Hospital Emergency Room Charges
EMERGENCY ROOM - LEVEL 1
EMERGENCY ROOM - LEVEL 2
EMERGENCY ROOM - LEVEL 3
EMERGENCY ROOM - LEVEL 4
EMERGENCY ROOM - LEVEL 5
EMERGENCY ROOM - CRITICAL CARE FIRST 74 MIN
EMERGENCY RM - CRITICAL CARE - EACH ADD'L 30 MIN.
99281
99282
99283
99284
99285
99291
99292
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
$
125.00
$
220.00
$
440.00
$
890.00
$
990.00
$ 1,570.00
$
700.00
(Professional Charge)
PHYSICIAN
- LEVEL 1
PHYSICIAN
- LEVEL 2
PHYSICIAN
- LEVEL 3
PHYSICIAN
- LEVEL 4
PHYSICIAN
- LEVEL 5
PHYSICIAN - CRITICAL CARE FIRST 74 MIN
PHYSICIAN - CRITICAL CARE - EACH ADD'L 30 MIN.
99281
99282
99283
99284
99285
99291
99292
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
Per Visit
$
$
$
$
$
$
$
Most visits to the emergency room will have a hospital and professional charge.
There may be additional charges such as: Lab, X-Ray, and/or other E/R procedures.
Those charges are based on your medical condition, severity of illness and level of service required.
If you are comparing prices it is important to consider the CPT code as well as the description.
CPT Code - Current Procedural Terminology
95.00
120.00
260.00
440.00
575.00
950.00
400.00
Hospital Room & Board and Observation Charges
DESCRIPTION
UNIT
PRICE
Medical / Surgical Care
Intensive Care
Nursery
Per Day
Per Day
Per Day
$ 1,200.00
$ 2,400.00
$ 1,200.00
Observation
Direct Referral to Observation
Per Hour
Per Visit
$
$
50.00
540.00
Room and Board charges are recognized daily starting with the day of admission.
There is no charge for room and board on the day of discharge unless it is the same day of admission.
Observation is when you are in a bed in a patient room but are not recognized as being admitted.
This is important because your insurance coverage is very different than if you were admitted.
Direct referral is when your provider asks for a bed for you in a patient room for observation (not
admitted).
There may be additional charges for room and board or observation services as needed for your care.
Hospital Laboratory Charges
DESCRIPTION
CPT CODE
UNIT
PRICE
ANTIBODY SCREEN
AUTOMATED BLOOD COUNT
BMP (BASIC METABOLIC PANEL)
CBC
CMP(COMP.METABOLIC PANEL)
CREATININE
CULTURE BLOOD
ESR (SED RATE)
GLUCOSE
HEMOGLOBIN
INR
IRON
IRON BINDING CAPACITY,TOTAL
LACTATE
LIPASE
LIPID PANEL
MAGNESIUM
PHOSPHORUS
PLATELET COUNT
POTASSIUM (K+)
PSA ANNUAL SCREENING
PTT
RENAL FUNCTION PANEL
STREP SCREENING
TSH
URINE CREATININE
VENIPUNCTURE
VITAMIN B12
VITAMIN D
86850
85027
80048
85025
80053
82565
87040
85651
82947
85018
85610
83540
83550
83605
83690
80061
83735
84100
85049
84132
84153
85730
80069
87880
84443
82570
36415
82607
82306
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
137.00
89.00
98.00
69.00
129.00
80.00
154.00
81.00
89.00
66.00
49.00
76.00
71.00
79.00
82.00
142.00
93.00
69.00
42.00
59.00
95.00
86.00
96.00
89.00
98.00
57.00
15.00
83.00
95.00
Hospital Radiology Charges*
DESCRIPTION
CPT CODE
UNIT
PRICE
X-RAY OF CHEST
X-RAY OF ABDOMEN WITH KUB
X-RAY OF SPINE
X-RAY OF PELVIS
X-RAY OF KNEE
X-RAY OF SHOULDER
X-RAY OF FOOT
MRI LUMBAR WITHOUT CONTRAST
71010
74000
72100
72170
73564
73030
73620
72148
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
Per Test
MRI BRAIN WITHOUT CONTRAST
70551
Per Test
CT OF THE HEAD WITHOUT CONTRAST
70450
Per Test
CT OF THE ABD/PEL WITH CONTRAST
74177
Per Test
CT OF THE ABD/PEL WITHOUT CONTRAST
74176
Per Test
CT OF THE CHEST WITH CONTRAST
71260
Per Test
CT OF THE CHEST WITHOUT CONTRAST
71250
Per Test
MAMMOGRAM BILATERAL SCREENING
MAMMOGRAM BILATERAL DIAGNOSTIC
ULTRASOUND OF THE PELVIS
ULTRASOUND OF THE ABDOMEN
77057
77056
76830
76705
Per Test
Per Test
Per Test
Per Test
$
195.00
$
216.00
$
303.00
$
216.00
$
290.00
$
290.00
$
238.00
$
1,490.00
$
1,490.00
$
1,170.00
$
2,400.00
$
2,200.00
$
1,280.00
$
1,170.00
$
210.00
$
260.00
$
475.00
$
350.00
* Radiologist interpretation fees are not included in the above charges.