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Procedure Description Price HC NEWBORN CHARGE STATISTIC Procedure Description Price HC NEWBORN CHARGE STATISTIC 0.00 HC ADMISSION CHARGE 584.43 HC ADM HSCRC RATE CHANGE 584.43 HC ANESTHESIA PER MINUTE 2.05 HC ANS HSCRC RATE CHANGE 2.05 HC ANESTHESIA - PAIN MANAGEMENT 2.05 HC ANESTHESIA - SPINE 2.05 HC ANESTHESIA - CARDIAC SURGERY 2.05 HC ANESTHESIA - CARDIOLOGY 2.05 HC ANESTHESIA - DENTISTRY 2.05 HC ANESTHESIA - ELECTROCONVULSIVE THERAPY (ECT) 2.05 HC ANESTHESIA - EMERGENCY SURGERY 2.05 HC ANESTHESIA - GENERAL SURGERY 2.05 HC ANESTHESIA - MEDICINE 2.05 HC ANESTHESIA - NEUROSURGERY 2.05 HC ANESTHESIA - OPHTHALMOLOGY 2.05 HC ANESTHESIA - ORGAN TRANSPLANT 2.05 HC ANESTHESIA - ORTHOPEDICS 2.05 HC ANESTHESIA - OTOLARYNGOLOGY 2.05 HC ANESTHESIA - PEDIATRIC SURGERY 2.05 HC ANESTHESIA - PLASTIC SURGERY 2.05 HC ANESTHESIA - SURGICAL ONCOLOGY 2.05 HC ANESTHESIA - THORACIC SURGERY 2.05 HC ANESTHESIA - TRAUMA GENERAL 2.05 HC ANESTHESIA - UROLOGY 2.05 HC ANESTHESIA - VASCULAR SURGERY 2.05 HC ANESTHESIA - WOMEN'S HEALTH 2.05 HC ANESTHESIA - GASTROENTEROLOGY 2.05 HC ANESTHESIA - ORAL MAXILLOFACIAL 2.05 HC ANESTHESIA - PEDIATRIC MEDICINE 2.05 HC ANESTHESIA - PODIATRY 2.05 HC ANESTHESIA - ANESTHESIA 2.05 HC ANESTHESIA - PEDIATRIC CATH 2.05 HC ANESTHESIA - PEDIATRIC GASTRO 2.05 HC ANESTHESIA - PEDIATRIC HEM ONC 2.05 HC ANESTHESIA - PULMONARY 2.05 HC HYDRATION IV INFUSION INIT 429.60 HC HYDRATE IV INFUSION ADD-ON 214.80 HC THER/PROPH/DIAG IV INF INIT 429.60 HC THER/PROPH/DIAG IV INF ADDON 214.80 HC TX/PROPH/DG ADDL SEQ IV INF 214.80 HC THER/DIAG CONCURRENT INF 35.80 HC TX/PRO/DX INJ NEW DRUG ADDON 107.40 HC IRRIG DRUG DELIVERY DEVICE 107.40 HC CHEMO ANTI-NEOPL SQ/IM 214.80 HC CHEMO IV PUSH SNGL DRUG 214.80 HC CHEMO IV INFUSION 1 HR 644.40 HC CHEMO IV INFUSION ADDL HR 322.20 HC BLOOD TRANSFUSION SERVICE 31-90 MIN 429.60 HC BLOOD TRANSFUSION SERVICE 91-150 MIN 644.40 HC BLOOD TRANSFUSION SERVICE 151-210 MIN 859.20 HC BLOOD TRANSFUSION SERVICE 211-270 MIN 1074.00 HC BLOOD TRANSFUSION SERVICE 271-330 MIN 1288.80 HC BLOOD TRANSFUSION SERVICE 331-390 MIN 1503.60 HC BLOOD TRANSFUSION SERVICE 391-450 MIN 1718.40 HC BLOOD TRANSFUSION SERVICE 451-510 MIN 1933.20 HC VISIT LVL 1 NEW 0-10 MIN 71.60 HC VISIT LVL 2 NEW 11-25 MIN 143.20 HC VISIT LVL 3 NEW 26-45 MIN 250.60 HC VISIT LVL 4 NEW 46-90 MIN 537.00 HC VISIT LVL 5 NEW 90+ MIN 644.40 HC VISIT LVL 1 EST 0-10 MIN 71.60 HC VISIT LVL 2 EST 11-25 MIN 143.20 HC VISIT LVL 3 EST 26-45 MIN 250.60 HC VISIT LVL 4 EST 46-90 MIN 537.00 HC VISIT LVL 5 EST 90+ MIN 644.40 HC IMMUNIZATION ADMIN 71.60 HC IMMUNIZATION ADMIN EACH ADD 35.80 HC THER/PROPH/DIAG INJ SC/IM 107.40 HC THER/PROPH/DIAG INJ IV PUSH; SINGLE/INITIAL 214.80 HC PULMONARY REHAB W EXER 179.00 HC DIAB MANAGE TRN PER INDIV 30 MIN 214.80 HC DIAB MANAGE TRN GROUP 30 MIN 107.40 HC CARDIAC REHAB W CONTINUOUS MONITORING 179.00 HC CL HSCRC RATE CHANGE 35.80 HC DRAW BLOOD OFF VENOUS DEVICE 214.80 HC RESP FCN/STRENGTH 2 OR MORE INDIV 179.00 HC PERIPHERAL ARTERIAL DISEASE REHAB, PER SESSION 179.00 HC CT ANGIOGRAPHY NECK WO&W CONTRAST 231.42 HC CT ANGIOGRAPHY CHEST WO&W CONTRAST 239.54 HC CT ANGIOGRAPHY PELVIS WO&W CONTRAST 243.60 HC CT ANGIOGRAPHY UPPER EXTREMITY WO&W CONTRAST 272.02 HC CT ANGIOGRAPHY LOWER EXTREMITY WO&W CONTRAST 296.38 HC CT ANGIOGRAPHY ABDOMEN WO&W CONTRAST 247.66 HC CT ANGIOGRAPHY ABDOMINAL ARTERIES WO&W CONTRAST 300.44 HC CT 3D RENDERING W POSTPROCESSING 36.54 HC CT LIMITED OR LOCALIZED FOLLOW-UP STUDY 109.62 HC CT HEAD OR BRAIN WO CONTRAST 85.26 HC CT HEAD OR BRAIN W CONTRAST 121.80 HC CT HEAD OR BRAIN WO&W CONTRAST 146.16 HC CT ORBIT SELLA MID/INNER EAR WO CONTRAST 190.82 HC CT ORBIT SELLA MID/INNER EAR W CONTRAST 235.48 HC CT MAXILLOFACIAL AREA WO CONTRAST 109.62 HC CT MAXILLOFACIAL AREA W CONTRAST 125.86 HC CT MAXILLOFACIAL AREA WO&W CONTRAST 162.40 HC CT SOFT TISSUE NECK WO CONTRAST 146.16 HC CT SOFT TISSUE NECK W CONTRAST 190.82 HC CT SOFT TISSUE NECK W&WO CONTRAST 235.48 HC CT ANGIOGRAPHY HEAD WO&W CONTRAST 235.48 HC CT THORAX WO CONTRAST 146.16 HC CT THORAX W CONTRAST 190.82 HC CT THORAX WO&W CONTRAST 235.48 HC CT CERVICAL SPINE WO CONTRAST 150.22 HC CT CERVICAL SPINE W CONTRAST 190.82 HC CT THORACIC SPINE WO CONTRAST 146.16 HC CT THORACIC SPINE W CONTRAST 190.82 HC CT THORACIC SPINE WO&W CONTRAST 235.48 HC CT LUMBAR SPINE WO CONTRAST 146.16 HC CT LUMBAR SPINE W CONTRAST 190.82 HC CT PELVIS WO CONTRAST 105.56 HC CT PELVIS W CONTRAST 190.82 HC CT UPPER EXTREMITY WO CONTRAST 146.16 HC CT UPPER EXTREMITY W CONTRAST 186.76 HC CT LOWER EXTREMITY WO CONTRAST 146.16 HC CT LOWER EXTREMITY W CONTRAST 190.82 HC CT ABDOMEN WO CONTRAST 101.50 HC CT ABDOMEN W CONTRAST 190.82 HC CT ABDOMEN WO&W CONTRAST 219.24 HC CT ANGIOGRAPHY ABDOMEN&PELVIS WO&W CONTRAST 316.68 HC CT ABDOMEN & PELVIS WO CONTRAST 129.92 HC CT ABDOMEN & PELVIS W CONTRAST 251.72 HC CT ABDOMEN & PELVIS WO&W CONTRAST 288.26 HC CAT HSCRC RATE CHANGE 4.06 HC CDSM EVICORE AUC 0.01 HC CDSM MEDCURRENT AUC 0.01 HC CDSM MEDICALIS AUC 0.01 HC CDSM NATIONAL DECISION SUPPORT COMPANY AUC 0.01 HC CDSM NATIONAL IMAGING ASSOCIATES AUC 0.01 HC CDSM TEST APPROPRIATE AUC 0.01 HC CDSM AIM SPECIALTY HEALTH AUC 0.01 HC CDSM CRANBERRY PEAK AUC 0.01 HC CDSM SAGE HEALTH MANAGEMENT SOLUTIONS AUC 0.01 HC CDSM STANSON AUC 0.01 HC CDSM QUALIFIED TOOL NOT OTHERWISE SPECIFIED AUC 0.01 HC MEDICAL SCREENING 100.75 HC TRIAGE VISIT ONLY 0.00 HC ED LEVEL I VISIT - BRIEF 0.00 HC ED LEVEL II VISIT - INTERMEDIATE 100.75 HC ED LEVEL III VISIT - EXTENDED 201.50 HC ED LEVEL IV VISIT - INTENSIVE 403.00 HC ED LEVEL V VISIT - COMPREHENSIVE 705.25 HC EXTENDED CARE SERVICES PER HOUR 50.38 HC EMG HSCRC RATE CHANGE 100.75 HC LWBS / NO CHARGE 0.00 HC ED PATIENT TXFRD TO L&D 0.00 HC EEG EXTENDED MONITORING; 61-119 MINUTES 1623.60 HC EEG RECORDING AWAKE AND ASLEEP 1822.04 HC EEG RECORDING IN COMA OR SLEEP ONLY 1605.56 HC EEG DURING NONINTRACRANIAL SURGERY 811.80 HC SOMATOSENSORY EPS UPPER & LOWER LIMBS 1497.32 HC NEEDLE EMG 2 EXTREMITIES 469.04 HC NEEDLE EMG LIMITED STUDY NONPARASPINAL/1 EXTREMITY 360.80 HC NEEDLE EMG EACH EXTREMITY COMPLETE 234.52 HC NEEDLE EMG NON EXTREMITY W NERVE CONDUCTION 216.48 HC NERVE CONDUCTION TEST 1-2 STUDIES 216.48 HC NEUROMUSCULAR JUNCTION TEST EA NERVE 234.52 HC EEG HSCRC RATE CHANGE 18.04 HC INTRAOP NEURO MONITORING REMOTE/NEARBY OR PER HR 54.12 HC CARDIOVASCULAR STRESS TEST TRACING ONLY 81.30 HC TTE CONGENITAL ANOMALIES COMPLETE 121.95 HC TTE CONGENITAL ANOMALIES FOLLOW UP/ LIMITED 54.20 HC TTE COMPLETE W SPECTRAL & COLOR FLOW 162.60 HC TTE FOLLOW UP OR LIMITED 54.20 HC DOPPLER ECHO COLOR FLOW ADD ON 13.55 HC ELECTROCARDIOGRAM 12 LEAD TRACING ONLY 32.52 HC EKG HSCRC RATE CHANGE 2.71 HC HYPERBARIC OXYGEN THERAPY PER 30 MINUTES 298.71 HC HYP HSCRC RATE CHANGE 597.42 HC IR INSERTION ENDOVAS VENA CAVA FILTER 41.61 HC IR MYELOGRAM CERVICAL 41.61 HC IR MYELOGRAM THORACIC 41.61 HC IR MYELOGRAM LUMBOSACRAL 41.61 HC IR MYELOGRAM 2+ SPINAL REGIONS 41.61 HC IR XRAY EXAM ABDOMEN 1 VIEW 41.61 HC IR UROGRAPHY ANTEGRADE 41.61 HC IR CORPORA CAVERNOSOGRAM 41.61 HC IR DILATION OF NEPHROSTOMY/ URETERS/ URETHRA 41.61 HC IR HYSTEROSALPINGOGRAM 41.61 HC IR THORACIC AORTOGRAM W SERIALOGRAPHY 41.61 HC IR ABDOMINAL AORTOGRAM W SERIALOGRAPHY 41.61 HC IR ABDOMINAL AORTOGRAM W BILATERAL RUNOFF 41.61 HC IR ANGIOGRAPHY EXTREMITY UNILATERAL 41.61 HC IR ANGIOGRAPHY EXTREMITY BILATERAL 41.61 HC IR ANGIOGRAPHY ADRENAL UNILATERAL 41.61 HC IR ANGIOGRAPHY ADRENAL BILATERAL 41.61 HC IR SHUNTOGRAM FOR NV SHUNT 41.61 HC IR VENOGRAPHY EXTREMITY UNILATERAL 41.61 HC IR VENOGRAPHY EXTREMITY BILATERAL 41.61 HC IR VENOGRAPHY CAVAL INFERIOR 41.61 HC IR VENOGRAPHY CAVAL SUPERIOR 41.61 HC IR VENOGRAPHY RENAL UNILATERAL 41.61 HC IR VENOGRAPHY RENAL BILATERAL 41.61 HC IR VENOGRAPHY VENOUS SINUS/ JUGULAR 41.61 HC IR VENOGRAPHY EPIDURAL 41.61 HC IR VENOUS SAMPLING THROUGH CATH 41.61 HC IR REMOVAL PERICATH OBSTRUCTIVE MATERIAL 41.61 HC IR REMOVAL INTRALUMINAL OBSTRUCTIVE MATERIAL 41.61 HC IR CHANGE OF PERC TUBE/ DRAINAGE CATH 41.61 HC IR PLACEMENT OF CATH FOR PERC DRAINAGE 41.61 HC IR FLUOROSCOPY UP TO 1 HOUR 41.61 HC IR ABSCESS/ FISTULA/ SINUS TRACT STUDY 41.61 HC IR SHOULDER ARTHROGRAM 41.61 HC IR HIP ARTHROGRAM 41.61 HC IR US GUIDANCE FOR VASCUAL ACCESS 41.61 HC IR FLUOROSCOPIC GUIDANCE CENTRAL VENOUS DEVICE 41.61 HC IR FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT 41.61 HC IR FLUOROSCOPIC GUIDANCE & LOCALIZATION 41.61 HC IR ARTHROCENTESIS SMALL JOINT OR BURSA 1.00 HC IR ANGIOGRAPHY SELECTIVE EA ADDTL VESSEL 41.61 HC IR XRAY EXAM CHEST 1 VIEW 41.61 HC IR ARTHROCENTESIS MAJOR JOINT OR BURSA 1.00 HC IR HIP ARTHROGRAPHY INJECTION WO ANESTHESIA 1.00 HC IR SHOULDER ARTHROGRAPHY INJECTION 41.61 HC IR SACROILIAC JOINT INJECTION W GUIDANCE 41.61 HC IR THORACENTESIS ASP OF PLEURAL SPACE WO GUIDANCE 1.00 HC IR THORACENTESIS ASP OF PLEURAL SPACE W GUIDANCE 41.61 HC IR EXTREMITY VENOGRAM INJECTION 1.00 HC IR INTRO OF CATH SUPERIOR/INFERIOR VENA CAVA 1.00 HC IR SELECT CATH VEIN 1ST ORDER FAMILY 1.00 HC IR SELECT CATH VEIN 2ND ORDER FAMILY 1.00 HC IR INTRO NEEDLE TO EXTREMITY ARTERY 1.00 HC IR INTRODUCTION OF CATHETER AORTA 1.00 HC IR NONSELECT CATH PLACEMNT THORACIC AORTA W GUIDANCE 41.61 HC IR CATH PLACEMNT CAROTID/INOM ART W GUIDANCE UNILATERAL 41.61 HC IR CATH PLACEMNT CAROTID/INOM ART W GUIDANCE&ANGIO UNILATERAL 41.61 HC IR CATH PLACEMNT INTERNAL CAROTID ART W GUIDANCE UNILATERAL 41.61 HC IR CATH PLACEMNT SUBCLAVIAN ART W GUIDANCE UNILATERAL 41.61 HC IR CATH PLACEMNT VERTEBRAL ARTERY W GUIDANCE UNILATERAL 41.61 HC IR CATH PLACEMNT EXT CAROTID ARTERY W GUIDANCE UNILATERAL 41.61 HC IR INS CATH ABD/ LOWER EXTREMITY ARTERY 1ST ORDER 1.00 HC IR INS CATH ABD/ LOWER EXTREMITY ARTERY 2ND ORDER 1.00 HC IR INS CATH ABD/
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