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

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24/7 Specialised ER Care

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 Description Charge 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

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) [Toggle Dictionary Definitions]  $   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
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 711
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour 700
96367 Intravenous infusion, Sequential to 1 hr 990
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
96375 IV PUSH ADD DRUG THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG 374
96376 Sequential intravenous push of the same substance/drug 289
97597 DEBRIDEMENT OPEN WOUND 20 SQ CM OR LESS 2512.03
97605 Pressure wound therapy 168
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 1800
99218 Initial Hospital Observation Care Services 2988.26
99219 initial observation care that involves high-level services provided on a daily basis 2219.62
99220 Initial Observation Care 3228.14
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. 1911.32
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. 2974.73
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 3974.27
99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 25 minutes must be met or exceeded. 1135.67
99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded. 1808.04
99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient 35 minutes must be met or exceeded. 2719.58
99234 OBSERVATION ADMIT/DISCHARGE – Level 1 2436.54
99235 OBSERVATION ADMIT/DISCHARGE – Level 2 2508.14
99236 OBSERVATION ADMIT/DISCHARGE – Same Day Greater than 8 hours 2239.76
99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter 1846.57
99239 Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter 2619.26
99281 EMER DEPT SELF LIMITED/MINOR 708.13
99282 MODERATE SEVERITY 1176.91
99283 Emergency department visit for the evaluation and management , the presenting problem(s) are of moderate severity. 2988
99284 Emergency department visit for the evaluation and management of a patient,presenting problem(s) are of high severity, and require urgent evaluation 4334.4
99285 EMERGENCY DEPT VISIT HI MDM 5520
99291 CRITICAL CARE (30-74 MIN) 7602
99292 CRITICAL CARE (EACH ADDITIONAL 30 MIN) 3712.97
99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour 2377.02
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
A4209 5+ CC STERILE SYRINGE&NEEDLE 19
A4215 Needle any size 56
A4216 STERILE WATER/SALINE, 10 ML 11
A4217 STERILE WATER/SALINE, 500 ML 120.3
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 201.6
A4247 BETADINE/IODINE SWABS/WIPES 60.76
A4314 123.6
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 102.8
A4450 LACERATION TRAY 17
A4452 Tape, waterproof, per 18 square inches 15.61
A4467 straps 32
A4550 150
A4556 ELECTRODES, PAIR 55
A4565 SLINGS 48
A4570 150
A4590 648.3
A4606 OXYGEN PROBE USED W OXIMETER 106.8
A4615 CANNULA NASAL 111.6
A4620 VARIABLE CONCENTRATION MASK 106.8
A4649 Suture 39
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
A6260 WOUND CLEANSERS ANY TYPE ANY SIZE 5
A6266 10.8
A6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 15
A6413 ADHESIVE BANDAGE FIRSTAID TYPE EA 12
A6448 Ace wrap 15
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 27.6
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 37.2
A9273 47.59
A9284 458.4
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 200.4
E0116 CRUTCH UNDERARM EACH NO WOOD 77
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
G0168 360
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 2268
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
J0153 ADENOSINE INJ 1MG 349.12
J0171 Injection, Adrenalin, epinephrine, 0.1 mg 57.6
J0282 Injection, amiodarone hydrochloride, 30 mg 46.8
J0290 60.72
J0295 60
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 55.2
J0613 54.12
J0665 INJ, BUPIVACAINE, NOS, 0.5MG 15.3
J0690 Injection, cefazolin sodium, 500 mg 84
J0692 Injection, cefepime hydrochloride, 500 mg 119.33
J0694 147.6
J0696 Injection, ceftriaxone sodium, per 250 mg 106.8
J0697 59.33
J0735 154.8
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
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 1512.43
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 63.6
J1650 Injection, enoxaparin sodium, 10 mg 59.92
J1741 35.39
J1790 “Injection, droperidol, up to 5 mg
49.96
J1800 PROPRANOLOL INJECTION 223.4
J1810 38.09
J1815 Injection, insulin, per 5 units 51.6
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
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 63.6
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 131.2
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 74.4
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 123.6
J7030 Infusion, normal saline solution , 1000 cc 78.13
J7040 Infusion, normal saline solution, sterile (500 ml=1 unit) 48
J7042 5% dextrose/normal saline (500 ml = 1 unit) 56.93
J7050 Infusion, normal saline solution , 250 cc 68.4
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
J7512 6
J7610 Albuterol, inhalation solution, compounded product, administered through DME, concentrated form, 1 mg 91.32
J7612 27.6
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 51.6
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
J7699 Noc drugs, inhalation solution administered through DME 48.59
J8498 34.8
J8499 “Prescription drug, oral, non chemotherapeutic, NOS
31
J8499AF CEPHALEXIN 500MG 19.93
J8499AN CYCLOBENZAPRINE HYDROCHLORIDE 19.93
J8499D AMOXICILLIN SUSPENSION 400MG 19.93
J8499F IBUPROFEN 600MG 19.93
J8499V 180
J8540 DEXAMETHASONE ORAL 0.25 MG 11
J9260 54.82
K0730 Inhalation drug delivery system 151
L0120 CERV FLEXIBLE NON-ADJUSTABLE 1038
L0172 Collar 689.63
L0174 360
L1830 Knee – KO IMMOBILIZER CANVAS LONGIT 201
L1833 1503.6
L3260 63
L3650 Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf 89
L3809 686.4
L4350 344.4
L4361 745.2
L4387 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf 182.79
L4631 ankle boot 357.6
M0222 1440
M0239 1080
M0243 1440
M0245 1080
M0247 1440
Q0144 Azithromycin dihydrate, oral, capsules/powder, 1 gram 272
Q0163 11
Q0169 Promethazine hydrochloride, 12.5 mg, oral, 106.38
Q0244 0.01
Q4046 1404.2
Q4049 123.6
Q4051 SPLINT SUPPLIES MISC 288.83
Q9962 228
Q9963 246.55
Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 444
Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 480
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 444
S0020 Injection, bupivacaine hydrochloride, 30 ml 480
S0028 PEPCID – INJECTION, FAMOTIDINE, 20 MG 64.44
S0030 Injection, metronidazole, 500 mg 63.6
S0039 INJECTION, SULFAMETHOXAZOLE 328.22
S0077 Injection, clindamycin phosphate, 300 mg 59.56
S0119 Ondansetron, oral, 4 mg 71
S0164 Injection, pantoprazole sodium, 40 mg 58.57
S0181 ONDANESTRON HCA, ORAL 4MG 5.1
S0182 47.59
S0630 REMOVAL OF SUTURES 303.6
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
S5013 19.2
S8100 49.2
S8101 75.6
S8430 67.2
S8431 54
S8451 250.8
U0002 coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), 792
U0003 Infectious agent detection by nucleic acid (DNA or RNA); se… 708
U0005 INFEC AGEN DETEC AMPLI PROBE 324
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