Charge code Description Category 10230 PED MOBILE UNIT-IN/KX Ambulance 10231 PED MED TRANSPORT IN KNOX Ambulance 10232 PED MED TRANS/OS/KNOX/PER 15M Ambulance 10235 PED MBL UNT ONE WAY / HR Ambulance 10240 AIR AMBULANCE ROTARY WING Ambulance 10251 PED SPECIALITY TRANSPORT IN Ambulance 10252 PED SPECIALITY TRANSPORT OUT Ambulance 10253 PED PER STATUTE MILE LOADED Ambulance 10254 NEONATAL TRANSPORT IN Ambulance 10256 NEONATAL TRANSPORT OUT Ambulance 10257 NEONATAL TRANSPORT FSRMC Ambulance 10258 NICU PER STATUTE MILE LOADED Ambulance 10351 PEDIATRIC TRANSPORT IN Ambulance 10352 PEDIATRIC TRANSPORT OUT Ambulance 10353 PEDIATRIC PER MILE LOADED Ambulance 60242 PED SPECIALITY TRANSPORT FSRMC Ambulance 10338 MAC ANESTHESIA INIT 30 MIN Anesthesia 10339 MAC ANESTHESIA EC ADDL 30MIN\ Anesthesia 10345 MOD SED 5 YR INTI 15 MIN Anesthesia 10350 MOD SED . 5 YR INT 15 MIN Anesthesia 10360 MOD DES EA ADDL 15 MIN Anesthesia 10550 GAS MACH. 0.0 TO 0.5 HRS Anesthesia 10555 GAS MACH. 0.5 TO 1.0 HRS Anesthesia 10560 GAS MACH. 1.0 TO 1.5 HRS Anesthesia 10565 GAS MACH. 1.5 TO 2.0 HRS Anesthesia 10570 GAS MACH. 2.0 TO 2.5 HRS Anesthesia 10575 GAS MACH. 2.5 TO 3.0 HRS Anesthesia 10580 GAS MACH. 3.0 TO 3.5 HRS Anesthesia 10585 GAS MACH. 3.5 TO 4.0 HRS Anesthesia 10590 GAS MACH. 4.0 TO 4.5 HRS Anesthesia 10595 GAS MACH. 4.5 TO 5.0 HRS Anesthesia 10600 GAS MACH. 5.0 TO 5.5 HRS Anesthesia 10605 GAS MACH. 5.5 TO 6.0 HRS Anesthesia 10610 GAS MACH. 6.0 TO 6.5 HRS Anesthesia 10615 GAS MACH. 6.5 TO 7.0 HRS Anesthesia 10620 GAS MACH. 7.0 TO 7.5 HRS Anesthesia 10625 GAS MACH. ADD 0.5 HRS Anesthesia 48546 MOD SED OTHER PHY<5YR INT 15 Anesthesia 48547 MOD SED OTHER PHY>5YR INIT 15 Anesthesia 48568 MOD SED OTHER PHYS. 5YR EA ADD Anesthesia 48634 MOD SED OTHER PHY,5YR INT 15 Anesthesia 48635 MOD SED OTHER PHY >5YR INT 15 Anesthesia 48638 MOD SED OTHER PHY<5YR INT 15 Anesthesia 48640 MOD SED OTHER PHY>5YR EA ADD15 Anesthesia 48643 MODSED OTHER PHY>5YR EA ADD15 Anesthesia 48646 MOD SED OTHER PHY>5YR INT 15 Anesthesia 48647 MODSED OTHER PHY>5YR EA ADD 15 Anesthesia 48661 MOD SED OTHER PHY.5YR EA ADD15 Anesthesia 48662 MODSED OTHER PHY>5YR INT 15 Anesthesia 48665 MOD SED OTHER PHY<5YR INT 15 Anesthesia 48670 MAC ANESTHESIA INIT 30 MIN Anesthesia 48671 MAC ANESTHESIA EC ADDL 30MIN\ Anesthesia 48673 MOD SED 5 YR INTI 15 MIN Anesthesia 48674 MOD SED . 5 YR INT 15 MIN Anesthesia 49020 GAS MACHINE TIME 1ST 30 MIN Anesthesia 49025 GAS MACHINE EACH ADDTL 30 MIN Anesthesia 50332 MAC ANES INIT 30 MIN Anesthesia 50333 MAC ANESTHESIA EA ADDL 30 MIN Anesthesia 60218 MAC ANESTHESIA INIT 30 MIN Anesthesia 60219 MAC ANESTHESIA EC ADDL 30 MIN Anesthesia 60221 MOD SED 5 YR INTI 15 MIN Anesthesia 60222 MOD SED . 5 YR INT 15 MIN Anesthesia 60223 MOD SED EA ADDL 15 MIN Anesthesia 10500 ANECTINE 20 mg/ml Anesthesia supplies 10505 ANECTINE FLO-PACK 1000mg Anesthesia supplies 10510 ANECTINE FLO-PACK 500mg Anesthesia supplies 10520 DANTROLENE 20mg VIAL Anesthesia supplies 10540 FLUID WARMER Anesthesia supplies 10545 GAS ANALYZER-ADD ON Anesthesia supplies 10645 KETAMINE 50mg/ml Anesthesia supplies 10650 LTA KIT Anesthesia supplies 10660 NON-IVASIVE BP CUFFS Anesthesia supplies 10665 PENTOTHAL 500mg SYRINGE Anesthesia supplies 27008 BAER W/INTERPRETATION & REPORT Audiology 27009 BAER - REPORT Audiology 27012 AUDITORY EVOKED SCREENING Audiology 27013 AUDITORY EVOKED W/INTR & REPT Audiology 27161 TYMPANOGRAM SCREEN ONLY Audiology 27673 BAER Limited Audiology 27674 AUDITORY EVOKED SCREENING Audiology 14255 CYROPRECIPITATE Blood Products 14257 HLA PHERESIS PLT Blood Products 14260 THAWING PRODUCT Blood Products 14265 FRESH FROZEN PLASMA Blood Products 14270 PLATELET CONCENTRATE PROD Blood Products 14275 PHERESIS PLATELET Blood Products 14290 TRANSFUSE GRANULOCYTE PED Blood Products 14295 TRANSFUSE RBC AUTOLOGOUS Blood Products 14300 TRANSFUSE RBC DEGLYCED AUTO Blood Products 14305 TRANSFUSE RBC DEGLYCED DES Blood Products 14310 TRANSFUSE RBC DESIGNATED Blood Products 14320 TRANSFUSE RBC PED Blood Products 14325 TRANSFUSE WASHED RBC DES Blood Products 14330 TRANSFUSE WB AUTOLOGOUS Blood Products 14335 TRANSFUSE WB DESIGNATED Blood Products 14340 TRANSFUSE WB PED Blood Products 14345 TRANSFUSE FROZEN R BLOOD CELLS Blood Products 14350 DEGLYCED PC Blood Products 14355 PACKED CELLS PC Blood Products 14360 WASHED PACKED CELLS WPC Blood Products 14365 WHOLE BLOOD WB Blood Products 14391 TRANSFUSION BLOOD / COMPONENT Blood Products 14392 PHERESIS PLATELET W/IRRAD Blood Products 14400 CRYO, POOLED Blood Products 14405 LOW YIELD PLATELET IRRADIA Blood Products 19621 EXCHANGE TRANSFUSION Blood Products 23315 RBC,LEUKOCYTES REDUCED EA UNIT Blood Products 23316 FRESH FROZEN PLASMA EA UNIT Blood Products 23317 PLATELETS,EACH UNIT Blood Products 23318 BLOOD, SPLIT UNIT Blood Products 23319 PLATELETS,IRRADIATED EA UNIT Blood Products 23321 RBC,LEUKOCYTES REDUCED IRRADIA Blood Products 23322 WHOLE BLOOD OR RED CELLS,CMVN Blood Products 23323 PLATELETS, PHER LRED CMVN IRRA Blood Products 23324 PLATELETS,LEUK RED CMVN Blood Products 23325 RBC FDW IRRAD Blood Products 23326 RBC LEUK RED CMVN,IRR Blood Products 23375 PLT STORAGE PROCESSING Blood Products 23376 PLT IRR STORAGE PROCESSING Blood Products 23377 PLT LR IRR STORAGE PROCESSING Blood Products 23378 PLT HLA IRR Blood Products 23379 AUTO BLOOD PROCES Blood Products 23380 FP 24 STORAGE PROCESSING Blood Products 23381 PLT STORAGE PROCESSING Blood Products 23382 PC STORAGE AND PROCESSING Blood Products 23383 WB,LEUKOCYTES RED, EA UNIT Blood Products 23384 WB LEUKOCYTES RED EA UNIT Blood Products 23385 PLATELETS HLA Blood Products 23390 PLATELETE,LEUK RED,EA UNIT Blood Products 23391 PLATELETES,LEU IRRAD, EA UNIT Blood Products 48591 BL PUSH TRANSFUSE 2 YR OR< Blood Products 48592 BL EXCHANGE/TRANSFUSE NEWBORN Blood Products 48594 WHOLE BLOOD WB PROC/STOR Blood Products 48595 CRYO.POOLED PROC/STOR Blood Products 48597 FRESH FROZEN PLASMA JUMBO Blood Products 48598 FRESH FROZEN PLASMA JUMBO PROC Blood Products 48600 PLATELET CONCENTRATE STOR/PROC Blood Products 48601 PACKED CELLS STOR/PROCESS Blood Products 48602 TRANSFUSE RBC PAD STOR/PROC Blood Products 48604 WSHED PACKED CELLS WPC STOR/PR Blood Products 48617 BL EXCHANGE/TRANSFUSE NON NB Blood Products 48619 CRYOPRECIPITATE PROC/STOR Blood Products 48620 FRESH FROZEN PLASMA PROC/STOR Blood Products 48622 DEGLYCED PC STOR/PROC Blood Products 48623 PHERESIS PLATELET STOR/PROCESS Blood Products 48625 LOW YIELD PLATELET IRRAD STOR/ Blood Products 48653 PHERESIS PLATELET W/IRRAD STOR Blood Products 44034 CARDIAC STRESS TEST Cardiology 56404 CPR Cardiology 58000 CHD 2D/MMODE Cardiology 58004 TEE CHD Cardiology 58025 SPECTRAL DOPPLER Cardiology 58071 COLOR FLOW MAPPING Cardiology 58272 FETAL 2 D/M-MODE Cardiology 58274 FETAL DOPPLER Cardiology 58805 LIMITED FETAL DOPPLER Cardiology 58806 LIMITED FETAL 2D/M-MODE Cardiology 58809 TEE Cardiology 58925 ECHO Cardiology 58930 ECHO CONTRACTED RATE Cardiology 58940 Jennings Clinic Echo Cardiology 60224 CPR Cardiology 60232 CARDIOVERSION EXTERNAL Cardiology 60233 CARDOVERSION DEFIB Cardiology 60234 PACING Cardiology 10410 CHEMO IV INFUSION INT HR Chemotherapy/Infusion 10411 CHEMO IV INFUSION EA ADDL HR Chemotherapy/Infusion 10412 CHEMO PROLONG INFUSE W/PUMP Chemotherapy/Infusion 10413 CHEMO IV INFUS EAC ADDL SEQ Chemotherapy/Infusion 10739 INITIAL CHEMO IV INFUSION HOUR Chemotherapy/Infusion 10740 ADD CHEMO INF HOUR Chemotherapy/Infusion 10741 SEQ CHEMO INFUSION Chemotherapy/Infusion 24021 PRIMARY CHEMO IV INFUSION HOUR Chemotherapy/Infusion 24022 ADD CHEMO INF HOUR Chemotherapy/Infusion 24023 SEQ CHEMO INFUSION Chemotherapy/Infusion 80181 INITIAL CHEMO IV INFUSION HOUR Chemotherapy/Infusion 80182 ADD CHEMO INF HOUR Chemotherapy/Infusion 80183 SEQ CHEMO INFUSION Chemotherapy/Infusion 92037 CHEMO ADMININFUS,INIT Chemotherapy/Infusion 92038 CHEMO INFUS EA ADD'L HR Chemotherapy/Infusion 99211 CHEMO INFUSION OVER 8 HRS PORT Chemotherapy/Infusion 10134 LP W/INTRATHECAL MEDICATION Chemotherapy/Injection 10406 CHEMO SUBQ/IM INJECT NON-HORM Chemotherapy/Injection 10407 CHEMO SUBQ/IM INJECT HORM Chemotherapy/Injection 10408 CHEMO IV PUSH INIT DRUG Chemotherapy/Injection 10409 CHEMO IV PUSH EA ADDL DRUG Chemotherapy/Injection 10420 CHEMO ADMIN OMMYA RESERVIOR Chemotherapy/Injection 10742 INITIAL CHEMO IV PUSH Chemotherapy/Injection 10743 SEQ CHEMO IV PUSH Chemotherapy/Injection 10744 PRIMARY CHEMO IV PUSH Chemotherapy/Injection 10745 CHEMO IVPUSH EACH ADD DRUG Chemotherapy/Injection 10746 CHEMO SQ/IM MED ADMIN Chemotherapy/Injection 10764 CHEMO SQ/IM EAC INJ NON HORM Chemotherapy/Injection 24024 SEQ CHEMO IV PUSH Chemotherapy/Injection 24025 PRIMARY CHEMO IV PUSH Chemotherapy/Injection 24026 CHEMO SQ/IM MED ADMIN Chemotherapy/Injection 24039 CHEMO SQ/IM EAC INJ NON HORM Chemotherapy/Injection 80134 LP W/INTRATHECAL MEDICATION Chemotherapy/Injection 80184 PRIMARY CHEMO IV PUSH Chemotherapy/Injection 80185 SEQ CHEMO IV PUSH Chemotherapy/Injection 80189 CHEMO SQ/IM MED ADMIN Chemotherapy/Injection 92036 CHEMO ADMINPUSH Chemotherapy/Injection 99212 CHEMO ADM SUBQ OR INTRA Chemotherapy/Injection 99213 HORMONAL ANTI NEOPLASTIC ADM Chemotherapy/Injection 99214 CHEMO ADM INTRALESIONAL Chemotherapy/Injection 99215 INTRALESIONAL >THAN 7 LESION Chemotherapy/Injection 99216 INTRAV PUSH SINGLE OR INITIAL Chemotherapy/Injection AMB96405 CHEMO INTRALESIONAL UP TO 7 Chemotherapy/Injection 10110 CLINIC FEE - LVL 1 NEW Clinics 10112 CLNC FEE-LVL 1 EST-MINIMAL Clinics 10115 CLINIC FEE LVL 2 NEW 15-29 MIN Clinics 10116 CLINIC FEE-LVL 2 EST 10-19 MIN Clinics 10120 CLNC FEE LVL 3 NEW (30-44 MIN) Clinics