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Facility Description Price
WH NURSG HOME PRIVATE ROOM 276
WH SNF RUGS CODE 0
WH SWING BED RUGS CODE 0
WH PRIVATE 1ST WEST 861
WH RPR CMPX LID/N/L 2.6‐7.5 1914
WH RPR CMPX LID/N/ E/A 5CM/< 1053
WH RPR CMPX LID/N/L 2.6‐7.5 1914
WH RPR CMPX LID/N/ E/A 5CM/< 1053
WH PRIVATE ECU 494
WH PERC REPLAC J TUBE W/O FL 1948
WH REPL CATH CVA SUBQ PORT 6767
WH NF D/S DAY MGMT 30 MNTS 240
WH NF D/S DAY
MGMT > 30 MINS 318
WH OBSERVATION PER HOUR 56
WH DIRECT REFER OBS ASSESMT 1951
WH RECOVERY PER HOUR 62
WH BIOPSY CERVIX SINGLE 1832
WH BIOPSY VAGINAL SIMPLE 1830
WH BLADDER IRRIGATION/LAVAGE 594
WH BLOOD DRAW VAD 422
WH CATHETER, INFUSION A79
WH CHANGE GASTROSTOMY TUBE 1317
WH MARSUP BARTHLIN CYST BL 6537
WH DEBRID SKIN SUB‐Q TISSUE 1236
WH APP SHORT ARM SPLINT LT 484
WH DEBRD SKN/SUB OPN FX/DIS 1483
WH BLADDER SCAN 711
WH MOD SEDATION 1ST 15 MIN 399
WH MOD SEDATON EA/ADD
15 MNS 53
WH E&M LEVEL 1 EST PATIENT 410
WH E&M LEVEL 1 EST PATIENT P 410
WH E&M LEVEL II EST PATIENT 425
WH E&M LEVEL II EST PAT P 425
WH E&M LEVEL 3 EST PATIENT 440
WH E&M LEVEL 3 EST PATIENT P 440
WH E&M LEVEL 4 EST PATIENT 460
WH E&M LEVEL 4 EST PATIENT P 460
WH E&M LEVEL 5 EST PATIENT 485
WH E&M LEVEL 5 EST PATIENT P 485
WH FINE NDL ASPRTION WO/IMAG 1238
WH GASTRIC INTUBATION LAVAGE 640
WH GUIDEWIRES 400
WH I&D ABCESS COMPLICATED 1236
WH I&D ABCESS SIMPLE 649
WH I&D BATHOLINS GLAND, LT 473
WH I&D BATHOLINS GLAND, RT 473
WH I&D HEMATOMA,FLUID COLL 4297
WH I&D PERIANAL ABSCESS 1652
WH I&D PERIRECTAL ABSCESS 5594
WH INCIS THROMBO HEMORRHOID 683
WH IV THRPY EA/ADD HR DX 202
WH IV THRPY IFRST HR DX 691
WH INJ IM OR SQ 205
WH INJ IV PUSH INITIAL 692
WH INSRT INDWL BLDR CATH CMX 468
WH INSRT INDWL BLDR CATH SIM 434
WH INSRT NON‐INDWL BLDR CATH 422
WH INSERT TUNNELED CV CATH 10789
WH INTRDUCR/SHEATH NON‐LASER 719
WH MARSUP BARTHLIN CYST LT 4358
WH MARSUP BARTHLIN CYST RT 4358
WH MISC PROCEDURE
WH PERC PLACE GASTRO TUBE 3262
WH PLACE CV CATH SUBCLV/JUG 6490
WH PLACE PICC LINE W/O PORT 8466
WH REM CTRL LINE W/O PORT 1883
WH REM FECAL IMPACTION/FB 966
WH REM IMPACTED CERUMEN 248
WH REMOVE
SKIN TAG 647
WH SHUNTS/DRAINS CATHS A 442
WH SPINAL PUNCTURE DRAIN CSF 2646
WH SPINAL PUNCTURE LUMBAR DX 2304
WH TRACHEOSTOMY TUBE CHANGE 748
WH TX WD DEHISCENCE SIMPLE 1914
WH TX WD DEHISCENCE;W/PACKNG 1236
WH IV THRPY ADD/SEQ TO 1 HR 205
WH IV THRPY CONCURRENT 122
WH IV THRPY FIRST HR HYDRTN 690
WH IV THRPY EA/ADD HR HYDRTN 134
WH INJ IV EA ADD DIFF MED 288
WH INJ IV EA ADD SAME MED 246
WH BLD DRAW FROM CNTRAL LINE 422
WH IMMUNIZATION 1ST
VAC 205
WH IMMUNIZATION EA ADD VAC 205
WH IRRIGATION OF A VAD 231
WH APP LONG ARM SPLINT LT 576
WH APP LONG ARM SPLINT RT 576
WH APP SHORT ARM SPLINT RT 484
WH APP FINGER SPLINT LT 231
WH APP FINGER SPLINT RT 231
WH APP LONG LEG SPLINT LT 557
WH APP LONG LEG SPLINT RT 557
WH APP SHORT LEG SPLINT LT 529
WH APP SHORT LEG SPLINT RT 529
WH OTHER SPLINT 529
WH ANKLE ORTHOSIS 37
WH KO IMMOBLIZR CNVS PREFAB 67
WH POST OF SHOE 27
WH WHO COCK‐UP PREFAB 37
WH INTUBATN ENDOTRACHEL EMRG 1444
WH APP LONG ARM SPLINT 50 865
WH APP SHORT ARM SPLINT BL 726
WH APP FINGER SPLINT BIL 346
WH APP LONG LEG SPLINT BL 793
WH APP SHORT LEG SPLINT BL 793
WH I&D BATHOLINS GLAND BL 711
WH PARACENTESIS W/O ULTRSOND 1893
WH PARACENTESIS W/ULTRASOUND 2030
WH EX FCE LD NSE LIP 2.1‐3CM 2585
WH SELCT DEBRID 20 SQCM OR < 474
WH PT DEBRID ADD 20 SQCM 198
WH REMOVE CUFFED CHEST TUBE 2805
WH TUBE THORACOSTOMY LT 6490
WH TUBE THORACOSTOMY RT 2893
WH THORCEN INS TUBE W/O GUID 2893
WH PICC LINE REMOVAL 1883
WH DECLOT CATHETER/PORT/VAD 1181
WH EXC NAIL & MATRX PRMNT 1236
WH BX MUSCLE/SOFT TISSUE 2585
WH CHEMODENERVATION MUSCLE 776
WH INJ ANES FEMRAL NRV SING
L 1577
WH INJ FEMORAL NERVE BILAT 2366
WH ENDOMTRL BX W/WO ENDOCERV 420
WH DESTRUCT MALIG LESN FACE 989
WH IR, MIDLINE PLACEMENT 5900
WH PERCUTANS NEEDLE BX LIVER 3937
WH INJ PLATLET RICH PLASMA 829
WH PICC LINE W/O PRT W/O IMA 4893
WH ADMIN INFLUENZA VACINE 61
WH ADMIN OF PNEUMONIA VACINE 61
WH MISC. PROCEDURE
WH CARDIOVERSION EXTERNAL 4633
WH SPD MISC DEVICE CHARGE
WH APP CAST LONG ARM BL 523
WH APP CAST LONG ARM LT 123
WH APP CAST LONG ARM RT 123
WH APP CAST LONG LEG BL 270
WH APP CAST LONG LEG LT 179
WH APP CAST LONG LEG RT 179
WH APP CAST SHORT ARM BL 156
WH APP CAST SHORT ARM LT 103
WH APP CAST SHORT ARM RT 103
WH APP CAST SHORT LEG BL 168
WH APP CAST SHORT LEG LT 112
WH APP CAST SHORT LEG RT 112
WH APP LONG ARM SPLINT 50 151
WH APP LONG ARM SPLINIT LT 103
WH APP LONG ARM SPLINT RT 103
WH APP SPLINT SHORT ARM BL 110
WH APP SPLINT SHORT ARM LT 71
WH APP SPLINT SHORT ARM RT 71
WH APP
SPLNT FNGR STATIC BL 747
WH APP SPLNT FNGR STATIC LT 503
WH APP SPLNT FNGR STATIC RT 503
WH APP SPLINT LONG LEG BL 131
WH APP SPLINT LONG LEG LT 84
WH APP SPLINT LONG LEG RT 84
WH APP SPLNT SHRT LEG LT 78
WH APP SPLNT SHRT LEG BL 126
WH APP SPLNT SHRT LEG RT 78
WH APP UNA BOOT BL 100
WH APP UNA BOOT LT 65
WH APP UNA BOOT RT 65
WH ARTERIAL PUNCTURE 30
WH ARH/ASP/INJ INTRMD JNT BL 130
WH ARH/ASP/INJ INTRMD JNT LT 90
WH ARH/ASP/INJ INTRMD JNT RT 90
WH ART/ASP/INJ MAJR JOINT BL 1714
WH ART/ASP/INJ MAJR JOINT LT 1138
WH ART/ASP/INJ MAJR JOINT RT 1138
WH ARTHO/ASP/INJ SML JNT BL 130
WH ARTHO/ASP/INJ SML JNT LT 88
WH ARTHO/ASP/INJ SML JNT RT 88
WH ASPRAT BLADR SUPRPUB CATH 474
WH AVULSN NAIL PLATE EA ADD 67
WH AVULSN NAIL PLATE SING 134
WH BLADDR HEMORRHGE IRRIGAT 90
WH BLADDER IRRIGATION SIMPLE 90
WH BURN DSG/DEBRID
LARGE 276
WH BURN DSG/DEBRID MEDIUM 243
WH BURN DSG/DEBRID SMALL 321
WH BURN INITIL TX 1ST DEGREE 102
WH CARDIOPLMONRY RESUSCITATN 394
WH CARDIOVERSION EXTERNAL 242
WH CHNG CYSTOSTMY TUBE SIMPL 126
WH CHANGE GASTROSTOMY TUBE 436
WH CHEMICAL CAUTERIZATION 72
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