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CDM WEB-Aug-W Charge# Description Price 0013144 ROOM CARE SEMI PRIVATE-2T 2T 5,181.00 0013169 ROOM CARE SEMI PRIVATE -P4 P4 5,544.00 0013177 ROOM CARE SEMI PRIV-OVERFLOW 72400 5,544.00 0013185 ROOM CARE SEMI PRIV-2S 2S 5,544.00 0013193 ROOM CARE SEMI PRIV - 76410 5,544.00 0013201 ROOM CARE SEMI PRIV-61703 5,544.00 0014001 ROOM CARE MED-SURG SEMI PRIV-1N 5,544.00 0014050 ROOM CARE SEMI PRIVATE-SUR SUR 5,544.00 0014134 ROOM CARE SEMI PRIV-EHD EHD 5,181.00 0015008 ROOM CARE SEMI PRIVATE -P2S P2 5,544.00 0015081 ROOM CARE SEMI PRIV-P4 P4 5,544.00 0015206 ROOM CARE SEMI PRIVATE-1T 1T 5,544.00 0015222 ROOM CARE SEMI PRIVATE-3T 3T 5,544.00 0015255 ROOM CARE SEMI-PRIV-4T 4T 5,544.00 0016303 ROOM CARE SEMI PRIV-OVERFLOW 60300 5,544.00 0016402 ROOM CARE SEMI PRIV-2W 2W 5,544.00 0017004 ROOM CARE SEMI PRIV-SAU SAU 5,544.00 0017053 ROOM CARE SEMI-PRIV-PACU PACU 5,544.00 0017103 ROOM CARE SEMI PRIVATE-CC1 CC1 5,544.00 0017202 ROOM CARE SEMI-PRIVATE-CC2 CC2 5,544.00 0017301 ROOM CARE SEMI-PRIVATE-3PZ 3PZ 5,544.00 0017319 ROOM CARE SEMI-PRIVATE-4PZ 4PZ 5,544.00 0017335 ROOM CARE SEMI-PRIV OVRFLOW 61705 5,544.00 0017343 ROOM CARE SEMI PRIV-77401 5,544.00 0017350 ROOM CARE SEMI PRIV-P4 P4 5,544.00 0017400 ROOM CARE SEMI-PRIV-4PZ 4PZ 5,544.00 0023143 ROOM CARE TELEMETRY-2T 2T 6,470.00 0023168 ROOM CARE NURSERY-P4 2,237.00 0023176 ROOM CARE TELEMETRY-OVERFLOW 72400 6,923.00 0023184 ROOM CARE TELEMETRY-2S 2S 6,923.00 0023200 ROOM CARE TELEMETRY-61703 6,923.00 0024059 ROOM CARE PRIVATE-SUR SUR 5,544.00 0024133 ROOM CARE TELEMETRY EHD EHD 6,470.00 0024141 ROOM CARE TELEMETRY-CATH LAB CLB 6,923.00 0025007 ROOM CARE NURSERY-P2 P2 2,237.00 0025031 ROOM CARE NURSERY-NSY NSY 2,237.00 0025049 ROOM CARE NURSERY-NICU NIN 2,237.00 0025072 ROOM CARE NURSERY-P3 P3 2,237.00 0025080 ROOM CARE TELEMETRY-P4 P4 6,923.00 0025205 ROOM CARE TELEMETRY-1T 1T 6,923.00 0025221 ROOM CARE TELEMETRY-3T 3T 6,923.00 0025254 ROOM CARE TELEMETRY-4T 4T 6,923.00 0026302 ROOM CARE TELEMETY-OVERFLOW 60300 6,923.00 0027003 ROOM CARE TELEMETRY-SAU SAU 6,923.00 0027052 ROOM CARE TELEMETRY-PACU PACU 6,923.00 0027102 ROOM CARE TELEMETRY-CC1 CC1 6,923.00 0027201 ROOM CARE TELEMETRY-CC2 CC2 6,923.00 0027300 ROOM CARE TELEMETRY-3PZ 3PZ 6,923.00 0027318 ROOM CARE TELEMETRY-4PZ 4PZ 6,923.00 0027334 ROOM CARE TELEMETRY-OVERFLOW 61705 6,923.00 0027342 ROOM CARE TELEMETRY-77401 6,923.00 0027359 ROOM CARE TELEMETRY-P4 P4 6,923.00 0027409 ROOM CARE TELEMETRY-4PZ 4PZ 6,923.00 0033167 ROOM CARE PERINATOLOGY-P4 P4 6,208.00 0034058 ROOM CARE ICU INTENSIVE-SUR SUR 13,336.00 0034082 ROOM CARE TCU-1S LEVEL III 1S 2,475.00 0034140 ROOM CARE INTERMEDT-CATH LAB CLB 10,124.00 0035006 ROOM CARE PERINATOLOGY-P2 P2 6,208.00 0035048 ROOM CARE NICU SURVEILLANCE NIN 8,903.00 0035071 ROOM CARE PERINATOLOGY-P3 P3 6,208.00 0037002 ROOM CARE ICU INTENSIVE-SAU SAU 11,541.00 0037051 ROOM CARE ICU INTENSIVE-PACU PACU 11,541.00 0037101 ROOM CARE ICU INTENSIVE-CC1 CC1 13,336.00 0037200 ROOM CARE ICU INTENSIVE-CC2 CC2 13,336.00 0037309 ROOM CARE ICU INTENSIVE-3PZ 3PZ 13,336.00 0043141 ROOM CARE ADMIN DAY-2T LOW SNF 2T 1,858.00 0043166 ROOM CARE SEMI PRIV LDRP-P4 P4 5,792.00 0043174 ROOM CARE ADMIN DAY-LOW SNF 72400 1,858.00 0043182 ROOM CARE ADMIN DAY-2S LOW SNF 2S 1,858.00 0043208 ROOM CARE ADMIN DAY-LOW SNF 61703 1,858.00 0044008 ROOM CARE ADMIN DAY-1N LOW SNF 1N 1,858.00 0044081 ROOM CARE ADMIN DAY-1N LOW SNF 1S 1,858.00 0045005 ROOM CARE SEMI PRIV LDRP-P2 P2 5,792.00 0045039 ROOM CARE NURSERY-INTERMED NSY 8,903.00 0045047 ROOM CARE NICU INTERMED NIN 8,903.00 0045070 ROOM CARE SEMI PRIV LDRP-P3 P3 5,792.00 0045088 ROOM CARE ADMIN DAY P4 LOW SNF P4 1,858.00 0045203 ROOM CARE ADMIN DAY-1T LOW SNF 1T 1,858.00 0045229 ROOM CARE ADMIN DAY-3T LOW SNF 3T 1,858.00 0045252 ROOM CARE ADMIN DAY-4T LOW SNF 4T 1,858.00 0046300 ROOM CARE ADMIN DAY-LOW SNF 60300 1,858.00 0047100 ROOM CARE ADMIN DAY-CC1 LOW SNF CC1 1,858.00 0047209 ROOM CARE ADMIN DAY-CC2 LOW SNF CC2 1,858.00 0047308 ROOM CARE ADMIN DAY-3PZ LOW SNF 3PZ 1,858.00 0047316 ROOM CARE ADMIN DAY-4PZ LOW SNF 4PZ 1,858.00 0047340 ROOM CARE ADMIN DAY LOW SNF-77401 1,858.00 0047357 ROOM CARE ADMIN DAY P4 LOW SNF P4 1,858.00 0047407 ROOM CARE ADMIN DAY-4PZ LOW SNF 4PZ 1,858.00 0053140 ROOM CARE ADMIN HIGH SUB ACUTE-2T 2,000.00 0053173 ROOM CARE ADMIN HI SUB ACUTE-72400 2,000.00 0053181 ROOM CARE ADMIN HIGH SUB ACUTE-2S 2,000.00 0053207 ROOM CARE ADMIN HI SUB ACUTE-61703 2,000.00 0054007 ROOM CARE ADMIN HIGH SUB ACUTE-1N 2,000.00 0054080 ROOM CARE ADMIN HIGH SUB ACUTE-1S 2,000.00 0055038 ROOM CARE NURSERY-NICU INTENSV NSY 22,521.00 0055046 ROOM CARE NICU INTENSIVE NIN 22,521.00 0055079 ROOM CARE SEMI PRIV P3 5,544.00 0055087 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0055202 ROOM CARE ADMIN HIGH SUB ACUTE-1T 2,000.00 0055228 ROOM CARE ADMIN HIGH SUB ACUTE-3T 2,000.00 0055251 ROOM CARE ADMIN HIGH SUB ACUTE-4T 2,000.00 0056309 ROOM CARE ADMIN HIGH SUB ACUTE60300 2,000.00 0057109 ROOM CARE ADMIN HIGH SUB ACUTE-CC1 2,000.00 0057208 ROOM CARE ADMIN HIGH SUB ACUTE-CC2 2,000.00 0057307 ROOM CARE ADMIN HIGH SUB ACUTE-3PZ 2,000.00 0057315 ROOM CARE ADMIN HIGH SUB ACUTE-4PZ 2,000.00 0057349 ROOM CARE ADMIN HI SUB ACUTE-77401 2,000.00 0057356 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0057406 ROOM CARE ADMIN HIGH SUB ACUTE-4PZ 2,000.00 0063198 ROOM CARE DOU/ONCOLOGY - 76410 5,544.00 0063206 ROOM CARE DOU/ONCOLOGY-61703 1,055.00 0064055 ROOM CARE INTERMEDIATE SUR SUR 10,124.00 0064147 ROOM CARE INTENS CARE-CLB CLB 13,336.00 0065078 ROOM CARE DOU/ONCOLOGY-P3 P3 1,055.00 0065086 ROOM CARE DOU/ONCOLOGY-P4 P4 5,544.00 0065250 ROOM CARE DOU/ONCOLOGY-4T 4T 5,544.00 0073163 ROOM CARE TELEMETRY-OBS-IPT-P4 P4 6,923.00 0074005 ROOM CARE ARC SEMI PRIVATE - 1N 3,419.00 0074088 ROOM CARE ARC SEMI PRIVATE - 1S 3,419.00 0075077 ROOM CARE ADMIN DAY P3 LOW SNF P4 1,858.00 0083162 ROOM CARE SEMI PRIV-OBS/IPT-P4 P4 5,544.00 0083188 ROOM CARE SEMI PRIVATE-2N 2N 3,195.00 0084087 ROOM CARE TCU-1S HOSPICE 1S 2,475.00 0085076 ROOM CARE ADMIN HIGH SUB ACUTE-P4 2,000.00 0094003 ROOM CARE SEMI PRIVATE-1N 1N 3,419.00 0094086 ROOM CARE TCU-1S LEVEL 3 1S 2,475.00 0100016 SUTURE VALVE 3,175.00 0100024 SUTURE CABG W/AV/MV 3,614.00 0100032 SUTURE CABG 1,591.00 0100446 ORSDS MAJOR B 1/4 HR 1,126.00 0100453 ORSDS MAJOR B 4,655.00 0100461 ORSDS MAJOR A 1/4 HR 1,298.00 0100487 ORSDS MAJOR A 5,273.00 0100503 ORSDS RECOVERY RM B 564.00 0100552 URETERAL GUIDE WIRE 129.00 0100602 CORNEAL PROCESSING-TISSUE ANGIOGDYE 8,067.00 0100610 CRYO PROBES 6,050.00 0100628 MINOR SURG-D 1/2 HR 5,516.00 0100636 MINOR SURG-D 1/4 HR 467.00 0100651 MINOR SURG-C 1/4 HR 659.00 0100982 UTERINE MANIPULATOR 148.00 0101097 TOURNIQUET 204.00 0101557 melatonin 3 mg tablet 2.25 0102962 MAJOR SURG-A 1 HR 14,816.00 0102970 MAJOR SURG-A 1/4 HR 1,844.00 0103721 MAJOR SUTURE SET 605.00 0103739 MINOR SUTURE SET 328.00 0103812 CENTRIMED PUMP-OR 3,259.00 0104059 MAJOR SUTURE A SET 1,241.00 0104406 CUSA STRAIGHT/CURVED 1,435.00 0104505 ONCOTECH ASSAY KIT 6,281.00 0104547 KIT ICU VENTRICULOSTOMY 532.00 0104646 ORSDS GENERAL SUTURE MINOR 565.00 0104653 ORSDS GENERAL SUTURE MAJOR 850.00 0104661 ORSDS EYE SUTURE 1,126.00 0104729 CABG OR SERVICES 36,828.00 0104752 MINOR C WITH LASER 15,946.00 0104760 MAJOR B WITH HIGH TECH 23,023.00 0104778 MAJOR A WITH HIGH TECH 30,955.00 0104786 COSMETIC 1/4 HR SSS 110.00 0104794 COSMETIC A 1 HR SSS 990.00 0104836 MINOR SURG-C 1 HR 9,618.00 0109165 BARD UROLOGIST TRAY 840.00 0109173 KII BALLOON BLUNT TIP SYSTEM 84.00 0109199 SEPRAFILM 1,020.00 0109207 MINICAP EXTENDED LIFE PD 230.00 0109215 MINICAP W/POVIDONE IODINE 21.00 0201079 RECOVERY ROOM A 1 HR 4,302.00 0201103 RECOVERY ROOM A 1/4 HR 613.00 0300244 ANES LOCAL/MAC ANESTH 798.00 0300426 ACTIVATED CLOTTING TIME (ACT) 678.00 0300590 ANES SDS GENERAL ANESTHESIA 1,862.00 0300608 ANES SDS MAC ANESTHESIA 745.00 0300780 IABP BALLOON CATHETER 4,692.00 0300798 IABP FO BALLOON CATHETER 5,414.00 0300806 GEN ANES 3HRS OR LESS 4,577.00 0300814 GEN ANES OVER 3 HOURS 14,916.00 0400218 DIABETES OP TRG-INDIVIDUAL 60 MIN 492.00 0400226 DIABETES OP TRG-GROUP 60MIN 285.00 0401448 DIABETES EDUCATION CLASS SERIES 75.00 0401455 DIABETES EDUCATION GESTATIONAL 17.00 0401505 DIABETES EDUCATION INDIVIDUAL 17.00 0401604 SSS SPINAL TAP 2,648.00 0608091 SDS MINOR C 1/4 HR 924.00 0608109 SDS RECOVERY RM A 1/4 HR 299.00 0608133 SDS MAJOR A 1/4 HR 1,555.00 0608141 SDS MINOR C 1/2 HR 5,516.00 0608158 SDS MAJOR A 1 HR 8,301.00 0608166 SDS RECOVERY RM A 1 HR 1,763.00 0608174 SDS RECOVERY RM B 559.00 0608398 SDS EYE SUTURE 1,126.00 0608406 SDS GENERAL SUTURE 3> PKG 850.00 0608414 SDS GENERAL SUTURE 1-3 PKG 565.00 0608463 SDS SCLERAL TISSUE 1,343.00 0608547 SDS MINOR HIGH TECH 15,946.00 0608554 SDS MAJOR HIGH TECH 17,771.00 0608562 COSMETIC A 1 HR 990.00 0608570 COSMETIC B 1/2 HR 605.00 0608588 COSMETIC 1/4 HR 110.00 0608638 SDS CONNECTIVE TISSUE,HUMAN 1,343.00 0615088 BREAST IMPLANT 4,232.00 0700039 AMNIOCENTESIS 974.00 0700047 LD CERCLAGE 12,453.00 0700062 LD FETAL MONITORING 343.00 0700096 LD MINOR SURG 1 HR 5,516.00 0700120 LD OR MAJOR SURG 3,593.00 0700161 NON-STRESS TEST 1,220.00 0705004 LD VAGINAL DELIVERY 8,603.00 0705020 L&D C-SECTION SURGERY 9,209.00 0705038 LD OB RECOVERY ROOM 2,108.00 0705046 OB OBS IV PUSH INITIAL 980.00 0705053 OB OBS INFUSION HYDR ADDL HR (>31M) 200.00 0705061 OB OBS SUBQ/1M INJECTION 531.00 0705079 OB OBS CATH INSERTION 357.00 0705087 OB OBS IV INFUSION HYDR 31-60M INTL 1,167.00 0705095 OB OBS IV PUSH ADDL NEW DRUG 735.00 0705103 BLOOD PATCH OB 1,457.00 0705129 I&D OF VULVA/PERINEUM 670.00 0705137 OUTPATIENT OBS HR ONE P2 MOD 25 300.00 0705145 OUTPATIENT OBS EA ADDL HR P2 MOD25 300.00 0705152 OB
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