX NAIL C1713 $ 1,989.00 11x235MM TI CANN TRACH NAIL STRL C1713 $ 1,602.00 12 X 125MM, 26MM HEAD NEER C1776 $ 3,157.50 12 X 40 WALL STENTS Acquisition cost 12 X 60MM WALL STENT Acquisition cost 12/14 FEMORAL HEAD 36MM C1776 $ 1,564.50 12/14 TO TAPER SLEEVE C1776 $ 140.40 12FR SS JUGULAR SYS. GREENFIELD FILTER Acquisition cost 12MM NONBIAS SCREW C1713 $ 1,049.20 12MM SELF DRILL/ST SCREW C1713 $ 150.00 12MM SELF DRILLING SCREW C1713 $ 217.50 12MM SPIN SCREW C1713 $ 300.00 12MM VARIABLE SCREWS C1713 $ 300.00 12X12 COATED VICRYL MESH KNITTED C1781 $ 3,697.43 12X12 COATED VICRYL MESH WOVEN C1781 $ 3,697.43 12X12X7 PEEK C1713 $ 1,492.50 12X20/8FR UNI PLUS HALO 100CM C1876 Acquisition cost 12X20X80 PTA BAL CATH OTW VASC C1725 $ 510.00 12X40/8FR UNI PLUS HALO 100CM C1876 Acquisition cost 12X60/8FR UNI PLUS HALO 100CM Acquisition cost Page 2 2018 13.5 X 21MM CAGE C1713 $ 2,700.00 132 NECK ANGLE HIP STEM C1776 $ 3,600.00 14 DISTAL CENTRALIZER C1776 $ 147.15 14 HOLE PLATE C1713 $ 399.72 14 X 40 STENT (WALL) Acquisition cost 14-HOLE STEM C1713 $ 399.72 14MM SCREW C1713 $ 217.50 14MM SPHERE C1713 $ 780.00 14MM TRINICA VARABLE SCREW C1713 $ 300.00 14X40/9FR UNI PLUS 100CM Acquisition cost 150MM CRVE CANN W/ACTVE TIP C1725 $ 652.50 15CC MACRO MORSELS VITOSS C1713 $ 1,327.50 15MM ENDOBUTTON ULTRA CLFIXBUT C1749 $ 494.55 16 SYNERGY STEM C1776 $ 5,852.25 16 X 40 STENT (WALL) Acquisition cost 16FREPLACE GTUBE STRGHT ENTRL A4616 $ 51.65 16x3.0MM CANNULATED SCREW C1713 $ 429.00 17 - HYDROXYCORTICOSTEROIDS 24 HR URINE 83491 $ 47.61 17 HYDROXY PROGESTERONE 83498 $ 73.79 17 KETOGENIC STEROID/URINE 83582 $ 38.50 17 KETOSTEROIDS/URINE 83586 $ 34.76 17 OH CORTICOSTEROIDS 83491 $ 47.61 17MM WASHER C1713 $ 399.00 17-OH-PREGNENOLONE 84143 $ 61.95 18 - HYDROXYCORTICOSTERONE 82528 $ 61.16 18 X 40 STENT (WALL) Acquisition cost 18 X 60MM. WALL STENT Acquisition cost 18FR SIGMOIDOSCOPIC SUCT INSTR A4624 $ 61.50 18G X0.038 ANGIOGRAPHIC NEEDLE C2618 $ 78.38 18-OH-CORTICOSTERONE 82528 $ 61.16 1CC SLS INSULIN 29GX1/2 $ 0.24 1CC SLS TUBERCULIN 25GX5/8 $ 0.28 1ST /SBSQ PSYC COLLAB CARE 99494 $ 275.00 1ST DEGREE BURN-INIT TX 16000 $ 446.80 1ST PSYC COLLAB CARE MGMT 99492 $ 275.00 1ST PSYC COLLAB CARE MGMT YR 2 99492 $ 275.00 1STG DSTL HYPSPAD REP W/SIMP MEATL ADV 54322 $ 4,484.35 1x8 SUBCOMPACT LEAD KIT C1778 $ 3,585.00 2 30ETHIBOND BRAIDED LR LR $ 112.22 2 PAIRED SUBDERM ELECTROD-EAR A4556 $ 138.00 2' REPR/SUTR LEG FLEXOR TENDON 27659 $ 14,826.61 2 Single Stinging Insect Venoms 95146 $ 97.92 2.0 CARBIDE BURR C1713 $ 413.13 2.0 KWIRE C1713 $ 13.40 2.0 LCKING PLATE L, 2/4 HOLE; RIGHT/LEFT C1713 $ 558.00 2.0 X 14 LOCKING SCREWS C1713 $ 550.50 2.0 X 10MM SCREW C1713 $ 225.00 2.0MM CATH (OTW) 150CM C1885 $ 4,200.00 2.0MM CATH RAPID-EXCHANG 150CM C1885 $ 3,150.00 2.0MM CATHETER 80HZ CONT.ON OTW 150CM C1885 $ 4,200.00 2.0MM LCP PLATE 7HOLES SHAFT C1713 $ 607.50 2.0MM NON-LOCKING SCREW C1713 $ 787.50 2.0MM X 8MM NONLOCKING SCREW C1713 $ 133.50 2.15MM FLUTED ROUTER CUT BURS C1713 $ 149.04 2.2 DRILL BIT C1713 $ 175.50 2.2MM DRILL C1713 $ 393.00 Page 3 2018 2.3 PENCIL BURR C1713 $ 159.08 2.3 SUTURE ANCHR W1 UB COBRAID C1713 $ 508.31 2.3 X 12MM NON LOCKING SCREW C1713 $ 177.00 2.3MM CATH OTW LASER ABLAT TUBO ELITE C1885 $ 3,150.00 2.3MM CATH OTW LASER ABLATION C1885 $ 3,150.00 2.3MM DURG BURR DIA HEAD HILAN C1713 $ 142.10 2.5 DRILL BIT C1713 $ 642.00 2.5 WER PLATE C1713 $ 963.00 2.5 WER PLATE C1713 $ 963.00 2.5" MED MESH SURG HERN PTCH C1781 $ 1,117.50 2.5FIXOS MARK TIP TROCAR KWIRE C1769 $ 55.12 2.5MM DIAMOND C1725 $ 139.73 2.5MM T PLATE C1713 $ 865.50 2.5MM TURBO ELITE LASER CATH C1885 $ 3,000.00 2.5MM TURBO ELITE LASER CATHETER C1887 $ 3,000.00 2.5X100 POLAR DCATH BALLOON C1725 $ 1,350.00 2.5X100 POLAR DCATH BALLOON, EA C1725 $ 1,350.00 2.6 DRILL C1713 $ 211.50 2.7FR SINGLE LUMEN CV CATHETER C1757 $ 312.08 2.7MM CORTICAL BONE SCREW X C1713 $ 124.32 2.7MM CORTICAL BONE SCREW x VARIOUS C1713 $ 1,456.37 2.7MM DRILL BIT C1713 $ 136.29 2.7MM LOCK SCREW, 20MM C1713 $ 118.13 2.7MM LOCKING SCREW 18MM C1713 $ 241.50 2.7MM LOCKING SCREW X 18MM C1713 $ 195.00 2.7MM LOCKING SCREWS C1713 $ 241.50 2.7MM LOCKING SCREWS 36MM C1713 $ 157.50 2.7MM X 18MM MD SCREW C1713 $ 327.00 2.9MM LOCKING SCREW C1713 $ 315.00 2/0 18 ETHILON MONO PS $ 187.37 2/0 27 CHROMIC SH $ 106.92 2/0 27 GUT CHROMIC CT-1 $ 102.08 2/0 27COATED VICRYL 0S-6 $ 123.47 2/0 30 ETHIBOND BRAIDE $ 155.03 2/0 30 ETHIBOND BRAIDED CT-1 $ 104.84 2/0 30 PROLENE MONO SH $ 119.85 2/0 30ETHICON MONO KS,628H $ 75.74 2/0 30SILK BRAIDED KS $ 1.94 2/0 36 PDS II MONO CT $ 138.11 2/0 36PROLENE MONO $ 256.27 2/0 48PROLENE MONO SHSH $ 205.95 2/0 54 GUT CHROMIC $ 64.20 2/0 54 GUT PLAIN $ 39.20 2/0 54COATED VICRYL $ 30.86 2-0 18" SILK BLACK BRAID PS-2 C1713 $ 159.10 2-0 30 ETHIBOND BRAID LRX496T C1713 $ 112.22 2-0 30" ETHIBOND BRAIDED CT-1 C1713 $ 104.84 2-0 30" V-7 SUTURE SILK NDL B C1713 $ 134.26 2-0 36" GUT CHROMIC #903H $ 105.71 2-0 COATED VICRYL RAPIDE 27 $ 42.54 2-0 COATED VICRYL RAPIDE 36 $ 45.30 20 DEGREE ELEVATED RIM LINER C1776 Acquisition cost 2-0 FS SILK NEEDLE BLK BRD C2618 $ 84.14 2-0 SILK BLK BRD 24" SH NEEDLE C2618 $ 171.56 2-0 SILK BLK BRD CP-1 36MM CI C1713 $ 73.36 2-0 SILK PS NEEDLE 18"-45CM BL C2618 $ 186.29 Page 4 2018 2-0 SILK PSLX $ 5.95 2-0 SILK SH $ 135.47 2-0 SILK' SUTUPAK 13 STRAND 34 C1713 $ 106.65 2-0 SILK TIES $ 64.49 2-0 TAPER T-12 SUTURES W/FIBER C1713 $ 33.00 20 X 24G ANGLED STEPPED PROBE C2618 $ 290.00 20MM CERVICAL PLATE C1713 $ 1,425.00 20MM ENDOBUTTON C1749 $ 494.55 20MM MINI AT2 SCREW C1713 $ 792.00 20MM TRINICA PLATE C1713 $ 1,500.00 2-0VICRYL +CIRCLE VIOLET BRAID C1713 $ 188.30 21MM ARTICULAR SURFACE Acquisition cost 22MM LINER Acquisition cost 22MM STANDARD AT2 SCREW C1713 $ 792.00 22MM TRINICA PLATE C1713 $ 1,500.00 22MM X 44MM HUMERAL HEAD C1776 Acquisition cost 23G ADJST INTUTVE LASRPROBE C2618 $ 315.00 23G VALVED ENTRY SYSTEM 4MM C1713 $ 864.00 23G X 3/4 HYPODERMIC NEEDLE C2618 $ 0.10 24MM CERVICAL PLATE C1713 $ 1,650.00 24MM HD LFT ANATOMIC RAD HD SYS CHROMIUM C1776 $ 3,000.00 24MM LOCKING SCREW C1713 $ 210.19 24MM TRINICA PLATE C1713 $ 1,875.00 25.4MM DIAMOND DISC
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