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 April 09, 2008)
ITEM CHARGE   CHARGE  CPT HCPCS UB-92  
NUMBER CODE DESCRIPTION RATE       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 LABOR AND DELIVERY
85 1600044 FETAL NON-STRESS TEST     128.96 59025 720 LABOR AND DELIVERY
86 1600100 VACCUM DELIVERY SYSTEM CMI     301.99 720 LABOR AND DELIVERY
87 1600105 LR-OUTPT OBSERVATION NO DELIVERY     191.64 99203 721 LABOR AND DELIVERY
88 1600110 ABC ROOM     804.82 724 LABOR AND DELIVERY
89 1600127 MORGUE FEE PER DAY       14.87 999 LABOR AND DELIVERY
90 1600250 MATERNAL-FETAL INTENSIVE CARE  1,171.36 209 LABOR AND DELIVERY
91 1600300 EPIDURAL ANEST MONITOR            -   720 LABOR AND DELIVERY
92 1600350 LR-INPT OBSERVATION     591.80 720 LABOR AND DELIVERY
93 1601583 ENFAMIL HUMAN MILK FORTIFIER     396.46 270 LABOR AND DELIVERY
94 1601850 NEEDLE SPINAL 18GAX5.0"       57.83 272 LABOR AND DELIVERY
95 1610027 CATHETER IUP MONITORING     202.40 272 LABOR AND DELIVERY
96 1610110 LARYNGEAL MASK AIRWAY SZ-1     210.99 272 LABOR AND DELIVERY
97 1610115 LARYNGEAL MASK AIRWAY SZ-1.5     210.99 272 LABOR AND DELIVERY
98 1610130 LARYNGEAL MASK AIRWAY SZ-3     210.99 272 LABOR AND DELIVERY
99 1611654 MECONIUM ASPIRATOR       26.66 272 LABOR AND DELIVERY
100 1612317 SET EXTENSION MICROBORE QUAD-LEG       47.60 272 LABOR AND DELIVERY
101 1620752 BLADE SURGICAL CLIPPER #9660       20.25 272 LABOR AND DELIVERY
102 1633303 PREGESTIMIL W/MCT OIL 20CAL 3OZ BOT/PK       62.89 270 LABOR AND DELIVERY
103 1670635 ENFACARE NURSETTE 22CAL 3OZ BOT/PK       53.59 270 LABOR AND DELIVERY
104 1670636 ENFAMIL PRM 24CAL 3OZ BOT/PK       53.59 270 LABOR AND DELIVERY
105 1670637 ENFAMIL PRM 20CAL 3OZ BOT/PK       53.59 270 LABOR AND DELIVERY
106 1670638 ENFAMIL AR LIPIL NR 20CAL 3OZ BOT/PK       53.59 270 LABOR AND DELIVERY
107 1696001 MASK OXYGEN-INFANT       20.99 270 LABOR AND DELIVERY
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 1700015 MASK FACE SAFETY SHIELD         6.79 272 CENTRAL SUPPLY ROOM
117 1700018 CUP GRADUATED 1000CC 32OZ       11.86 270 CENTRAL SUPPLY ROOM
118 1700019 ISOLATION CART         9.65 270 CENTRAL SUPPLY ROOM
119 1700024 KIT-MON-1295KM SINGLE LINE     213.16 270 CENTRAL SUPPLY ROOM
120 1700025 KIT-MON-1295KH DOUBLE LINE     236.46 270 CENTRAL SUPPLY ROOM
121 1700026 KIT CATHETER INTRODUCER     301.02 270 CENTRAL SUPPLY ROOM
122 1700030 PAD DEFIBRILLATOR       27.59 272 CENTRAL SUPPLY ROOM
123 1700032 ARMBOARD W/ COVER 9" DISP         3.10 270 CENTRAL SUPPLY ROOM
124 1700033 ARMBOARD W/ COVER 18"         4.39 270 CENTRAL SUPPLY ROOM
125 1700036 BRUSH SCRUB SURG W/LODOPH         4.00 272 CENTRAL SUPPLY ROOM
126 1700037 SYRINGE CANNISTER 2GAL       16.96 272 CENTRAL SUPPLY ROOM
127 1700039 HEMOVAC 400ML D.D. 1/4" 19F     197.56 270 CENTRAL SUPPLY ROOM
128 1700041 SYRINGE ECCENTRIC TIP 60CC         3.38 272 CENTRAL SUPPLY ROOM
129 1700042 SYRINGE INSULIN 1CC M/FINE         1.02 270 CENTRAL SUPPLY ROOM
130 1700043 AIR MATTRESS MACH/D       10.63 270 CENTRAL SUPPLY ROOM
131 1700047 TUBE NASOGAST W/ SENT 18FR       15.15 272 CENTRAL SUPPLY ROOM
132 1700059 BODY RESTRAINT       64.71 270 CENTRAL SUPPLY ROOM
133 1700067 NEEDLE SPINAL 18GAX3-1/2"       11.32 272 CENTRAL SUPPLY ROOM
134 1700069 NEEDLE SPINAL 20GAX3-1/2"         7.19 272 CENTRAL SUPPLY ROOM
135 1700070 NEEDLE SPINAL 22GAX3-1/2"         8.09 272 CENTRAL SUPPLY ROOM
136 1700071 NEEDLE MULTI-SAM 21GAX1"         0.79 272 CENTRAL SUPPLY ROOM
137 1700077 CRUTCH TIP WIDE BASE       11.87 273 CENTRAL SUPPLY ROOM
138 1700079 BAG BODY CADAVER-PEDS       56.53 270 CENTRAL SUPPLY ROOM
139 1700080 COLLECTOR MIDSTREAM URINE         8.80 272 CENTRAL SUPPLY ROOM
140 1700083 NEEDLE BONE MARROW 18GA     117.13 272 CENTRAL SUPPLY ROOM
141 1700085 ARTERIAL LINE ARROW       43.86 272 CENTRAL SUPPLY ROOM
142 1700086 CATHETER 3-LUMEN ARROW     673.31 272 CENTRAL SUPPLY ROOM
143 1700088 TUBING PENROSE 1"X18"         4.05 272 CENTRAL SUPPLY ROOM
144 1700089 TUBING PENROSE 5/8"X18"         5.90 272 CENTRAL SUPPLY ROOM
145 1700090 TUBING PENROSE 1/4"X18"         3.71 272 CENTRAL SUPPLY ROOM
146 1700091 TUBING PENROSE 1/2"X18"         2.41 272 CENTRAL SUPPLY ROOM
147 1700092 SYRINGE ASCEPTO DISP       23.12 272 CENTRAL SUPPLY ROOM
148 1700093 TUBING PENROSE 7/8"X18"         4.07 272 CENTRAL SUPPLY ROOM
149 1700094 TUBING PENROSE 5/16"X18"         4.07 272 CENTRAL SUPPLY ROOM
150 1700095 TUBING PENROSE 3/8"X18"         8.36 272 CENTRAL SUPPLY ROOM
151 1700096 SET ADMIN VENTED PRIM 60DR       22.65 272 CENTRAL SUPPLY ROOM
152 1700097 SYRINGE IRRIG C/TIP 50CC         3.19 272 CENTRAL SUPPLY ROOM
153 1700098 MOTOR PUMP ALTERNATOR     454.28 270 CENTRAL SUPPLY ROOM
154 1700100 BAG BILE       14.41 A4649 272 CENTRAL SUPPLY ROOM
155 1700101 GLOVES EXAM LTX PDLESS SML         0.51 272 CENTRAL SUPPLY ROOM
156 1700102 STERI-STRIP 1/2"X4"         6.36 A4454 272 CENTRAL SUPPLY ROOM
157 1700103 CATH ANGIOCATH 20GAX2"         5.85 A4649 272 CENTRAL SUPPLY ROOM
158 1700104 TUBE ENDOTRACH W/CUFF 3.5M       11.14 272 CENTRAL SUPPLY ROOM
159 1700105 NUGAUZE PLAIN 1"       21.63 272 CENTRAL SUPPLY ROOM
160 1700107 TUBE ENDOTRACH W/ CUFF 6MM       14.77 272 CENTRAL SUPPLY ROOM
161 1700108 TUBE ENDOTRACH W/CUFF 9.5M       20.34 272 CENTRAL SUPPLY ROOM
162 1700109 TUBE ENDOTRACH W/ CUFF 8MM