Item NumberItem Description Current PriceDefault 1 CPT Code 100000 OBSERVATION BED22.3 PER HR MED/SURG 100001 OBSERVATION BED31.9 PER HR PEDS 100002 OP INITIAL HOUR129.1 100003 OP PER HOUR MED/SURG19.2 100004 OV INITIAL HOUR168.7 100005 IM INJECTION 80.1 96372 100006 PICC PROCEDURE456.1 36569 100007 MED INTIAL BLOOD124.2 TRANSFUSION 100008 IV INFUSION INITIAL399.3 UP TO 1HR 100009 IV INFUSION EACH84.3 ADDT'L HOUR96366 100010 INJECTION IVP INITIAL190.5 DRUG 100011 INJECTION IVP EACH132.2 ADDT'L DRUG 100012 CHEMO ADMIN 221.2SUBQ/IM NON96401 HORMONAL 100013 CHEMO ADMIN IVP271.7 INITIAL96409 DRUG 100014 CHEMO ADMIN 184.9IVP EACH ADDT'L96411 DRUG 100015 CHEMO ADMIN INFUSION638.5 UP96413 TO 1 HOUR 100016 CHEMO ADMIN INFUSION129.3 EACH96415 ADDT'L HR 100017 CHEMO ADMIN INFUSION200 EACH96417 ADD DRUG 100018 IV INFUSION ADDT'L252 INF UP96367 TO 1HR 100019 INJECTION SUBQ/IM80.1 100020 IV INFUSION CONCURRENT252 96368 INFUSION 100021 IV INFUSION HYDRATION227.2 INITIAL96360 100022 IV INFUSION HYDRATION80.1 EACH96361 ADDT'LHR 100023 INJECTION IVP EACH143.1 ADDTL SAME DRUG 100024 CHEMO ADMIN PROLONGED601.9 96416 INFUSION 100025 CARDIOVERSION1,534.50 92960 100026 OP MED PER HOUR29.5 100027 OBSERVATION PER54.4 HOUR 100028 BEDSIDE SURGICAL791.6 PROCEDURE 1ST 30 MINS 100029 BEDSIDE SURGICAL174.2 PROCEDURE ADDTL 15 MINS 100030 VACCINE ADMINISTRATION:80.1 ONE VACCINE 100031 VACCINE ADMINISTRATION:80.1 ADDT'L VACCINE 100032 TREATMENT ROOM442.8 100033 DECLOT VASCULAR236.3 DEVICE 36593 100034 CENTRAL LINE PLACEMENT456.1 36556 100035 URINE CAPACITY155.6 MEASURE51798 100036 BLOOD DRAW PICC120 OR CENTRAL36592 LINE 100037 PHLEBOTOMY 209 99195 100038 BLOOD DRAW VENOUS205 PORT36591 DEVICE 100039 PORT FLUSH ONLY178.2 96523 100040 DECLOT VASCULAR236.3 DEVICE 36593 100041 IMMUNIZATION ADMIN80.1 ADDTL90471 VACCINE 100042 PEDIATRIC IMMUNIZATION23.03 90471ADMIN ONE VACCINE 131000 VACCINE ADMINISTRATION - 300000 RECOVERY ROOM247.9 1ST 1/2 HR 300001 RECOVERY ROOM554.4 1ST 1/2 HR (CCU) 300002 RECOVERY ROOM69.7 ADDL 15 MIN 300003 RECOVERY ROOM70.5 ADDL 15 MIN (CCU) 300004 DAY SURGERY-INITIAL187.9 300005 PHASE II RECOVERY141.8 30 MIN OR LESS 300006 PHASE II RECOVERY167.5 - 45 MINUTES 300007 PHASE II RECOVERY192.4 - 1 HOUR 300008 PHASE II RECOVERY260.4 - 1 HR + 15 MINUTES 300009 PHASE II RECOVERY277.2 - 1 HR + 30 MINUTES 300010 PHASE II RECOVERY464.4 - 1HR + 45 MINUTES 300011 PHASE II RECOVERY511.2 - 2 HOURS 300012 PHASE II RECOVERY597.3 - 2 HRS +15 MINUTES 300013 PHASE II RECOVERY597.3 - 2 HRS +30 MINUTES 300014 PHASE II RECOVERY587.9 - 2 HRS + 45 MINUTES 300015 PHASE II RECOVERY869.6 - 3 HRS OR MORE 300016 DAY SURGERY INITIAL/GI110.2 300017 INFORM GLUCOSE TEST-OP6.8 82962SURGERY 300018 INFORM GLUCOSE34.2 TEST SUPPLIES-OP SX 300019 SURGERY - EMERGENCY513.6 (CALL BACK) 300020 SURGERY 1ST2,033.90 30 MIN 300021 SURGERY ADDL' 398.215 MIN 300022 SCRUB NURSE 38.6 300023 EFFERENT LOOP 117.5DILATATION 300024 PEG TUBE REPLACEMENT225 300025 DIGIFLATOR ALLIANCE162.6 INFL SYS 506005 300026 GASTRO INTESTINAL2,330.00 SERVICE 1ST 1/2HR 300027 G I SERVICES ADDL147.6 15 MINS EA 300029 MALONEY 11 300030 G I- EMERGENCY CALL301 BACK 300031 PAIN CLINIC 1ST1,168.40 30 MINS 300032 SAVORY GILLIAR DILITATION26.8 300033 PAIN CLINIC ADDL 18115 MIN 300034 MINOR PROCEDURE677.1 ROOM 300035 SECONDARY MINOR363.2 PROCEDURE ROOM 300036 CYSTOSCOPY 151.2 300037 ARGON BEAM USAGE103.1 300038 CATARACT ROOM1,637.30 300039 PROCEDURE ROOM1,637.30 3 - 1ST 30 MIN 300040 PROCEDURE ROOM325.2 ADDITIONAL 15 MIN 300041 PERCLOSE KIT 689.3 300042 HOLMIUM LASER2,850.90 300043 FIBER-HOLMIUM438.6 LASER 300044 GLYDESCOPE FOR210.5 INTUBATION 300045 YAG LASER TREATMENT1,066.00 300046 INFORM GLUCOSE - TEST EXPLOSION-OP SX 300047 PHASE I RECOVERY541.9 30 MINS OR LESS 300048 PHASE I RECOVERY763.3 45 MINS 300049 PHASE I RECOVERY930.9 1 HOUR 300050 PHASE I RECOVERY997.7 1 HR 15 MINS 300051 PHASE I RECOVERY1,264.90 1 HR 30 MINS 300052 PHASE I RECOVERY1,201.40 1 HR 45 MINS 300053 PHASE I RECOVERY1,598.40 2 HOURS 300054 OUTPATIENT LEVEL166.8 1 99211 300055 ESOPHAGEAL MANOMETRY517.3 91010 300056 ESOPHAGEAL ROOM117.5 300057 SECONDARY ENDOSCOPY1,128.40 PROCEDURE 300058 TERTIARY ENDOSCOPY181.9 PROCEDURE 300059 TEE PROCEDURE1,913.60 ROOM 300060 DAY SURGERY TEE199.5 300061 TEE PROCEDURE325.2 ROOM ADD'L 15 MIN 300062 CT HYDRATION INITIAL227.2 HOUR96360 300063 CT HYDRATION ADDTL77.7 HOUR96361 300064 INJECTION IVP INITIAL190.5 DRUG96374 300065 THORACENTESIS 626.1NEEDLE OR32554 CATH W/O IMAGING 300066 US THORACENTESIS626.1 NEEDLE32555 OR CATH W IMAGIN 300067 PLEURAL DRAINAGE626.1 PERCUTANE32556 W/O IMAGING 300068 US PLEURAL DRAINAGE626.1 PERCUTAN32557 W IMAGING 300069 FLUORO THORACENTESIS626.1 WITH32555 IMAGING 300070 FLUORO PLEURAL626.1 DRAINAGE32557 PERCUT W IMAGING 300071 BX BREAST W MKR619.4 1ST LESION US GUIDANCE 300072 BX BREAST W MKR951.6 1ST LESION STEREOTACTIC 300073 TERTIARY MINOR181.9 PROCEDURE ROOM 399999 NO CHARGE - PAT 500000 OBSERVATION BED-STEP35.1 DOWN 650000 DEXMEDETOMIDINE - HCL IV SOLN 100MCG/1ML 700000 PSYCHIATRIC DIAG272.1 INTERVIEW90801 EXAM-IN 700001 FAMILY PSYCHOTHERAPY235.3 INCLUDES90847 PT INPT 700002 INITIAL INPT HOSPITAL186.8 CARE99221 LEVEL 1 700003 INITIAL INPT HOSPITAL273.3 CARE99222 LEVEL 2 700004 INITIAL INPT HOSPITAL299 CARE99223 LEVEL 3 700005 SUBSEQUENT INPT104.1 HOSPITAL99231 CARE LEV 1 700006 SUBSEQUENT INPT131.8 HOSPITAL99232 CARE LEV 2 700007 SUBSEQUENT INPT207.6 HOSPITAL99233 CARE LEV 3 700008 CONSULT INPT SUBSEQUENT159.5 99231 LEVEL 1 700009 CONSULT INPT SUBSEQUENT207.6 99232 LEVEL 2 700010 CONSULT INPT INITIAL232.5 LEVEL99221 1 700011 CONSULT INPT INITIAL318.7 LEVEL99222 2 700012 CONSULT INPT INITIAL414.8 LEVEL99223 3 700013 HOSPITAL DISCHARGE138.5 DAY MGMT99238 30MINS 700014 HOSPITAL DISCHARGE173.1 DAY MGMT>99239 30MIN 700015 PHARMACOLOGIC MANAGEMENT98 90862 700016 JHC INPATIENT CONSULT144.9 LEVEL99222 4 700017 JHC INITIAL INPT144.9 HOSPITAL 99222CARE LEVEL 2 700018 JHC INITIAL INPT144.9 HOSPITAL 99223CARE LEVEL 3 700019 JHC INPATIENT CONSULT144.9 LEVEL99221 3 700020 JHC HOSPITAL DISCHARGE144.9 DAY99238 MGMT 30MINS 700021 JHC SUBSEQUENT144.9 INPT HOSPITAL99233 CARE LEV 3 700022 JHC INPATIENT CONSULT144.9 LEVEL99223 5 700023 JHC INITIAL INPT144.9 HOSPITAL 99221CARE LEVEL 1 700024 JHC INPATIENT CONSULT144.9 LEVEL99231 2 700025 JHC SUBSEQUENT144.9 INPT HOSPITAL99232 CARE LEV 2 700026 PSYCH OBSERVATION212 CONSULT99204 LEVEL 4 NEW PT 700027 INITIAL NURSING247.8 FACILITY CARE99305 700028 INITIAL OBSERVATION270.1 CARE99219 LEVEL 2 700029 INITIAL NURSING176.1 FACILITY CARE99304 700030 INITIAL NURSING313.3 FACILITY CARE99306 700031 INITIAL OBSERVATION369.6 CARE99220 LEVEL 3 700033 PSYCHOTHERAPY120.6 ADDT'L EM90833 30 MIN INPATIENT 700034 PSYCHOTHERAPY190.8 38-52 MIN90834 INPATIENT 700035 PSYCHOTHERAPY134.4 16-37 MIN90832 INPATIENT 700036 PSYCHOTHERAPY129.9 ADDT'L EM90836 45 MIN INPATIENT 700039 CRISIS PSYCHOTHERAPY215.3 FIRST90839 60 MIN INPT 700040 CRISIS PSYCHOTHERAPY95.1 EA 90840ADDT'L 30 MIN IP 700046 FAMILY PSYCHOTHERAPY212.8 W/O90846 PT INPATIENT 700048 CONSULT INPT SUBSEQUENT268.4 99233 LEVEL 3 700057 SNF CONSULT LEVEL92.6 1 99307 700058 SNF CONSULT LEVEL143.1 2 99308 700059 SNF CONSULT LEVEL188.1 3 99309 700060 SNF CONSULT LEVEL279.3 4 99310 700085 INTERACTIVE COMPLEXITY19.2 90785INPATIENT 700092 PSYCHIATRIC DIAGNOSTIC232.9 EVAL90792 W/MEDICAL IP 718997 ST CH SWALLOWING - GOALG8997 904684 guai - 919191 ..TESTING ALDOLASE73.1 SPARROW82085 919192 ..TESTING WOUND73.1 CULTURE82085 SPARROW 929292 ..TEST DO NOT ORDER52.9 COVIDU0003 SPARROW 999001 MISC ITEM MED - SURG 999003 MISC ITEM O/P - SURG 999005 MISC ITEM STEP - DOWN 999007 MISC ITEM PSYCH - 999009 MISC ITEM MCGUIRE - UNIT/SNF 999010 MISC ITEM NURSERY - 999012 MISC ITEM MACRITCHIE - UNIT 999013 MISC ITEM OBSTETRICS - 999015 MISC. SURGERY - 999017 MISC ITEM ICU/CCU - 999019 MISC ITEM JOINT - REPLACEMENT UNIT 999021 MISC ITEM BARIATRICS - 999023 MISC ITEM ER - 999027 MISC ITEM WOMENS - HEALTH 999029 MISC ITEM WOUND - CARE 999031 MISC ITEM STERILIAZTION - 999033 MISC ITEM BLOOD - BANK 999034 MISC ITEM PATHOLOGY - 999035 MISC ITEM LABORATORY - 999051 MISC ITEM MATERIALS - MANAGEMENT 999053 MISC ITEM ONCOLOGY - 999055 MISC ITEM XRAY-MAMMOGRAPHY - 999057 MISC ITEM ULTRASOUND - 999059 MISC ITEM NUCLEAR - MEDICINE 999061 MISC ITEM CAT - SCAN 999063 MISC ITEM MRI - SCANS 999065 MISC ITEM PHARMACY - 999066 MISC ITEM IV - SOLUTIONS 999067 MISC ITEM ANESTHESIA - 999069 MISC ITEM PHYSICAL - THERAPY 999072 MISC ITEM RESPIRATORY - THERAPY 999073 MISC ITEM OCCUPATIONAL - THERAPY 999074 MISC ITEM CARDIO - 999075 MISC ITEM DIETICIAN - 999077 DIET-CAFE MISC - ITEM 999079 MISC ITEM INFUSION - CENTER 999081 MISC ITEM SLEEP - STUDY 999085 MISC ITEM HOME - O2 999087 MISC ITEM HOME - CARE 999089 MISC. ITEM HOSPITALISTS- 999092 DIABETIC CLINIC - MISC ITEM 999098 MISC ITEM SECURITY - 999102 MISC ITEM DR. - BEDIAKO 999105 MISC ITEM PSYCHIATRIC - CLINIC 999106 MISC ITEM PULMONARY - CLINIC 999107 MISC ITEM ORTHOPEDIC - CLINIC 999108 MISC ITEM PAIN - CLINIC 999109 MISC ITEM KARIM - 999110 MISC ITEM PESHEK - 999111 MISC ITEM PEDIATRIC - CLINIC 999112 MISC ITEM UROLOGY - CLINIC 999113 MISC ITEM SURGICAL - GROUP 999115 MISC ITEM BAXTER - 999116 MISC ITEM DR. - HOGG 999117 MISC ITEM ANDERSON - 999118 MISC. HILLSDALE - HEALTH & WELLNESS 999119 MISC ITEM JANUSZ - 999121 MISC ITEM PARKER - 999122 MISC DR. SHEN - 999123 MISC ITEM DR. - COLLINS 999124 MISC LITCHFIELD - 999125 MISC INTERN - / RESIDENTS 999126 MISC DR. SINISCHO - OB OFFICE 999127 MISC ITEM DR. - PATEL 999128 MISC ITEM DR. - SHENDGE 999129 DR BOAKYE -MISC ITEM 999130 MISC ITEM NURSING - ADMINISTRATION 999133 MISC