HOSPITAL PRICING MOST COMMON ITEMS AS OF 06/18/18
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1 EMERGENCY DEPARTMENT VISITS (NURSING) ER LEVEL 1 $ ER LEVEL 2 $ ER LEVEL 3 $ ER LEVEL 4 $ ER LEVEL 5 $ ER LEVEL 6 (CRITICAL CARE) $ 1, ER LEVEL 6 (CRITICAL CARE) EA ADD 30 MIN $ PROFESSIONAL (MD/PA) ER LEVEL 1 PRO FEE $ ER LEVEL 2 PRO FEE $ ER LEVEL 3 PRO FEE $ ER LEVEL 4 PRO FEE $ ER LEVEL 5 PRO FEE $ ER LEVEL 6 (CRITICAL CARE) $ ER LEVEL 6 CRITICAL CARE EA ADD 30 MIN $ EMERGENCY DEPARTMENT PROCEDURES (NURSING) RPR SCALP/NCK/AXIL/GENITALIA/TRNK 2.5C < $ INS FOLEY CATHETER-INDWELLING-SIMPLE $ BLADDER SCAN (VOLUME) $ IV HYDRATION THERAPY (UP TO 1 HR $ IV HYDRATION EA ADD HR $ IV DRUG INFUSION UP TO 1HR $ IV DRUG INFUSION EA ADD HR $ IV DRUG INFUS, ADD SEQ INFUS <1HR $ IV DRUG INFUS, CONCURRENT INFUSION $ SUBCU IM INJ THERAPEUTIC $ IV INJECTION $ IV PUSH EA ADD SUBSTANCE/DRUG $ EA ADD SEQ IV PUSH SAME SUBS DRUG $ IM/SQ VACCINE INIT OTHER $
2 EMERGENCY DEPARTMENT PROCEDURES PROFESSIONAL (MD/PA) RPR SCALP/NCK/AXIL/GENITALIA/TRNK 2.5C < $ LABORATORY DEPARTMENT PROCEDURES VENIPUNCTURE OP/INLAB $ BASIC METABOLIC PANEL $ COMPREHENSIVE METABOLIC PANEL $ LIPID PANEL $ RENAL PANEL $ HEP ACUTE PANEL $ HEPATIC FUNCTION PANEL $ OB PRENATAL PANEL $ DIGOXIN $ VALPROIC ACID $ LITHIUM $ VANCOMYCIN-TROUGH $ DRUGS OF ABUSE, URINE $ ETHANOL LEVEL, SERUM $ ACETAMINOPHEN $ BUPRENORPHINE W/ METABOLITES $ THC GC/MS URINE QN $ METHYLPHENIDATE, GC/MS URINE $ URINALYSIS WITH MICROSCOPIC $ URINE DIPSTICK ONLY $ MICROSCOPIC ONLY URINE $ PREGNANCY TEST URINE $ MICROALBUMIN (RANDOM) QN $ AMMONIA $ AMYLASE SERUM $
3 LABORATORY DEPARTMENT PROCEDURES (Continued) BILIRUBIN TOTAL $ BILIRUBIN DIRECT $ OCCULT BLOOD $ VITAMIN D 25 HYDROXY $ CPK $ CREATININE SERUM $ CREATININE RANDOM URINE $ VITAMIN B12 $ FERRITIN $ FOLATE,SERUM $ ABG $ GLUCOSE SERUM $ HGBA1C $ IRON $ TOTAL BINDING CAPACITY $ LACTIC ACID $ LDH $ LIPASE $ DIRECT LDL REFLEX $ MAGNESIUM $ PRO BNP $ PARATHYROID HORMONE(INTACT) $ PTH W/O CALCIUM $ PHOSPHORUS $ POTASSIUM $ PROLACTIN $ PSA ELECSYS $ PROTEIN RANDOM URINE $ ELECTROPHORESIS,PROTEIN SERUM $ LEAD, PEDIATRIC $ TESTOSTERONE (TOTAL) $ T4 FREE ELECSYS $ TSH $ AST (SGOT) $
4 LABORATORY DEPARTMENT PROCEDURES (Continued) ALT (SGPT) $ T3 TOTAL $ T3, FREE $ TROPONIN $ BUN,BLOOD UREA NITROGEN $ URIC ACID $ PREG HCG QUANT $ MANUAL DIFFERENTIAL $ HCT $ HGB $ CBC WITH AUTO DIFF $ BLOOD COUNT $ CBC NO DIFF $ D-DIMER, QUANTITATIVE $ INR $ ESR SED RATE $ PTT $ ANA $ CRP $ MONOSPOT $ H PYLORI IGG QN $ RA SCREEN $ RPR $ LYME AB (IGG/IGM) $ HERPES SIMPLEX TYPE 1 $ STS $ HEP BS AB $ VARICELLA IGG $ HEP C ANTIBODY $ BB ANTIBODY SCREEN $ BB COMPATIBILITY,IMMED.SPIN $
5 LABORATORY DEPARTMENT PROCEDURES (Continued VAGINAL SCREEN $ CLOSTRIDIUM DIFF A&B $ HELICOBACTER PYLORI STOOL ANTIGEN $ HEP B SURF ANTIGEN $ RAPID STREP SCN $ INFECTIOUS ANTIGEN DETECTION, EA ORGA $ INFECTIOUS AGENT, CHLAMYDIA $ INFECTIOUS AGENT, NEISSERIA $ TRICHOMONAS VAGINALIS MOLECULAR $ INFECTIOUS AGENT DETECTION, AMP PROBE $ RESPIRATORY SYNCYTICAL VIRUS $ GROSS PATH (LEVEL 4) $ G0103 PSA SCREENING $ G0328 OCCULT BLD STL ICT 3 SPCS(CA SCRN) $ P9040 BB RBC LEUKO, IRRAD $ CULTURE BLOOD $ CULTURE STOOL $ ISOLATION CAMPY/ECOLI 0157 $ ISOLATION/PRESUMPTIVE ID $ CULT BACTI DEFINITIVE ID $ CULTURE URINE $ AEROBIC ISOLATION/PRESUMPTIVE ID $ OVA & PARA $ CULTURE - SENSITIVITY $ *CULT ROUTINE AEROBIC $ *CULT VAG SCRN PP PM AGE $ *CULTURE ANAEROBIC $ (add l possible charge) *GRAM STAIN CHARGE $ INFLUENZA B VIRUS $ INFLUENZA A VIRUS $
6 NUTRITIONAL SERVICES PROCEDURES NUTRITION CONS INITIAL INDIV (PER 15 MINS) $ MED NUTRITION SUBSEQ INDIV (PER 15 MINS) $ MED SURG PROCEDURES IV DRUG INFUSION (UP TO 1 HR) $ IV DRUG INFUSION (EA ADD HR) $ SUBCU IM INJ THERAPEUTIC $ RADIOLOGY PROCEDURES (continued) CT-HEAD W/O CONT $ 1, CT-MAX/FAC W/O CONT $ MRI BRAIN WO CONTRAST $ 1, MRI BRAIN W/WO CONTRAST $ 1, CHEST AP PORT SINGLE VIEW $ CHEST-2 VWS $ CT-THORAX W/O CONT $ 1, CT-THORAX W/ CONT $ 1, CT-ANGIO CHEST (NON CORONARY) $ 1, SPINE CERV 2 OR 3 VIEWS $ SPINE CERV 4 VIEWS $ SPINE THORACIC $ SPINE LUMBAR AP LAT $ CT-CERV/SPINE W/O CO $ 1, MRI CERVICAL SPINE WO CONTRAST $ MRI LUMBAR SPINE WITHOUT CONTRAST $
7 RADIOLOGY PROCEDURES (continued) PELVIS AP $ MRI UPP EXT JOINT WO CONTRAST $ SHOULDER COMPLETE RT $ WRIST COMPLETE RT $ HAND-COMPLETE RT $ HIP-AP PELVIS LT $ KNEE-COMPLETE RT $ ANKLE-COMPLETE RIGHT $ FOOT-COMPLETE RT $ MRI LOWER EXT JOINT WO CONTRAST $ ABDOMEN-SINGLE AP $ ABDOMEN-COMPLETE $ ABDOMINAL SERIES $ CT-ABDOMEN & PELVIS WO CONTRAST $ 2, CT-ABDOMEN & PELVIS WITH CONTRAST $ 3, ESOPHAGRAM $ US-THYROID-NECK $ US-BREAST ULTRA-UNI RT $ US-ABD QUADRANT OR SGL ORGAN LTD $ US-RETROPER-COMP $ US-RETROPER-LIM $ US-PREGNANCY COMPLETE TRANS-ABDOMINAL $ US-PREGNANCY LIMITED $ US-PREGNANCY FOLLOW UP $ US-PREGNANCY TRANS VAG $ US-PREG-BIOPHYSICAL $ US-ENDOVAGINAL $ AXIAL-DEXA SCAN $ CARDIAC REHAB (PHASE 2) $ US-CAROTID COMPLETE $ US-EXT W/DOPP-UNI RT LOWER EXT $ G0202 MAMMOGRAM SCREEN BILAT (DIGITAL) $ G0204 MAMMOGRAM DIAG BILAT (DIGITAL) $
8 RADIOLOGY PROCEDURES (continued) G0206 MAMMO DIAG UNI LT (DIGITAL) $ Q9967 LOW OSMOLAR CM MG/ML CONTRAST $ MAMMO 3D SCREENING TOMO, BILAT (DIGITAL) $ G0279 MAMMO 3D DIAG TOMO,BILAT OR UNI (DIGITAL) $ A9500 (charge assoc ) NM-CARDIOLITE/TC 99M, PER DOSE $ NM-MYOCARD PERF SCAN MULT (SPECT) $ 1, STRESS TESTING PROCEDURES STRESS TESTING CARDIOVASCULAR, TRACING $ STRESS TESTING PROCEDURES PROFESSIONAL STRESS TEST PHYS SUPERVISION ONLY $ STRESS TEST PHYS INT & REPORT $ REHAB SERVICES EVALS PT EVALUATION $ OT EVALUATION (FULL) $ PT EVALUATION - LOW COMPLEXITY $ PT EVALUATION - HI COMPLEXITY $ OT EVALUATION -LOW COMPLEXITY $ OT EVALUATION - MOD COMPLEXITY $ OT EVALUATION - HIGH COMPLEXITY $
9 REHAB SERVICES PROCEDURES (continued) ULTRASOUND $ THERAPEUTIC PROCEDURE $ NEUROMUSCULAR RE-ED $ GAIT TRAINING $ MASSAGE $ JM/MYOFASCIAL/STM/MANUAL TRACTION $ THERAPEUTIC ACTIVITY $ ADLS $ DEBRIDEMENT-NON SELECTIVE $ G0283 ELECTRICAL STIMULATION $ AMBULANCE SERVICES A0426 ALS ROUTINE TRANSFER H/H $ A0428 AMBULANCE BLS H/N TRNF $ A0429 AMBULANCE BLS E/H EMRG $ A0434 SPECIALTY CARE TRANSPORT $ 1, A0425 BLS MILEAGE $ A0425 ALS MILEAGE $
10 OPERATING ROOM AND ANESTHESIA SERVICES (SURGEON S FEES ARE SEPARATE) OPERATING $1, OPERATING $2, OPERATING $2, OPERATING $3, OPERATING $4, OPERATING $5, OPERATING $6, OPERATING $6, OPERATING $7, OPERATING $8, OPERATING $9, OPERATING $10, OPERATING ADDTL 15 $ OR ESWL LITHOTRIPSY $ 6, OR HOLMIUON LITHOTRIPSY $ 7, RECOVERY MINS $ RECOVERY MINS $ SECOND STAGE RECOVERY (0-60 MIN) $ SECOND STAGE RECOVERY ( MIN) $ CRNA UNSUPERVISED FIRST HOUR facility $ CRNA UNSUPERVISED (Per addit l 15 mins) $ ANESTHESIA PROFESSSIONAL CRNA UNSUPERVISED (Per 15 mins) pro fee $
11 ECHOCARDIOGRAM PROCEDURES (possible add l charges) ECHO COMP W SPECT & DOPPLER $ ECHO INJ FOR DEFINITY (NON STRESS) $ Q9957 DEFINITY CONTRAST FOR ECHOGRAPHY $ CARDIOPULMONARY PROCEDURES HOLTER MONITOR $ PFT-SPIROMETRY SIMPLE $ PFT-SPIROMETRY W/MEDS $ AIRWAY INHALATION TREATMENT $ PFT-LUNG VOLUMES-HELIUM STUDY $ PFT-DLCO $ OXIMETRY EACH $ SLEEP STUDY HOME (LEVEL 3) $ 1, SLEEP STUDY-DIAGNOSTIC $ 2, SLEEP STUDY-W CPAP/BIPAP TITRATION $ 3, ONCOLOGY IV DRUG INFUSION UP TO 1 HR $ THERAPEUTIC SUBQ/IM INJ $ THER IV PUSH EA ADD NEW DRUG $ CHEMO NON HORMONAL ANTI-NEOPL SQ/IM $ CHEMO INFUSION UP TO 1 HR $ CHEMO IV INFUSION EA ADD HR $ PORT FLUSH $ ONCOLOGY CLINIC VISIT (Level 3) $ ONCOLOGY CLINIC VISIT (Level 4) $
12 EKG PROCEDURES EKG STANDARD $ EKG PROCEDURES EKG READ & INTERPRETATIONS $ OBSTETRICS LABOR ROOM 01 HOUR $ LABOR ROOM 02 HOURS $ LABOR ROOM 03 HOURS $ LABOR ROOM 04 HOURS $ LABOR ROOM 05 HOURS $ LABOR ROOM 06 HOURS $ LABOR ROOM 07 HOURS $ LABOR ROOM 08 HOURS $ LABOR ROMM 09 HOURS $ LABOR ROOM 10 HOURS $ LABOR ROOM 11 HOURS $ LABOR ROOM 12 HOURS $ FETAL NON-STRESS TEST $ HEARING SCREENING NEWBORNS $
13 ROOM & BOARD Semi-Private Med/Surg, Obstetrics $ 1, Private Med/Surg, Obstetrics $ 1, Special Care Unit $ 1, Nursery $ Semi-Private Skilled Care (Swing Bed, SNF) $ Private Skilled Care (Swing Bed, SNF) $ Telemetry $ 1, COUNSELING SERVICES AND PROFESSIONAL SERVICES PSYCHOTHERAPY 45 MI $
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Our service area includes these counties in: Michigan: Berrien, Branch, Gratiot, Hillsdale, Tuscola, Washtenaw.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (HMO SNP) H2247-001 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
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Our service area includes the 50 United States, the District of Columbia and all US territories.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Group Medicare Advantage (PPO) Group Name (Plan Sponsor): HP PPO Plus Plan Group Number: 13603 H2001-828 Look inside to learn more about
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Another choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Value Rx Plan (HMO)).
Summary of Benefits Report SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare
Our service area includes these counties in: Florida: Charlotte, Collier, Lee, Manatee, Sarasota.
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Another choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Freedom Rx Select Plan (PPO)).
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Our service area includes the following county in: Hawaii: Honolulu.
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Dual Complete (PPO SNP) H2228-043 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
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