GUAM MEMORIAL HOSPITAL AUTHORITY
SUMMARY OF EXISTING FEE SCHEDULE - ITEMS / SERVICES 
Proposed for Submission to the 29th Guam Legislature
Public Hearing on March 24, 2008
(Last Update on March 18, 2008)
ITEM NUMBER CHARGE CODE DESCRIPTION CHARGE RATE CPT HCPCS UB-92 DEPARTMENT
1 AA00000 ROOM & BOARD ICU          1,272.84 200 ROOM AND BOARD
2 AA00001 ROOM & BOARD NURSERY             362.92 171 ROOM AND BOARD
3 AA00002 ROOM & BOARD INTMED NURSERY             546.82 179 ROOM AND BOARD
4 AA00003 ROOM & BOARD NICU             825.29 175 ROOM AND BOARD
5 AA00004 ROOM & BOARD TELEMETRY             714.94 129 ROOM AND BOARD
6 AA00005 ROOM & BOARD SNF             396.55 169 ROOM AND BOARD
7 AA00006 ROOM & BOARD PICU          1,098.70 203 ROOM AND BOARD
8 AA00007 ROOM & BOARD ICF             329.14 130 ROOM AND BOARD
9 AA00008 ROOM & BOARD MED/SURG PRIVATE             544.82 111 ROOM AND BOARD
10 AA00009 ROOM & BOARD MED/SURG SEMI-PRIVATE             494.82 121 ROOM AND BOARD
11 AA00011 ROOM & BOARD MEDICAL PRIVATE             587.94 111 ROOM AND BOARD
12 AA00012 ROOM & BOARD MEDICAL SEMI-PRIVATE             537.94 121 ROOM AND BOARD
13 AA00014 ROOM & BOARD PEDS PRIVATE             732.19 113 ROOM AND BOARD
14 AA00015 ROOM & BOARD PEDS SEMI-PRIVATE             682.19 123 ROOM AND BOARD
15 AA00017 ROOM & BOARD OB/GYN PRIVATE             600.62 112 ROOM AND BOARD
16 AA00018 ROOM & BOARD OB/GYN SEMI-PRIVATE             550.62 122 ROOM AND BOARD
17 AA00020 ROOM & BOARD SURGICAL PRIVATE             573.21 111 ROOM AND BOARD
18 AA00021 ROOM & BOARD SURGICAL SEMI-PRIVATE             523.21 121 ROOM AND BOARD
19 AA00055 ROOM & BOARD SNF             396.55 169 ROOM AND BOARD
20 AA00057 ROOM & BOARD ICF             329.14 130 ROOM AND BOARD
21 AA12006 ROOM & BOARD PCU             993.89 209 ROOM AND BOARD
22 AA24009 OBSERVATION BED/HOUR MED/SURG               20.62 762 ROOM AND BOARD
23 AA24012 OBSERVATION BED/HOUR MEDICAL               22.41 762 ROOM AND BOARD
24 AA24015 OBSERVATION BED/HOUR PEDS               28.42 762 ROOM AND BOARD
25 AA24018 OBSERVATION BED/HOUR OB               22.94 762 ROOM AND BOARD
26 AA24021 OBSERVATION BED/HOUR SURGICAL               21.80 762 ROOM AND BOARD
27 MP98001 MIP CO-PAYMENT-ER                 5.00 220 MISCELLANEOUS
28 MP98002 MIP CO-PAYMENT-PHARMACY                 2.50 220 MISCELLANEOUS
29 900000 DEFIBRILLATION/CARDIOVERSION             117.53 92960 489 EMERGENCY ROOM
30 900088 PHYSICAL EXAM-ANNUAL               84.89 969 EMERGENCY ROOM
31 900178 ER-OB/GYN ROOM             115.48 99214 450 EMERGENCY ROOM
32 900185 ER-SPECIALTY ROOM               57.38 99213 450 EMERGENCY ROOM
33 900194 ER-TRAUMA ROOM             999.62 99215 450 EMERGENCY ROOM
34 900227 EMERGENCY ROOM               67.48 99201 450 EMERGENCY ROOM
35 900243 ER-OBSERVATION ROOM               84.35 99211 450 EMERGENCY ROOM
36 901056 ANOSCOPE DISP                 9.03 272 EMERGENCY ROOM
37 901282 CATHETER BARTHOLIN GLAND 10/12FR               85.88 272 EMERGENCY ROOM
38 902000 MORGAN MEDI-FLO LENS               99.91 272 EMERGENCY ROOM
39 910060 I&D ABSCESS               26.42 490 EMERGENCY ROOM
40 910202 MORGAN LENS DELIVERY SET               28.97 272 EMERGENCY ROOM
41 910942 SET ADMIN GRAVITY FLOW               31.89 272 EMERGENCY ROOM
42 911010 SPONGE RHINO ROCKET XLGE               73.69 272 EMERGENCY ROOM
43 911300 SPONGE RHINO ROCKET SML               50.10 272 EMERGENCY ROOM
44 911500 SPONGE RHINO ROCHET MED               56.51 272 EMERGENCY ROOM
45 911800 SPONGE RHINO ROCKET LGE               65.52 272 EMERGENCY ROOM
46 912140 LARYNGEAL MASK AIRWAY S-4             205.61 272 EMERGENCY ROOM
47 912150 LARYNGEAL MASK AIRWAY S-5             205.61 272 EMERGENCY ROOM
48 931500 INTUBATION                 4.62 31500 489 EMERGENCY ROOM
49 932020 THORACOSTOMY INSERTION               64.71 32020 490 EMERGENCY ROOM
50 936425 VENIPUNCTURE               38.30 36415 490 EMERGENCY ROOM
51 936480 CVP CATHETER INSERTION             101.69 36489 490 EMERGENCY ROOM
52 996000 CODE 72 (ARREST) PCV             104.34 92950 981 EMERGENCY ROOM
53 1100049 MED REC COPIES </=10 COPIES               18.92 999 MISCELLANEOUS
54 1100064 MED REC COPIES >10-PER PAGE                 1.85 999 MISCELLANEOUS
55 1104001 ITEMIZED BILLING=1-5COPIES                 5.00 999 MISCELLANEOUS
56 1104002 ITEMIZED BILLING=>5-PER COPY                 0.75 999 MISCELLANEOUS
57 1195001 HOSPITAL BIRTH CERTIFICATE                 5.00 999 MISCELLANEOUS
58 1195002 CERTIFICATION OF DEATH                 2.50 999 MISCELLANEOUS
59 1200000 M.L. REPAIR-SIMPLE               42.46 361 EMERGENCY ROOM
60 1201000 SKIN, SUBQ & AREOLAR TISSUE               63.68 361 EMERGENCY ROOM
61 1202000 ML REPAIR-SUPERFICIAL WOUND               84.89 361 EMERGENCY ROOM
62 1212000 SIMPLE REPAIR-SUPERF WOUND               84.89 361 EMERGENCY ROOM
63 1214000 ADJ TISSUE TRANS/REARRANGM             106.12 361 EMERGENCY ROOM
64 1220000 GENERAL INCISION-ABSCESS             106.12 361 EMERGENCY ROOM
65 1222000 SPINE (VERTEBRAL COLUMN)             159.20 361 EMERGENCY ROOM
66 1223000 SHOULDER INCISION             212.27 361 EMERGENCY ROOM
67 1224000 HUMERUS UP ARM/ELBOW INCISION                     -   361 EMERGENCY ROOM
68 1230000 RESP SYSTEM-NOSE INCISION                     -   361 EMERGENCY ROOM
69 1310449 CANNULA NASAL CPAP SZ-0               79.68 272 NURSERY
70 1310450 CANNULA NASAL CPAP SZ-1               79.68 272 NURSERY
71 1310451 CANNULA NASAL CPAP SZ-2               79.68 272 NURSERY
72 1332100 TRAY PER-Q-CATH SINGLE-LUMEN 2.0FR             197.69 272 NURSERY
73 1335000 TRAY NEO V-CATH SINGLE-LUMEN 2.0FR             502.15 272 NURSERY
74 1370742 CATHETER SUCTION ARGYLE 10FR               60.17 272 NURSERY
75 1395001 PEDS INTUBATION KIT 3.0               25.77 272 NURSERY
76 1395002 PEDS INTUBATION KIT 3.5               25.77 272 NURSERY
77 1395003 IV PUMP SET (SYRINGE)               26.88 272 NURSERY
78 1395004 IV PUMP SET (TUBING)               22.39 A4649 272 NURSERY
79 1395005 MICROBORE 60" EXT SET                 8.78 272 NURSERY
80 1395006 PEDS INTUBATION KIT 2.5               34.49 272 NURSERY
81 1395007 T-CONNECTOR WITH M.L.S.                 6.21 272 NURSERY
82 1395008 NUTRAMIGEN POWDER 1 LB               97.01 250 NURSERY
83 1395009 PREGESTIMIL POWDER 16 OZ             106.28 250 NURSERY
84 1600028 DELIVERY ROOM             708.81 722 DELIVERY ROOM
85 1600044 FETAL NON-STRESS TEST             128.96 59025 720 DELIVERY ROOM
86 1600100 VACCUM DELIVERY SYSTEM CMI             301.99 720 DELIVERY ROOM
87 1600105 LR-OUTPT OBSERVATION NO DELIVERY             191.64 99203 721 DELIVERY ROOM
88 1600110 ABC ROOM             804.82 724 DELIVERY ROOM
89 1600127 MORGUE FEE PER DAY               14.87 999 DELIVERY ROOM
90 1600250 MATERNAL-FETAL INTENSIVE CARE          1,171.36 209 DELIVERY ROOM
91 1600300 EPIDURAL ANEST MONITOR                     -   720 DELIVERY ROOM
92 1600350 LR-INPT OBSERVATION             591.80 720 DELIVERY ROOM
93 1601583 ENFAMIL HUMAN MILK FORTIFIER             396.46 270 DELIVERY ROOM
94 1601850 NEEDLE SPINAL 18GAX5.0"               57.83 272 DELIVERY ROOM
95 1610027 CATHETER IUP MONITORING             202.40 272 DELIVERY ROOM
96 1610110 LARYNGEAL MASK AIRWAY SZ-1             210.99 272 DELIVERY ROOM
97 1610115 LARYNGEAL MASK AIRWAY SZ-1.5             210.99 272 DELIVERY ROOM
98 1610130 LARYNGEAL MASK AIRWAY SZ-3             210.99 272 DELIVERY ROOM
99 1611654 MECONIUM ASPIRATOR               26.66 272 DELIVERY ROOM
100 1612317 SET EXTENSION MICROBORE QUAD-LEG               47.60 272 DELIVERY ROOM
101 1620752 BLADE SURGICAL CLIPPER #9660               20.25 272 DELIVERY ROOM
102 1633303 PREGESTIMIL W/MCT OIL 20CAL 3OZ BOT/PK               62.89 270 DELIVERY ROOM
103 1670635 ENFACARE NURSETTE 22CAL 3OZ BOT/PK               53.59 270 DELIVERY ROOM
104 1670636 ENFAMIL PRM 24CAL 3OZ BOT/PK               53.59 270 DELIVERY ROOM
105 1670637 ENFAMIL PRM 20CAL 3OZ BOT/PK               53.59 270 DELIVERY ROOM
106 1670638 ENFAMIL AR LIPIL NR 20CAL 3OZ BOT/PK               53.59 270 DELIVERY ROOM
107 1696001 MASK OXYGEN-INFANT               20.99 270 DELIVERY ROOM
108 1700005 CATHETER THERMOD VIP             695.03 272 CENTRAL SUPPLY ROOM
109 1700006 CATHETER SWAN-GANZ 6FR             278.71 272 CENTRAL SUPPLY ROOM
110 1700007 CATHETER BALLOON VERI PACE             693.83 272 CENTRAL SUPPLY ROOM
111 1700009 LEAD INTRO SUBCLAVIAN 8FR             103.72 275 CENTRAL SUPPLY ROOM
112 1700010 LEAD INTRO SUBCLAVIAN 10FR             490.41 275 CENTRAL SUPPLY ROOM
113 1700011 LEAD INTRO SUBCLAVIAN 9FR          1,001.27 275 CENTRAL SUPPLY ROOM
114 1700012 LEAD INTRO SUBCLAVIAN 11FR             490.41 275 CENTRAL SUPPLY ROOM
115 1700013 LEAD INTRO SUBCLAVIAN 12FR             490.41 275 CENTRAL SUPPLY ROOM
116 1700014 CATHETER DOUBLE LUMEN 4FR             349.28 272 CENTRAL SUPPLY ROOM
117 1700015 MASK FACE SAFETY SHIELD                 6.79 272 CENTRAL SUPPLY ROOM
118 1700016 CATHETER DOUBLE LUMEN 5FR             349.28 272 CENTRAL SUPPLY ROOM
119 1700017 CATHETER DOUBLE LUMEN 8FR             349.28 272 CENTRAL SUPPLY ROOM
120 1700018 CUP GRADUATED 1000CC 32OZ               11.86 270 CENTRAL SUPPLY ROOM
121 1700019 ISOLATION CART                 9.65 270 CENTRAL SUPPLY ROOM
122 1700024 KIT-MON-1295KM SINGLE LINE             213.16 270 CENTRAL SUPPLY ROOM
123 1700025 KIT-MON-1295KH DOUBLE LINE             236.46 270 CENTRAL SUPPLY ROOM
124 1700026 KIT CATHETER INTRODUCER             301.02 270 CENTRAL SUPPLY ROOM
125 1700028 CATHETER DUAL LUMEN 11FR             817.66 A4300 272 CENTRAL SUPPLY ROOM
126 1700030 PAD DEFIBRILLATOR               27.59 272 CENTRAL SUPPLY ROOM
127 1700032 ARMBOARD W/ COVER 9" DISP                 3.10 270 CENTRAL SUPPLY ROOM
128 1700033 ARMBOARD W/ COVER 18"                 4.39 270 CENTRAL SUPPLY ROOM
129 1700036 BRUSH SCRUB SURG W/LODOPH                 4.00 272 CENTRAL SUPPLY ROOM
130 1700037 SYRINGE CANNISTER 2GAL               16.96 272 CENTRAL SUPPLY ROOM
131 1700039 HEMOVAC 400ML D.D. 1/4" 19F             197.56 270 CENTRAL SUPPLY ROOM
132 1700041 SYRINGE ECCENTRIC TIP 60CC                 3.38 272 CENTRAL SUPPLY ROOM
133 1700042 SYRINGE INSULIN 1CC M/FINE                 1.02 270 CENTRAL SUPPLY ROOM
134 1700043 AIR MATTRESS MACH/D               10.63 270 CENTRAL SUPPLY ROOM
135 1700047 TUBE NASOGAST W/ SENT 18FR               15.15 272 CENTRAL SUPPLY ROOM
136 1700059 BODY RESTRAINT               64.71 270 CENTRAL SUPPLY ROOM
137 1700067 NEEDLE SPINAL 18GAX3-1/2"               11.32 272 CENTRAL SUPPLY ROOM
138 1700069 NEEDLE SPINAL 20GAX3-1/2"                 7.19 272 CENTRAL SUPPLY ROOM
139 1700070 NEEDLE SPINAL 22GAX3-1/2"                 8.09 272 CENTRAL SUPPLY ROOM
140 1700071 NEEDLE MULTI-SAM 21GAX1"                 0.79 272 CENTRAL SUPPLY ROOM
141 1700077 CRUTCH TIP WIDE BASE               11.87 273 CENTRAL SUPPLY ROOM
142 1700079 BAG BODY CADAVER-PEDS               56.53 270 CENTRAL SUPPLY ROOM
143 1700080 COLLECTOR MIDSTREAM URINE                 8.80 272 CENTRAL SUPPLY ROOM
144 1700083 NEEDLE BONE MARROW 18GA             117.13 272 CENTRAL SUPPLY ROOM
145 1700085 ARTERIAL LINE ARROW               43.86 272 CENTRAL SUPPLY ROOM
146 1700086 CATHETER 3-LUMEN ARROW             673.31 272 CENTRAL SUPPLY ROOM
147 1700088 TUBING PENROSE 1"X18"                 4.05 272 CENTRAL SUPPLY ROOM
148 1700089 TUBING PENROSE 5/8"X18"                 5.90 272 CENTRAL SUPPLY ROOM
149 1700090 TUBING PENROSE 1/4"X18"                 3.71 272 CENTRAL SUPPLY ROOM
150 1700091 TUBING PENROSE 1/2"X18"                 2.41 272 CENTRAL SUPPLY ROOM
151 1700092 SYRINGE ASCEPTO DISP               23.12 272 CENTRAL SUPPLY ROOM
152 1700093 TUBING PENROSE 7/8"X18"                 4.07 272 CENTRAL SUPPLY ROOM
153 1700094 TUBING PENROSE 5/16"X18"                 4.07 272 CENTRAL SUPPLY ROOM
154 1700095 TUBING PENROSE 3/8"X18"                 8.36 272 CENTRAL SUPPLY ROOM
155 1700096 SET ADMIN VENTED PRIM 60DR               22.65 272 CENTRAL SUPPLY ROOM
156 1700097 SYRINGE IRRIG C/TIP 50CC                 3.19 272 CENTRAL SUPPLY ROOM
157 1700098 MOTOR PUMP ALTERNATOR             454.28 270 CENTRAL SUPPLY ROOM
158 1700100 BAG BILE               14.41 A4649 272 CENTRAL SUPPLY ROOM
159 1700101 GLOVES EXAM LTX PDLESS SML                 0.51 272 CENTRAL SUPPLY ROOM
160 1700102 STERI-STRIP 1/2"X4"                 6.36 A4454 272 CENTRAL SUPPLY ROOM
161 1700103 CATH ANGIOCATH 20GAX2"                 5.85 A4649 272 CENTRAL SUPPLY ROOM
162 1700104 TUBE ENDOTRACH W/CUFF 3.5M               11.14 272 CENTRAL SUPPLY ROOM
163 1700105 NUGAUZE PLAIN 1"               21.63 272 CENTRAL SUPPLY ROOM
164 1700107 TUBE ENDOTRACH W/ CUFF 6MM               14.77 272 CENTRAL SUPPLY ROOM
165 1700108 TUBE ENDOTRACH W/CUFF 9.5M               20.34 272 CENTRAL SUPPLY ROOM
166 1700109 TUBE ENDOTRACH W/ CUFF 8MM               17.66 272