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Charge Master Code Description Price Effective Date Department Charge Code Type 100001 ABD PARACENTESIS W/ IMAGING 999 11/1/2017 Emergency Standard 100002 ABD PARACENTESIS W/O IMAGING 1276 11/1/2017 Emergency Standard 100003 APPLY SHRT ARM SPLNT 602 11/1/2017 Emergency Standard 100004 ARTHROCENTESIS INJ/ASPIR INTERMED JOINT 814 11/1/2017 Emergency Standard 100005 ARTHROCENTESIS INJ/ASPIR MAJOR JOINT 1038 11/1/2017 Emergency Standard 100006 ARTHROCENTESIS INJ/ASPIR MJR JT W/GUID 1612 11/1/2017 Emergency Standard 100007 ARTHROCENTESIS INJ/ASPIR SMALL JOINT 832 11/1/2017 Emergency Standard 100008 ARTHROTOMY ANKLE W/ EXPLORATION 2870 11/1/2017 Emergency Standard 100009 ARTHROTOMY WRIST JOINT W/ EXPLORATION 1770 11/1/2017 Emergency Standard 100010 AVULSION NAIL PLATE SIMPLE SINGLE 672 11/1/2017 Emergency Standard 100011 BLADDER IRRIGATION 714 11/1/2017 Emergency Standard 100012 BLOOD DRAW FROM PERIPHERAL IV 102 11/1/2017 Emergency Standard 100013 BLOOD DRAW FROM PORT 102 11/1/2017 Emergency Standard 100014 BURN CARE FIRST DEGREE INITIAL 372 11/1/2017 Emergency Standard 100015 BURN DRESS/DEBRIDE LG > 10% BSA 784 11/1/2017 Emergency Standard 100016 BURN DRESS/DEBRIDE MED 5‐10% BSA 533 11/1/2017 Emergency Standard 100017 BURN DRESS/DEBRIDE SMALL < 5% BSA 540 11/1/2017 Emergency Standard 100018 CARDIOVERSION ER 1499 11/1/2017 Emergency Standard 100019 CHEMICAL CAUTERY OF GRANULATION TISSUE 690 11/1/2017 Emergency Standard 100020 CL FX TX BIMALLEOLAR ANKLE W/ MANIP 1109 11/1/2017 Emergency Standard 100021 CL FX TX BIMALLEOLAR ANKLE W/O MANIP 786 11/1/2017 Emergency Standard 100022 CL FX TX HUMERAL SHAFT W/ MANIP 827 11/1/2017 Emergency Standard 100023 CL FX TX MEDIAL MALLEOLUS W/ MANIP 1880 11/1/2017 Emergency Standard 100024 CL FX TX METACARPAL W/ MANIP 603 11/1/2017 Emergency Standard 100025 CL FX TX NASAL BONE W/O STABILIZATION 670 11/1/2017 Emergency Standard 100026 CL FX TX PHALANGEAL SHAFT W/ MANIP 849 11/1/2017 Emergency Standard 100027 CL FX TX PHALANX W/ MANIP EACH 516 3/16/2018 Emergency Standard 100028 CL FX TX RADIAL HEAD/NECK W/MANIP 927 11/1/2017 Emergency Standard 100029 CL FX TX RADIUS & ULNA W/ MANIP 961 11/1/2017 Emergency Standard 100030 CL FX TX RADIUS & ULNA W/O MANIP 515 11/1/2017 Emergency Standard 100031 CL FX TX RADIUS/ULNA W/MANIP 1192 11/1/2017 Emergency Standard 100032 CL FX TX TIBIAL SHAFT W/ MANIP 2816 3/10/2018 Emergency Standard 100033 CL FX TX TRIMALLEOLAR ANKLE W/MANIP 1401 11/1/2017 Emergency Standard 100034 CL FX TX ULNAR STYLOID 1310 11/1/2017 Emergency Standard 100035 CL TX ELBOW DISLOCATION W/ ANES 1006 11/1/2017 Emergency Standard 100036 CL TX HIP DISLOCATION TRAUMATIC W/ ANES 2633 11/1/2017 Emergency Standard 100037 CL TX HIP DISLOCATION TRAUMATIC W/O ANES 1554 11/1/2017 Emergency Standard 100038 CL TX INTERPHALANGEAL JT DISLO W/ANES 608 11/1/2017 Emergency Standard 100039 CL TX KNEE DISLOCATION W/ ANESTHESIA 1114 11/1/2017 Emergency Standard 100040 CL TX KNEE DISLOCATION W/O ANESTHESIA 833 11/1/2017 Emergency Standard 100041 CL TX MCP DISLOCATION W/MANIP W/ANES 347 11/1/2017 Emergency Standard 100042 CL TX MCP DISLOCATION W/MANIP W/O ANES 837 11/1/2017 Emergency Standard 100043 CL TX PATELLAR DISLOCATION W/ ANES 2090 11/1/2017 Emergency Standard 100044 CL TX PATELLAR DISLOCATION W/O ANES 1299 11/1/2017 Emergency Standard 100045 CL TX RAD HD SUBLUX NURSEMD ELB W/MANIP 380 11/1/2017 Emergency Standard 100046 CL TX SHOULDER DISLOC W/ MAN W/ ANES 1362 11/1/2017 Emergency Standard 100047 CL TX SHOULDER DISLOC W/ MAN W/O ANES 1258 11/1/2017 Emergency Standard 100048 CPR ER 1584 11/1/2017 Emergency Standard 100049 CRITICAL CARE 30 ‐ 74 MIN 5370 11/1/2017 Emergency Standard 100050 CRITICAL CARE 30 ‐ 74 MIN 5370 11/1/2017 Emergency Standard 100051 CRITICAL CARE ADD'L HALF HR 1058 11/1/2017 Emergency Standard 100052 CRITICAL CARE ADD'L HALF HR 1058 11/1/2017 Emergency Standard 100053 DEBRIDE SKIN ‐ PARTIAL 895 11/1/2017 Emergency Standard 100054 DEBRIDE SKIN ‐ TISSUE ER 737 11/1/2017 Emergency Standard 100055 DEBRIDEMENT =%10 BSA 676 11/1/2017 Emergency Standard 100056 DEBRIDEMENT SIMPLE EA ADD %10 BSA 338 11/1/2017 Emergency Standard 100057 ER LEVEL I 403 11/1/2017 Emergency Standard 100058 ER LEVEL I W/MOD 25 403 11/1/2017 Emergency Standard 100059 ER LEVEL II 601 11/1/2017 Emergency Standard 100060 ER LEVEL II W/MOD 25 601 11/1/2017 Emergency Standard 100061 ER LEVEL III 1016 11/1/2017 Emergency Standard 100062 ER LEVEL III W/MOD 25 1016 11/1/2017 Emergency Standard 100063 ER LEVEL IV 1744 11/1/2017 Emergency Standard 100064 ER LEVEL IV W/MOD 25 1744 11/1/2017 Emergency Standard 100065 ER LEVEL V 2844 11/1/2017 Emergency Standard 100066 ER LEVEL V W/MOD 25 2844 11/1/2017 Emergency Standard 100067 EVACUATION SUBUNGUAL HEMATOMA 525 11/1/2017 Emergency Standard 100068 EXC NAIL FOLD TOE 748 11/1/2017 Emergency Standard 100069 EXT PACEMAKER TEMPORARY 1204 11/1/2017 Emergency Standard 100070 FOLEY CATHETER INSERTION COMPLICATED 519 11/1/2017 Emergency Standard 100071 GASTRC INTUB & LAVGE 514 11/1/2017 Emergency Standard 100072 GLUCOSE FINGERSTICK 60 11/1/2017 Emergency Standard 100073 HAND OR FINGER SPLINT 474 11/1/2017 Emergency Standard 100074 HEP B VAC ER 109 11/1/2017 Emergency Standard 100075 I&D ABSCESS BARTHOLINS GLAND 539 11/1/2017 Emergency Standard 100076 I&D ABSCESS DENTOALVEOLAR 695 11/1/2017 Emergency Standard 100077 I&D ABSCESS PERITONSILLAR 630 11/1/2017 Emergency Standard 100078 I&D ABSCESS VULVA OR PERINEAL 927 11/1/2017 Emergency Standard 100079 I&D ABSCESS W/PACKING 815 11/1/2017 Emergency Standard 100080 I&D ADCESS SIMPLE 661 11/1/2017 Emergency Standard 100081 I&D HEMATOMA FLUID 1655 11/1/2017 Emergency Standard 100082 I&D PILONIDAL CYST SIMPLE 543 11/1/2017 Emergency Standard 100083 IM OR SUBQ INJECTION 258 11/1/2017 Emergency Standard 100084 IMMUNIZATION ADMIN 1 VACCINE 132 11/1/2017 Emergency Standard 100085 IMMUNIZATION ADMIN ADDTL VACCINE 60 11/1/2017 Emergency Standard 100086 INCISION OF THROMB HEMORRHOID EXTERNAL 812 11/1/2017 Emergency Standard 100087 INJ NERVE BLOCK OTHER PERIPHERAL 1142 11/1/2017 Emergency Standard 100088 INJ NERVE BLOCK TRIGEMINAL 795 11/1/2017 Emergency Standard 100089 INSERTION CATHETER SIMPLE 402 11/1/2017 Emergency Standard 100090 INSERTION NON TUNNELED CEN VEN CATH 5YR+ 2233 11/1/2017 Emergency Standard 100091 INSERTION NON‐INDWELLING CATHETER STRAIG 262 11/1/2017 Emergency Standard 100092 INTRAOSSEOUS NEEDLE PLACEMENT 458 11/1/2017 Emergency Standard 100093 INTUBATION ENDOTRACHEAL ER 1250 11/1/2017 Emergency Standard 100094 IV CORONARY THROMBOLYSIS 2751 11/1/2017 Emergency Standard 100095 IV INFUS TX/DX MD SUP TO 1H 550 11/1/2017 Emergency Standard 100096 IV INFUS TX/DX SEQ UP TO 1 HR 257 11/1/2017 Emergency Standard 100097 IV INFUS TX/DX W/MD SUP ADD HR<8 204 11/1/2017 Emergency Standard 100098 IV INFUSION FOR THERAPY PROPHYLAXIS 289 11/1/2017 Emergency Standard 100099 IV INFUSION HYDRATION 31MIN ‐ 60MIN 479 11/1/2017 Emergency Standard 100100 IV INFUSION HYDRATION ADDL HR UP TO 8 HR 246 11/1/2017 Emergency Standard 100101 IVP EA ADD SEQ PUSH SAME DRUG 272 11/1/2017 Emergency Standard 100102 IVP FOR EA ADD SEQUENTIAL PUSH NEW DRUG 287 11/1/2017 Emergency Standard 100103 IVP INTRAVENOUS INJECTION‐CLINICAL ER 305 11/1/2017 Emergency Standard 100104 LONG ARM SPLNT 590 11/1/2017 Emergency Standard 100105 LONG LEG SPLNT 586 11/1/2017 Emergency Standard 100106 LUMBAR PUNCTURE DIAGNOSTIC 1160 11/1/2017 Emergency Standard 100107 LUMBAR PUNCTURE THERAPEUTIC 1192 11/1/2017 Emergency Standard 100108 MEASURE BLOOD OXYGEN LEVEL 97 11/1/2017 Emergency Standard 100109 MOD SED W/ASSIST <5 YRS 1ST 15 MIN 293 11/1/2017 Emergency Standard 100110 MOD SED W/ASSIST 5+ YRS 1ST 15 MIN 150 11/1/2017 Emergency Standard 100111 MOD SED W/ASSIST EA ADDL 15 MIN 140 11/1/2017 Emergency Standard 100112 MOD SED W/O ASSIST <5 YRS 1ST 15 MIN 1150 11/1/2017 Emergency Standard 100113 MOD SED W/O ASSIST 5+ YRS 1ST 15 MIN 940 11/1/2017 Emergency Standard 100114 MOD SED W/O ASSIST EA ADDL 15 MIN 713 11/1/2017 Emergency Standard 100115 NASO/GASTRIC TUBE PLACEMENT 851 11/1/2017 Emergency Standard 100116 NOSEBLEED ANTERIOR COMPLEX ANY METHOD 692 11/1/2017 Emergency Standard 100117 NOSEBLEED ANTERIOR SIMPLE ANY METHOD 732 11/1/2017 Emergency Standard 100118 NOSEBLEED POSTERIOR W/PACK INITIAL 667 11/1/2017 Emergency Standard 100119 NOSEBLEED POSTERIOR W/PACK SUBS 785 11/1/2017 Emergency Standard 100120 OBSERVATION ER PER HOUR 124 11/1/2017 Emergency Standard 100121 OBSERVATION TELE ER PER HOUR 180 11/1/2017 Emergency Standard 100122 OP E&M LEVEL I 51 11/1/2017 Emergency Standard 100123 OP E&M LEVEL II 102 11/1/2017 Emergency Standard 100124 OP E&M LEVEL III 153 11/1/2017 Emergency Standard 100125 OP E&M LEVEL IV 204 11/1/2017 Emergency Standard 100126 OP E&M LEVEL V 255 11/1/2017 Emergency Standard 100127 PICC HICK PORT FLUSH 270 11/1/2017 Emergency Standard 100128 PICC LINE REMOVAL 1853 11/1/2017 Emergency Standard 100129 POSITIVE AIRWAY PRESSURE, CPAP 1367 11/1/2017 Emergency Standard 100130 REMOVE FB CONJUNCTIVAL EMBEDDED 775 11/1/2017 Emergency Standard 100131 REMOVE FB CONJUNCTIVAL SUPERFICIAL 640 11/1/2017 Emergency Standard 100132 REMOVE FB CORNEAL W/O SLIT LAMP 723 11/1/2017 Emergency Standard 100133 REMOVE FB CORNEAL W/SLIT LAMP 505 11/1/2017 Emergency Standard 100134 REMOVE FB EXT AUDITORY CANAL W/ ANES 973 11/1/2017 Emergency Standard 100135 REMOVE FB EXT AUDITORY CANAL W/O ANES 456 11/1/2017 Emergency Standard 100136 REMOVE FB FOOT SUBCUTANEOUS 1265 11/1/2017 Emergency Standard 100137 REMOVE FB MCP JOINT / ARTHROTOMY 1460 11/1/2017 Emergency Standard 100138 REMOVE FB SUBCUT SIMPLE
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