Supply Charges Part 3
Our Commitment to Quality
Helping ensure our patients receive the highest level of care, delivered with dignity and compassion, is our goal with every patient and family member, every time. Our Board challenges us to remain in the Top 10 percent of hospitals in the country in quality scores, and they meet monthly with physicians and clinical staff to analyze the data and develop a plan to better serve our patients. It is this goal-driven mindset that has earned us recognition in key areas for our quality strides. Learn more about our quality awards and recognition.
NOTE: Costs displayed on these documents include: procedure, anesthesia and recovery time if applicable, some medications and supplies, laboratory tests and room & board). Not included are physician fees.
| Charge Code | Supply Description | Charge |
|---|---|---|
| 27000653 | HC TUBING PRESSURE 84IN 0111 | $34 |
| 27000654 | HC CHEST DRAINAGE BOTTLE 90CC | $121 |
| 27000655 | HC IAP TRANSDUCER PRESS INTRA-ABD 013358 | $62 |
| 27000656 | HC IAP MONITOR KIT 013364 | $407 |
| 27000657 | HC WIRE-GUIDE-35-80-7/5 | $102 |
| 27000658 | HC PROBE ESOPHAGEAL TEMP 013387 | $495 |
| 27000659 | HC VAC CANISTER ABthera 013490 | $80 |
| 27000660 | HC BANDAGE PROFORE 4 LAYER SYS 013121 | $98 |
| 27000661 | HC FEMORAL BIOPSY SHEATH 7FR-CORD | $199 |
| 27000662 | HC CATHETER HOLDER---COLOSTOMY | $44 |
| 27000663 | HC SWAN-GANZ CATH 93A731H-7.5FR | $970 |
| 27000664 | HC HEART BIOPSY TRAY | $95 |
| 27000665 | HC CUTDOWN CATH PED-18 | $50 |
| 27000666 | HC HYPOTHERMIA BLANKET KOOL KIT 013386 | $1,000 |
| 27000667 | HC IAP DEVICE PRESS MONITOR INTRA 013357 | $370 |
| 27000668 | HC DENTAL WIRE SET | $124 |
| 27000669 | HC NASAL PACK 2 PER PKG | $27 |
| 27000670 | HC ENDOMETRIAL BIOPSY TRAY | $77 |
| 27000671 | HC BIOPTONE-BIOPSY-104 CM-LONG | $714 |
| 27000672 | HC PACEMAKER TRAY-EXTERNAL- | $134 |
| 27000673 | HC ANGIOGRAPHIC CATHETER | $107 |
| 27000674 | HC COOK DIALATOR | $36 |
| 27000675 | HC NDL JAMSHIDI 18GA BONE MAR 810014 | $65 |
| 27000676 | HC NDL ILL 15G 3/8X1 7/8 BON 804326 | $65 |
| 27000677 | HC BIOPTONE SHEATH 104 CM-LONG 7F | $199 |
| 27000678 | HC BIOPTONE-BIOPSY-50 CM-SHORT | $693 |
| 27000679 | HC DUAL LUMEN CV CATH SET PED 5CM | $162 |
| 27000680 | HC PRESSURE MONITOR TRAY 3.0-8CM | $243 |
| 27000681 | HC PRESSURE MONITOR TRAY 4.0-12CM | $243 |
| 27000682 | HC DUAL LUMEN CV CATH SET 15CM | $162 |
| 27000683 | HC TROCAR CATHETER 24FR | $116 |
| 27000684 | HC FEMORAL BIOPSY FORCEP-CORDIS- | $714 |
| 27000685 | HC SWAN-GANZ CATH-THE-93A931H 7.5 | $815 |
| 27000686 | HC BIOPTONE SHEATH 50CM SHORT 8F | $162 |
| 27000687 | HC INTRODUCER-CORDIS CATH 9 FR | $131 |
| 27000688 | HC RT-CIRCUIT BIPAP | $107 |
| 27000689 | HC TRAY QUICK TAP PARACENTESI 000616 | $411 |
| 27000690 | HC RT-MASL CPAP MED | $299 |
| 27000691 | HC RT-MASK CPAP LARGE | $299 |
| 27000692 | HC KIDNEY DIALYZER NT150 | $143 |
| 27000693 | HC RT-MASK NASAL SMALL | $158 |
| 27000694 | HC CATH LUTHER MIDLINE 20G PE 24580 | $187 |
| 27000695 | HC VINYL CONN TUBE | $104 |
| 27000696 | HC RT-HUMIDIFIER BOTTLE | $30 |
| 27000697 | HC RT-CIRCUIT IPPB | $30 |
| 27000698 | HC CIRCUIT VENT UNIVERSAL 301215 | $150 |
| 27000699 | HC RT-MASK CPAP SMALL | $299 |
| 27000700 | HC TENT CANOPIES RT 301196 | $71 |
| 27000701 | HC RT-LARGE FULL CPAP MASK | $299 |
| 27000702 | HC RT-SMALL FULL CPAP MASK | $299 |
| 27000703 | HC RT-LARGE NASAL MASK - BIPAP | $158 |
| 27000704 | HC RT-ISOTHERMAL CIRCUIT | $64 |
| 27000705 | HC RT-BIPAP CIRCUIT | $107 |
| 27000706 | HC RT-MED FULL CPAP MASK | $299 |
| 27000707 | HC RT-MASK NASAL MED | $158 |
| 27000708 | HC RT-MASK NASAL LARGE | $158 |
| 27000709 | HC RT-HEADSTRAP BIPAP | $70 |
| 27000710 | HC HEMO CATH DBL LUMEN 11.5X20CM | $699 |
| 27000711 | HC 6.5 SILICONE FEEDING TUBE 010822 | $167 |
| 27000712 | HC SURG-O-PAK HIP PACK | $236 |
| 27000713 | HC COLPOSCOPETRAY | $77 |
| 27000714 | HC NEEDLE-HUBER 19X1 W-TUBING | $28 |
| 27000715 | HC DUAL LUMEN CVP TRAY PED 8CM 5F | $295 |
| 27000716 | HC ILEAL CONDUIT SAMPLING CATH | $33 |
| 27000717 | HC CENTRAL CATH SINGLE LUMEN | $361 |
| 27000718 | HC WIRES GUIDE CSCF-18-50-2-J | $84 |
| 27000719 | HC WIRES GUIDE-CSF-18-50-STR | $69 |
| 27000720 | HC TROCAR-SURGIPORT 10MM | $555 |
| 27000721 | HC TUBE FEEDING CAP-ABBOT-IRR-BOT | $51 |
| 27000722 | HC PD TRANSFER SET EXCHANGE KIT | $450 |
| 27000723 | HC PRESSURE MONITORING SET 2-1/2F | $89 |
| 27000724 | HC DUAL LUMEN CVP TRAY PED 10C 5F | $295 |
| 27000725 | HC NEEDLE-SURGINEEDLE 120MM | $153 |
| 27000726 | HC OVERHEAD IRR SET-BAG-USE CYSTO | $32 |
| 27000727 | HC KIDNEY AV FISTULA NEEDLE 16GA | $20 |
| 27000728 | HC VENOUS PRESSURE SET B/P | $64 |
| 27000729 | HC RENAL BIOPSY TRAY W/NEEDLE-DIS | $168 |
| 27000730 | HC POLYETHYLENE TUBE 12 PE 205 | $27 |
| 27000731 | HC POLYETHYLENE TUBE 12 PE 50 | $27 |
| 27000732 | HC TRAY CATH CV MLMEN 7X20 AN 000891 | $485 |
| 27000733 | HC SUT 3-0 SILK FS-1 684H 300701 | $27 |
| 27000734 | HC POLYETHYLENE TUBE 12 PE 240 | $27 |
| 27000735 | HC ET ANTIMICROB ROLL | $23 |
| 27000736 | HC ET ANTIMICROB SPONGE | $21 |
| 27000737 | HC COMPRESSOR DISC DISP [5302] 5302 | $116 |
| 27000738 | HC POLYETHYLENE TUBE 12 PE 190 | $27 |
| 27000739 | HC POLYETHYLENE TUBE 12 PE 90 | $27 |
| 27000740 | HC CATH BARDEX SELF RETA 34F 5414 | $70 |
| 27000741 | HC CATH MALECOT 32FR LTX STR 805413 | $70 |
| 27000742 | HC CATH MALECOT 30FR LTX STRY 000826 | $70 |
| 27000743 | HC SOUND SET | $77 |
| 27000744 | HC LIVER BIOPSY TRAY | $77 |
| 27000745 | HC I AND D TRAY REUSABLE | $88 |
| 27000746 | HC CATH MALECOT 22FR LTX STR 5409 | $50 |
| 27000747 | HC CATH MALECOT 12FRLTX STR 800367 | $50 |
| 27000748 | HC CATHETER MALECOT WINGTIP 20 | $50 |
| 27000749 | HC CATHETER MALECOT WINGTIP 18 | $50 |
| 27000750 | HC CATH MALECOT 24FR LTX STR 5410 | $70 |
| 27000751 | HC CUFF BP NEONATAL SIZE 4 | $34 |
| 27000752 | HC CUFF BP NEONATAL SIZE 3 | $34 |
| 27000753 | HC CUFF BP NEONATAL SIZE 1 | $34 |
| 27000754 | HC SCALP VEIN 20GX1 BD SAFT I 004302 | $41 |
| 27000755 | HC SCALP VEIN 18GX1 BD SAFT I 004301 | $41 |
| 27000756 | HC RT-MED. NASAL MASK - BIPAP | $158 |
| 27000757 | HC RT-SM. NASAL MASK - BIPAP | $158 |
| 27000758 | HC #5 UNICATH FOLEY SET CLOSED SY 010629 | $252 |
| 27000759 | HC CUFF BP NEONATAL SIZE 2 | $51 |
| 27000760 | HC #8 UNICATH FOLEY SET CLOSED SY 010630 | $252 |
| 27000761 | HC INTRO CATH 1.9 FR 010819 | $251 |
| 27000762 | HC SHEATH PEEL AWAY 20G 010595 | $219 |
| 27000763 | HC HUBERLOC HUBER NDL REMOVAL 003332 | $39 |
| 27000764 | HC FEMORAL ART CATH 20GA | $71 |
| 27000765 | HC PACING 7FR ELECTRODE | $530 |
| 27000766 | HC DIALATOR JCD 6.3-38-20 | $60 |
| 27000767 | HC CATH IV 14X1-1/4 INTROCAN 004787 | $25 |
| 27000768 | HC CATH MULTI LUMEN CV COATED 000836 | $443 |
| 27000769 | HC CANNULA INNER DISP XLT 8.00MM 011098 | $43 |
| 27000770 | HC TUBE TRACH XLT 011821 | $248 |
| 27000771 | HC CUFF CRYO KNEE LG W/COOLER 012200 | $336 |
| 27000772 | HC STERILE SLEEVE NEEDLE GUIDE 011853 | $101 |
| 27000773 | HC 5FR PICC MICRO EZ SHEATH 011852 | $253 |
| 27000774 | HC CANNULA INNER DISP XLT 7.00MM 011099 | $37 |
| 27000775 | HC CANNULA INNER DISP XLT 6.0 MM 011714 | $37 |
| 27000776 | HC TUBE TRACH XLT PROXIMAL CUFF 7.0MM 011100 | $264 |
| 27000777 | HC TUBE FEED 55 IN FOR CORTRA 010568 | $259 |
| 27000778 | HC TUBE FEED 43 IN FOR CORTRA 010567 | $259 |
| 27000779 | HC SET IV EXT 3ML W/LUER T P 007868 | $17 |
| 27000780 | HC SLEEVE SCD THIGH MED | $249 |
| 27000781 | HC BAG DRAIN BEDSIDE LATEX FR 001005 | $55 |
| 27000782 | HC CATH FOLEY 18FR 2W 5CC LAT 001004 | $99 |
| 27000783 | HC CATH FOLEY 16FR LX-FREE 001003 | $99 |
| 27000784 | HC GEL IODOSORB CADEXOMER IOD 003591 | $324 |
| 27000785 | HC SET GEM V/NVQS MC .2MF 3VS 60D 005032 | $89 |
| 27000786 | HC SET GEM PED SYRINGE DEH 000992 | $53 |
| 27000787 | HC KIT CATH RADIAL ARTERIAL S 006524 | $181 |
| 27000788 | HC DRESSING SILVER 4 IN X 4IN 004798 | $66 |
| 27000789 | HC CATH IV 16X1-1/4 PROTECT 301507 | $25 |
| 27000790 | HC CATH TRACH CARE 5FR NEONAT 003889 | $155 |
| 27000791 | HC CUFF BP ADULT THIGH | $85 |
| 27000792 | HC CUFF BP ADULT LARGE | $57 |
| 27000793 | HC CUFF BP ADULT MED | $57 |
| 27000794 | HC CUFF BP ADULT SMALL | $57 |
| 27000795 | HC TRACH PERC PORTEX KIT 7.00 | $1,570 |
| 27000796 | HC CANNULA TRACH 7.00 mm POR 003970 | $47 |
| 27000797 | HC SET EXTENSION MINIVOLUME 1C8 003887 | $59 |
| 27000798 | HC MIDLINE INTRO KIT 010624 | $350 |
| 27000799 | HC BANDAGE HIGH COMPRESSION 000701 | $143 |
| 27000800 | HC CATH MAHURKAR11.5X24 800447 | $627 |
| 27000801 | HC CATH MAHURKAR 11.5X16CM Q 800887 | $638 |
| 27000802 | HC CATH MAHURKAR11.5X13 800886 | $638 |
| 27000803 | HC CATH TRACH CARE SX 14FR 12in S 301676 | $97 |
| 27000804 | HC SET IV ADM EXT 43IN 2SITE 005020 | $25 |
| 27000805 | HC BAG DRAIN 4000CC 000308 | $45 |
| 27000806 | HC SET PUMP FEED and FLUSH KANGRO 003189 | $47 |
| 27000807 | HC SET PUMP SPIKE FEED and FLUSH 003191 | $33 |
| 27000808 | HC BAG VENTRICULA DRAIN 000020 | $252 |
| 27000809 | HC DRAIN SYSTEM WITH BAG VENT 000088 | $508 |
| 27000810 | HC PAD TELFA 3X4 DRESS STR 301085 | $8 |
| 27000811 | HC DRESSING BIAFINE WOUND 801625 | $150 |
| 27000812 | HC IV INFUSION EXT HBO | $154 |
| 27000813 | HC SET TUR IRRIGATION Y LATEX FR 8132 | $79 |
| 27000814 | HC SET IV EXT 5IN MICRBR W MI 010513 | $27 |
| 27000815 | HC TRAY URINMETER 18FR LTX SL 301588 | $158 |
| 27000816 | HC TRAY URINMETER FOLEY 16FR 301587 | $158 |
| 27000817 | HC POUCH BONGORT URINARY 301565 | $264 |
| 27000818 | HC SET PUMP AMB 101 IN 800013 | $114 |
| 27000819 | HC TRAY PERCUTANEOUS 800426 | $236 |
| 27000820 | HC POUCH DRN W/2 3/4 FLAN 12 000780 | $89 |
| 27000821 | HC POUCH DRN W/1 3/4 FLAN 12 000782 | $89 |
| 27000822 | HC SET IV W/Y LL MICRO 800510 | $19 |
| 27000823 | HC SET IV VIAL ADAPTER 005028 | $18 |
| 27000824 | HC SET IV 3 PORT ADAPTER 005023 | $32 |
| 27000825 | HC SET IV PRIM 110IN 10DROP 005012 | $37 |
| 27000826 | HC SET IV MINIDROP 108IN 60D 005013 | $11 |
| 27000827 | HC SET IV BLD ADMINISTRATION 005019 | $25 |
| 27000828 | HC SET IV EXT 15CM [6in] P V 313115 | $36 |
| 27000829 | HC SET IV EXT W/2Y LL 005022 | $25 |
| 27000830 | HC SET IV EXT IV W/FIL 16IN H 005024 | $18 |
| 27000831 | HC SET IV EXT 15 24cm [6 in] 005085 | $13 |
| 27000832 | HC SET IV EXT 30IN W/LL 313106 | $11 |
| 27000833 | HC SET IV BASIC 100 15 DROP 005014 | $19 |
| 27000834 | HC SET IV BURR W/FIL 150ML 005018 | $32 |
| 27000835 | HC IV SET BASIC 80IN 10 DROP | $30 |
| 27000836 | HC SET IV SEC W/CANN GRAVITY 005015 | $13 |
| 27000837 | HC SET IV GEMINI VENTED 005026 | $69 |
| 27000838 | HC CANNULA INNER DISP 10 DIC 805400 | $23 |
| 27000839 | HC CANNULA 8 DISP 301310 | $23 |
| 27000840 | HC CANNULA 6 DISP 301309 | $23 |
| 27000841 | HC TRACH INNER CANNULA SIZE 4 | $23 |
| 27000842 | HC CATH COUDE FOLE SILCONE-5C-16F | $82 |
| 27000843 | HC CATH IV 20X1-1/4 PROTECT 301509 | $30 |
| 27000844 | HC SYSTEM LOOP OSTOMY 4 IN 800262 | $82 |
| 27000845 | HC TUBING PRESSURE 12 IN 808254 | $33 |
| 27000846 | HC TUBE TRACH SIZE 10 15160 | $219 |
| 27000847 | HC TRAY CENTRAL LINE DRESS CH 004720 | $112 |
| 27000848 | HC IV START KIT W/CHLORAPREP 004869 | $82 |
| 27000849 | HC TUBE TRACH LOPRO 5.5 22F 301165 | $32 |
| 27000850 | HC TUBE TRACH LOPRO 5.0 20F 301166 | $32 |
| 27000851 | HC STOCKINET TUB 6X5 300920 | $33 |
| 27000852 | HC VALVE HEIMLICH CHEST DRAI 800086 | $50 |
| 27000853 | HC TUBE TRACH PED 2.5MM 10FR 300848 | $32 |
| 27000854 | HC TUBE TRACH PED 3.5MM 14F 300850 | $32 |
| 27000855 | HC TUBE TRACH PED 3.0MM 12F 300849 | $32 |
| 27000856 | HC CORD CLAMP UMBILICAL ST 300836 | $23 |
| 27000857 | HC BIOPSY NEEDLE TRU CUT ADULT | $129 |
| 27000858 | HC TUBE TRACH LO PRESCUFF SIZ 301261 | $219 |
| 27000859 | HC TUBE TRACH LO PRESSCUF SIZ 301262 | $219 |
| 27000860 | HC TUBE TRACH SIZE 4 0248 | $219 |
| 27000861 | HC KIT TRACH CARE W/FCP and GL 300783 | $32 |
| 27000862 | HC TUBE SAL SUMP 18F 48IN 300831 | $32 |
| 27000863 | HC DEVICE MALE EXTERNAL CATH 000732 | $27 |
| 27000864 | HC DRAIN PENROSE 3/4 X 18 300939 | $21 |
| 27000865 | HC KIT HEMOVAC MASECTOMY 1/4 300845 | $271 |
| 27000866 | HC KIT HEMOVAC MASECTOMY 1/8 300846 | $271 |
| 27000867 | HC BELT OSTOMY MEDIUM 26in - 810601 | $37 |
| 27000868 | HC CATH ROBINSON 20FR RED RUB 301597 | $27 |
| 27000869 | HC CATH ROBINSON 18FR RED RUB 301596 | $27 |
| 27000870 | HC CATH ROBINSON 16FR RED RUB 301595 | $27 |
| 27000871 | HC CATH ROBINSON 14FR RED RUB 301070 | $27 |
| 27000872 | HC CATH ROBINSON 12FR RED RUB 301594 | $27 |
| 27000873 | HC CATH FOLEY 8F 3CC PED SILI 000912 | $77 |
| 27000875 | HC VENESECTION CUTDOWN ADULT 007130 | $108 |
| 27000876 | HC ELASTOMER INFUSION CATH 18 GA | $37 |
| 27000877 | HC TRAY HEMO-CATH 11.5FRX20CM 001221 | $714 |
| 27000878 | HC TUBE TRACH BIG BOY SZ 9 004209 | $266 |
| 27000879 | HC PACING ELECTRODE INSERT KIT | $282 |
| 27000880 | HC L-CATH BLUNT CATH REPAIR KIT | $321 |
| 27000881 | HC UT CATH TRAY | $324 |
| 27000882 | HC TUBE FEEDING SET W/DYE | $62 |
| 27000883 | HC CANNULA TRACH 8.00mm PORTE 003971 | $47 |
| 27000884 | HC TUBE TRACH BIG BOY SZ 8 004206 | $266 |
| 27000885 | HC TRACH PERC PORTEX KIT 8.00 | $1,570 |
| 27000886 | HC TUBE TRACH BIG BOY SZ 6 004205 | $266 |
| 27000887 | HC CENTRAL LINE INSERTION KIT | $123 |
| 27000888 | HC LARYNGECTOMY TUBE SIZE 36 EA | $337 |
| 27000889 | HC LARYNGECTOMY TUBE SIZE 8 EA | $337 |
| 27000890 | HC LARYNGECTOMY TUBE SIZE 10 EA | $337 |
| 27000891 | HC LARYNGECTOMY TUBE SIZE 40 EA | $337 |
| 27000892 | HC TROCATH IV SET | $70 |
