Your Billing & Insurance Details

Billing Overview

Montrose Emergency Room is a freestanding emergency room licensed by the State of Texas.

We are not an urgent care clinic. We are a full-service freestanding emergency room. Because of this, we must bill your insurance emergency room benefits.

Montrose Emergency Room is happy to bill your insurance company and works with all major private insurance plans. We are unable to accept government-sponsored insurance at this time, such as Medicare, Medicaid, CHIP or Tri-Care.

What happens at the time of my visit?

Montrose Emergency Room will collect the emergency room co-pay, and your insurance will be billed as per your emergency room benefits. Patients may also elect to be seen as self-pay patients.

What happens after my visit?

Your insurance company will receive two separate claims: one claim for the facility and one claim for the physician. Your insurance company will not be charged separately for radiology, pathology or cardiology overhead as with hospital-based ERs. These charges are included in your facility bill.

Should you have any financial responsibility after your insurance company processes the claim, you will be responsible for those charges. If you disagree with the final outcome of the claim processing, please call our billing company for assistance.

Out-of-Network & Texas Insurance Law

Please be advised that Montrose Emergency Room is not contracted with any specific commercial insurance providers and is considered an out-of-network provider.

However, if you are judged to have a medical emergency, Texas insurance laws require commercial insurance companies to pay for all necessary emergency medical services, including those furnished by out-of-network providers, at in-network rates.

The determination of what constitutes an emergency medical condition is based on a prudent layperson definition, not the arbitrary definition of the insurance companies.

We cannot anticipate accurately what specific rates your carrier will apply for individual services rendered.

Questions About Your Bill?

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.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

Your Protections & How to Report a Problem

When balance billing isn’t allowed, you also have these protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed

Contact the federal No Surprises Help Desk at (800) 985-3059 or the Texas Department of Insurance at (800) 252-3439.

Visit cms.gov/nosurprises/consumers for more information about your rights under federal law. Visit tdi.texas.gov for more information about your rights under Texas law.

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

Chargemaster (CDM) & Fees

Select a section below to view Montrose Emergency Room’s standard facility fees, physician fees and full chargemaster (CDM). Questions about a charge? Contact our billing company, Simplex Med Billing, at (713) 457-4600.

Facility Fees / Tarifas

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

Facility Fee by Level of Service / Tarifa por Nivel de Servicio

Level of Service / Nivel de Servicio	Facility Fee / Tarifa
EMERGENCY DEPT VISIT – LEVEL 1VISITA DE EMERGENCIA – NIVEL 1	$394.90
EMERGENCY DEPT VISIT – LEVEL 2VISITA DE EMERGENCIA – NIVEL 2	$954.49
EMERGENCY DEPT VISIT – LEVEL 3VISITA DE EMERGENCIA – NIVEL 3	$1,763.85
EMERGENCY DEPT VISIT – LEVEL 4VISITA DE EMERGENCIA – NIVEL 4	$3,232.38
EMERGENCY DEPT VISIT – LEVEL 5VISITA DE EMERGENCIA – NIVEL 5	$4,070.86

Range of Possible Facility Fees / Rango de Posibles Cuotas

Level of Service / Nivel de Servicio	Range of Possible Facility Fees for Service / Rango de Posibles Cuotas por el Servicio
EMERGENCY DEPT VISIT – LEVEL 1VISITA DE EMERGENCIA – NIVEL 1	Less than $650
EMERGENCY DEPT VISIT – LEVEL 2VISITA DE EMERGENCIA – NIVEL 2	$650 – $2,500
EMERGENCY DEPT VISIT – LEVEL 3VISITA DE EMERGENCIA – NIVEL 3	$2,500 – $13,000
EMERGENCY DEPT VISIT – LEVEL 4VISITA DE EMERGENCIA – NIVEL 4	$4,500 – $35,00
EMERGENCY DEPT VISIT – LEVEL 5VISITA 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 1VISITA DE EMERGENCIA – NIVEL 1	$220.00
EMERGENCY DEPT VISIT – LEVEL 2VISITA DE EMERGENCIA – NIVEL 2	$310.04
EMERGENCY DEPT VISIT – LEVEL 3VISITA DE EMERGENCIA – NIVEL 3	$590.40
EMERGENCY DEPT VISIT – LEVEL 4VISITA DE EMERGENCIA – NIVEL 4	$820.40
EMERGENCY DEPT VISIT – LEVEL 5VISITA DE EMERGENCIA – NIVEL 5	$1,020.60
INITIAL OBSERVATION CARE – LEVEL 1CUIDADO DE OBSERVACION INICIAL – NIVEL 1	$866.80
INITIAL OBSERVATION CARE – LEVEL 2CUIDADO DE OBSERVACION INICIAL – NIVEL 2	$898.70
INITIAL OBSERVATION CARE – LEVEL 3CUIDADO DE OBSERVACION INICIAL – NIVEL 3	$917.40
OBSERVATION CARE DISCHARGEALTA DE OBSERVACION	$1,145.36
OBSERVATION ADMIT/DISCHARGE – LEVEL 1ADMISION DE OBSERVACION/DISCARGA – NIVEL 1	$1,169.17
OBSERVATION ADMIT/DISCHARGE – LEVEL 2ADMISION DE OBSERVACION/DISCARGA – NIVEL 2	$1,190.39
OBSERVATION ADMIT/DISCHARGE – LEVEL 3ADMISION DE OBSERVACION/DISCARGA – NIVEL 3	$1,198.28

Full Chargemaster (CDM) – 750 Items

750 items

Code	Service Description	Charge Amount
0202U	Infectious 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
0240U	Infectious disease (viral respiratory tract infection)	$1,516.19
0241U	Infectious disease (viral respiratory tract infection), pat...	$2,028.59
10021	FINE NEED	$1,800.26
10060	Incision and drainage of abscess, simple or single	$1,892.75
10061	Incision and drainage of abscess, complicated or multiple	$3,117.22
10080	INCISION & DRAINAGE PILONIDAL CYST SIMPLE	$3,043.20
10081	INCISION & DRAINAGE PILONIDAL CYST COMPLICATED	$3,449.24
10120	Incision and removal of foreign body, subcutaneous tissues; simple	$1,803.60
10121	INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMP	$3,237.60
10180	incision and drainage, complex, postoperative wound infection	$2,160.00
11042	debridement, subcutaneous tissue	$3,043.20
11056	TRIM SKIN LESIONS 2 TO 4	$45.00
11106	Incisional biopsies	$1,892.75
11200	Removal of Skin Tags Procedures	$532.49
11719	Trimming of nondystrophic nails, any number	$2,268.55
11730	Avulsion of nail plate, partial or complete, simple; single	$1,150.00
11740	Evacuation of subungual hematoma	$1,380.00
11750	Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal	$3,043.20
11900	Injection, intralesional; up to and including 7 lesions	$376.80
11982	Removal, non-biodegradable drug delivery implant.	$1,380.00
12001	Simple 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
12002	Simple 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
12004	Simple 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
12005	simple 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
12011	Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less	$1,838.32
12013	Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm	$2,361.78
12014	Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm	$2,452.15
12015	Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm	$3,062.90
12016	Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm	$4,243.88
12018	RPR F/E/E/N/L/M >30.0 CM	$2,133.66
12020	Treatment of superficial wound dehiscence; simple closure	$3,109.54
12031	INTMD RPR S/A/T/EXT 2.5 CM/<	$1,689.63
12032	intermediate 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
12042	REPAIR (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
13153	CMPLX 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
16030	Dressings and/or debridement of partial-thickness burns, initial or subsequent	$3,802.85
17250	—	$1,119.60
19000	—	$3,120.00
20520	Removal of foreign body in muscle or tendon sheath; simple	$5,029.91
20552	Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)	$1,220.71
20600	—	$1,220.71
20605	Arthrocentesis, aspiration (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance.	$1,100.00
20610	Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance	$1,532.16
20611	Arthrocentesis, 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
20612	Aspiration and/or injection of ganglion cyst(s) any location	$1,236.14
21320	—	$5,182.67
21480	Closed treatment of temporomandibular dislocation; initial or subsequent	$3,375.77
23650	Closed treatment of shoulder dislocation, with manipulation; without anesthesia	$2,988.00
23655	Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia	$1,428.00
23700	—	$1,068.90
23931	—	$2,771.03
24640	Closed 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
26641	Closed treatment of carpometacarpal dislocation, thumb, with manipulation	$1,164.00
26700	—	$2,828.27
26720	TREAT FINGER FRACTURE EACH	$4,857.31
26735	—	$7,035.95
26750	—	$942.36
26770	—	$2,988.00
26775	—	$3,371.27
27372	Removal of foreign body, deep, thigh region or knee area	$1,128.67
27750	TREATMENT OF TIBIA FRACTURE	$4,365.19
28160	—	$1,092.36
28190	REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS	$1,694.40
28193	—	$5,268.14
28490	—	$1,157.24
28510	TREATMENT OF TOE FRACTURE	$2,400.84
28515	Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each	$2,988.30
29105	Application of long arm splint (shoulder to hand)	$1,688.57
29125	Application of short arm splint (forearm to hand); static	$1,463.46
29126	SHORT ARM SPLINT DYNAMIC	$1,301.12
29130	Application of finger splint; static	$910.12
29131	Application of finger splint; dynamic	$1,432.66
29505	LONG LEG SPLINT THIGH ANKLE/TOES	$1,744.67
29515	Application of short leg splint (calf to foot)	$1,463.39
29550	—	$367.08
30300	Removal foreign body, intranasal; office type procedure	$3,953.88
30901	Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method	$1,694.40
30903	Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method	$1,252.30
36000	—	$120.00
36415	Vein Puncturing	$83.00
36416	—	$94.00
36556	—	$2,107.67
36573	Insertion 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
36589	Removal of tunneled central venous catheter, without subcutaneous port or pump	$1,308.53
40804	Removal of embedded foreign body, vestibule of mouth; simple	$3,624.82
42809	Removal of foreign body from pharynx	$612.00
43752	Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)	$766.27
43753	—	$1,055.56
43830	Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure)	$1,668.00
46050	—	$5,816.05
51700	Bladder irrigation, simple, lavage and/or instillation	$896.36
51701	—	$456.00
51702	Insertion of temporary indwelling bladder catheter; simple (eg, Foley)	$1,453.50
54060	Destruction 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
55899	Unlisted procedure, male genital system	$3,000.00
56405	Incision and drainage of vulva or perineal abscess	$811.20
56420	—	$2,412.42
62270	—	$1,220.40
64400	N BLOCK INJ TRIGEMINAL	$2,202.74
64450	Injection(s), anesthetic agent(s) and/or steroid; other per...	$634.93
64451	Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)	$1,530.87
65205	Removal of foreign body, external eye; conjunctiva superficial	$952.78
65210	Removal foreign body external eye conjunctiva embedded	$1,143.88
65220	Removal of foreign body, external eye; corneal, without sli...	$1,428.00
65222	Removal of foreign body, external eye; corneal, with slit lamp	$1,188.00
69200	REMOVAL OF FOREIGN BODY OF EAR XTRNL AUD CANAL W/O ANES	$2,311.93
69205	Removal foreign body from external auditory canal; with general anesthesia	$2,232.76
69209	Removal impacted cerumen using irrigation/lavage, unilateral	$1,694.91
69210	Removal impacted cerumen requiring instrumentation, unilateral	$2,311.93
69399	—	$252.00
70100	Radiologic examination, mandible; partial, less than 4 views	$2,627.56
70110	Radiologic examination, mandible 4 views	$1,231.16
70140	Radiologic examination, facial bones; less than 3 views	$2,268.58
70150	Radiologic examination, facial bones; less than 3 views	$2,460.00
70160	Radiologic examination, nasal bones, complete, minimum of 3 views	$3,168.00
70210	RADEX SINUSES PARANSL < 3 VIEWS	$461.74
70220	Radiologic examination, sinuses, paranasal, complete, minimum of 3 views	$2,264.40
70250	—	$1,365.54
70260	RADEX SKL COMPL MINIMUM 4 VIEWS	$2,760.00
70330	X-RAY EXAM OF JAW JOINTS	$743.59
70360	Radiologic examination; neck, soft tissue	$3,000.00
70450	Computed tomography, head or brain; without contrast material	$5,760.00
70460	CT HEAD/BRN C+ MATRL	$4,987.14
70470	CT HEAD/BRN C-/C+	$5,868.56
70480	CT ORBIT SELLA/POST FOSSA/EAR C-MATRL	$5,520.00
70481	CT ORBIT SELLA/POST FOSSA/EAR C+ MATRL	$6,193.20
70482	Computed 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
70486	Computed tomography, maxillofacial area; without contrast material	$6,720.82
70487	CT MAXLFCL AREA C+ MATRL	$7,920.70
70488	Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections	$6,481.07
70490	Computed tomography, soft tissue neck; without contrast material	$6,240.00
70491	CT SOFT TISS NCK C+ MATRL	$6,600.71
70492	Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections	$10,201.13
70496	Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing	$7,633.15
70498	Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing	$7,315.73
71045	Radiologic examination, chest; single view	$2,460.00
71046	Chest X-Ray 2 Views	$2,700.00
71047	Radiologic examination, chest; 3 views	$1,668.13
71048	Radiologic examination, chest; 4 or more views	$1,765.19
71100	RADEX RIBS UNI 2 VIEWS	$1,548.53
71101	Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views	$2,760.00
71110	Radiologic examination, ribs, bilateral; 3 views	$3,000.00
71111	Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views	$3,024.00
71120	Radiologic examination; sternum, minimum of 2 views	$2,220.00
71250	Computed tomography, thorax, diagnostic; without contrast material	$5,640.00
71260	CT SCAN chest (thorax); with contrast material(s)	$5,880.00
71275	Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing	$5,760.00
72040	Radiologic examination, spine, cervical; 2 or 3 views	$2,760.00
72050	Radiologic examination, spine, cervical; 4 or 5 views	$2,861.44
72052	RADEX SPI CRV COMPL W/OBLQ&FLEXION&/XTN STDS	$3,684.06
72070	Radiologic examination, spine; thoracic, 2 views	$2,640.00
72072	RADEX SPI THRC 3 VIEWS	$2,481.76
72074	Radiologic examination, spine; thoracic, minimum of 4 views	$798.78
72082	Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views	$1,920.00
72100	Radiologic examination, spine, lumbosacral; 2 or 3 views	$3,000.00
72110	Radiologic examination, spine, lumbosacral; minimum of 4 views	$3,348.53
72114	—	$2,481.76
72120	RADEX SPI LUMBOSAC BENDING MINIMUM 4 VIEWS	$1,774.43
72125	Computed tomography, cervical spine; without contrast material	$7,428.53
72126	CT CRV SPI C+ MATRL	$9,227.58
72127	CT CRV SPI C-/C+	$7,932.64
72128	Computed tomography, thoracic spine; without contrast material	$6,420.00
72129	Computed tomography, thoracic spine; with contrast material	$6,804.00
72130	Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections	$7,187.64
72131	Computed tomography, lumbar spine; without contrast material	$6,804.00
72132	CT LMBR SPI C+ MATRL	$8,486.54
72133	Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections	$8,298.38
72170	RADEX PELVIS 1/2 VIEWS	$1,860.00
72190	Radiologic examination, pelvis; complete, minimum of 3 views	$3,108.90
72192	Computed tomography, pelvis; without contrast material	$6,120.00
72193	CT PELVIS C+ MATRL	$6,240.00
72194	CT PELVIS C-/C+	$7,312.01
72220	Radiologic examination, sacrum and coccyx, minimum of 2 views	$2,208.00
73000	Radiologic examination; clavicle, complete	$2,592.00
73010	Radiologic examination; scapula, complete	$1,188.00
73020	Radiologic examination, shoulder; 1 view	$2,988.26
73030	Radiologic examination, shoulder; complete, minimum of 2 views	$3,120.00
73060	Radiologic examination; humerus, minimum of 2 views	$2,700.52
73070	Radiologic examination, elbow; 2 views	$2,268.50
73080	Radiologic examination, elbow; complete, minimum of 3 views	$3,024.00
73090	Radiologic examination; forearm, 2 views	$3,024.00
73100	—	$2,147.36
73110	Radiologic examination, wrist; complete, minimum of 3 views	$3,024.00
73120	—	$2,628.53
73130	Radiologic examination, hand; minimum of 3 views	$2,988.90
73140	Radiologic examination, finger(s), minimum of 2 views	$2,988.26
73200	CT UXTR C-MATRL	$10,211.56
73201	Computed tomography, upper extremity; with contrast material(s)	$9,690.50
73501	—	$1,860.00
73502	Hip, unilateral, with pelvis when performed; 2-3 views	$3,024.00
73503	—	$3,024.00
73521	Radiologic examination, hips, bilateral, with pelvis when performed; 2 views	$2,279.33
73522	Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views	$2,370.00
73523	Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views	$2,352.14
73552	Radiologic examination, femur; minimum 2 views	$2,090.54
73560	Radiologic examination, knee; 1 or 2 views	$1,920.00
73562	Radiologic examination, knee; 3 views	$3,024.00
73564	Radiologic examination, knee; complete, 4 or more views	$3,908.27
73565	Radiologic examination, knee; both knees, standing, anteroposterior	$533.72
73590	Radiologic examination; tibia and fibula, 2 views	$3,024.00
73600	RADEX ANKLE 2 VIEWS	$2,232.29
73610	Radiologic examination, ankle; complete, minimum of 3 views	$3,428.27
73620	RADEX FOOT 2 VIEWS	$2,189.33
73630	Radiologic examination, foot; complete, minimum of 3 views	$3,132.84
73650	Radiologic examination; calcaneus, minimum of 2 views	$3,024.00
73660	XR RT TOE(S) 2 OR MORE VIEWS	$1,800.00
73700	Computed tomography, lower extremity; without contrast material	$5,424.72
73701	Computed tomography, lower extremity; with contrast material(s)	$7,770.00
73721	—	$8,412.53
74018	Radiologic examination, abdomen; 1 view	$1,800.00
74019	Radiologic examination, abdomen; 2 views	$1,800.53
74021	Radiologic examination, abdomen; 3 or more views	$2,268.56
74022	Radiologic 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
74170	CT ABD C-/C+	$10,188.54
74174	Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing	$8,528.40
74175	Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing	$10,908.53
74176	Computed tomography, abdomen and pelvis; without contrast material	$9,850.69
74177	CT Scan , abdomen and pelvis; with contrast material(s)	$9,850.69
74178	CT ABD & PELVIS W/O CONTRST 1+ BODY REGNS	$9,708.53
75635	—	$7,622.88
76010	Radiologic examination from nose to rectum for foreign body, single view, child	$639.29
76380	Other Diagnostic Radiology (Diagnostic Imaging) Related Procedures	$3,152.33
76536	Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation	$2,227.69
76641	Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete	$1,068.00
76642	Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited	$1,643.33
76700	Ultrasound, abdominal, real time with image documentation; complete	$1,642.80
76705	Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up)	$3,660.26
76770	Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete	$3,253.09
76775	Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited	$1,236.13
76801	Ultrasound, pregnant uterus, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation	$2,724.00
76805	US PG UTER F&MAT AFTER 1ST TRI 1/1ST GESTATION	$3,664.42
76810	Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal	$1,706.20
76815	ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTAT...	$517.01
76816	Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters	$1,974.24
76817	Ultrasound, pregnant uterus, real time with image documentation, transvaginal	$2,856.53
76830	Ultrasound, transvaginal	$3,221.30
76856	Ultrasound, pelvic (nonobstetric), real time with image documentation; complete	$4,247.53
76857	Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)	$2,352.29
76870	Ultrasound, scrotum and contents	$3,414.24
76882	Ultrasound, 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
80047	METABOLIC PANEL IONIZED CA	$13.73
80048	BASIC METABOLIC PANEL CALCIUM TOTAL	$2,022.24
80050	GENERAL HEALTH PANEL	$10,000.00
80051	ELECTROLYTE PANEL	$540.00
80053	COMPREHENSIVE METABOLIC PANNEL	$1,404.20
80061	Lipid panel	$172.67
80069	—	$147.94
80074	—	$648.00
80076	LFT ; Hepatic function panel	$780.00
80143	—	$409.82
80162	—	$561.46
80178	—	$252.00
80179	Salicylate	$431.56
80183	Oxcarbazepine	$186.63
80305	Drug test(s)	$582.00
80306	Drug 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
81000	Urinalysis , by dip stick or tablet reagent	$420.00
81001	—	$330.00
81002	—	$252.00
81003	Urinalysis, by dip stick or tablet reagent for bilirubin, g.	$54.00
81007	—	$101.24
81025	Urine pregnancy test, by visual color comparison methods	$504.00
82010	—	$65.56
82040	Albumin; serum, plasma or whole blood	$180.00
82077	—	$393.76
82135	—	$138.00
82140	—	$360.00
82150	Amylase	$516.00
82247	—	$164.40
82248	Bilirubin; direct	$232.14
82270	BLD OCLT PROXIDASE ACTV QUAL FECES 1 DETER	$660.00
82272	—	$38.40
82274	—	$498.96
82310	—	$468.00
82533	—	$138.00
82550	Creatine kinase (CK), (CPK); total	$468.52
82553	CKMB - CREATINE KINASE MB FXJ ONLY	$468.00
82565	Creatinine; blood	$360.00
82570	—	$102.00
82607	Cyanocobalamin (Vitamin B-12)	$220.19
82627	—	$204.28
82670	—	$324.48
82728	Ferritin	$179.56
82746	—	$259.56
82747	Folic acid; RBC	$211.02
82803	—	$612.00
82945	—	$59.92
82947	Glucose; quantitative, blood (except reagent strip)	$468.52
82962	Blood Sugar Test	$144.00
82977	Glutamyltransferase, gamma (GGT)	$300.00
83001	—	$660.64
83002	—	$660.00
83010	—	$54.00
83020	—	$179.56
83036	Hemoglobin; glycosylated (A1C)	$220.80
83520	—	$393.76
83540	—	$300.00
83550	—	$881.47
83605	LACTATE	$174.98
83690	Lipase	$1,156.20
83735	Magnesium	$600.00
83874	MYOGLOBIN	$594.00
83880	BNP - B TYPE NATRIURETIC PEPTIDE	$746.78
83921	—	$324.00
83970	—	$459.60
84075	Phosphatase, alkaline	$610.20
84100	Phosphorus inorganic (phosphate)	$240.00
84146	—	$150.00
84155	—	$31.20
84403	—	$144.00
84425	—	$976.31
84436	—	$1,188.00
84439	Thyroxine; free	$420.00
84443	Thyroid stimulating hormone (TSH)	$1,188.00
84450	—	$120.00
84460	—	$127.82
84466	Transferrin	$162.52
84479	—	$336.00
84481	—	$474.00
84484	TROPONIN QUAN	$918.00
84520	Urea nitrogen; quantitative	$468.52
84550	URIC ACID BLOOD	$218.03
84600	—	$428.40
84702	Gonadotropin, chorionic (hCG); quantitative	$960.00
84703	Human Chorionic Gonadotropin , pregnancy test	$139.24
85025	complete blood count	$1,212.00
85060	—	$503.56
85379	Fibrin degradation products, D-dimer; quantitative	$966.00
85610	PT - PROTHROMBIN TIME	$852.00
85652	Sedimentation rate, erythrocyte; automated	$504.00
85730	—	$108.00
86038	—	$300.00
86039	—	$254.45
86140	C-reactive protein	$588.52
86141	—	$960.00
86308	Heterophile antibodies; screening	$660.00
86328	Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus	$468.00
86431	Rheumatoid factor; quantitative	$175.00
86592	—	$97.56
86593	—	$96.00
86677	Antibody; 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
86769	SARS-COV-2 COVID-19 ANTIBODY	$260.10
86780	—	$156.00
86803	—	$325.36
86850	—	$138.76
86900	Blood typing, serologic; ABO	$504.00
86901	Blood typing, serologic; Rh (D)	$468.15
87040	Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)	$1,500.00
87045	Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species	$648.30
87046	Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate	$648.30
87070	Culture, bacterial; any other source except urine, blood or...	$739.94
87077	Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate	$385.40
87086	CUL BACT QUAN COLONY CNT URINE	$348.00
87088	—	$108.00
87102	—	$191.75
87150	—	$204.00
87177	—	$214.06
87187	Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate.	$355.36
87205	Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types	$300.00
87206	—	$48.00
87209	—	$648.30
87210	Smear, primary source with interpretation; wet mount for in...	$167.18
87255	GENET VIRUS ISOLATE HSV	$790.80
87301	Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay , enzyme-linked immunosorbent assay or semiquantitative; adenovirus enteric types	$588.00
87338	H-pylori blood test	$1,527.73
87340	—	$111.56
87341	—	$378.76
87389	Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result	$348.53
87420	Infectious agent antigen detection by enzyme immunoassay techniqu	$360.35
87426	Infectious agent antigen detection by immunoassay technique...	$816.53
87427	—	$648.30
87428	Infectious 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
87486	Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique	$780.52
87491	Infectious 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
87529	Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique	$2,268.55
87541	—	$204.00
87581	Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique	$780.52
87591	Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique	$588.00
87631	Infectious 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
87633	Infectious 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
87635	Infectious 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
87651	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique	$319.70
87660	—	$463.73
87661	—	$428.40
87798	Infectious agent detection by nucleic acid (DNA or RNA), no...	$660.52
87801	Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique	$1,351.94
87804	Infectious agent antigen detection by immunoassay with dire...	$427.39
87807	Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus	$600.23
87880	Rapid strep test	$984.00
87905	—	$349.19
89051	—	$660.00
89055	—	$457.69
89060	—	$347.56
90471	IMADM PRQ ID SUBQ/IM NJXS 1 VACC	$433.20
90714	Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use	$696.00
90715	Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use	$588.52
91301	Severe 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
93000	ECG ROUTINE ECG W/LEAST 12 LDS W/I&R	$294.49
93005	Electrocardiogram (ECG or EKG)	$294.49
93010	ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY EKG	$251.51
93040	Rhythm ECG, 1-3 leads; with interpretation and report	$123.60
93041	RHYTHM ECG 1-3 LDS TRCG ONLY W/O I&R	$180.00
93042	Rhythm ECG, 1-3 leads; interpretation and report only	$180.00
93227	ECG MONIT/REPRT UP TO 48 HRS	$308.45
93306	Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography	$4,153.81
93308	Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study	$4,241.51
93880	Duplex scan of extracranial arteries; complete bilateral study	$8,364.62
93925	Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study	$3,564.53
93926	Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study	$3,570.40
93931	—	$3,060.00
93970	Duplex scan of extremity veins including responses to compr...	$3,228.52
93971	Duplex scan of extremity veins including responses to compr...	$4,382.58
93975	Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study	$8,376.88
93976	Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study	$2,268.30
94010	—	$631.10
94640	Pressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator,	$348.52
94760	Noninvasive ear or pulse oximetry for oxygen saturation; single determination	$69.63
94761	Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)	$88.80
96360	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	$725.25
96361	Intravenous infusion, hydration; each additional hour	$449.00
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour	$711.00
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour	$700.00
96367	Intravenous infusion, Sequential to 1 hr	$990.00
96368	THER/DIAG CONCURRENT INF	$353.39
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	$164.05
96374	IV PUSH THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG	$357.00
96375	IV PUSH ADD DRUG THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG	$374.00
96376	Sequential intravenous push of the same substance/drug	$289.00
97597	DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS	$2,512.03
97605	Pressure wound therapy	$168.00
99000	Specimen handling	$95.82
99001	—	$127.82
99024	—	$587.56
99053	Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service	$491.56
99070	SUPPLIES&MATERIALS PRV BY PHYS >&ABOVE	$73.45
99072	Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s)	$198.53
99217	Observation Care Discharge	$1,800.00
99218	Initial Hospital Observation Care Services	$2,988.26
99219	initial observation care that involves high-level services provided on a daily basis	$2,219.62
99220	Initial Observation Care	$3,228.14
99221	Initial 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.	$1,911.32
99222	Initial 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.	$2,974.73
99223	Initial 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 exceeded	$3,974.27
99231	Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 25 minutes must be met or exceeded.	$1,135.67
99232	Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded.	$1,808.04
99233	Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded.	$2,719.58
99234	OBSERVATION ADMIT/DISCHARGE - Level 1	$2,436.54
99235	OBSERVATION ADMIT/DISCHARGE - Level 2	$2,508.14
99236	OBSERVATION ADMIT/DISCHARGE - Same Day Greater than 8 hours	$2,239.76
99238	Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter	$1,846.57
99239	Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter	$2,619.26
99281	EMER DEPT SELF LIMITED/MINOR	$708.13
99282	MODERATE SEVERITY	$1,176.91
99283	Emergency department visit for the evaluation and management , the presenting problem(s) are of moderate severity.	$2,988.00
99284	Emergency department visit for the evaluation and management of a patient, presenting problem(s) are of high severity, and require urgent evaluation	$4,334.40
99285	EMERGENCY DEPT VISIT HI MDM	$5,520.00
99291	CRITICAL CARE (30-74 MIN)	$7,602.00
99292	CRITICAL CARE (EACH ADDITIONAL 30 MIN)	$3,712.97
99356	Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour	$2,377.02
99357	Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; each additional 30 minutes	$130.93
99406	Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes	$291.95
99407	Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes	$393.61
99418	PROLNG IP/OBS E/M EA 15 MIN	$118.02
A4208	IM MEDS-BUNDLE	$18.00
A4209	5+ CC STERILE SYRINGE&NEEDLE	$19.00
A4215	Needle any size	$56.00
A4216	STERILE WATER/SALINE, 10 ML	$11.00
A4217	STERILE WATER/SALINE, 500 ML	$120.30
A4222	INFUSION SUPPLIES WITH PUMP	$73.48
A4244	ALCOHOL OR PEROXIDE PER PINT	$131.04
A4245	—	$11.63
A4246	Betadine or pHisoHex solution, per pint	$201.60
A4247	BETADINE/IODINE SWABS/WIPES	$60.76
A4314	—	$123.60
A4320	IRRIGATION TRAY	$118.36
A4327	FEM URINARY COLLECT DEV CUP	$116.52
A4334	FOLEY CATHETER LEG STRAP	$26.22
A4340	FOLEY CATH 2-WAY W/ 5CC BALLOON 20 FR (IF foley catheter insert)	$89.42
A4364	Adhesive, liquid or equal, any type, per oz	$102.80
A4450	LACERATION TRAY	$17.00
A4452	Tape, waterproof, per 18 square inches	$15.61
A4467	straps	$32.00
A4550	—	$150.00
A4556	ELECTRODES, PAIR	$55.00
A4565	SLINGS	$48.00
A4570	—	$150.00
A4590	—	$648.30
A4606	OXYGEN PROBE USED W OXIMETER	$106.80
A4615	CANNULA NASAL	$111.60
A4620	VARIABLE CONCENTRATION MASK	$106.80
A4649	Suture	$39.00
A4770	BLOOD COLLECTION TUBE/VACUUM	$60.11
A4930	STERILE, GLOVES PER PAIR	$95.82
A6216	—	$0.17
A6219	GAUZE <= 16 SQ IN W/BORDER	$143.56
A6250	SKIN SEAL PROTECT MOISTURIZR	$52.00
A6260	WOUND CLEANSERS ANY TYPE ANY SIZE	$5.00
A6266	—	$10.80
A6402	Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing	$15.00
A6413	ADHESIVE BANDAGE FIRSTAID TYPE EA	$12.00
A6448	Ace wrap	$15.00
A6449	Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard	$118.36
A6450	LT COMPRES BAND >=5/YD	$26.14
A6454	—	$27.60
A7000	DISPOSABLE CANISTER FOR PUMP	$75.74
A7003	NEBULIZER ADMINISTRATION SET	$95.82
A7015	AEROSOL MASK USED W NEBULIZE	$59.63
A9150	Administrative, Miscellaneous and Investigational	$37.20
A9273	—	$47.59
A9284	—	$458.40
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	$251.56
E0114	CRUTCH UNDERARM PAIR NO WOOD	$200.40
E0116	CRUTCH UNDERARM EACH NO WOOD	$77.00
E0325	URINAL MALE JUG-TYPE	$9.59
E0431	Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing	$95.00
G0168	—	$360.00
G0316	Prolonged hospital inpatient or observation care evaluation and management service(s) each additional 15 minutes by the physician	$118.02
G0378	Observation initial 1 hour	$2,268.00
G2023	Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	$300.16
G6039	ACETAMINOPHEN	$162.22
J0131	Injection, acetaminophen, 10 mg	$42.79
J0132	—	$36.00
J0153	ADENOSINE INJ 1MG	$349.12
J0171	Injection, Adrenalin, epinephrine, 0.1 mg	$57.60
J0282	Injection, amiodarone hydrochloride, 30 mg	$46.80
J0290	—	$60.72
J0295	—	$60.00
J0360	Injection, hydralazine hcl, up to 20 mg	$253.12
J0456	Injection, azithromycin, 500 mg	$119.92
J0461	Injection, atropine sulfate, 0.01 mg	$35.59
J0500	Injection, dicyclomine hcl, up to 20 mg	$385.21
J0558	—	$61.12
J0561	Injection, penicillin G benzathine, 100, 000 units	$107.56
J0610	Injection, calcium gluconate, per 10 ml	$50.03
J0612	—	$55.20
J0613	—	$54.12
J0665	INJ, BUPIVACAINE, NOS, 0.5MG	$15.30
J0690	Injection, cefazolin sodium, 500 mg	$84.00
J0692	Injection, cefepime hydrochloride, 500 mg	$119.33
J0694	—	$147.60
J0696	Injection, ceftriaxone sodium, per 250 mg	$106.80
J0697	—	$59.33
J0735	—	$154.80
J0736	Injection, clindamycin phosphate, 300 mg	$41.51
J0744	Injection, ciprofloxacin for intravenous infusion, 200 mg	$235.58
J0780	Injection, prochlorperazine, up to 10 mg	$95.82
J0840	—	$46.19
J1020	—	$47.56
J1030	METHYLPREDNISOLONE 40 MG INJ	$83.82
J1040	METHYLPREDNISOLONE 80 MG INJ	$115.82
J1094	—	$348.52
J1100	DEXAMETHASONE 1mg	$44.35
J1110	—	$204.00
J1160	DIGOXIN INJECTION	$82.75
J1165	—	$123.91
J1170	Injection, hydromorphone, up to 4 mg	$181.12
J1200	Injection, diphenhydramine HCl, up to 50 mg	$71.56
J1265	—	$46.19
J1335	—	$159.42
J1450	—	$59.56
J1580	—	$109.79
J1610	Injection, glucagon hydrochloride, per 1 mg	$1,512.43
J1630	Injection, haloperidol, up to 5 mg	$104.12
J1631	Injection, haloperidol decanoate, per 50 mg	$59.65
J1642	—	$31.81
J1644	Injection, heparin sodium, per 1000 units	$63.60
J1650	Injection, enoxaparin sodium, 10 mg	$59.92
J1741	—	$35.39
J1790	Injection, droperidol, up to 5 mg	$49.96
J1800	PROPRANOLOL INJECTION	$223.40
J1810	—	$38.09
J1815	Injection, insulin, per 5 units	$51.60
J1817	—	$35.77
J1836	Injection, metronidazole, 10 mg	$33.19
J1885	Injection, ketorolac tromethamine, per 15 mg	$59.53
J1920	—	$31.38
J1940	Injection, furosemide, up to 20 mg	$52.57
J1956	Injection, levofloxacin, 250 mg	$150.00
J1980	—	$348.52
J2001	Injection, lidocaine HCl for intravenous infusion, 10 mg	$47.75
J2020	—	$126.38
J2060	Injection, lorazepam, 2 mg	$47.75
J2175	—	$115.62
J2180	—	$47.59
J2250	Injection, midazolam hydrochloride, per 1 mg	$63.60
J2270	MORPHINE SULFATE INJECTION	$78.76
J2274	—	$50.03
J2310	Injection, naloxone hydrochloride, per 1 mg	$95.92
J2358	—	$70.93
J2360	Injection, orphenadrine citrate, up to 60 mg	$52.55
J2405	ONDANSETRON HCL INJECTION	$69.17
J2543	PIPERACILLIN/TAZOBACTAM	$131.20
J2550	Injection, promethazine HCl, up to 50 mg	$71.92
J2650	PREDNISOLONE ACETATE INJ	$115.33
J2704	—	$45.37
J2765	Injection, metoclopramide HCl, up to 10 mg	$40.19
J2780	—	$28.09
J2800	—	$70.36
J2920	Injection, methylprednisolone sodium succinate, up to 40 mg	$61.79
J2930	Injection, methylprednisolone sodium succinate, up to 125 mg	$65.33
J2997	—	$708.76
J3010	FENTANYL CITRATE INJECITON 0.1MG	$95.33
J3030	SUMATRIPTAN SUCCINATE / 6 MG	$239.92
J3105	—	$179.56
J3260	—	$65.56
J3301	Injection, triamcinolone acetonide, not otherwise specified, 10 mg	$34.93
J3360	Injection, diazepam, up to 5 mg	$46.27
J3370	VANCOMYCIN Inj - 500MG	$74.40
J3410	Injection, hydroxyzine HCl, up to 25 mg	$55.87
J3411	—	$80.99
J3430	—	$59.95
J3475	Injection, magnesium sulfate, per 500 mg	$85.79
J3480	INJ POTASSIUM CHLORIDE	$127.07
J3486	—	$123.16
J3490	DRUGS UNCLASSIFIED INJECTION	$185.92
J3490G	—	$123.60
J7030	Infusion, normal saline solution , 1000 cc	$78.13
J7040	Infusion, normal saline solution, sterile (500 ml=1 unit)	$48.00
J7042	5% dextrose/normal saline (500 ml = 1 unit)	$56.93
J7050	Infusion, normal saline solution , 250 cc	$68.40
J7060	5% dextrose/water (500 ml = 1 unit)	$57.52
J7070	D5W INFUSION	$59.99
J7120	RINGERS LACTATE INFUSION	$59.87
J7121	5% dextrose in lactated ringers infusion, up to 1000 cc	$64.67
J7509	—	$19.63
J7510	Prednisolone oral, per 5 mg	$6.00
J7512	—	$6.00
J7610	Albuterol, inhalation solution, compounded product, administered through DME, concentrated form, 1 mg	$91.32
J7612	—	$27.60
J7613	ALBUTEROL NON-COMP UNIT	$47.33
J7615	—	$56.59
J7620	ALBUTEROL IPRATROP NON-COMP	$52.43
J7626	Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.5 mg	$51.60
J7637	—	$42.53
J7644	Ipratropium bromide, inhalation solution, compounded product, administered through DME, unit dose form, per milligram	$71.56
J7645	Ipratropium bromide, inhalation solution, compounded product, administered through DME, unit dose form, per milligram	$27.61
J7682	—	$30.00
J7699	Noc drugs, inhalation solution administered through DME	$48.59
J8498	—	$34.80
J8499	Prescription drug, oral, non chemotherapeutic, NOS	$31.00
J8499AF	CEPHALEXIN 500MG	$19.93
J8499AN	CYCLOBENZAPRINE HYDROCHLORIDE	$19.93
J8499D	AMOXICILLIN SUSPENSION 400MG	$19.93
J8499F	IBUPROFEN 600MG	$19.93
J8499V	—	$180.00
J8540	DEXAMETHASONE ORAL 0.25 MG	$11.00
J9260	—	$54.82
K0730	Inhalation drug delivery system	$151.00
L0120	CERV FLEXIBLE NON-ADJUSTABLE	$1,038.00
L0172	Collar	$689.63
L0174	—	$360.00
L1830	Knee - KO IMMOBILIZER CANVAS LONGIT	$201.00
L1833	—	$1,503.60
L3260	—	$63.00
L3650	Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf	$89.00
L3809	—	$686.40
L4350	—	$344.40
L4361	—	$745.20
L4387	Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf	$182.79
L4631	ankle boot	$357.60
M0222	—	$1,440.00
M0239	—	$1,080.00
M0243	—	$1,440.00
M0245	—	$1,080.00
M0247	—	$1,440.00
Q0144	Azithromycin dihydrate, oral, capsules/powder, 1 gram	$272.00
Q0163	—	$11.00
Q0169	Promethazine hydrochloride, 12.5 mg, oral,	$106.38
Q0244	—	$0.01
Q4046	—	$1,404.20
Q4049	—	$123.60
Q4051	SPLINT SUPPLIES MISC	$288.83
Q9962	—	$228.00
Q9963	—	$246.55
Q9965	Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml	$444.00
Q9966	Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml	$480.00
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	$444.00
S0020	Injection, bupivacaine hydrochloride, 30 ml	$480.00
S0028	PEPCID - INJECTION, FAMOTIDINE, 20 MG	$64.44
S0030	Injection, metronidazole, 500 mg	$63.60
S0039	INJECTION, SULFAMETHOXAZOLE	$328.22
S0077	Injection, clindamycin phosphate, 300 mg	$59.56
S0119	Ondansetron, oral, 4 mg	$71.00
S0164	Injection, pantoprazole sodium, 40 mg	$58.57
S0181	ONDANESTRON HCA, ORAL 4MG	$5.10
S0182	—	$47.59
S0630	REMOVAL OF SUTURES	$303.60
S1015	IV TUBING EXTENSION SET	$49.73
S5000	PRESCRIPTION DRUG, GENERIC	$16.27
S5001	NON-GENERIC DRUG	$35.53
S5010	5% DEXTROSE AND 0.45% SALINE	$8.04
S5012	5% DEXTROSE WITH POTASSIUM	$72.00
S5013	—	$19.20
S8100	—	$49.20
S8101	—	$75.60
S8430	—	$67.20
S8431	—	$54.00
S8451	—	$250.80
U0002	coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets),	$792.00
U0003	Infectious agent detection by nucleic acid (DNA or RNA); se...	$708.00
U0005	INFEC AGEN DETEC AMPLI PROBE	$324.00

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Comprehensive 24/7 Emergency Care at Montrose Emergency Room

At Montrose Emergency Room, located in the heart of Montrose, we proudly serve the surrounding areas, including Greater Houston. We know emergencies can occur anytime, which is why we're your nearest ER, open 24/7 with state-of-the-art facilities. We offer comprehensive emergency care for various situations, including:

ER for Chest Pain/Heart attack symptoms

Emergency room for severe stomach pain

Pediatric Emergency Care

Severe headache or Migraine

ER Care for Infection & Sepsis

Emergency Care for Breathing difficulties

Respiratory or other infections

Back pain for injuries or spinal issues.

ER for Abdominal Pain

ER for broken bone or fracture

Auto Accident Injuries

Emergency care for severe allergic reaction

More Comprehensive List of Services

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Reviews

Testimonials on Our 24/7 Emergency Assistance

10/10 highly recommend this ER! I came in for abdominal pain came out feeling much better thank you Dr.Aponte Vinson and David

Maria Flores

No wait time and super fast service,my son was taking good care of!! I would definitely recommend Montrose Emergency Room to family and friends.thank you Frank,Darby and Dr.Mendoza🙏🏻

Tina

So glad I came into the Montrose Emergency Room-no wait and the staff were all very kind and most importantly very professional! I got a diagnosis that might have been missed elsewhere. This will definitely be my family’’s go to place for emergency care!

Denise Hulett