We Are Based In Montrose and Surroundings

1110 W. Gray St #101 – Houston, TX 77019

Call us at: (832) 487-0911

24-Hour Montrose ER with No Wait

Patient FAQs

Our 24-hour Montrose Emergency Room offers comprehensive care with a full-time internal medicine physician on staff. Our passionate team is dedicated to delivering exceptional results and helping you achieve optimal health and well-being through innovation and excellence.

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Frequently Asked Questions

Do you accept Medicare or Medicaid?

Unfortunately, we are unable to accept any type of Government insurance, as we are not affiliated with any hospital. This includes Medicare, Medicaid, CHIP and Tri-Care.

Do I need to make an appointment?

Because we are an Emergency Room, we are strictly on a walk-in basis. There is no need to make an appointment. Simply come on in when the need for quality emergency care arises.

How Much Does a Visit Cost?

As an Emergency Room, we bill your Emergency Room benefits on your insurance plan. The amount you’ll be responsible for when you arrive will be the co-pay amount for an ER visit, based on your insurance plan. This amount can usually be found on your insurance card.

I don’t have insurance, can I still be seen?

Absolutely! We offer a self-pay option for people without insurance. An initial payment will be due upon arrival. The remaining balance will then be billed to you at a later date, usually within 2-3 weeks.

I have some questions about my bill. Who should I contact?

We encourage you to contact our billing company if you have any concerns or questions or have difficulty paying your bill. You can contact the billing company, Simplex Med Billing, at (713) 457-4600

What is a freestanding emergency room?

A freestanding emergency center is a facility licensed by the state to provide 24-hour emergency services to patients at the same level as a hospital-based emergency room. (From the TAFEC website)

What is the difference between Montrose Emergency Room, a freestanding emergency room, and an urgent care center?

Freestanding emergency centers are required to provide the same level of access and services as hospital-based emergency rooms, with the exception of trauma care. But freestanding emergency centers are often closer and wait time is consistently quicker than hospital ERs. Unlike urgent-care centers, freestanding emergency centers are required to operate 24/7 – they must be open 24 hours, have ER physicians on-site at all times, provide round-the-clock lab and imaging services, and stock medications not required for urgent-care centers. As state-licensed facilities, freestanding emergency centers must also fulfill architectural and equipment requirements, as well as train their staffs at a level not required of urgent-care centers. (From the TAFEC website)

Montrose Emergency Room provide medical services for children?

Montrose Emergency Room is equipped to treat patients of all ages, including infants and children. We have a patient room dedicated to our pediatric patients and our staff is trained to provide compassionate care to children in order to alleviate any fears they may have.

What is considered a medical emergency?

You should visit an emergency room such as Care Plus ER when you have a potentially serious medical condition, examples including a heart attack, stroke, seizure, fracture, head injury, or anaphylactic shock. Emergency rooms are also available to treat mild to serious symptoms that occur during the weekend or night when your doctor is not available, such as strep throat, fever, bronchitis, pneumonia, animal bites, severe headaches, or broken bones. Come visit us at Care Plus ER when you need quality emergency services without a wait.

Will I see a physician or a mid-level practitioner (Physician’s Assistant or Nurse Practitioner)?

Upon visiting us at Montrose Emergency Room, you will be seen by a Board Certified and specially trained emergency room physician. Our physicians are on-site 24 hours a day and are here to serve your emergency needs. The physician will perform a medical screening and discuss your health history and will then recommend your treatment options.

What if I need to stay in the hospital or need emergency surgery?

For patients requiring a transfer to a hospital for admittance and/or surgery, our staff will arrange for ambulance transport to that patient’s choice of hospital. We coordinate all arrangements to get you transferred to the receiving hospital and to ensure they are prepared for your admittance.

Do I need to make an appointment?

While you are free to call ahead to talk to our friendly Montrose Emergency Room front desk staff and have them assist you with any questions you may have, you do not need to schedule an appointment.

What insurance plans does Montrose Emergency Room accept?

Montrose Emergency Room bills out of network for all insurances. Montrose Emergency Room is unable to bill Medicare/Medicaid. Montrose Emergency Room also accepts Worker Compensation Insurance, and Auto Insurance for Motor Vehicle Accidents (MVA) and will provide you with a special finance option for self-pay. For any questions regarding your insurance plan coverage, please call the facility and speak with a representative.

What if I don’t have insurance?

When you visit Montrose Emergency Room without a traditional insurance plan, you will receive a medical screening. If the screening determines that you are experiencing a life-threatening emergency, Montrose Emergency Room will promptly treat you. If it is determined that you are experiencing a non-emergent condition, you will be given an option to self-pay or receive a referral to another facility or physician. Montrose Emergency Room’s self-pay option is for those patients without private insurance who wish to pay by cash, check or credit card.

What if I have questions about my bill?

Please give us a call if you have any questions about your bill. We will be happy to assist you with any concerns or information you may need.

Texas House Bill No. 2041 Notice

This facility is a freestanding emergency medical care facility. This facility charges rates comparable to a hospital emergency room and may charge a facility fee for medical treatment. Either the facility or a physician providing services at the facility may be out-of-network provider for the patient’s health benefit plan provider network. The physician providing medical care at this facility may bill separately from this facility for the medical care provided to a patient. This facility is out-of-network for all benefit plans at this time.

Texas Senate Bill 425

Senate Bill 425, passed by the Texas Legislature during the 84th Regular Session, requires all FECs to post notice of the following:
This is a Freestanding Emergency Medical Care Facility
This facility charges rates comparable to a hospital Emergency Room and may charge a facility fee
This facility or physician providing medical care at this facility may not be a participating provider in your
Health Benefit Plan provider network
A physician providing medical care at this facility may bill separately from the facility for the medical care provided to you

CDM

Facility Fees/TARIFAS:

Service DescriptionCharge Amount
Average Billing for Regular ER (Facility Visit)$3,200.00
Average Billing for Observation$7,000.00

LEVEL OF SERVICE/NIVEL DE SERVICIO

FACILITY FEE/TARIFA

EMERGENCY DEPT VISIT- LEVEL 1 VISITA DE EMERGENCIA- NIVEL 1

$394.90

EMERGENCY DEPT VISIT- LEVEL 2 VISITA DE EMERGENCIA – NIVEL 2

$954.49

EMERGENCY DEPT VISIT- LEVEL 3 VISITA DE EMERGENCIA – NIVEL 3

$1,763.85

EMERGENCY DEPT VISIT- LEVEL 4 VISITA DE EMERGENCIA – NIVEL 4

$3,232.38

EMERGENCY DEPT VISIT – LEVEL 5 VISITA DE EMERGENCIA – NIVEL 5

$4,070.86

LEVEL OF SERVICE/NIVEL DE SERVICO

RANGE OF POSSIBLE FACILITY FEES FOR SERVICE/RANGO DE POSIBLES CUOTAS POR EL SERVICIO

EMERGENCY DEPT VISIT- LEVEL 1 VISITA DE EMERGENCIA- NIVEL 1

LESS THAN $650

EMERGENCY DEPT VISIT- LEVEL 2 VISITA DE EMERGENCIA – NIVEL 2

$650

-$2,500

EMERGENCY DEPT VISIT- LEVEL 3 VISITA DE EMERGENCIA – NIVEL 3

$2,500

-$13,000

EMERGENCY DEPT VISIT- LEVEL 4 VISITA DE EMERGENCIA- NIVEL 4

$4,500

-$35,00

EMERGENCY DEPT VISIT- LEVEL 5 VISITA DE EMERGENCIA- NIVEL 5

$5,000

-$65,000

Physician Fees/Cargos del Medico:

LEVEL OF CARE/NIVEL DE CUIDADO MEDICO

PHYSICIAN FEE/ CARGOS DE MEDICO

EMERGENCY DEPT VISIT- LEVEL 1 VISITA DE EMERGENCIA- NIVEL 1

$220.00

EMERGENCY DEPT VISIT- LEVEL 2 VISITA DE EMERGENCIA- NIVEL 2

$310.04

EMERGENCY DEPT VISIT- LEVEL 3 VISITA DE EMERGENCIA-NIVEL 3

$590.40

EMERGENCY DEPT VISIT – LEVEL 4 VISITA DE EMERGENCIA- NIVEL 4

$820.40

EMERGENCY DEPT VISIT- LEVEL 5 VISITA DE EMERGENCIA – NIVEL 5

$1,020.60

INITIAL OBSERVATION CARE – LEVEL 1 CUIDADO DE OBSERVACION INICIAL- NIVEL 1

$866.80

INITIAL OBSERVATION CARE – LEVEL 2 CUIDADO DE OBSERVACION INICIAL- NIVEL 2

$898 70

INITIAL OBSERVATION CARE – LEVEL 3 CUIDADO DE OBSERVACION INICIAL – NIVEL 3

$917.40

OBSERVATION CARE DISCHARGE ALTA DE OBSERVACION

$1,145.36

OBSERVATION ADMIT/DISCHARGE – LEVEL 1 ADMISION DE OBSERVACION/DISCARGA –

NIVEL 1

$1,169.17

OBSERVATION ADMIT/DISCHARGE – LEVEL 2 ADMISION DE OBSERVACION/DISCARGA –

NIVEL 2

$1,190.39

OBSERVATION ADMIT/DISCHARGE – LEVEL 3 ADMISION DE OBSERVACION/DISCARGA –

NIVEL 3

$1,198.28

CodeService DescriptionCharge Amount
0202UInfectious disease, pathogen-specific nucleic acid, 22 targets including (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected $   2,988.00
0240UInfectious disease (viral respiratory tract infection) $   1,516.19
0241UInfectious disease (viral respiratory tract infection), pat… $   2,028.59
10021FINE NEED $   1,800.26
10060Incision and drainage of abscess,  simple or single $   1,892.75
10061Incision and drainage of abscess, complicated or multiple $   3,117.22
10080INCISION & DRAINAGE PILONIDAL CYST SIMPLE $   3,043.20
10081INCISION & DRAINAGE PILONIDAL CYST COMPLICATED $   3,449.24
10120Incision and removal of foreign body, subcutaneous tissues; simple $   1,803.60
10121INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMP $   3,237.60
10180incision and drainage, complex, postoperative wound infection $   2,160.00
11042debridement, subcutaneous tissue $   3,043.20
11056TRIM SKIN LESIONS 2 TO 4 $         45.00
11106Incisional biopsies $   1,892.75
11200Removal of Skin Tags Procedures $      532.49
11719Trimming of nondystrophic nails, any number $   2,268.55
11730Avulsion of nail plate, partial or complete, simple; single $   1,150.00
11740Evacuation of subungual hematoma $   1,380.00
11750Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal $   3,043.20
11900Injection, intralesional; up to and including 7 lesions $      376.80
11982Removal, non-biodegradable drug delivery implant. $   1,380.00
12001Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less $   1,524.20
12002Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm $   1,841.26
12004Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm $   2,250.00
12005simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 12.6 to 20 cm in size. $   2,604.00
12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less $   1,838.32
12013Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm $   2,361.78
12014Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm $   2,452.15
12015Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm $   3,062.90
12016Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm $   4,243.88
12018RPR F/E/E/N/L/M >30.0 CM $   2,133.66
12020Treatment of superficial wound dehiscence; simple closure $   3,109.54
12031INTMD RPR S/A/T/EXT 2.5 CM/< $   1,689.63
12032intermediate repair of wounds to the scalp, axillae, trunk and/or extremities (excluding hands and feet) that are 2.6 to 7.5 cm in size. $   2,160.00
12034 $   2,659.20
12035 $   3,408.94
12041 $   1,915.20
12042REPAIR (LACERATION)INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM $   2,186.40
12045 $   2,720.40
12051 $   1,665.00
12052 $   1,684.80
12054 $   2,985.60
13120 $   1,422.00
13121 $   3,371.27
13132 $   4,136.40
13151 $   1,428.00
13152 $   2,996.80
13153CMPLX RPR E/N/E/L ADDL 5CM/< $      898.50
15850 $   1,074.00
15853 $         82.80
16000 $   1,244.35
16020 $   1,428.00
16025 $   2,361.78
16030Dressings and/or debridement of partial-thickness burns, initial or subsequent $   3,802.85
17250 $   1,119.60
19000 $   3,120.00
20520Removal of foreign body in muscle or tendon sheath; simple $   5,029.91
20552Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) $   1,220.71
20600 $   1,220.71
20605Arthrocentesis, aspiration (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance. $   1,100.00
20610Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance $   1,532.16
20611Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting $   1,120.00
20612Aspiration and/or injection of ganglion cyst(s) any location $   1,236.14
21320 $   5,182.67
21480Closed treatment of temporomandibular dislocation; initial or subsequent $   3,375.77
23650Closed treatment of shoulder dislocation, with manipulation; without anesthesia $   2,988.00
23655Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia $   1,428.00
23700 $   1,068.90
23931 $   2,771.03
24640Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation $   1,643.81
25560 $   4,940.83
25605 $   3,323.33
26605 $   4,967.57
26641Closed treatment of carpometacarpal dislocation, thumb, with manipulation $   1,164.00
26700 $   2,828.27
26720TREAT FINGER FRACTURE EACH $   4,857.31
26735 $   7,035.95
26750 $      942.36
26770 $   2,988.00
26775 $   3,371.27
27372Removal of foreign body, deep, thigh region or knee area $   1,128.67
27750TREATMENT OF TIBIA FRACTURE $   4,365.19
28160 $   1,092.36
28190REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS $   1,694.40
28193 $   5,268.14
28490 $   1,157.24
28510TREATMENT OF TOE FRACTURE $   2,400.84
28515Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each $   2,988.30
29105Application of long arm splint (shoulder to hand) $   1,688.57
29125Application of short arm splint (forearm to hand); static $   1,463.46
29126SHORT ARM SPLINT DYNAMIC $   1,301.12
29130Application of finger splint; static $      910.12
29131Application of finger splint; dynamic $   1,432.66
29505LONG LEG SPLINT THIGH ANKLE/TOES $   1,744.67
29515Application of short leg splint (calf to foot) $   1,463.39
29550 $      367.08
30300Removal foreign body, intranasal; office type procedure $   3,953.88
30901Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method $   1,694.40
30903Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method $   1,252.30
36000 $      120.00
36415Vein Puncturing $         83.00
36416 $         94.00
36556 $   2,107.67
36573Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation; age 5 years or older $   5,689.45
36585 $   3,218.03
36589Removal of tunneled central venous catheter, without subcutaneous port or pump $   1,308.53
40804Removal of embedded foreign body, vestibule of mouth; simple $   3,624.82
42809Removal of foreign body from pharynx $      612.00
43752Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report) $      766.27
43753 $   1,055.56
43830Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) $   1,668.00
46050 $   5,816.05
51700Bladder irrigation, simple, lavage and/or instillation $      896.36
51701 $      456.00
51702Insertion of temporary indwelling bladder catheter; simple (eg, Foley) $   1,453.50
54060Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision $   2,196.59
54220 $   5,244.00
54520 $   2,027.46
55899Unlisted procedure, male genital system $   3,000.00
56405Incision and drainage of vulva or perineal abscess $      811.20
56420 $   2,412.42
62270 $   1,220.40
64400N BLOCK INJ TRIGEMINAL $   2,202.74
64450Injection(s), anesthetic agent(s) and/or steroid; other per… $      634.93
64451Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) $   1,530.87
65205Removal of foreign body, external eye; conjunctiva superficial $      952.78
65210Removal foreign body external eye conjunctiva embedded $   1,143.88
65220Removal of foreign body, external eye; corneal, without sli… $   1,428.00
65222Removal of foreign body, external eye; corneal, with slit lamp $   1,188.00
69200REMOVAL OF FOREIGN BODY OF EAR XTRNL AUD CANAL W/O ANES $   2,311.93
69205Removal foreign body from external auditory canal; with general anesthesia $   2,232.76
69209Removal impacted cerumen using irrigation/lavage, unilateral $   1,694.91
69210Removal impacted cerumen requiring instrumentation, unilateral $   2,311.93
69399 $      252.00
70100Radiologic examination, mandible; partial, less than 4 views $   2,627.56
70110Radiologic examination, mandible 4 views $   1,231.16
70140Radiologic examination, facial bones; less than 3 views $   2,268.58
70150Radiologic examination, facial bones; less than 3 views $   2,460.00
70160Radiologic examination, nasal bones, complete, minimum of 3 views $   3,168.00
70210RADEX SINUSES PARANSL < 3 VIEWS $      461.74
70220Radiologic examination, sinuses, paranasal, complete, minimum of 3 views $   2,264.40
70250 $   1,365.54
70260RADEX SKL COMPL MINIMUM 4 VIEWS $   2,760.00
70330X-RAY EXAM OF JAW JOINTS $      743.59
70360Radiologic examination; neck, soft tissue $   3,000.00
70450Computed tomography, head or brain; without contrast material $   5,760.00
70460CT HEAD/BRN C+ MATRL $   4,987.14
70470CT HEAD/BRN C-/C+ $   5,868.56
70480CT ORBIT SELLA/POST FOSSA/EAR C-MATRL $   5,520.00
70481CT ORBIT SELLA/POST FOSSA/EAR C+ MATRL $   6,193.20
70482Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections $   7,800.70
70486Computed tomography, maxillofacial area; without contrast material $   6,720.82
70487CT MAXLFCL AREA C+ MATRL $   7,920.70
70488Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections $   6,481.07
70490Computed tomography, soft tissue neck; without contrast material $   6,240.00
70491CT SOFT TISS NCK C+ MATRL $   6,600.71
70492Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections $10,201.13
70496Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing $   7,633.15
70498Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing $   7,315.73
71045Radiologic examination, chest; single view $   2,460.00
71046Chest X-Ray 2 Views $   2,700.00
71047Radiologic examination, chest; 3 views $   1,668.13
71048Radiologic examination, chest; 4 or more views $   1,765.19
71100RADEX RIBS UNI 2 VIEWS $   1,548.53
71101Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views $   2,760.00
71110Radiologic examination, ribs, bilateral; 3 views $   3,000.00
71111Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views $   3,024.00
71120Radiologic examination; sternum, minimum of 2 views $   2,220.00
71250Computed tomography, thorax, diagnostic; without contrast material $   5,640.00
71260CT SCAN chest (thorax); with contrast material(s) $   5,880.00
71275Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing $   5,760.00
72040Radiologic examination, spine, cervical; 2 or 3 views $   2,760.00
72050Radiologic examination, spine, cervical; 4 or 5 views $   2,861.44
72052RADEX SPI CRV COMPL W/OBLQ&FLEXION&/XTN STDS $   3,684.06
72070Radiologic examination, spine; thoracic, 2 views $   2,640.00
72072RADEX SPI THRC 3 VIEWS $   2,481.76
72074Radiologic examination, spine; thoracic, minimum of 4 views $      798.78
72082Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views $   1,920.00
72100Radiologic examination, spine, lumbosacral; 2 or 3 views $   3,000.00
72110Radiologic examination, spine, lumbosacral; minimum of 4 views $   3,348.53
72114 $   2,481.76
72120RADEX SPI LUMBOSAC BENDING MINIMUM 4 VIEWS $   1,774.43
72125Computed tomography, cervical spine; without contrast material $   7,428.53
72126CT CRV SPI C+ MATRL $   9,227.58
72127CT CRV SPI C-/C+ $   7,932.64
72128Computed tomography, thoracic spine; without contrast material $   6,420.00
72129Computed tomography, thoracic spine; with contrast material $   6,804.00
72130Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections $   7,187.64
72131Computed tomography, lumbar spine; without contrast material $   6,804.00
72132CT LMBR SPI C+ MATRL $   8,486.54
72133Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections $   8,298.38
72170RADEX PELVIS 1/2 VIEWS $   1,860.00
72190Radiologic examination, pelvis; complete, minimum of 3 views $   3,108.90
72192Computed tomography, pelvis; without contrast material $   6,120.00
72193CT PELVIS C+ MATRL $   6,240.00
72194CT PELVIS C-/C+ $   7,312.01
72220Radiologic examination, sacrum and coccyx, minimum of 2 views $   2,208.00
73000Radiologic examination; clavicle, complete $   2,592.00
73010Radiologic examination; scapula, complete $   1,188.00
73020Radiologic examination, shoulder; 1 view $   2,988.26
73030Radiologic examination, shoulder; complete, minimum of 2 views $   3,120.00
73060Radiologic examination; humerus, minimum of 2 views $   2,700.52
73070Radiologic examination, elbow; 2 views $   2,268.50
73080Radiologic examination, elbow; complete, minimum of 3 views $   3,024.00
73090Radiologic examination; forearm, 2 views $   3,024.00
73100 $   2,147.36
73110Radiologic examination, wrist; complete, minimum of 3 views $   3,024.00
73120 $   2,628.53
73130Radiologic examination, hand; minimum of 3 views $   2,988.90
73140Radiologic examination, finger(s), minimum of 2 views $   2,988.26
73200CT UXTR C-MATRL $10,211.56
73201Computed tomography, upper extremity; with contrast material(s) $   9,690.50
73501 $   1,860.00
73502Hip, unilateral, with pelvis when performed; 2-3 views $   3,024.00
73503 $   3,024.00
73521Radiologic examination, hips, bilateral, with pelvis when performed; 2 views $   2,279.33
73522Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views $   2,370.00
73523Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views $   2,352.14
73552Radiologic examination, femur; minimum 2 views $   2,090.54
73560Radiologic examination, knee; 1 or 2 views $   1,920.00
73562Radiologic examination, knee; 3 views $   3,024.00
73564Radiologic examination, knee; complete, 4 or more views $   3,908.27
73565Radiologic examination, knee; both knees, standing, anteroposterior $      533.72
73590Radiologic examination; tibia and fibula, 2 views $   3,024.00
73600RADEX ANKLE 2 VIEWS $   2,232.29
73610Radiologic examination, ankle; complete, minimum of 3 views $   3,428.27
73620RADEX FOOT 2 VIEWS $   2,189.33
73630Radiologic examination, foot; complete, minimum of 3 views $   3,132.84
73650Radiologic examination; calcaneus, minimum of 2 views $   3,024.00
73660XR RT TOE(S) 2 OR MORE VIEWS $   1,800.00
73700Computed tomography, lower extremity; without contrast material $   5,424.72
73701Computed tomography, lower extremity; with contrast material(s) [Toggle Dictionary Definitions] $   7,770.00
73721 $   8,412.53
74018Radiologic examination, abdomen; 1 view $   1,800.00
74019Radiologic examination, abdomen; 2 views $   1,800.53
74021Radiologic examination, abdomen; 3 or more views $   2,268.56
74022Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest $   2,268.52
74150“Computed tomography, abdomen; without contrast material
 $   8,060.12
74160“Computed tomography, abdomen; with contrast material(s)
 $   8,179.73
74170CT ABD C-/C+ $10,188.54
74174Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing $   8,528.40
74175Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing $10,908.53
74176Computed tomography, abdomen and pelvis; without contrast material $   9,850.69
74177CT Scan , abdomen and pelvis; with contrast material(s) $   9,850.69
74178CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS $   9,708.53
75635 $   7,622.88
76010Radiologic examination from nose to rectum for foreign body, single view, child $      639.29
76380Other Diagnostic Radiology (Diagnostic Imaging) Related Procedures $   3,152.33
76536Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation $   2,227.69
76641Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete $   1,068.00
76642Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited $   1,643.33
76700Ultrasound, abdominal, real time with image documentation; complete $   1,642.80
76705Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) $   3,660.26
76770Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete $   3,253.09
76775Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited $   1,236.13
76801Ultrasound, pregnant uterus, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation $   2,724.00
76805US PG UTER F&MAT AFTER 1ST TRI 1/1ST GESTATION $   3,664.42
76810Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal $   1,706.20
76815ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTAT… $      517.01
76816Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters $   1,974.24
76817Ultrasound, pregnant uterus, real time with image documentation, transvaginal $   2,856.53
76830Ultrasound, transvaginal $   3,221.30
76856Ultrasound, pelvic (nonobstetric), real time with image documentation; complete $   4,247.53
76857Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) $   2,352.29
76870Ultrasound, scrotum and contents $   3,414.24
76882Ultrasound, limited, joint or other nonvascular extremity structure (eg muscle, nerve, other soft-tissue structure, or soft-tissue mass, real-time with image documentation $   1,188.00
76937 $      911.77
76999 $   1,595.56
80047METABOLIC PANEL IONIZED CA $         13.73
80048BASIC METABOLIC PANEL CALCIUM TOTAL $   2,022.24
80050GENERAL HEALTH PANEL $10,000.00
80051ELECTROLYTE PANEL $      540.00
80053COMPREHENSIVE METABOLIC PANNEL $   1,404.20
80061Lipid panel $      172.67
80069 $      147.94
80074 $      648.00
80076LFT ; Hepatic function panel $      780.00
80143 $      409.82
80162 $      561.46
80178 $      252.00
80179Salicylate $      431.56
80183Oxcarbazepine $      186.63
80305Drug test(s) $      582.00
80306Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (eg, immunoassay); (eg, dipsticks, cups, cards, cartridges), $      360.36
80307 $      360.36
80320 $      654.00
80329 $      588.00
81000Urinalysis , by dip stick or tablet reagent $      420.00
81001 $      330.00
81002 $      252.00
81003Urinalysis, by dip stick or tablet reagent for bilirubin, g. $         54.00
81007 $      101.24
81025Urine pregnancy test, by visual color comparison methods $      504.00
82010 $         65.56
82040Albumin; serum, plasma or whole blood $      180.00
82077 $      393.76
82135 $      138.00
82140 $      360.00
82150Amylase $      516.00
82247 $      164.40
82248Bilirubin; direct $      232.14
82270BLD OCLT PROXIDASE ACTV QUAL FECES 1 DETER $      660.00
82272 $         38.40
82274 $      498.96
82310 $      468.00
82533 $      138.00
82550Creatine kinase (CK), (CPK); total $      468.52
82553CKMB – CREATINE KINASE MB FXJ ONLY $      468.00
82565Creatinine; blood $      360.00
82570 $      102.00
82607Cyanocobalamin (Vitamin B-12) $      220.19
82627 $      204.28
82670 $      324.48
82728Ferritin $      179.56
82746 $      259.56
82747Folic acid; RBC $      211.02
82803 $      612.00
82945 $         59.92
82947Glucose; quantitative, blood (except reagent strip) $      468.52
82962Blood Sugar Test $      144.00
82977Glutamyltransferase, gamma (GGT) $      300.00
83001 $      660.64
83002 $      660.00
83010 $         54.00
83020 $      179.56
83036Hemoglobin; glycosylated (A1C) $      220.80
83520 $      393.76
83540 $      300.00
83550 $      881.47
83605LACTATE $      174.98
83690Lipase $   1,156.20
83735Magnesium $      600.00
83874MYOGLOBIN $      594.00
83880BNP – B TYPE NATRIURETIC PEPTIDE $      746.78
83921 $      324.00
83970 $      459.60
84075Phosphatase, alkaline $      610.20
84100Phosphorus inorganic (phosphate) $      240.00
84146 $      150.00
84155 $         31.20
84403 $      144.00
84425 $      976.31
84436 $   1,188.00
84439Thyroxine; free $      420.00
84443Thyroid stimulating hormone (TSH) $   1,188.00
84450 $      120.00
84460 $      127.82
84466Transferrin $      162.52
84479 $      336.00
84481 $      474.00
84484TROPONIN QUAN $      918.00
84520Urea nitrogen; quantitative $      468.52
84550URIC ACID BLOOD $      218.03
84600 $      428.40
84702Gonadotropin, chorionic (hCG); quantitative $      960.00
84703Human Chorionic Gonadotropin , pregnancy test $      139.24
85025complete blood count $   1,212.00
85060 $      503.56
85379Fibrin degradation products, D-dimer; quantitative $      966.00
85610PT – PROTHROMBIN TIME $      852.00
85652Sedimentation rate, erythrocyte; automated $      504.00
85730 $      108.00
86038 $      300.00
86039 $      254.45
86140C-reactive protein $      588.52
86141 $      960.00
86308Heterophile antibodies; screening $      660.00
86328Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus $      468.00
86431Rheumatoid factor; quantitative $      175.00
86592 $         97.56
86593 $         96.00
86677Antibody; Helicobacter pylori $      360.53
86694 $      128.27
86695 $      128.27
86696 $      202.80
86701 $      468.52
86703 $      270.54
86704 $      274.74
86706 $      244.87
86708 $      282.49
86709 $      121.61
86735 $      588.76
86757 $   1,075.73
86769SARS-COV-2 COVID-19 ANTIBODY $      260.10
86780 $      156.00
86803 $      325.36
86850 $      138.76
86900Blood typing, serologic; ABO $      504.00
86901Blood typing, serologic; Rh (D) $      468.15
87040Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) $   1,500.00
87045Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species $      648.30
87046Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate $      648.30
87070Culture, bacterial; any other source except urine, blood or… $      739.94
87077Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate $      385.40
87086CUL BACT QUAN COLONY CNT URINE $      348.00
87088 $      108.00
87102 $      191.75
87150 $      204.00
87177 $      214.06
87187Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate. $      355.36
87205Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types $      300.00
87206 $         48.00
87209 $      648.30
87210Smear, primary source with interpretation; wet mount for in… $      167.18
87255GENET VIRUS ISOLATE HSV $      790.80
87301Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay , enzyme-linked immunosorbent assay or semiquantitative; adenovirus enteric types $      588.00
87338H-pylori blood test $   1,527.73
87340 $      111.56
87341 $      378.76
87389Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result $      348.53
87420Infectious agent antigen detection by enzyme immunoassay techniqu $      360.35
87426Infectious agent antigen detection by immunoassay technique… $      816.53
87427 $      648.30
87428Infectious agent antigen detection by immunoassay technique,  severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B $   1,584.52
87480 $      467.56
87486Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique $      780.52
87491Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique $      588.00
87493 $      661.20
87505 $   2,925.01
87507 $   3,468.00
87510 $      457.69
87521 $      800.05
87522 $      462.67
87529Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique $   2,268.55
87541 $      204.00
87581Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique $      780.52
87591Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique $      588.00
87631Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus,  includes multiplex reverse transcription,, technique, multiple types or subtypes, 3-5 targets $   1,689.10
87633Infectious agent detection by nucleic acid,includes multiplex reverse transcription,when performed,and multiplex amplified probe technique,multiple types or sub types,12-25 targets $   2,988.00
87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique $      708.00
87651Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique $      319.70
87660 $      463.73
87661 $      428.40
87798Infectious agent detection by nucleic acid (DNA or RNA), no… $      660.52
87801Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique $   1,351.94
87804Infectious agent antigen detection by immunoassay with dire… $      427.39
87807Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus $      600.23
87880Rapid strep test $      984.00
87905 $      349.19
89051 $      660.00
89055 $      457.69
89060 $      347.56
90471IMADM PRQ ID SUBQ/IM NJXS 1 VACC $      433.20
90714Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use $      696.00
90715Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use $      588.52
91301Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use $         21.61
93000ECG ROUTINE ECG W/LEAST 12 LDS W/I&R $      294.49
93005Electrocardiogram (ECG or EKG) $      294.49
93010ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY EKG $      251.51
93040Rhythm ECG, 1-3 leads; with interpretation and report $      123.60
93041RHYTHM ECG 1-3 LDS TRCG ONLY W/O I&R $      180.00
93042Rhythm ECG, 1-3 leads; interpretation and report only $      180.00
93227ECG MONIT/REPRT UP TO 48 HRS $      308.45
93306Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography $   4,153.81
93308Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study $   4,241.51
93880Duplex scan of extracranial arteries; complete bilateral study $   8,364.62
93925Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study $   3,564.53
93926Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study $   3,570.40
93931 $   3,060.00
93970Duplex scan of extremity veins including responses to compr… $   3,228.52
93971Duplex scan of extremity veins including responses to compr… $   4,382.58
93975Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study $   8,376.88
93976Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study $   2,268.30
94010 $      631.10
94640Pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, $      348.52
94760Noninvasive ear or pulse oximetry for oxygen saturation; single determination $         69.63
94761Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise) $         88.80
96360Intravenous infusion, hydration; initial, 31 minutes to 1 hour725.25
96361Intravenous infusion, hydration; each additional hour449
96365Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour711
96366Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour700
96367Intravenous infusion, Sequential to 1 hr990
96368THER/DIAG CONCURRENT INF353.39
96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular164.05
96374IV PUSH THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG357
96375IV PUSH ADD DRUG THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG374
96376Sequential intravenous push of the same substance/drug289
97597DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS2512.03
97605Pressure wound therapy168
99000Specimen handling95.82
99001127.82
99024587.56
99053Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service491.56
99070SUPPLIES&MATERIALS PRV BY PHYS >&ABOVE73.45
99072Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s)198.53
99217Observation Care Discharge1800
99218Initial Hospital Observation Care Services2988.26
99219initial observation care that involves high-level services provided on a daily basis2219.62
99220Initial Observation Care3228.14
99221Initial hospital inpat or obs care, per day, for E&M of a pat, which requires an examination and moder level of MDM  on the date of the encounter for code selection, 40 mins  must be met or exceeded.1911.32
99222Initial hospital inpat or obs care, per day, for E&M of a pat, which requires an examination and moder level of MDM  on the date of the encounter for code selection, 55 mins  must be met or exceeded.2974.73
99223Initial hospital inpat or obs care, per day, for E&M of a pat, which requires an examination and moder level of MDM  on the date of the encounter for code selection, 75 mins  must be met or exceeded3974.27
99231Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 25 minutes must be met or exceeded.1135.67
99232Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded.1808.04
99233Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded.2719.58
99234OBSERVATION ADMIT/DISCHARGE – Level 12436.54
99235OBSERVATION ADMIT/DISCHARGE – Level 22508.14
99236OBSERVATION ADMIT/DISCHARGE – Same Day Greater than 8 hours2239.76
99238Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter1846.57
99239Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter2619.26
99281EMER DEPT SELF LIMITED/MINOR708.13
99282MODERATE SEVERITY1176.91
99283Emergency department visit for the evaluation and management , the presenting problem(s) are of moderate severity.2988
99284Emergency department visit for the evaluation and management of a patient,presenting problem(s) are of high severity, and require urgent evaluation4334.4
99285EMERGENCY DEPT VISIT HI MDM5520
99291CRITICAL CARE (30-74 MIN)7602
99292CRITICAL CARE (EACH ADDITIONAL 30 MIN)3712.97
99356Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour2377.02
99357Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes130.93
99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes291.95
99407Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes393.61
99418PROLNG IP/OBS E/M EA 15 MIN118.02
A4208IM MEDS-BUNDLE18
A42095+ CC STERILE SYRINGE&NEEDLE19
A4215Needle any size56
A4216STERILE WATER/SALINE, 10 ML11
A4217STERILE WATER/SALINE, 500 ML120.3
A4222INFUSION SUPPLIES WITH PUMP73.48
A4244ALCOHOL OR PEROXIDE PER PINT131.04
A424511.63
A4246Betadine or pHisoHex solution, per pint201.6
A4247BETADINE/IODINE SWABS/WIPES60.76
A4314123.6
A4320IRRIGATION TRAY118.36
A4327FEM URINARY COLLECT DEV CUP116.52
A4334FOLEY CATHETER LEG STRAP26.22
A4340FOLEY CATH 2-WAY W/ 5CC BALLOON 20 FR  ( IF foley catheter insert)89.42
A4364Adhesive, liquid or equal, any type, per oz102.8
A4450LACERATION TRAY17
A4452Tape, waterproof, per 18 square inches15.61
A4467straps32
A4550150
A4556ELECTRODES, PAIR55
A4565SLINGS48
A4570150
A4590648.3
A4606OXYGEN PROBE USED W OXIMETER106.8
A4615CANNULA NASAL111.6
A4620VARIABLE CONCENTRATION MASK106.8
A4649Suture39
A4770BLOOD COLLECTION TUBE/VACUUM60.11
A4930STERILE, GLOVES PER PAIR95.82
A62160.17
A6219GAUZE <= 16 SQ IN W/BORDER143.56
A6250SKIN SEAL PROTECT MOISTURIZR52
A6260WOUND CLEANSERS ANY TYPE ANY SIZE5
A626610.8
A6402Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing15
A6413ADHESIVE BANDAGE FIRSTAID TYPE EA12
A6448Ace wrap15
A6449Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard118.36
A6450LT COMPRES BAND >=5/YD26.14
A645427.6
A7000DISPOSABLE CANISTER FOR PUMP75.74
A7003NEBULIZER ADMINISTRATION SET95.82
A7015AEROSOL MASK USED W NEBULIZE59.63
A9150Administrative, Miscellaneous and Investigational37.2
A927347.59
A9284458.4
C9803Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source251.56
E0114CRUTCH UNDERARM PAIR NO WOOD200.4
E0116CRUTCH UNDERARM EACH NO WOOD77
E0325URINAL MALE JUG-TYPE9.59
E0431Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing95
G0168360
G0316Prolonged hospital inpatient or observation care evaluation and management service(s)  each additional 15 minutes by the physician118.02
G0378Observation initial 1 hour2268
G2023Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source300.16
G6039ACETAMINOPHEN162.22
J0131Injection, acetaminophen, 10 mg42.79
J013236
J0153ADENOSINE INJ 1MG349.12
J0171Injection, Adrenalin, epinephrine, 0.1 mg57.6
J0282Injection, amiodarone hydrochloride, 30 mg46.8
J029060.72
J029560
J0360Injection, hydralazine hcl, up to 20 mg253.12
J0456Injection, azithromycin, 500 mg119.92
J0461Injection, atropine sulfate, 0.01 mg35.59
J0500Injection, dicyclomine hcl, up to 20 mg385.21
J055861.12
J0561Injection, penicillin G benzathine, 100, 000 units107.56
J0610Injection, calcium gluconate, per 10 ml50.03
J061255.2
J061354.12
J0665INJ, BUPIVACAINE, NOS, 0.5MG15.3
J0690Injection, cefazolin sodium, 500 mg84
J0692Injection, cefepime hydrochloride, 500 mg119.33
J0694147.6
J0696Injection, ceftriaxone sodium, per 250 mg106.8
J069759.33
J0735154.8
J0736Injection, clindamycin phosphate, 300 mg41.51
J0744Injection, ciprofloxacin for intravenous infusion, 200 mg235.58
J0780Injection, prochlorperazine, up to 10 mg95.82
J084046.19
J102047.56
J1030METHYLPREDNISOLONE 40 MG INJ83.82
J1040METHYLPREDNISOLONE 80 MG INJ115.82
J1094348.52
J1100DEXAMETHASONE 1mg44.35
J1110204
J1160DIGOXIN INJECTION82.75
J1165123.91
J1170Injection, hydromorphone, up to 4 mg181.12
J1200Injection, diphenhydramine HCl, up to 50 mg71.56
J126546.19
J1335159.42
J145059.56
J1580109.79
J1610Injection, glucagon hydrochloride, per 1 mg1512.43
J1630Injection, haloperidol, up to 5 mg104.12
J1631Injection, haloperidol decanoate, per 50 mg59.65
J164231.81
J1644Injection, heparin sodium, per 1000 units63.6
J1650Injection, enoxaparin sodium, 10 mg59.92
J174135.39
J1790“Injection, droperidol, up to 5 mg
49.96
J1800PROPRANOLOL INJECTION223.4
J181038.09
J1815Injection, insulin, per 5 units51.6
J181735.77
J1836Injection, metronidazole, 10 mg33.19
J1885Injection, ketorolac tromethamine, per 15 mg59.53
J192031.38
J1940Injection, furosemide, up to 20 mg52.57
J1956Injection, levofloxacin, 250 mg150
J1980348.52
J2001Injection, lidocaine HCl for intravenous infusion, 10 mg47.75
J2020126.38
J2060Injection, lorazepam, 2 mg47.75
J2175115.62
J218047.59
J2250Injection, midazolam hydrochloride, per 1 mg63.6
J2270MORPHINE SULFATE INJECTION78.76
J227450.03
J2310Injection, naloxone hydrochloride, per 1 mg95.92
J235870.93
J2360Injection, orphenadrine citrate, up to 60 mg52.55
J2405ONDANSETRON HCL INJECTION69.17
J2543PIPERACILLIN/TAZOBACTAM131.2
J2550Injection, promethazine HCl, up to 50 mg71.92
J2650PREDNISOLONE ACETATE INJ115.33
J270445.37
J2765Injection, metoclopramide HCl, up to 10 mg40.19
J278028.09
J280070.36
J2920Injection, methylprednisolone sodium succinate, up to 40 mg61.79
J2930Injection, methylprednisolone sodium succinate, up to 125 mg65.33
J2997708.76
J3010FENTANYL CITRATE INJECITON 0.1MG95.33
J3030SUMATRIPTAN SUCCINATE / 6 MG239.92
J3105179.56
J326065.56
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg34.93
J3360Injection, diazepam, up to 5 mg46.27
J3370VANCOMYCIN Inj – 500MG74.4
J3410“Injection, hydroxyzine HCl, up to 25 mg
55.87
J341180.99
J343059.95
J3475Injection, magnesium sulfate, per 500 mg85.79
J3480INJ POTASSIUM CHLORIDE127.07
J3486123.16
J3490DRUGS UNCLASSIFIED INJECTION185.92
J3490G123.6
J7030Infusion, normal saline solution , 1000 cc78.13
J7040Infusion, normal saline solution, sterile (500 ml=1 unit)48
J70425% dextrose/normal saline (500 ml = 1 unit)56.93
J7050Infusion, normal saline solution , 250 cc68.4
J70605% dextrose/water (500 ml = 1 unit)57.52
J7070D5W INFUSION59.99
J7120RINGERS LACTATE INFUSION59.87
J71215% dextrose in lactated ringers infusion, up to 1000 cc64.67
J750919.63
J7510Prednisolone oral, per 5 mg6
J75126
J7610Albuterol, inhalation solution, compounded product, administered through DME, concentrated form, 1 mg91.32
J761227.6
J7613ALBUTEROL NON-COMP UNIT47.33
J761556.59
J7620ALBUTEROL IPRATROP NON-COMP52.43
J7626Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.5 mg51.6
J763742.53
J7644Ipratropium bromide, inhalation solution, compounded product, administered through DME, unit dose form, per milligram71.56
J7645Ipratropium bromide, inhalation solution, compounded product, administered through DME, unit dose form, per milligram27.61
J768230
J7699Noc drugs, inhalation solution administered through DME48.59
J849834.8
J8499“Prescription drug, oral, non chemotherapeutic, NOS
31
J8499AFCEPHALEXIN 500MG19.93
J8499ANCYCLOBENZAPRINE HYDROCHLORIDE19.93
J8499DAMOXICILLIN SUSPENSION 400MG19.93
J8499FIBUPROFEN 600MG19.93
J8499V180
J8540DEXAMETHASONE ORAL 0.25 MG11
J926054.82
K0730Inhalation drug delivery system151
L0120CERV FLEXIBLE NON-ADJUSTABLE1038
L0172Collar689.63
L0174360
L1830Knee – KO IMMOBILIZER CANVAS LONGIT201
L18331503.6
L326063
L3650Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf89
L3809686.4
L4350344.4
L4361745.2
L4387Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf182.79
L4631ankle boot357.6
M02221440
M02391080
M02431440
M02451080
M02471440
Q0144Azithromycin dihydrate, oral, capsules/powder, 1 gram272
Q016311
Q0169Promethazine hydrochloride, 12.5 mg, oral,106.38
Q02440.01
Q40461404.2
Q4049123.6
Q4051SPLINT SUPPLIES MISC288.83
Q9962228
Q9963246.55
Q9965Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml444
Q9966Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml480
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml444
S0020Injection, bupivacaine hydrochloride, 30 ml480
S0028PEPCID – INJECTION, FAMOTIDINE, 20 MG64.44
S0030Injection, metronidazole, 500 mg63.6
S0039INJECTION, SULFAMETHOXAZOLE328.22
S0077Injection, clindamycin phosphate, 300 mg59.56
S0119Ondansetron, oral, 4 mg71
S0164Injection, pantoprazole sodium, 40 mg58.57
S0181ONDANESTRON HCA, ORAL 4MG5.1
S018247.59
S0630REMOVAL OF SUTURES303.6
S1015IV TUBING EXTENSION SET49.73
S5000PRESCRIPTION DRUG, GENERIC16.27
S5001NON-GENERIC DRUG35.53
S50105% DEXTROSE AND 0.45% SALINE8.04
S50125% DEXTROSE WITH POTASSIUM72
S501319.2
S810049.2
S810175.6
S843067.2
S843154
S8451250.8
U0002coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets),792
U0003Infectious agent detection by nucleic acid (DNA or RNA); se…708
U0005INFEC AGEN DETEC AMPLI PROBE324

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