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Chargemaster Charge Code Description Price Medicare CPT 400481 OR 481 TO 540 MIN 9100 SURG 400777 SUTURES-RUN 92 400778 SUTURE-POP OFF 128 400779 SUTURE-REEL 33 400780 SUTURE-TIES 84 440002 STALEVO 150 11.2 3000817 PNEUM VACCINE ADMINI 57 G0009 3000819 CA SCREEN; PELVIC/BR 103 G0101 3000823 COLORECTAL SCR SCOPE 1030 G0105 3001087 APPLICATION FOREARM 200 29085 3001104 TECH COMP EXC DEB 42 376 11042 3001297 HIPPS 0 MANUL 3001740 CENTRAL VENOUS LINE 1500 36556 3001741 TECH COMP REPLACMENT 1500 36580 3001742 TECH COMP REMOVAL HI 1000 36589 3001745 TECH COMP GASTROSTOM 325 3001746 TECH COMP I&D SCROTA 1700 55100 3001913 PRIVATE ROOM W/BATH 982 3002874 SEMI-PRIVATE 960 3002879 TECH COMP TUBE THORA 900 32551 3002882 TECH COMP REPLACEMEN 1500 36580 3003298 CVP TECHNICAL COMPON 1500 36556 3003882 ADMIN BLD/BLD PRDUCT 565 36430 3004250 TECH COMP INS ART LN 515 36245 3004251 CVP TECHNICAL COMPON 1500 36556 3004253 TECH COMP REPLACEMEN 1500 36580 3004256 TECH COMP BX 45100 3300 45100 3004259 TECH COMP PARACENTES 815 49082 3004261 INSERTION TEMP BLADD 200 51702 3004263 DILATION URETHRA SUB 275 53621 3004264 TECH COMP DILATION U 150 53661 3004538 NURSERY/SICK BABY 450 3004850 TREATMENT ROOM LVL 1 150 99211 3004853 TREATMENT RM LVL 3 250 99213 3004995 TECH COMP PARA REPEA 815 49082 3005022 OBS DIRECT ADMIT 1ST 600 G0379 3005110 SWING BED 441 3005209 OBSERV RM. EACH HR 50 G0378 3005845 INJ INTRA-A THERAPEU 200 96373 3005933 IMMUN ADMIN ONE VACC 53 90471 3005938 IV INF HYDRATION INI 215 96360 3005939 IV INF HYDRATION EAC 65 96361 3005940 IV INF THER PROPH DI 300 96365 3005941 IV INF THER PROPH DX 73 96366 3005942 IV INF THER PROPH DX 73 96367 3005943 INFUSION EACH ADD CO 50 96368 3005944 INJ IM/SQ TX PROPH 73 96372 3005945 INJ INTRA-A TX PROPH 200 96373 3005946 INJ IV SING INI < 15 200 96374 3005947 INJ THER PROPH DIAG 35 96376 3010061 DEXTROSTIX 12 82962 3014555 TECH COMP INS CH TUB 900 32551 3016140 TC INS ART CA 36140 550 36140 3016558 TC INS TUNN CV 36558 3800 36558 3017597 DEBRIDEMENT NON-EXC 325.36 97597 3202588 CARDIAC MONITOR 0 93224 3300518 DISPOSABLE O2 SENSOR 32 3302880 TECH COMP INS ART LN 515 36245 3302881 CVP TECHNICAL COMPON 1500 36556 3303150 ENDOTRACH INTU ICU 325 31500 3303187 CVP TECHNICAL COMPON 1500 36556 3303965 INTENSIVE CARE UNIT 1871 3406360 IV INFUSE/HYDRATION 215 96360 3406361 IV INFUSE/HYDRA EA H 65 96361 3406365 IV INF INI 1HR 96365 300 96365 3406366 IV INFUSE EA ADDL HR 73 96366 3406367 SEQUENTIAL IV 1 HR 73 96367 3406368 CONCURRENT IV INFUSE 50 96368 3406372 IM/SQ INJECTION 73 96372 3406374 IVP; SINGLE/INITIAL 200 96374 3406375 IVP- EA ADD'L DRUG 73 96375 3406376 IVP EA ADD'L SAME 35 96376 3406409 CHEMO IVP INITIAL 300 96409 3406411 CHEMO IVP EA ADD DRU 128 96411 3406413 CHEMO IV INITIAL 1HR 364 96413 3406415 CHEMO IV INFUS EA HR 73 96415 3406417 CHEMO SEQUENTIAL 1HR 128 96417 3406523 PORT FLUSH 150 96523 3406549 CHEMO CONCURRENT 73 96549 3409201 OV NEW PROB FOCUS 187 99201 3409202 NEW PT EXPANDED PROB 222.11 99202 3409203 NEW PT DETAILED 294.84 99203 3409204 NEW PT COMPREHENSIVE 370.16 99204 3409205 NEW PT/COMPREHE HIGH 484.65 99205 3409211 OV EST PT PROB FOCUS 150 99211 3409212 OVEST PT EXPAND PROB 175 99212 3409213 EST PT DETAILED 250 99213 3409214 EST PT COMPREHENSIVE 300 99214 3409215 EST PT COMPREH HIGH 370.16 99215 3409901 OV NEW PT PROB FOCUS 187 99201 3409902 NEW PT EXPAND PROB 222.11 99202 3409903 NEW PT DETAILED 294.84 99203 3409904 NEW PT-COMPREHENSIVE 375 99204 3409905 NEW PT COMPREHENSIVE 485 99205 3409911 OV EST PT PROB FOCUS 150 99211 3409912 OVEST PT EXPAND PROB 175 99212 3409913 EST PT -DETAILED 250 99213 3409914 EST PT-COMPRHENSIVE 300 99214 3409915 EST PT-COMP- HIGH 370.16 99215 3419201 PF OV NEW PROB FOCUS 187 99201 3419202 PF NEW EXP PROB FOC 222.11 99202 3419203 PF NEW PT DETAILED 294.84 99203 3419204 PF NEW COMPREHENSIVE 370.16 99204 3419205 PF NEW COMP HIGH 484.65 99205 3419211 PF OV EST PROB FOCUS 150 99211 3419212 PF OVEST EXPAND PROB 175 99212 3419213 PF OV EST DETAILED 250 99213 3419214 PF OV EST COMP 300 99214 3419215 PF OV EST HIGH COM 370.16 99215 3421044 DEBRIDE BONE 1100 11044 3503557 NON STRESS TEST OB 243 59025 3504225 PROGRESS ROOM 481 3504514 PHY FEE NORMAL DEL W 3600 59400 3504516 PHY FEE VAGINAL DELI 3600 59409 3504517 PF NORM DEL 59410 3600 59410 3504518 DELIVERY PLACENTA 3600 59414 3504523 PHY FEE C-SECTION W 3707 59510 3504524 PHY FEE ASSISTED C-S 3707 59510 3504525 PHY FEE C-SECTION DE 3707 59514 3504526 PHY FEE C-SECTION W 3707 59515 3504999 PHILLIPS ABD STRAPS 3 3600061 DEXTROSTIX NURSERY 12 82962 3602043 BILILIGHT PER SHIFT 40 3602834 TC REM EXT DIGIT NB 155 11200 3603507 NURSERY 375 3604694 PPH HEMORRHOIDECTOMY 5000 46947 3605407 PHENYLKETONURIA PKU 41 84030 3608344 PF REM EXT DIGIT NB 3000 28344 3611140 EXC LES TRK/EXT11406 2300 11406 3611142 TC EXC LES B9 11423 2300 11423 3611203 REPAIR LAYERED 12032 425 12032 3611420 TC EXC BEN LES 11042 1100 11420 3614376 CHANGE GASTRO 288.6 SURG 3619120 EXC LESION BRS 19120 3300 19120 3619652 TECH COMP DECLOT VAS 325 36593 3810021 ASPIRATION NEEDLE 242 10021 3810022 DEBRID OPN WND 194.95 97597 3810023 ARTERIAL CATHER/CANN 113.8 36620 3810260 INJ SACROILIAC JOINT 1200 G0260 3810382 PF TELEMED PE 90791 275 90791 3811017 LEAVE OF ABSENCE DAY 0 3811041 PF EXC DEBR 97598 183.9 97598 3811043 PF EXC DEB 11043 400 11043 3811045 PF EA ADDTL 20 SQ CM 150 11045 3811140 PF EXC BEN LES SMALL 600 11400 3811300 PF SHAVING DERMAL LE 155 11300 3811470 SENIOR CARE/ROOM-BOA 1257 3812222 PF PSYCH TELE 25 245 G0407 3812223 PF PSYCH TELE 35 MN 255 G0408 3812950 CPR 529 92950 3812958 PF APP UNNA BT 29580 375 29580 3813753 PF GASTRIC INTUB 200 43753 3814093 SKILLS ASSESSMENT 117 1003F 3814094 DIDACTIC EDUCATION G 117 99078 3814095 SKILLS THERAPY/GRP 117 99078 3814096 SKILLS THERAPY INDIV 150 97535 3814098 ROUTINE PSYCHOLOGICA 824 90885 3814099 HEALTH TEACHING GROU 117 99078 3814100 TREATMENT PLANNING/P 138 3814101 SPECIAL CLINICAL MAN 138 3814104 PSYCHOLOGICAL ASSESS 138 90885 3814105 INDIVIDUAL THERAPY/H 206 3814106 FAMILY THERAPY 90847 200 90847 3814107 GROUP THERAPY 90853 200 90853 3814112 PF EXC SEB CYST11042 376 11042 3814180 DRAIN GUM LES 41800 300 41800 3815005 PF I&D RECTAL ABSCES 3000 45005 3815565 FX RADIAL/ULNA 225 25565 3815948 PF TELE INI PE 275 90791 3815949 PSYCHOTHERAPY 30 MIN 84 90832 3815950 PSYCHOTH 45MIN 90834 250 90834 3815951 PSYCHOTHERAPY FAMILY 122 90847 3815952 OUTPATIENT GRP THERA 50 90853 3816025 PF 2ND DEG BURN MED 300 16025 3816030 PF 2ND DEG BURN-LG 300 16030 3816140 PF INS ART CA 36140 550 36140 3816156 PF INI PE 275 90791 3816157 PF INITIAL PE HOSP 275 99222 3816158 PF INI III HI 378 99223 3816159 PF IP PSYCHVIS 99231 100 99231 3816160 PF IOP SUB VIS 99232 150 99232 3816161 PF IP PSYCHVIS 99233 200 99233 3816162 PF PSYCH DDMGT 99238 250 99238 3816163 PF PSY DD MGT >30MIN 275 99239 3816535 PF REPAIR JOINT FNG 6000 26535 3816558 PF INST TUNN CV36558 3800 36558 3816559 PF OBS SERVICE BRIEF 200 99218 3816560 PF OBS SERVICE LIM 250 99219 3816561 PF OBS SERVICE EXT 300 99220 3816562 PF OBS DISCHARGE 150 99217 3816660 PF SUBS VISIT 99232 150 99232 3816662 PF DD MGT 99238 250 99238 3816663 PF CX FOR SC ADMT 250 99254 3817788 TX FIBULAR FX W/MAN 265 27788 3817818 PF FX TRIMALL ANKL 788 27818 3817825 CLSD TX TIBIA FX MAN 2500 27825 3817938 REMOVE FB EYELID 600 67938 3819055 PF CAST SHOULDER SPI 315 29055 3819082 PF PARACENTESIS ABD 815 49082 3819083 PSYCHOTH 60MIN 90837 250 90837 3819202 PF OFF VISIT 99202 222.11 99202 3819211 PF OFF VISIT 99211 175 G0463 3819212 PF OFF VST 99212 175 G0463 3819213 PF OFF VST 99213 250 G0463 3819214 PF OBS IP SD 99234 255 99234 3819215 PF OBS IP LIMITED 335 99235 3819216 PF OBS IP SD EXTEND 417 99236 3819222 PSYCH TELE SUB 99232 150 99232 3819223 PSYCH TELE SUB 99232 150 99232 3819382 PF PSYCH TELE SC 15 200 G0406 3819425 CAST SHORT LEG WALK 315 29425 3819450 PF REPLACE PEG TUBE 800 49450 3819505 LONG LEG SPLINT 200 29505 3821043 DEBRIDE MUSCLE 400 11043 3821140 TC EXC BEN LES 11404 2300 11404 3821622 TC-BRONCHOSPY W/WASH 1900 31622 3822013 REPAIR EYEBROW LAC 203 12013 3822554 TC-THORACENTESIS 900 32554 3822560 TC PLEURODESIS 900 32560 3823160 TC LT CLS WND 13160 3300 13160 3823242 TC THORACENTESIS WTU 900 32554 3823255 TC-THORACENTESIS -US 900 32555 3823491 TECH COMP THORACENTE 900 32554 3823659 TECH COMP THORA32421 900 32554 3823760 TECH COMP CHG GASTRO 300 3827000 BX LIVER NDLE PERCU 1410 47000 3829083 PARACENTESIS W/IMAG 815 49083 4000030 SENSICARE GLOVES 6.0 7.5 4000033 LINEAR CUTTER STANDA 2419 4000035 LINEA CUTTER VASCULA 2419 4000042 LINEA STAP ARTICULAT 740 4000061 DEXTROSTIX - ER 12 82962 4000083 SUTURE PROLENE 6.0 19.5 4000087 CATH 24F 30CC RIB BA 33 4000093 FOLEY CATH TRAY #16 55 4000100 YANKAUER TIP 8 4000118 BLADES SCALPEL SZ 11 4 4000121 OR 121 TO 180 MIN 4900 SURG 4000181 OR 181 TO 240 MIN 5600 SURG 4000241 OR 241 TO 300 MIN 6300 SURG 4000301 OR 301 TO 360 MIN 7000 SURG 4000315 SUTURE 4.0 VICRYL 3 4000361 OR 361 TO 420 MIN 7700 SURG 4000379 TABLE COVER 12 4000421 OR 421 TO 480 MIN 8400 SURG 4000434 SUCTION CANN 1200CC 15 4000442 SUTURE 3.0 VICRYL 3 4000443 SUTURE 2.0 VICRYL 3 4000449 SUTURE 6.0 VICRYL 3 4000454 CLOSURE KIT 340 4000460 TISSUE SPECIMEN TRAP 37 4000461 WOUND RETRACTOR ALEX 601.68 4000462 WOUND RETRACTOR ALEX 308 4000464 DISP ACTIVE CORD 54 4000466 ENDOFLO IRRIGATOR 140 4000467 SHOWERHEAD TIP 54 4000468 SPLASH SHIELD 6.5 300 4000500 SUTURE 5.0 VICRYL 3 4000512 ELASTIC BANDAGE MATR 17 4000519 ENDO ANCHOR 1020 4000521 ENDOCATH GOLD 379 4000527 EMS HERNIA STAPLER 523 4000541 OR 541 TO 600 MIN 9800 SURG 4000661 SUTURE 5.0 ETHILON 3 4000662 SUTURE 4.0 ETHILON 3 4000663 SUTURE 3.0
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