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This Is Not a Helpful Tool for Patients to Comparison Shop. for Information About the Cost of Your Specific This is not a helpful tool for patients to comparison shop. For information about the cost of your specific Description Amount HOSPICE PAIN/SYMPTOM MGMT- 2S $903.65 HOSPICE RESPITE $862.55 HOSPICE $903.60 HOSPICE RESPITE CARE $915.50 OBSERVATION OB MOD 1HR $840.00 OBSERVATION OB HIGH 1HR $840.00 NEWBORN AUDIOLOGY SCREENING $294.95 OBSERVATION OB MOD >1HR $6.75 OBSERVATION OB HIGH >1HR $6.75 ULTRASOUND LIMITED $271.60 NON STRESS TEST - FETAL $342.80 OB ASSESSMENT 1ST HOUR $838.80 OB ASSESSMENT > 1 HR $6.55 VERSION; EXTERNAL $2,618.65 FETAL CONTRACTION STRESS TEST $188.20 NURSERY LEVEL 1 $1,230.00 EPIDURAL $1,761.25 CAR SEAT TEST 60 MIN $75.85 CAR SEAT ADD'L 30 MIN $11.30 INSERT CERVICAL DILATOR $335.80 RHOGAM INJECTION $62.20 OBSERVATION ICU 1ST HR $1,652.90 OBSERVATION ICU >1HR $12.70 PRIVATE ROOM - 4MSI $995.00 PRIVATE ROOM - 3MPS $995.00 PRIVATE ROOM - 2MBS $995.00 PRIVATE ROOM - ICU $1,945.00 HOSPICE RESPITE $1,095.75 HOSPICE RESPITE $1,095.75 HOSPICE GEN - NON RESPITE $1,095.75 HOSPICE GEN - NON RESPITE $1,095.75 RN ASSESSMENT $145.50 ARTHROCENTESIS $337.20 ASTHMA TEACHING $98.10 BIPAP $310.55 ARTERIAL PUNCTURE $132.90 CPAP - ARABELLA $310.55 ABG $147.80 ACAPELLA THERAPY, INITIAL $200.05 ACAPELLA THERAPY, SUBQUENTIAL $122.05 EZ-PAP THERAPY, INITIAL $200.05 EZ-PAP THERAPY, SUBQUENTIAL $200.05 FLO-MIST CONTINUOUS NEB (INIT) $200.05 FLO-MIST CONTINUOUS NEB (SUBQ) $200.05 ALBUTEROL BOTTLE $88.95 PFT PRE & POST $582.75 PEAK FLOW INIT $194.60 ASSISTED VENTILATION $620.40 CPT W/POST DRAINAGE INITIAL $122.05 CPT W/POST DRAINAGE SUB $74.90 LUNG VOLUMES $294.95 PULSE OXIMETRY SINGLE $80.40 Sa02 OVERNIGHT $283.65 METER DOSE INHALER SUBQ $200.05 RESPIRATORY ASSESSMENT $173.70 NEBULIZER THERAPY INIT $200.05 NEBULIZER THERAPY SUBSQ $200.05 PEAK FLOW SUBQ $294.95 NASOTRACHEAL SUCTION $200.05 CONTINUOUS VENT INIT 1ST DAY $611.85 CONTINUOUS VENT SUBQ DAY(S) $611.85 NORMAL SALINE 10% SOLUTION $2.50 ALBUTEROL 5.0mg $5.55 PULMONARY FUNCTION TEST $208.45 SPUTUM SPEC COLLECT (INDUCED) $136.80 O2 PER HR $8.80 O2 PER 15 MINUTES $2.30 O2 BY CANNULA - 1st 15 MIN $12.90 O2 PER DAY $209.10 O2 BY CANNULA - 1ST HOUR $51.30 LUNG DIFFUSION $282.45 CO EXPIRED GAS BY IR $335.40 IP COPD EDUCATION $0.00 METER DOSE INHALER INIT $200.05 MULT SLEEP LATENCY-MSLT or MWT $4,274.60 SLEEP STAGING 4/> PARAMETERS $4,695.40 POLYSOMNOGRAPHY w/CPAP or VENT $4,927.05 POLY w/CPAP or VENT DISCONTINU $4,927.05 SLEEP STAGING 4/> PARAMETERS $4,695.40 SLEEP CLINIC $0.00 SLEEP STUDY UNATT&RESP EFFT $570.80 PAP-NAP <6 HOURS $585.50 INCEN SPIROM INIT PROD STATS $173.70 MONIT DURING C-SEC (ADULT) $0.00 MONIT DURING C-SEC (NEONATE) $34.00 MONIT DURING THERAP BRONCH $0.00 EVALUATE PT USE OF INHALER $200.05 MECHANICAL CHEST WALL OSCILL $200.05 NB RESUSCITATION $625.15 NAVIGATIONAL BRONCHOSCOPY $1,721.05 INTUBATION ET EMERGENT $226.55 INITIATION OF VENT IN ER $0.00 MAC VENTILATION ASSIST $0.00 VAPOTHERM THERAPY $173.70 LABOR ROOM $1,867.55 LABOR >24 HRS ea add'l hr $85.85 DELIVERY $2,728.55 DELIVERY OF PLACENTA $2,491.00 ARTHROSCOPY, O/P $1,828.10 ORGAN AND/OR TISSUE PROCUREMEN $543.25 SIGMOIDOSCOPY $659.15 LAP CHOLE $5,355.10 MINOR SURGERY $3,344.90 MINOR SURGERY EACH ADDL 1/2 HR $830.65 TRABECULOTOMY $9,551.75 3M ARTHROSCOPY PUMP $280.30 MAJOR SURGERY $4,862.75 MAJOR SURGERY EACH ADDL 1/2 HR $1,688.65 SYNEVAC VACUUM $918.65 OR SCOPE $194.50 RN ASSESSMENT $171.75 CATARACT SURGERY WITHOUT LENS $6,150.00 ASTIMATISM RELAXING INCISION $2,359.30 COSMETIC PROCEDURE/HOUR $399.00 COSMETIC ANESTHESIA $299.00 SPECIAL PROCEDURE $798.45 SMOKE EVACUATOR $0.00 LITHOTRIPSY $25,838.50 RECOVERY ROOM $1,800.85 RECOVERY ROOM EACH ADDL 1/2 HR $292.20 RECOVERY TEE PROCEDURE (SURG) $653.75 NAVIGATION $0.00 THERAPEUTIC PHLEBOTOMY $218.80 CHEMOTHERAPY BLADDER INSTILL $504.10 IV INJECTION EACH ADD'L $181.80 INJECTION SQ/IM $108.45 INJECTION IV $200.05 INJECTION IV EACH ADDITIONAL $181.80 COLLECT BLOOD FROM PICC LINE $122.05 COLLECT BLOOD IMPLANT PORT ONC $122.05 BONE MARROW BIOPSY - ONCOLOGY $1,892.90 DECLOT PICC (ONC) $371.55 ONC VISIT FACILITY L1 (NEW) $104.10 ONC VISIT FACILITY L2 (NEW) $114.60 ONC VISIT FACILITY L3 (NEW) $141.90 ONC VISIT FACILITY L4 (NEW) $170.15 ONC VISIT FACILITY L5 (NEW) $178.70 ONC VISIT FACILITY L1 (EST) $169.70 ONC VISIT FACILITY L1 (EST)-25 $169.70 ONC VISIT FACILITY L2 (EST) $213.80 ONC VISIT FACILITY L2 (EST)-25 $213.80 ONC VISIT FACILITY L3 (EST) $312.00 ONC VISIT FACILITY L3 (EST)-25 $312.00 ONC VISIT FACILITY L4 (EST) $453.65 ONC VISIT FACILITY L4 (EST)-25 $453.65 ONC VISIT FACILITY L5 (EST) $602.45 ONC VISIT FACILITY L5 (EST)-25 $602.45 CHEMO ADMIN NON-HORMONAL IM/SQ $279.55 CHEMO ADMIN HORMONAL SQ/IM $279.55 CHEMO IV PUSH - INITIAL $355.60 CHEMO IV PUSH -EA ADDITIONAL $355.60 CHEMO INFUSION 1ST HOUR $616.90 INFUSION CHEMOTHERAPY $247.35 CHEMO INFUSION SEQUENTIAL $245.95 INFUSION HYDRATION $41.40 INFUSION 1ST HOUR THERAPY $492.90 INFUSION THERAPEUTIC $41.40 CHEMO ADMIN VIA PORTABLE PUMP $462.30 INFUSION SEQUENTIAL $136.65 INFUSION CONCURRENT $136.65 ADMIN OF INFLUENZA VACCINE $31.00 ADMIN OF PNEMONCOCCAL VACCINE $56.65 ADMIN IMMUNIZATION - 1 VACCINE $72.65 PORT FLUSH $111.50 INFUSION HYDRATION $354.20 INFUSION HYDRATION $41.40 FMLA $19.60 BEHAV CHNG SMOKING 3-10 MIN $36.35 BEHAV CHNG SMOKING > 10 MIN $36.35 IMMUNIZATION ADM;EA ADDTL $54.90 ADMINISTER HEP B VACCINE $63.25 INJECTION SQ/IM $108.45 CHEMO ADMIN NON-HORMONAL IM/SQ $279.55 CHEMO ADMIN HORMONAL SQ/IM $279.55 INFUSION THER ONC 1st HR $492.90 REFILL/MAINT PORTABLE PUMP $231.35 VENIPUNCTURE ONC $18.30 STELKAST HEADLESS PIN SC2110-1 $916.95 STELKAST HOLD SCREW SC3520-55 $916.95 DEFIB PADS ZOLL ADULT $280.15 ITS 52MM LOCK CANCELLOUS SCREW $1,408.60 BLS MILEAGE (PER MILE) $17.50 AMBULANCE CONVALESCENCE $251.55 PARAMEDIC INTERCEPT $150.00 ALS MILEAGE (PER MILE) $17.75 AMBULANCE BLS EMERGENCY $790.40 AMBULANCE ALS I EMERGENCY $1,146.00 AMBULANCE ALS II EMERGENCY $1,481.25 AMBULANCE ALS NON-EMERGENCY $1,046.00 AMBULANCE BLS NON-EMERGENCY $442.55 AMB SPECIALTY CARE TRANSPORT $1,810.55 AMBULANCE MILEAGE PER .10 MILE $1.65 AMBULANCE MILEAGE PER MILE $16.05 CAS MA AMB NON-EMERGENCY $15.10 NAS MA AMB NON-EMERG WHEELCHR $30.15 ORTHO SHORTRUNNER AIRMESH LRG $531.60 ORTHO SHORTRUNNER AIRMESH XLRG $531.60 ORTHO SHORTRUNNER AIRMESH XXLG $531.60 NASAL SEPTAL PROSTHESIS $1,650.30 BIOTRONIC ENTRINSA PACER $13,304.00 QUICKCROSS CATHETER 135CM $649.65 QUICKCROSS CATHETER 150CM $649.65 ORTHO SHORTRUNNER AIRMESH SM $531.60 TUBE TRACHEAL SHILEY PED $540.60 ORTHO CAST ALTERATION $0.00 BILLIRUBIN LIGHT DAILY $0.00 ROD RUSH $430.00 DRESSING ABD $0.00 CAPNOGRAPHY NASAL ADT CANNU LT $100.10 CATHETER FOLEY 5CC 24FR $68.65 CATHETER FOLEY 5CC 20FR $0.00 CATHETER FOLEY 5CC 18FR $0.00 CATHETER FOLEY 5CC 16FR $0.00 CATHETER FOLEY 5CC 12FR $0.00 DRESSING ADAPTIC 3 X 3 $0.00 LENS INTEROCULAR $712.40 END TIDAL CO-2 MONITOR DISP $0.00 IV ADAPTER MALE CLAVE PLUG $0.00 CONNECTOR Y 1/8 $0.00 CATHETER 5CC 22FR LATEX $0.00 ORTHO CAST ARM/ELBOW $0.00 CAPNOGRAPHY NASAL TUBING PED $85.45 PIN STEINMAN $95.85 FECAL INCONTINENCE COLLECTOR $0.00 CATHETER ST 18FR $0.00 CATHETER ST RUBBER 14FR $0.00 CATHETER ST COUDE 10FR $0.00 LAVAGE GASTRIC-CLOSED SYSTEM $763.25 CATHETER TURP 3W 24FR $0.00 TAMPON POPE POSTERIOR NASAL $0.00 DRILL AIR $395.65 CAST, SPICA $1,191.10 CATHETER ST ROBNEL 18FR $0.00 CATHETER ST ROBNEL 16FR $0.00 CATHETER ST COUDE 8FR $0.00 JURGAN, PIN COVER $0.00 ORTHO CAST LEG SHORT $308.70 DAVOL/FLAT MESH 3 X 5 $287.90 NOZ STOP POSTERIOR PACKING KIT $568.55 CATHETER SUCTION 10FR $0.00 KIWI-COMPLETE VACUUM DELIVERY $0.00 DAVOL/FLAT MESH 14 X 10 $810.30 WOUND CLEANSING SOLUTION $0.00 SUCTION, DAILY (CSS) $0.00 KIT COLONY COUNT $0.00 WIRE EYE PRE CUT $757.55 VAC DRESSING ABD $1,281.60 VAC PADS TRACK $0.00 VAC Y CONNECTOR $0.00 VAC CANNISTER $169.15 VAC DRESSING VERSAFOAM 10X15 $0.00 VAC DRESSING KIT $206.05 GELOCAST BANDAGE 4 $0.00 VAC DRESSING GRANUFOAM SILVER $0.00 STRAP MONTGOMERY $0.00 POST OP SHOE WOMEN SM $101.70 POST OP SHOE WOMEN MD $101.70 POST OP SHOE WOMEN LG $101.70 TRAY EMERGENCY DELIVERY $0.00 POST OP SHOE MEN SM $101.70 MESH SANITARY PANTIES $0.00 POST OP SHOE MEN MD $101.70 POST OP SHOE MEN LG $101.70 POST OP SHOE MEN XL $101.70 SENSOR MASIMO LNCS $0.00 PACK CASSETTE COVER $0.00 ENDO GIA RELOAD $506.00 BOVIE BLADE INSULATED ENT $0.00 SPINAL NEEDLE 22x7 008560 $0.00 BOVIE EXTENSION $0.00 LINVATEC ARTHROSCOPY BUR $291.90 SYNTHES SCREW 2.7 $543.35 SYNTHES SCREW 2.4 $791.20 SYNTHES SCREW 1.8 $600.95 TRAY EYE W/MORGAN LENS $0.00 SYN DRILL BIT 2.0 & 2.7 $672.00 SYNTHES DRILL BIT 1.8 & 2.4 $1,024.00 BEATH PIN $218.70 LINVATEC STAPLE $681.00 SUTURE RETRIEVER $163.60 INTERCEED $997.95 RECTAL SWAB STERILE $0.00 REMOVER LOTION 3M $0.00 ETHICON LIGA CLIP SM/MED/LG $308.70 BOVIE TEFLON LONG TIP $0.00 ETHICON EEA 21,25 $1,335.75 PUMP EPIDURAL DAILY $521.95 SKIN STAPLE PREM 35 $0.00 PUMP, EMERSON DAILY $0.00 ETHICON TX 30 $574.60 ETHICON ROTICULATOR 55 $937.35 ETHICON ENDOCLIP 10MM $548.40 ETHICON TLH90 $590.70 ETHICON TX30V $570.20 TRAY EPIDURAL-DR.
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