Emergency room visit, complex
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Emergency room visit, complex Standard Service Package (SSP EM002). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS 99285 | Facility Fee | Ed Visit for Complex Medical Decision-making Involving History/Exam/counseling |
| HCPCS 96374 | Facility Fee | Therapeutic IV injection of single substance/drug |
| HCPCS 71045 | Facility Fee | X-ray of chest for viewing single structure |
| HCPCS 93005 | Facility Fee | Electrocardiogram (ECG) with recording only, no interpretation |
| HCPCS 84484 | Facility Fee | Quantitative measurement of cardiac muscle protein, troponin |
| HCPCS 85025 | Facility Fee | Complete blood count (CBC) with differential WBC |
| HCPCS 80053 | Facility Fee | Comprehensive metabolic panel also includes albumin, total protein, ALP, ALT, AST and bilirubin |
| Revenue Code 270 | Facility Fee | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - General |
| Revenue Code 636 | Facility Fee | Pharmacy - Extension of 025X - Drugs requiring detailed coding |
| HCPCS 36415 | Facility Fee | Collection of blood from a vein via puncture |
| Revenue Code 637 | Facility Fee | Pharmacy - Extension of 025X - Self-administered drugs |