Orchard Hospital Chargemaster Item # Description Charge ... master - cms website  · 2000009

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  • Orchard Hospital Chargemaster

    Item # Description Charge

    100210 TRANSFUSION BLOOD OR COMPONENT 700.00$

    100215 PICC INSERTION FOR PATIENT >5 3,000.00$

    200200 TRANSFUSION BLOOD OR COMPONENT 700.00$

    400005 OBSERVATION SERVICES - 1ST HR 280.91$

    400010 OBSERVATION SERVICES - 2ND HR 156.06$

    400015 OBSERVATION SERVICES - 3RD HR 104.04$

    400020 OBSERVATION SERVICES - ADDL HR 52.02$

    400030 TRANSFUSION BLOOD OR COMPONENT 714.00$

    1200011 SIGMOIDOSCOPE 290.55$

    1212002 SURGERY RM SETUP-PK 1,126.59$

    1212008 RECOVERY RM 1HR 674.88$

    1212009 RECOVERY RM 2HR 640.97$

    1212014 MINOR RM SUPPLY S/UP 2,642.82$

    1213390 MAJOR RM SUPPLY S/UP 3,111.46$

    1213391 ORTHOPEDIC RM SET-UP 1,906.94$

    1213430 OPERATING RM 3 HR 6,088.33$

    1217012 PROCEDURE ROOM 645.81$

    1230035 EXC CA TRUNK 630.77$

    1251000 OPERATING RM 1 HR 2,437.90$

    1251002 OR 1ST ADDTL 1/2 HR 1,209.26$

    1251003 OR 2ND ADDTL 1/2 HR 1,209.26$

    1400004 BIER BLOCK 132.50$

    1400010 SPINAL 317.93$

    1412006 NURSE ANES 1/2 HR 310.59$

    1412007 NURSE ANES 1 HR 687.99$

    1500001 99281 ER EXAM ROOM I 369.75$

    1500002 99283 ER EXAM ROOM III 701.25$

    1500003 99284 ER EXAM ROOM IV 1,083.75$

    1500004 99285 ER EXAM ROOM V 1,572.10$

    1500005 99282 ER EXAM ROOM II 554.65$

    1500010 99292 ER CRITICAL CARE ADD'L 30 MIN 600.00$

    1500025 CHARGE VOIDED 933.75$

    1500031 EAR WAX REMOVAL 65.70$

    1500035 ER IV BUNDLE 132.05$

    1500417 SNELLEN EYE TEST 7> 17.85$

    1502000 IV INFUSION INITIAL UP 1 HR 529.95$

    1502001 IV INFUSION EA ADD'L HR. 97.90$

    1502002 IV INFUSION HYDRAT EA ADD'L HR 97.90$

    1502003 INJECTION EA ADD'L PUSH 141.80$

    1502004 INJECTION SUBCUTAN OR IM 141.80$

    1502005 INJECTION IV PUSH SINGL OR INI 141.80$

    1502006 SUBCUT OR IM INJECT 1 VACCINE 113.40$

    1502007 INSERT TEMP BLADDER CATH SIMPL 179.60$

  • Orchard Hospital Chargemaster

    1502008 STRAPPING SHOULDER - RIGHT 218.90$

    1502009 STRAPPING SHOULDER LEFT 218.90$

    1502010 INJECTION EA ADD SEQUENT PUSH 141.80$

    1502011 IV INFUSION HYDRATION 31M-1HR 158.80$

    1502012 CONTROL NASAL HEMORRHAGE SIMPL 283.00$

    1502013 CPR 582.85$

    1502015 STRAPPING HAND OR FINGER 195.45$

    1502016 SHORT ARM SPLIT - LEFT 342.60$

    1502017 SIMPLE REPAIR 2.6 CM TO 5 CM 310.75$

    1502018 SIMPLE REPAIR 2.6CM TO 7.5 CM 310.75$

    1502019 SHORT ARM SPLINT - RIGHT 342.60$

    1502020 SIMPLE REPAIR 2.5 CM OR LESS 310.75$

    1502021 REPAIR COMPLETE 1.1CM TO 2.5CM 729.10$

    1502022 CONTROL NASAL HEMORRHAGE INITI 283.00$

    1502023 SIMPLE REPAIR 2.5 OR LESS 310.75$

    1502025 SHORT LEG SPLINT LT CALF/FOOT 342.60$

    1502026 SHORT LEG SPLIT RT CALF/FOOT 342.60$

    1502030 DISLOCATED SHOULD REDUCTION RT 542.45$

    1502031 DISLOCATED SHOULD REDUCTION LT 542.45$

    1502032 FOLEY CATHETER - COMPLICATED 332.80$

    1502033 FOREIGN BODY REMOVAL EAR - RT 201.50$

    1502034 FOREIGN BODY REMOVAL EAR - LT 243.00$

    1502037 DIGIT NERVE BLCK LT HAND 2ND D 1,057.25$

    1502038 DIGITAL NERVE BLOCK TOE - T5 1,057.25$

    1502039 NAIL REMOVAL - TOE - T5 344.75$

    1502040 FINGER SPLINT - LEFT THUMB 195.45$

    1502041 STRAPPING KNEE - LT 218.90$

    1502042 STRAPPING KNEE - RT 218.90$

    1502043 LONG ARM SPLINT - RT 342.60$

    1502044 LONG ARM SPLIT - LT 342.60$

    1502045 FB REMOVAL NOSE - LEFT 195.45$

    1502046 FB REMOVAL OF NOSE - RIGHT 195.10$

    1502047 BURN DRESSING/DEBRIDE SMALL 310.10$

    1502048 STRAPPING TOES 195.45$

    1502049 SOFT TISSUE FB REMOVAL 759.80$

    1502050 FINGER SPLINT LT HAND 5TH DIGI 195.45$

    1502052 WOUND REPAIR INTERM 2.5 CM < 911.35$

    1502055 FINGER SPLIT-LT HAND 3RD DIGIT 195.45$

    1502056 FINGER SPLIT-LF HAND 2ND DIGIT 195.35$

    1502057 FINGER SPLIT-RT HAND 2ND DIGIT 195.45$

    1502058 WOUND REPAIR-FACE 2.6CM-5.0CM 911.35$

    1502059 IV INFUSION ADDL SEQ - UP 1 HR 128.70$

    1502060 FINGER SPLIT-LT HAND/4TH DIGIT 195.45$

    1502061 FINGER SPLINT - RT HAND THUMB 195.45$

  • Orchard Hospital Chargemaster

    1502062 IV INFUSION/RX CONCURRENT INF 97.90$

    1502063 THORACENTESIS W/O IMAGING GUID 1,426.20$

    1502064 DIGIT NERVE BLCK RT HAND 5TH D 1,057.25$

    1502065 FINGER SPLIT - RT HAND 3RD DIG 195.45$

    1502066 FINGER SPLIT RT HAND 5TH DIGIT 195.45$

    1502067 CONTROL NASAL HEMORRHAGE 316.95$

    1502068 WOUND REPAIR - INTERM. 729.10$

    1502069 LONG LEG SPLINT - RIGHT 342.60$

    1502070 LONG LEG SPLINT - LEFT 342.60$

    1502071 CERUMEN REMOVAL UNILATERAL 179.90$

    1502078 FOREIGN BODY REMOVAL 268.40$

    1502079 WOUND REPAIR EYE NOSE LIPS 1,020.70$

    1502080 INCISION&DRAINAGE ABSCESS 509.20$

    1502081 INSERTION NON TUNNELED CATHETE 2,848.70$

    1502082 BURN DRESSING/DEBRIDEMENT MED 387.60$

    1502083 INITIAL TMNT 1ST DEGREE BURNS 259.25$

    1502084 INSERTION NONINDWELLING CATHET 288.80$

    1502085 INSERTION TEMP CATHETER COMPLI 621.55$

    1502086 WOUND REPAIR 7.6 CM TO 12.5 CM 310.75$

    1502087 99291 ER CRITICAL CARE FIRST 30-75 MIN 1,554.25$

    1502088 CHEST TUBE 1,195.55$

    1502089 FB REMOVAL - NOSE RIGHT 195.45$

    1502090 SOFT TISSUE FB REMOVAL - RT 2,114.95$

    1502091 SOFT TISSUE FB REMOVAL - LT 2,114.95$

    1502092 REMOVAL OF FB RT 247.00$

    1502093 REMOVAL OF FB LT 247.00$

    1502094 FRACTURE AND/OR DISLOCATION RT 552.90$

    1502095 FRACTURE AND/OR DISLOCATION LT 552.90$

    1502096 FOREIGN BODY REMOVAL - EYE/LT 268.40$

    1502097 FOREIGN BODY REMOVAL - EYE/RT 268.40$

    1502100 ARTHROCENTESIS 612.00$

    1502105 WOUND REPAIR 7.6CM TO 12.5CM 428.40$

    1502110 TRANSFUSION BLOOD OR COMPONENT 700.00$

    1503000 STRAPPING ACE BANDAGE-F-ARM 195.35$

    1509560 STRAPPING - ANKLE AND/OR FOOT 218.90$

    1510005 ET INTUBATION 282.75$

    1510024 BLADDER IRRIGATION 152.00$

    1510067 INCISION & DRAINAGE 181.35$

    1512015 MODERATE SEDATION - E.R. 357.00$

    1512016 INTERMEDIATE REPAIR 2.5 CM OR LESS 450.00$

    1512017 INTERMEDIATE REPAIR 2.6 TO 7.5 CM 450.00$

    1512018 INTERMEDIATE REPAIR 7.6 TO 12.5 CM 450.00$

    1512019 INTERMEDIATE REPAIR 12.6 TO 20.0 CM 450.00$

    1512020 IV BUNDLE - SPECIFIC TO ER 132.05$

  • Orchard Hospital Chargemaster

    2000005 PT MCAL 1ST 30 MIN/RPT 160.44$

    2000006 PT ELECTRICAL STIMUL UNATTENDED 58.14$

    2000007 PT BALANCED TX SET UP 108.05$

    2000009 PT THERAPY INITIAL 30 MINS MCAL 128.24$

    2000017 PT TESTS/MEASUR -EA ADD'L 15M 80.17$

    2000024 PT THER ACTIVITY 69.57$

    2000026 PT GAIT TRAINING 91.80$

    2000031 PT SELF CARE ADL 75.03$

    2000032 PT PARAFFIN BATH 58.66$

    2000037 PT THERAPY EA ADD'L 15 MINS MCAL 64.12$

    2000038 PT CONTRAST BATH 65.48$

    2000040 PT THER EX 87.72$

    2000041 PT HOT OR COLD PACKS 47.75$

    2000048 PT WHIRLPOOL 45.90$

    2000055 PT MECHANICAL TRACTION 96.90$

    2000070 PT RE-EVAL 143.82$

    2000083 PT TENS 144.62$

    2000088 PT MANUAL THERAPY - EA 15 MINS. 112.20$

    2000089 PT ULTRA SOUND 63.24$

    2000090 PT WHEEL CHAIR TRAINING 59.16$

    2000093 PT WOUND CARE MAJOR 924.12$

    2000100 PT DRESSING/DEBRIDEMENT 255.00$

    2000105 PT DRESSING/DEBRIDEMENT ADD'L 255.00$

    2000115 PT NEUROMUSC. RE-ED 137.79$

    2000120 PT MASSAGE 69.57$

    2000140 PT CANALITH REPOSITION PRO/PERDAY 89.76$

    2000150 PT PHYSICA