Charges

Procedure Description Facility
43235 Facility Fee/EGD $693.03
43236 Facility Fee/EGO $993.03
43239 Facility Fee/EGO $912.81
43243 Facility Fee/EGO $930.75
43245 Facility Fee/EGO $945.88
43247 Facility Fee/EGO $935.88
43248 Facility Fee/EGO $945.88
43249 Facility Fee/EGO $945.88
43250 Facility Fee/EGO $936.90
43251 Facility Fee/EGO $936.90
43255 Facility Fee/EGO $933.31
43450 Facility Fee/Esophageal Dilation, Unguided Bougie $620.25
43760 Facility Fee/Change of Peg/Gastrostomy Tube $912.81
44360 Facility Fee/Sm Intestine Endoscopy – Push Enteroscopy $912.81
44361 Facility Fee/Sm Intestine Endoscopy – Push w/Bx $750.00
44380 Facility Fee/lleoscopy Thru Stoma $599.75
44382 Facility Fee / lleoscopy Thru Stoma w/Bx $699.75
44388 Facility Fee/Colon Thru Stoma $910.25
44389 Facility Fee/Colon Thru Stoma w/Bx $925.63
44392 Facility Fee/Colon Thru Stoma w/Polyp Removal, Hot Bx $951.25
44394 Facility Fee/Colon Thru Stoma w/Polyp Rem, Not Hot Bx $943.56
44799 Unlisted procedure small intestine $300.00
45330 Facility Fee/Flexible Sigmoidoscopy $558.75
45331 Facility Fee/Flexible Sigmoidoscopy w/Bx $599.75
45333 Facility Fee/Flex Sig w/Polyp Removal $624.35
45335 Facility Fee/Flex Sig w/Submucosal Injection $300.00
45338 Facility Fee/Flex Sig w/Polyp Removal, Snare $624.35
45378 Facility Fee/Colonoscopy $910.25
45379 Facility Fee/Colon w/Removal Foreign Body $945.63
45380 Facility Fee/Colon w/Bx $925.63
45381 Facility Fee/Colon w/Submucosal Injection $300.00
45382 Facility Fee/Colon w/Control of Bleeding $930.75
45384 Facility Fee/Colon w/Polyp Removal, Hot Bx $951.25
45385 Facility Fee/Colon w/Polyp Removal, Snare $943.56
45386 Colsc flexible w/transendoscopic balloon dilat $1,530.50
45388 Facility Fee/Colon w/Ablation $942.03
45390 Facility Fee/Colon w/EMR $943.56
46930 DESTRUCTION OF HEMORRHOIDS $599.75
49082 Facility Fee/Paracentesis w/o Imaging Guidance $250.00
G0104 Facility Fee/Flex Sigmoidoscopy Screening $0.00
G0105 Facility Fee/Colon Screening, High Risk $910.25
G0121 Facility Fee/Colon Screening, Not High Risk $910.25
G8907 No Burn/Fall/Site/Transfer $0.00
G8908 Pt Burn Documented $0.00
G8909 No Pt Burn $0.00
G8910 Pt Fall $0.00
G8911 No Pt Fall $0.00
G8912 Wrong Site/Side/Patient/Procedure $0.00
G8913 Not Wrong Site/Side/Patient/Procedure $0.00
G8914 Pt Hospital Transfer /Admission $0.00
G8915 No Pt Hospital Transfer/Admission $0.00
G8916 Antibiotic Prophalaxis Started-on time $0.00
G8917 Antibiotic Prophalaxis Started-not on time $0.00
G8918 No Order for Antibiotic Prophylaxis $0.00
MISS APPT MISSED APPOINTMENT $100.00

 

*The prices listed are the facility charges that are billed to the insurance. Every insurance company we participate with, we have a contracted allowed amount. To find out what you may be responsible for please contact your insurance company.