70 3150100 4 West Private 1

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70 3150100 4 West Private 1 Charge Code Charge Desc Charge Amt 3140100 3 WEST TELEMETRY 2200 3149000 OBSERVATION ROOM (PER HOUR) 70 3150100 4 WEST PRIVATE 1700 3150103 4 W NURSERY WELL BABY BASSINET 980 3152022 CHG EXTENDED RECOVERY HR 63 3180100 6 WEST PRIVATE - Paragon 1700 3182021 CHG DIRECT OBS FROM OFFICE 1846 3190100 4 EAST PRIVATE - Paragon 1700 3200100 5 EAST PRIVATE - Paragon 1700 3210130 4 NORTH PRIVATE LDR-PARAGON 1700 3210135 4 NORTH PRIVATE GYN-PARAGON 1700 3212023 RHOGRAM INJECTION 225 3220100 6 EAST PRIVATE - Paragon 1700 3250125 3 EAST PROGRESSIVE CARE 2200 3260100 5 WEST PRIVATE - Paragon 1700 3300100 6 NORTH PRIVATE 1700 3400100 3 NORTH PRIVATE - Paragon 1700 3510200 CC INTENSIVE CARE 3400 3511190 CHG STERNOTOMY CCC 1415 3511193 CHG CARDIOVERSION CCC 1970 3513050 INSERTION ARTERIAL LINE 1415 3513055 IMMUNIZATION ADMINISTRATION (CCU) 220 3520028 CHG INSERTION PACEMAKER 1415 3520040 SICU OBSERVATION 9 3520052 CHG EXTERNAL PACER/DEFIB 255 3520053 CHG HEMODYNAMIC MONITOR DAIL SCC 120 3520100 CHG INSERTION AORTIC BALLOON 1415 3520130 SURGICAL INTENSIVE CARE 3400 3520200 SC INTENSIVE CARE 3400 3521190 CHG STERNOTOMY SCC 1415 3521193 CHG CARDIOVERSION SCC 1970 3521194 CHG FORCED AIR WARMING SCC 63 3530040 CV INTENSIVE CARE HOURLY 99 3530200 CVI INTENSIVE CARE 3400 3530625 CHG ACT-ACTIVATED CLOT TIME CVICU 58 3531185 CHG CPR CVI 921 3531190 CHG STERNOTOMY CVICU 1285 3531193 CHG CARDIOVERSION CVICU 1970 3533055 IMMUNIZATION ADMINISTRATION (CVICU) 220 3700100 4N NURSERY WELL BABY BASSINET 980 3700101 INTERMEDIATE CARE NURSERY 1280 3700102 SPECIAL CARE NURSERY 1405 3700130 CHG INSERTION PICC/MIDLINE<5YRS 3150 3701740 CHG CIRCUMCISION NEWBORN 265 3705390 CHG PHOTO THERAPY PER DAY 50 3705600 CHG PEDIATRIC PNEUMOGRAM 825 3705610 CHG STERILE PROCEDURE 440 3705611 CAR SEAT/BED TEST 60 MIN 125 3705612 CAR SEAT/BED TEST + 30 MIN 60 3705615 CHG NEONATAL RESUSCITATION 500 3705625 CHG NEWBORN SCREENING-PKU 175 3705630 IMMUNIZATION ADMINISTRATION (NUR) 220 4004260 PERFUSION-KWAN 3396 4004265 PERFUSION SUPPLIES 1269 4004270 PERFUSION STANDBY 1196 4004280 AUTOTRANSFUSION < 6 HOURS 1238 4004281 AUTOTRANSFUSION >6HRS PER HOUR 89 4004285 AUTOTRANSFUSION STANDBY/CANCEL 505 4004290 COLLECTION RESERVOIR EXTRA 125 4004291 ASPIRATION/ANTICOAG ASSEMBLY 63 4004292 CIRCUIT SET EXTRA 323 4011173 BLOOD PATCH-OR 2770 4014025 ABDOMINAL AORTOGRAM W/INTERVENT 12381 4014135 EXTREMITY UNILSTERAL W/INTERVENT 12381 4014140 EXTREMITY BILATERAL W/O INTERVENT 9016 4014230 SURGICAL TIME PER MINUTE 61 4014290 EXTREMITY UNILATERAL W/O INTERVEN 2997 4014505 ULTRASOUND CATHETER GUIDANCE-VASCULAR 379 4014510 EMG-ANAL/URETH SPHINC W/NEEDLE ELECTRODE 850 4014511 EEG 41-60 MINUTES 731 4014513 EMG THORACIC 206 4014514 EMG LIMITED 1 LIMB <5 MUSCLES OR ABDOMEN 217 4014515 EMG W/NCV < 5 MUSCLES PER LIMB 217 4014516 EMG W/NCV > 5 MUSCLES PER LIMB 217 4014517 SSEP UPPER LIMBS 872 4014518 SSEP LOWER LIMBS 514 4014519 SSEP UPPER AND LOWER LIMBS 872 4014520 tcMEP UPPER EXTREMITIES 872 4014521 tcMEP LOWER EXTREMITIES 3465 4014522 tcMEP UPPER AND LOWER EXTREMITIES 872 4014523 EEG DURING NONCRANIAL SURGERY 731 4014524 EMG W/NCV NON-LIMB 217 4014525 NEUROMUSCULAR JUNCTION TESTING 206 4014526 NERVE AND/OR SENSORY CONDUCTION 206 4014527 EMG-2 EXT-MORE THAN 5 MUSCLES STUDIED 217 4014530 ULTRASOUND GUIDANCE FOR NEEDLE PLACEMENT 379 4014535 ULTRASOUND GUIDANCE, INTRAOPERATIVE 379 4014540 ULTRASOUND, TRANSRECTAL 395 4021452 DISKOGRAPHY, LUMBAR, RADIOLOGICAL 15438 4021466 CHOLANGIOGRAM INTRAOP S & I 645 4021480 ATTEMPT CHOLANG INTRAOP S & I 645 4021551 FLUOROSCOPIC GUIDE,VAD PLACE/REMO 437 4021617 CYSTOGRAM S & I 879 4021621 UROGRAM RETROGRADE S & I 879 4021635 UROGRAM ANTEGRADE S & I 1020 4022000 LITHOTRIPSY EX SHOCK WAVE 12480 4031800 PEG TUBE REPLACEMENT 412 4032000 DILATOR-BALLOON 823 4032001 BILIARY RETRIEVAL BALLOON 806 4032002 CATH BALLOON DILATATION CRE 806 4032003 CAUTERY GOLD PROBE 823 4032005 CYTOLOGY BRUSH 233 4032013 FEEDING TUBE-ENDO TUBE 477 4032015 GUIDE WIRE 493 4032017 HOT BX FORCEP 482 4032018 J TUBE 531 4032020 PANCREATIC/BILIARY STENTS 866 4032021 PAPPILLOTOMIES/SPHINCTERO 1104 4032022 PEG KITS 602 4032025 POLYPECTOMY SNARE 363 4032026 REGULAR BIOPSY FORCEP 460 4032027 SCLERATHERAPY NEEDLE 477 4032028 TRACER WIRE 866 4032029 WIRE BASKET STONE EXT 1061 4032031 COLON DECOMPRESSION TUBE 331 4032032 ULTRA TOME/STONE TOME 580 4032035 BRONCHOSCOPY/FB/BX 1964 4032037 TRANS-ESOPHAGEAL ECHO 1937 4032039 FORCEPS BX JUMBO 82 4032040 FORCEPS BIOPSY PULMONARY 255 4032060 BILIARY STENT-METAL Z WALL 4203 4032550 VARICIES BANDING 996 4033004 EN BRONCHOSCOPY 2959 4033005 EN B/WASHINGS 2959 4033007 EN B/BIOPSY, SINGLE/MULTIPLE 2959 4033009 EN B/BRUSHINGS 2959 4033011 EN B/REMOVAL FB 2959 4033012 EN E/BAND LIGATION OF VARICES 2542 4033016 EN ER/INSERTION STENT 8464 4033018 EN BONE MARROW BIOPSY/ASPIRATION 6105 4033020 EN E/BX,SINGLE/MULTIPLE 2542 4033029 EN C/DILATION BALLOON 2689 4033030 EN COLONSCOPY 2689 4033031 EN C/REMOVAL FB 2689 4033033 EN C/BX SINGLE/MULTIPLE 2689 4033034 EN C/CONTROL BLEEDING 2689 4033035 EN C/REMOVAL-HOT BX FORC 2689 4033036 EN C/REMOVAL BY SNARE 2689 4033037 EN C/COLON DECOMPRESSION 2689 4033038 EN C/INJECTION ANY SUBST 2689 4033040 EN EGD 2542 4033041 EN E/STENT PLACEMENT 2542 4033042 EN E/BALLOON DILATATION 2542 4033043 EN E/RIGID DILATION 2542 4033045 EN E/REMOVAL HOT BX FORCEPS 2542 4033046 EN PLACEMENT ENDO TUBE 2542 4033047 EN E/REMOVAL BY SNARE 2542 4033048 EN ERCP 5863 4033049 EN ER/BX SINGLE/MULTIPLE 5863 4033052 EN ER/BALLOON DILATION OF DUCTS 5863 4033054 EN F/SIGMOIDOSCOPY W/BX 1488 4033055 EN FLEXIBLE SIGMOIDOSCOPY 1488 4033056 EN F/REMOVAL FB 1488 4033057 EN F/REMOVAL HOT BX FORCEP 2418 4033059 EN F/REMOVAL BY SNARE 2418 4033080 EN ER/SPHINCTEROTOMY/PAPILLOTOM 5863 4033082 EN E/PEG PLACEMENT 2542 4033083 EN PEG REMOVAL W/O EGD 250 4033086 EN PEG REPLACEMENT 2542 4033088 EN PEG 2542 4033092 EN E/REMOVAL FB 2542 4033096 EN ER/STONE REMOVAL 5863 4033099 EN E/SCLEROSIS OF VARICES 2542 4034018 PEG TUBE INITIAL 1467 4034019 SPHINCTER/PAPILLO W/ERCP 2380 4034021 STONE REMOVAL, CBD W/ERCP 2548 4034022 EN ER/INSERT,DRAINAGE TUBE 2473 4034026 PEG TUBE REMOVAL 493 4034028 DOPPLER ECHO 277 4034029 DOPPLER ECHO PROFESSIONAL 217 4034036 ESOPHAGEAL REFLUX TEST W/CAP PLACEMENT 1830 4034037 EGD W OR WO BX FOR BRAVO CAP PLACEMENT 3370 4034038 GI TRACT CAPSULE ENDOSCOPY 2920 4040400 OBSERVATION PER HOUR 55 4041173 BLOOD PATCH 2770 4041175 MYASTHENIA GRAVIS ENLON TEST 639 4041193 CARDIOVERSION 1970 4041194 ICD THRESHOLD EVALUATION 2954 4041198 PACU SPECIAL PROCEDURE 1261 4045910 RECOVERY POST-OP 1 HOUR 1126 4045920 RECOVERY POST-OP ADD 15M 288 4045950 PACU PROGRESSIVE CARE 2200 4046000 PACU PRIVATE 1700 4050075 CHG BLOOD ADMINISTRATION-OPT 1144 4050096 CHG INSERT BLADDER CATH SIMPLE 629 4050097 CHG RECLAST ADMINISTRATION 671 4050098 CHG PROLIA ADMINISTRATION 225 4050140 CHG BLADDER INSTILL-ANTICARC-OP 1019 4050150 CHG PHLEBOTOMY, THERAPEUTIC 376 4050160 CHG REMVL CENT VEN CATH 1851 4051100 CHG IRRIGATION OF VAD 376 4051150 CHG REMOVAL OF PICC LINE 239 4051151 CHG BLADDER SCAN 250 4051152 CHG BLD COLLECT VENIPUNCTURE 17 4051153 CHG BLD COLLECT VAD 376 4051154 CHG BLD COLLECT CVC/PICC 376 4051500 CHG CHEMOTHERAPY INFUS 1ST HR 985 4051503 CHG CHEMOTHERAPY INFUS-ADD HR 985 4051509 CHG METHOTHREXATE IM 363 4051510 CHG CHEMO, HORM, SQ/IM 363 4051515 CHEMO IV PUSH SNGL DRUG 735 4052525 CHG CATH INSERT FOR SPEC COLLECT 17 4052526 DECLOT PICC/VAD 715 4052600 ANEMIA CLINIC BLD VENIPUNCTURE 17 4052601 ANEMA CLINIC IV INFUSION THERAPY 671 4052602 ANEMIA CLINIC IM/SQ INJECT 225 4052603 ANEMIA CLINIC INITIAL VISIT 250 4052605 ANEMIA CLINIC IVF ADD'L HR 125 4052606 CHG SOLUMEDROL IVF, 1ST HR 671 4052607 CHG SOLUMEDROL IVF, ADD'L HR 125 4057400 CHG REMICADE IVF, 1ST HOUR 899 4057401 CHG REMICADE IVF, EACH ADD'L HOUR 163 4057402 CHG PAIN PUMP ANALYSIS ONLY 1179 4057403 CHG PAIN PUMP REPROGRAM 1179 4057404 CHG PAIN PUMP REFILL 1179 4057405 CHG PAIN PUMP MD REFILL 1179 4057406 IMMUNIZATION ADMINISTRATION (OPT) 220 4057408 2E OPT PROGRESSIVE CARE 2200 4057409 CHG PROVENGE IVF, 1ST HOUR 985 4057410 CHG PROVENGE IVF, EACH ADD'L HOUR 185 4057412 ESOPHAGEAL MANOMETRY TEST 1830 4057414 UNSUCCESSFUL ESOPHAGEAL MANOMETRY TEST 915 4082021 EXCHANGE TRANSFUSION BLOOD; NEWBORN 1440 4082022 UMBIL CATH NB FOR DX OR TX 300 4082023 I & D VAGINAL HEMATOMA PP 5175 4082025 INSERT CERVICAL DILATOR 1030 4082026 IMMUNIZATION ADMINISTRATION (4N) 220 4082030 FETAL CONTRACTION STRESS TEST 520 4082035 FETAL NON STRESS TEST 624 4082036 FETAL NST EA ADD'L FETUS 624 4082040 EFM LABOR CHECK 315 4082041 EFM LABOR CHECK EA ADD'L FETUS 315 4082170 VAGINAL DELIVERY 1440 4082175 HIGH RISK DELIVERY 1910 4084780 LACTATION KIT 201 4120001 TETRACAINE HCL 0.5% DROP 15ML $60.40 4120003 CEFAZOLIN IN DEXTROSE 1GM/50ML PGBK $174.65 4120004 MISOPROSTOL TAB 50MCG $36.50 4120005 MISOPROSTOL TAB 25MCG $37.00 4120006 ROTIGOTINE PATCH 3MG/2HR PT24 $54.25 4120007 TRACE METALS INJ 5ML $174.20 4120008 ACETAMINOPHEN TAB 650MG $5.20 4120009 ACETAMINOPHEN SUPP 325MG $5.20 4120010 ACETAMINOPHEN SUPP 650MG $5.20 4120011 BOTULISM TOXIN A, 100 UNIT $2,602.05 4120013 PROVIGIL TABLET 200MG $48.10 4120014 TACROLIMUS SOLN 5MG/ML 1 ML $863.30 4120015 HOMATROPINE 2% OPH DROPS 5ML $97.30 4120016 MYCOPHENOLATE MOFETIL HCL SOLR 500MG $8,211.35 4120017 INSULIN ASPART INJ 100UNIT/ML-3ML $89.95 4120018 VANCOMYCIN BULK SOLN 1GM $174.75 4120019 ABILIFY TAB 10 MG $41.30 4120020 BROMPHENIRAMINE-PSEUDO-DM SYRP 5ML $36.95 4120021 D5RL 1L W/OXYTOCIN 20 UNITS $182.60 4120024 METFORMIN SR TAB 750MG $36.05 4120025 ACTIFED (GENERIC) TAB $35.90 4120026 ACTIFED SYRUP 5ML $36.85 4120027
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