Whitman Hospital and Medical Clinics Charge Description Master Prices Effective 1/1/2020 Description Price/Charge .035 MICROVASIVE GUIDE WIRE $ 646.75 .038 MICROVASIVE GUIDE WIRE $ 646.75 .045x6 K-WIRE $ 246.25 1 HR PROLONGED CARE $ 422.50 1.5 CODYLAR RIGHT PLATE 7 HOLE $ 2,191.50 10/12MM DILATING TIP TROCAR $ 874.00 10MM CORING REAMER W/ PIN $ 2,774.00 10MM ENDO CATCH SPECIMEN BAG $ 2,077.25 135 DHS DCP 12 HOLE PLATE $ 4,512.00 14FR SUPER PUBIC CATH $ 638.25 18MM TENSION SCREW $ 1,495.00 2.0 CODYLAR LEFT PLATE 7 HOLE $ 2,091.75 2.0 CODYLAR RIGHT PLATE 7 HOLE $ 2,091.75 2.5MM DRILL BIT $ 369.00 2.7 CODYLAR LEFT PLATE 7 HOLE $ 2,247.75 2.7 CODYLAR RIGHT PLATE 7 HOLE $ 2,247.75 20MM TENSION SCREW $ 1,495.00 210MM TI FLEX HUMERAL NAIL $ 9,002.50 225MM TI FLEX HUMERAL NAIL $ 9,896.50 22MM TENSION SCREW $ 1,495.00 240MM TI FLEX HUMERAL NAIL $ 9,002.50 24MM TENSION SCREW $ 1,495.00 255MM TI FLEX HUMERAL NAIL $ 8,656.25 26FR CUTTING LOOP $ 814.75 26MM TENSION SCREW $ 1,495.00 27 GA 1.57 MM CANNULA $ 89.25 270MM TI FLEX HUMERAL NAIL $ 8,656.25 2ND ADDITIONAL GLUCOSE >3 $ 31.00 2nd closure surgical wound $ 3,014.00 3.0MM WEDGE TAG $ 971.25 3.5 CODYLAR LEFT PLATE 7 HOLE $ 2,191.50 3.5 CURVED RECONSTR 12 HOLE PL $ 4,195.00 3.5 PANALOK WHITE ANCHOR $ 2,784.00 3.5M CANNULATED 5 HOLE PLATE $ 3,693.75 3.5M CORTEX 14MM SCREW $ 156.75 3.5MM 11 HOLE PLATE $ 1,484.50 3.5MM BIO ROC ANCHOR $ 3,277.75 3/16 STEINMAN PIN $ 20.50 30MM TENSION SCREW $ 1,495.00 34MM TENSION SCREW $ 1,495.00 3RD ADD GLUCOSE >3 $ 31.00 4.5 CANNULATED SCREW $ 251.25 4.5 RND FLUTED BURR $ 979.00 4.5MM CAN CORTEX SCREW $ 1,751.75 5.0 URETERAL INDWELLING STENT $ 1,383.75 5CC PUTTY - BONE $ 3,757.75 5MM ETHICON TROCAR LONG SLEEVE $ 685.25 5MM TROCAR X 75MM LENGTH $ 685.25 6.5 CANNULATED THREAD SCREW $ 2,518.75 6.5 X 110 CANCELLOUS SCREW $ 255.00 6.5MM CANCELLOUS SCREW $ 321.75 7 HOLE 4.5 RECONSTR PLATE $ 2,845.75 9 HOLE 151MM SYNTHES PLATE $ 2,160.75 ABDOMEN XRAY, 2 VIEWS $ 310.25 ABDOMEN XRAY, 3 OR MORE VIEWS $ 243.50 ABDOMEN XRAY, SINGLE VIEW $ 264.50 ABDOMEN,COMP,SINGLE VIEW CHEST $ 285.25 ABDOMINAL PARACENTESIS $ 493.75 ABDOMINAL PARACENTESIS $ 789.00 ABDOMINAL PARACENTESIS,W/IMAGE $ 789.75 ABDOMINAL PARACENTESIS,W/IMAGE $ 1,220.00 ABDOMINAL PARACENTESIS,W/IMAGE $ 1,220.00 ABDOMINAL PARACENTESIS,W/IMAGE $ 2,403.75 ABSCESS,FISTULA,SINUS TRACT $ 454.00 ACETABULAR HIP SHELL, RIGHT $ 4,586.75 ACETONE QUAL $ 42.00 ACETYLCHOLINESTERASE ASSAY $ 99.25 ACID FAST SMEAR $ 42.50 ACROMIOCLAVICULAR JTS,BILATERL $ 215.00 ACTH STIMULATION PANEL $ 183.75 ACTIVATED PROTEIN C RESISTANCE $ 120.50 ACTIVE MATRIX 0.5cc AM50 $ 12,112.50 ACTIVE MATRIX 1cc $ 17,955.25 ACTIVITY PRESCRIPTION FORM $ 58.50 ACTIVITY PRESCRIPTION FORM $ 58.50 ACTIVITY PRESCRIPTION FORM $ 58.50 ADENOVIRUS ABY $ 161.50 ADEPTIC ADHESIVE REPAIR FLUID $ 2,119.25 ADM OF THROMBOLITIC AGENT $ 763.25 ADM OF THROMBOLITIC AGENT $ 1,338.00 ADV BODY COMP FOLLOW-UP $ 90.25 ADV BODY COMP W/ NO RAD FEE $ 116.75 ADV.CEMENT KIT STRYKER $ 1,552.00 ADVANCE CARE PLANNING & FORMS $ 213.25 ADVANCE CARE PLANNING & FORMS $ 213.25 ADVANCE CARE PLANNING & FORMS $ 213.25 ADVANCED BODY COMPOSITION $ 138.00 AGGRESSIVE MEDIUM/NARROW BLADE $ 94.75 AIRWAY INH TREATMENT,EA SUBSQ $ 117.25 AIRWAY INHALATION TREATMENT $ 49.00 AIRWAY INHALATION TREATMENT $ 49.00 AIRWAY INHALATION TREATMENT $ 49.00 AIRWAY INHALATION, INITIAL $ 408.75 ALBUMIN SERUM $ 39.00 ALBUMIN, CSF $ 72.50 ALLERGEN SPECIFIC ANTIBODY, EA $ 34.75 ALLERGEN SPECIFIC IGE $ 16.00 ALLERGEN THERAPY,2+ INJECTIONS $ 29.00 ALLERGEN THERAPY,2+ INJECTIONS $ 29.00 ALLERGEN THERAPY,2+ INJECTIONS $ 29.00 ALLERGEN THERAPY,SINGLE INJ $ 26.50 ALLERGEN THERAPY,SINGLE INJ $ 26.50 ALLERGEN THERAPY,SINGLE INJ $ 26.50 ALLIGATOR MINI LAP 255-000-001 $ 1,964.25 ALLODERM, 6 X 12 $ 12,269.25 ALPHA FETOPROTEIN (TM) $ 79.50 ALPHA-1-ANTITRYPSIN; TOTAL $ 191.25 ALPHA-FETOPROTEIN, MATERNAL $ 79.50 AMIKACIN PEAK $ 101.50 AMIKACIN TROUGH $ 101.50 AMMONIA $ 114.50 Amputation IP joint $ 1,420.25 AMPUTATION OF FINGER/THUMB $ 2,057.25 AMPUTATION OF FINGER/THUMB $ 2,479.50 AMPUTATION OF FINGER/THUMB $ 2,778.00 AMPUTATION OF FOOT AT ANKLE $ 2,425.75 AMPUTATION OF FOOT AT ANKLE $ 2,571.75 AMPUTATION OF LOWER LEG $ 3,419.50 AMPUTATION OF TOE $ 1,519.25 AMPUTATION OF UPPER ARM $ 2,748.50 AMPUTATION THRU METATARSAL $ 2,775.25 Amputation w/MET w/toe single $ 1,632.25 AMYLASE OTHER $ 76.50 AMYLASE SERUM $ 51.00 AMYLASE, BODY FLUID $ 79.50 AMYLASE, URINE QNT $ 79.50 ANA FA ABY SCRN $ 95.00 ANALGESICS, NON-OPOID; 1 OR 2 $ 101.25 ANCHOR BIORAPTOR DURA 72200783 $ 2,088.50 ANCHOR CUFF TACK $ 3,272.00 ANCHOR, BIO-SCREW 5.0MM $ 3,200.25 ANCHOR, MICRO MINI $ 2,304.25 ANCHOR, MINILOK QUICK PLUS $ 2,675.25 ANCHOR,5.0MM SPIRALOK $ 3,370.25 ANCHOR,6.5MM SPIRALOK $ 3,370.25 ANCHOR,FOOTPRINT SUTURE 5.5 $ 3,182.25 ANCHOR,FOOTPRINT SUTURE 6.5 $ 3,182.25 ANCHOR,LUPINE ORTHOCORD $ 2,594.25 ANCHOR,MICROFIX 3-0 ETHIBOND $ 2,532.50 ANCHOR,MICROFIX Q (212856 $ 2,964.50 ANCHOR,PANALOK LOOP $ 3,455.25 ANCHOR,PANALOK ROTATOR CUFF $ 2,050.75 ANCHOR,PANALOK, 3.5MM $ 3,583.50 ANCHOR,ROTATOR CUFF $ 1,888.75 ANCHOR,SPIRALOK W/ETHIBOND 5.0 $ 3,462.00 ANCHOR,SPIRALOK W/ETHIBOND 6.5 $ 3,462.00 ANCHOR,VERSA LOK $ 3,117.25 ANCHORS, MITEK STEALTH $ 1,837.25 ANES, PATIENT AGE <1 YR OR >70 $ 96.75 ANESTHESIA BASE, FIRST 15 MIN $ 498.75 ANESTHESIA, EACH ADD'L MIN $ 24.00 ANESTHESIA,EMERGENCY CONDITION $ 193.25 ANGIOTENSIN CONVERTING ENZYME $ 168.75 ANKLE ARTHROGRAPHY, LEFT $ 553.25 ANKLE ARTHROGRAPHY, RIGHT $ 553.25 ANKLE ARTHROPLASTY W/IMPLANT $ 3,631.25 ANKLE ARTHROSCOPY,TALUS DEFECT $ 2,528.50 ANKLE ARTHROSCOPY/SURGERY $ 1,813.00 ANKLE ARTHROSCOPY/SURGERY $ 1,925.25 ANKLE ARTHROSCOPY/SURGERY $ 3,902.50 ANKLE JOINT CAPSULE RELEASE $ 2,112.50 ANKLE,BILATERAL, 2 VIEWS $ 325.75 ANKLE,BILATERAL, 3 VIEWS $ 393.50 ANKLE,LEFT, 2 VIEWS $ 227.25 ANKLE,LEFT,COMPLETE,MIN 3 VIEW $ 268.25 ANKLE,RIGHT, 2 VIEWS $ 227.25 ANKLE,RIGHT,COMPLETE,MIN 3VIEW $ 268.25 ANKLE/FOOT ELEVATOR CRADLE $ 486.75 ANNUAL DEPRESSION SCREENING $ 25.50 ANNUAL DEPRESSION SCREENING $ 25.50 ANNUAL DEPRESSION SCREENING $ 25.50 ANNUAL WELLNESS VISIT,INITIAL $ 191.00 ANNUAL WELLNESS VISIT,INITIAL $ 191.00 ANNUAL WELLNESS VISIT,INITIAL $ 191.00 ANNUAL WELLNESS VISIT,SUBSEQ $ 133.00 ANNUAL WELLNESS VISIT,SUBSEQ $ 133.00 ANNUAL WELLNESS VISIT,SUBSEQ $ 133.00 ANOSCOPY $ 111.75 ANOSCOPY $ 173.25 ANOSCOPY, DIAGNOSTIC $ 93.75 ANOSCOPY, DIAGNOSTIC $ 156.00 ANTEPARTUM CARE ONLY,4-6VISITS $ 1,689.75 ANTEPARTUM CARE ONLY,4-6VISITS $ 1,689.75 ANTEPARTUM CARE ONLY,4-6VISITS $ 1,689.75 ANTEPARTUM CARE ONLY,7+ VISITS $ 1,718.00 ANTEPARTUM CARE ONLY,7+ VISITS $ 1,718.00 ANTEPARTUM CARE ONLY,7+ VISITS $ 1,718.00 ANTERIOR CHAMBER LENS $ 1,852.50 ANTI CENTROMERE $ 88.75 ANTI DBL STRAND DNA $ 108.00 ANTI RNP $ 141.00 ANTI SCLERODERMA $ 158.50 ANTI SM $ 274.50 ANTI SMOOTH MUSCLE ANTIBODY $ 137.75 ANTIBODY,HERPES SIMPLEX NOS $ 113.25 ANTIBODY,HERPES SIMPLEX,TYPE 1 $ 86.25 ANTIBODY,HERPES SIMPLEX,TYPE 2 $ 152.00 ANTIBODY,TREPONEMA PALLIDUM $ 104.00 ANTIG SCRN COMPAT VS PT SERUM $ 186.75 ANTIG SCRN COMPAT/RGT SERUM $ 59.00 ANTIHUMAN GLOB TEST, DIRECT $ 42.50 ANTIHUMAN GLOBULIN TEST,INDIRE $ 101.00 ANTIMICROBIAL DRUG EVALUATION $ 47.00 ANTINUCLEAR ANTIBODIES,TITER $ 482.75 ANTIPHOSPHOLIPID ANITBODY $ 126.25 ANTISTREPTOLYSIN O $ 57.50 ANTITHROMBIN III, ACTIVITY $ 93.25 ANTITHROMBIN III,ANTIGEN ASSAY $ 85.00 APHASIA ASSESSMENT, PER HOUR $ 255.25 APOLIPOPROTEIN, EACH $ 133.25 APPLICATION FINGER SPLINT $ 165.00 APPLICATION LOWER LEG SPLINT $ 27.00 APPLICATION LOWER LEG SPLINT $ 109.00 APPLICATION LOWER LEG SPLINT $ 136.00 APPLICATION LOWER LEG SPLINT $ 191.25 APPLICATION OF FINGER SPLINT $ 79.50 APPLICATION OF FINGER SPLINT $ 79.50 APPLICATION OF FINGER SPLINT $ 79.50 APPLICATION OF FINGER SPLINT $ 108.00 APPLICATION OF FINGER SPLINT $ 354.00 APPLICATION OF FOREARM CAST $ 37.00 APPLICATION OF FOREARM CAST $ 146.00 APPLICATION OF FOREARM CAST $ 183.00 APPLICATION OF FOREARM SPLINT $ 153.00 APPLICATION OF FOREARM SPLINT $ 207.25 APPLICATION OF HAND/WRIST CAST $ 38.25 APPLICATION OF HAND/WRIST CAST $ 151.00 APPLICATION OF HAND/WRIST CAST $ 189.25 APPLICATION OF LONG ARM CAST $ 40.50 APPLICATION OF LONG ARM CAST $ 160.00 APPLICATION OF LONG ARM CAST $ 176.00 APPLICATION OF LONG ARM CAST $ 176.00 APPLICATION OF LONG ARM CAST $ 176.00 APPLICATION OF LONG ARM CAST $ 200.50 APPLICATION OF LONG ARM CAST $ 247.75 APPLICATION OF LONG ARM CAST $ 261.25 APPLICATION OF LONG ARM CAST $ 332.00 APPLICATION OF LONG LEG CAST $ 54.50 APPLICATION OF LONG LEG CAST $ 220.00 APPLICATION OF LONG LEG CAST $ 274.50 APPLICATION OF RIGID LEG CAST $ 56.00 APPLICATION OF RIGID LEG CAST $ 225.00 APPLICATION OF RIGID LEG CAST $ 281.00 APPLICATION OF SHORTARM SPLINT $ 108.25 APPLICATION OF SHORTARM SPLINT $ 108.25 APPLICATION OF SHORTARM SPLINT $ 108.25 APPLIER,ENDO CLIP 5MM $ 4,170.50 APPLY BONE FIXATION DEVICE $ 2,233.00 APPLY BONE FIXATION DEVICE $ 4,221.75 APPLY HAND/WRIST CAST $ 273.50 APPLY HAND/WRIST CAST $ 367.25 APPLY LONG ARM SPLINT $ 34.50 APPLY LONG ARM SPLINT $ 139.00 APPLY LONG ARM SPLINT $ 173.50 APPLY LONG ARM SPLINT $ 226.25 APPLY SHORT LEG CAST $ 33.75 APPLY SHORT LEG CAST $ 134.00 APPLY SHORT LEG CAST $ 167.75 APPLY SHORT LEG CAST $ 229.50 APPLY SHORT LEG CAST $ 395.00 APPLY SHORT LEG CAST $ 848.50 APPLY SKIN SUBSTITUTE,ARM/LEG $ 318.75 APPLY STATIC FOREARM SPLINT $ 23.25 APPLY STATIC FOREARM SPLINT $ 93.00 APPLY STATIC FOREARM SPLINT $ 116.25 AQUATIC EXERCISE, EACH 15 MIN $ 141.75 AQUATIC EXERCISE, EACH 15 MIN $ 141.75 AQUATIC EXERCISE, EACH 15 MIN $ 141.75 AQUATIC EXERCISE, GROUP $ 100.50 ARROW #10 $ 1,567.50 ARROW #16 $ 1,567.50 ARROW, SIZE 13 $