Elliot Health System is a non-profit organization serving your healthcare needs since 1890.

Micellaneous Price Lists

Access to csv file
https://www.elliothospital.org/website/price-lists/Micellaneous-pl.csv


ABCD
1
CategoryCharge CodeDescription 1/1/2019
Unit Charge
2
MISCELLANEOUS
77102G0010ADMIN IMMUN HEP B (MDCR) $ 23
3
MISCELLANEOUS
9210093788AMBULATORY BP ANALYSIS 24 HRS/LONGER $ 382
4
MISCELLANEOUS
9210093786AMBULATORY BP RECORDING 24 HRS/LONGER $ 382
5
MISCELLANEOUS
77001G0444ANNUAL DEPRESSION SCREEN $ 168
6
MISCELLANEOUS
3310096409BIO/CHEM/COMPLEX IV DRUG PUSH SNGL $ 544
7
MISCELLANEOUS
3350096415BIO/CHEM/COMPLEX IV INF ADDL HR $ 310
8
MISCELLANEOUS
3350096413BIO/CHEM/COMPLEX IV INFUSED 1ST HR $ 843
9
MISCELLANEOUS
77000G0101CA SCREEN,PELVIC/BREAST EXAM $ 95
10
MISCELLANEOUS
9100371CELERO VACUUM SPRING LOAD BX $ 563
11
MISCELLANEOUS
5101225COLOR VISION EXTENDED EXAM $ 176
12
MISCELLANEOUS
8020000001
CRRT DAILY (CONT RENAL REPLMNT THERAPY)(MULTIPLE EVALS)
$ 4,485
13
MISCELLANEOUS
35000G0297CT LOW DOSE LUNG SCREENING $ 2,021
14
MISCELLANEOUS
94200G0109DIAB MANAGE TRN/GRP 30 MIN $ 96
15
MISCELLANEOUS
76200G0379DIRECT REFERRAL TO OBSERVATION $ 252
16
MISCELLANEOUS
73000G0404EKG COMP IPPE PBB/MEDICARE $ 82
17
MISCELLANEOUS
9200092225EYE EXAM INITIAL $ 131
18
MISCELLANEOUS
9200092226EYE EXAM SUBSEQUENT $ 114
19
MISCELLANEOUS
5401071GENERAL LAB/SEROLOGY HIV COMBO $ 207
20
MISCELLANEOUS
41300G0277HBOT, FULL BODY CHAMBER, 30M $ 705
21
MISCELLANEOUS
9400000003HYPOTHERMIA THERAPY - ADULT $ 4,545
22
MISCELLANEOUS
9400000004HYPOTHERMIA THERAPY-CHILD/INFANT $ 2,392
23
MISCELLANEOUS
51000G0402IPPE VISIT $ 137
24
MISCELLANEOUS
2600296368IV DRUG INF CONCURRENT ADD NEW DRUG $ 125
25
MISCELLANEOUS
2600296366IV DRUG INF EA ADDL HR $ 140
26
MISCELLANEOUS
2600096365IV DRUG INF INITIAL UP TO 1 HR $ 438
27
MISCELLANEOUS
2600296367IV DRUG INF SEQ ADD NEW DRUG $ 214
28
MISCELLANEOUS
2600296375IV DRUG PUSH ADD NEW DRUG $ 129
29
MISCELLANEOUS
2600296376IV DRUG PUSH SAME DRUG EA ADDL PUSH $ 121
30
MISCELLANEOUS
2600296361IV HYDRATION EA ADDL HR $ 136
31
MISCELLANEOUS
2600296360IV HYDRATION INITIAL UP TO 1HR $ 327
32
MISCELLANEOUS
7610096920LASER TX SKIN <250 SQCM $ 274
33
MISCELLANEOUS
7610096921LASER TX SKIN 250-500 SQCM $ 379
34
MISCELLANEOUS
48100G0278M'DCRE ILIAC ART ANGIO CARD CATH $ 2,850
35
MISCELLANEOUS
9400299156MOD SED OTH PHYS/QHP 5/>YRS $ 552
36
MISCELLANEOUS
5100391OBTAIN SCREEN PAP SMEAR(MDCR) $ 107
37
MISCELLANEOUS
41000G0238OTHER THERAPEUTIC RESP PROC EA 15 MIN $ 124
38
MISCELLANEOUS
7610096567PHOTODYNAMIC TX SKIN $ 364
39
MISCELLANEOUS
7802646PHP, PEER SUPPORT (MCAID ONLY), PER 15 MIN $ 25
40
MISCELLANEOUS
7802644PHP, TRAINING & EDUC SVCS $ 100
41
MISCELLANEOUS
9400196523PORT FLUSH $ 220
42
MISCELLANEOUS
4810289PSA SCREENING $ 145
43
MISCELLANEOUS
5000873SCR C/V CYTO THINLAYER RESCR (MDCR,TRI,MP) $ 244
44
MISCELLANEOUS
5000856SCR GYN CYTO THIN PREP (M'CRE) $ 160
45
MISCELLANEOUS
4808004
SELF PAY PHLEB DRAW HANDLING & SHIPPING ($50.00)
$ 50
46
MISCELLANEOUS
4808003SELF PAY PHLEB DRAW ONLY FOR KITS ($25.00) $ 25
47
MISCELLANEOUS
4808005SELF PAY PHLEB HANDLING & SHIPPING ($25.00) $ 25
48
MISCELLANEOUS
9400099195THERAPEUTIC PHLEBOTOMY $ 234
49
MISCELLANEOUS
41000G0239
THERAPEUTIC PROC STRG ENDUR RESP MUSC PER HR/SESSION
$ 153
50
MISCELLANEOUS
41000G0237
THEREAPEUTIC PROCD STRG ENDUR RESP MUSCLES EA 15 MIN
$ 124
51
MISCELLANEOUS
4100000001TRANSITIONAL CARE $ 500
52
MISCELLANEOUS
68302G0390TRAUMA RESPONSE TEAM $ 3,178
53
MISCELLANEOUS
4400092507TX SPEECH LANG VOICE COMM & AUDITORY PROC IND $ 264
54
MISCELLANEOUS
92100G0365USV PRE-OP MAPPING AV FISTULA CREATION $ 1,150
55
MISCELLANEOUS
77000G0296VISIT TO DETERM LDCT ELIG $ 96
56
MISCELLANEOUS
4820371VOLUNTARY BLOOD ALCOHOL $ 200
57
MISCELLANEOUS
3203064BED AIR FLOTATION KINAIR III DAILY $ 108
58
MISCELLANEOUS
3241205BED BARI AIR THERAPY DAILY $ 550
59
MISCELLANEOUS
3214244BED BARI MAXX II DAILY $ 260
60
MISCELLANEOUS
3210503TRAPEZE SW DAILY $ 28