Greenwich Hospital Price Master - CT.gov

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90000047 HC PSYCH THRPY PT AND/OR FAM W/E&M 45MIN 416.50 4/1/2013 90000049 HC PSYCH THERAPY GROUP - IOP 600.00 4/1/2013 91400001 HC PHARMACOLOGIC MNGT ONLY LEVEL 1 230.00 4/1/2013 91400002 HCPR PHARMACOLOGIC MNGT ONLY LEVEL 1 50.00 4/1/2013 91400004 HCPR PHARMACOLOGIC MNGT ONLY LEVEL 2 75.00 4/1/2013 91400006 HCPR PHARMACOLOGIC MNGT ONLY LEVEL 3 100.00 4/1/2013 91400008 HCPR PHARMACOLOGIC MNGT ONLY LEVEL 4 125.00 4/1/2013 91400011 HC PHARMACOLOGIC MNGT LEVEL 1 + TX 230.00 4/1/2013 91400012 HCPR PHARMACOLOGIC MNGT LEVEL 1 + TX 250.00 4/1/2013 91400014 HCPR PHARMACOLOGIC MNGT LEVEL 2 + TX 75.00 4/1/2013 91400016 HCPR PHARMACOLOGIC MNGT LEVEL 3 + TX 100.00 4/1/2013 91400018 HCPR PHARMACOLOGIC MNGT LEVEL 4 + TX 125.00 4/1/2013 92000003 HC GLAUCOMA PROVOCATIVE TEST W/O TONOGRAPHY 38.90 4/1/2013 92000013 HC DUPLEX EXTRACRANIAL/CAROTID 1,726.00 4/1/2013 92000019 HC DOPPLER AERIAL EXTREM COMPL 1,138.00 4/1/2013 92000020 HC DUPLEX AERIAL LWR EXTREM 1,631.00 4/1/2013 92000021 HC DUPLEX AERIAL LWR EXTREM UNILAT/LTD 1,237.00 4/1/2013 92000023 HC DUPLEX AERIAL UPR EXTREM UNILAT/LTD 1,181.33 4/1/2013 92000024 HC DUPLEX VENOUS EXTREM 1,785.00 4/1/2013 92000025 HC DUPLEX VENOUS EXTREM UNI/LTD 1,323.43 4/1/2013 92000026 HC DUPLEX ABD/PELVIS/RETRO COMPL 1,631.00 4/1/2013 92000035 HC MULT SLEEP LATENCY 3,506.28 4/1/2013 92000036 HC SLEEP STDY UNATTENDED 2,706.00 4/1/2013 92000038 HC PSG (SLEEP STAGING) 4+ PARAMETERS 6,144.00 4/1/2013 92000039 HC PSG (SLEEP STAGING) 4+ PARAMETERS W/CPAP 7,801.00 4/1/2013 92000040 HC EMG 1 EXTREM 363.16 4/1/2013 92000051 HC NRV CONDUCTION MOTOR W/F-WAVE 439.00 4/1/2013 92000052 HC NRV CONDUCTION SENSORY 380.00 4/1/2013 92000058 HC PLETHYSMOGRAPHY LUNG VOL 483.00 4/1/2013 92400004 HC IMMUNOTHPY ALLERGEN 1 INJ W/O EXTRACT 35.00 4/1/2013 92400005 HC IMMUNOTHPY ALLERGEN INJ 2+ W/O EXTRACT 36.00 4/1/2013 92400008 HC IMMUNOTHPY ALLERGEN 3 INSECT VENOM 95.00 4/1/2013 94000002 HC IMMUN ADM EA ADDL VACC PERC/IM/SUB-Q/ID 29.91 4/1/2013 94000003 HC PROPH/PROPH/DIAG INJ SQ/IM 166.81 4/1/2013 94000005 HC TX/PROPH/DIAG INJ IV PUSH INIT 330.15 4/1/2013 94000006 HC PROPH/PROPH/DIAG INJ IV PUSH ADDL SEQ 327.85 4/1/2013 94000007 HC PROPH/PROPH/DIAG INJ IV PUSH SAME 290.00 4/1/2013 94000010 HC NUTRITIONAL THPY INDIV EVAL 15 MIN 64.00 4/1/2013 94000011 HC NUTRITIONAL THPY INDIV RE-EVAL 15 MIN 55.00 4/1/2013 94000012 HC PHLEBOTOMY PROPH 438.00 4/1/2013 94000013 HC DIABETES SELF-MGT TRN INDIV O/P 30 MIN 172.00 4/1/2013 94000014 HC DIABETES SELF-MGT TRN GRP O/P 30 MIN 28.00 4/1/2013 94300002 HC CARDIAC REHAB W/MONITOR PER SESSION 209.19 4/1/2013 94800001 HC PULM REHAB W/EXERCISE PER HR PER SESSION 150.00 4/1/2013 94900005 HC CARDIAC SUPERVISED SINGLE VT 18.73 4/1/2013 94900006 HC MED FITNESS SINGLE SUPERVISED 20.00 4/1/2013 96000008 HCPR AHROCENTESIS ASP/INJ JOINT/BURSA MAJOR 134.18 4/1/2013 96000014 HCPR VISIT CLINIC NEW LEVEL I 59.90 4/1/2013 96000015 HCPR VISIT CLINIC NEW LEVEL II 144.45 4/1/2013 96000016 HCPR VISIT CLINIC NEW LEVEL III 202.23 4/1/2013 96000017 HCPR VISIT CLINIC NEW LEVEL IV 238.29 4/1/2013 96000018 HCPR VISIT CLINIC NEW LEVEL V 583.00 4/1/2013 96000019 HCPR VISIT CLINIC ESTAB LEVEL I 122.55 4/1/2013 96000020 HCPR VISIT CLINIC ESTAB LEVEL II 714.39 4/1/2013 96000021 HCPR VISIT CLINIC ESTAB LEVEL III 384.77 4/1/2013 96000022 HCPR VISIT CLINIC ESTAB LEVEL IV 569.78 4/1/2013 96000023 HCPR VISIT CLINIC ESTAB LEVEL V 882.27 4/1/2013 96000024 HCPR SUBSEQUENT HOSPITAL CARE PROB FOC 228.66 4/1/2013 96000025 HCPR SUBSEQUENT HOSPITAL CARE EXPANDED 376.53 4/1/2013 96000026 HCPR PF SUBSEQUENT HOSP CARE DETAILED 483.32 4/1/2013 96000038 HCPR PF INITIAL HOSPITAL CARE DETAIL 223.63 4/1/2013 96000039 HCPR PF INITIAL HOSPITAL CARE COMPREHENSIVE 301.74 4/1/2013 96000040 HCPR PF INITIAL HOSPITAL CARE COMPLEX 442.98 4/1/2013 96000041 HCPR PF HOSPITAL D/C DAY MGMT 30 MIN OR LESS 158.36 4/1/2013 96000043 HCPR PF PROLONGED SERVICE 1ST HR I/P OR OBS 200.09 4/1/2013 96100002 HCPR PSYCH THERAPY O/P 20-30 MIN 165.85 4/1/2013 96100004 HCPR PSYCH THERAPY O/P 45-50 MIN 266.60 4/1/2013 96100005 HCPR PSYCH THERAPY W/EVAL O/P 45-50 MIN 283.55 4/1/2013 96100012 HCPR PSYCH THERAPY FAMILY W/O PATIENT 255.52 4/1/2013 96100016 HCPR PSYCH PHARMACOLOGIC MANAGEMENT 147.55 4/1/2013 96100023 HCPR PSYCH THERAPY FAMILY W/PATIENT - LSW 324.26 4/1/2013 96100024 HCPR PSYCH THERAPY GROUP - LCSW 0.00 4/1/2013 96100025 HCPR PSYCH DIAGNOSTIC EVALUATION 637.85 4/1/2013 96100026 HCPR PSYCH DIAG EVAL W/MED SERVICES 674.40 4/1/2013 96100027 HCPR PSYCH THERPY PT AND/OR FAMILY 30MIN 165.85 4/1/2013 96100028 HCPR PSYCH THERPY PT AND/OR FAMILY 45MIN 266.60 4/1/2013 96100029 HCPR PSYCH THERPY PT AND/OR FAMILY 60MIN 416.15 4/1/2013 96100030 HCPR PSYCH TX PT AND/OR FAM W/E&M 30MIN 165.85 4/1/2013 96100031 HCPR PSYCH TX PT AND/OR FAM W/E&M 45MIN 266.60 4/1/2013 96100033 HCPR PSYCH THPY GRP FAMILY MULTI 0.00 4/1/2013 96100034 HCPR PSYCH THERAPY GROUP - IOP 0.00 4/1/2013 97700001 HCPR ACUPUNCTURE W/O E-STIM INITIAL 15 MIN 143.81 4/1/2013 98100001 HCPR I&D ABSCESS SIMPLE 226.25 4/1/2013 98100003 HCPR I&D CYST PILONIDAL SIMPLE 241.50 4/1/2013 98100004 HCPR INC/REMV FOREIGN BODY SUBQ SIMPLE 218.49 4/1/2013 98100006 HCPR I&D HEMATOMA/SEROMA/FLUID 249.52 4/1/2013 98100007 HCPR ASPIRATION ABSCESS/HEMATOMA/BULLA/CYST 301.53 4/1/2013 98100012 HCPR EVAC HEMATOMA SUBUNGAL 98.87 4/1/2013 98100013 HCPR EXCISION NAIL & MATRIX 376.53 4/1/2013 98100015 HCPR EXCISION WEDGE SKIN NAIL FOLD 140.54 4/1/2013
98100016 HCPR REPAIR LAC SIMPLE SCALP/HAND/FT/GEN
Page 1 and 2: Greenwich Hospital Price Master as
Page 3 and 4: 27200017 HC ELECTRODE TRANSVENOUS P
Page 5 and 6: 27800067 HC STAPLER SKIN ROYAL 35 2
Page 7 and 8: 30000464 HC ACTIVATED PROTEIN C RES
Page 9 and 10: 30001771 HC CYSTIC FIBROSIS NEWBORN
Page 11 and 12: 30100318 HC MOL DIA;SEP BY GEL E4,E
Page 13 and 14: 30600038 HC PAPILLOMAVIRUS, HUMAN:A
Page 15 and 16: 32000101 HC XR ANKLE 2 VIEWS 406.00
Page 17 and 18: 36000178 HC BX BREAST NDL PERC W/GU
Page 19 and 20: 40000043 HC US GUIDANCE INTRAOPERAT
Page 21: 61000039 HC MRI UPR EXTREM JT W/O C
Page 25 and 26: 27250001628 SUTURE SILK 6-0 S1769K
Page 27 and 28: 250000051465 CEFUROXIME SODIUM 750
Page 29 and 30: 270500013282 INDERMIL TISSUE ADHESI
Page 31 and 32: 272500012059 BLANKET WARMER BAIR HU
Page 33 and 34: 272500015138 BLADE DIEGO SERRATED 4
Page 35 and 36: 276500023575 LENSE SN60WF18.5 569.1
Page 37 and 38: 278500015237 CUP BIPOLAR 5001-53-28
Page 39 and 40: 278500232831 POLARIS STENT KIT 7FR
Page 41 and 42: 637000017753 TEMAZEPAM 15 MG CAPSUL
Page 43 and 44: 2500000433512 ESCITALOPRAM 10 MG TA
Page 45 and 46: 2705000126822 TUBE VACUUM AQUILEX H
Page 47 and 48: 6370000111218 PSYLLIUM ORAL PACKET
Page 49 and 50: 6370000129858 METOPROLOL SUCCINATE
Page 51 and 52: 25000005113667 SODIUM CHLORIDE 0.9

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