Elmhurst Hospital Menu
| Items | |||||
|---|---|---|---|---|---|
| Wound Debridements For Injuries W Mcc (901) | $322,076.00 |
N/A
|
|
||
| Treatment Room - Removal Of Tissue From Wounds, Per Session (76100005) | $659.00 |
N/A
|
|
||
| Wound Debridements For Injuries W Cc (902) | $39,025.00 |
N/A
|
|
||
| Treatment Room - Removal Of Tissue From Wounds, Per Session (76100007) | $573.00 |
N/A
|
|
||
| Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W/o Cc/mcc (465) | $97,801.00 |
N/A
|
|
||
| Treatment Room - Removal Of Tissue From Wounds, Per Session (76100006) | $97.00 |
N/A
|
|
||
| Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W Mcc (463) | $152,937.00 |
N/A
|
|
||
| Treatment Room - Refilling And Maintenance Of Portable Pump (76100022) | $608.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy, Surface Area Less Than Or Equal To 50 Square Centimeters, Per Session (76100008) | $659.00 |
N/A
|
|
||
| Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W Cc (464) | $93,833.00 |
N/A
|
|
||
| Viral Meningitis W Cc/mcc (075) | $26,434.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy, Surface Area Greater Than 50 Square Centimeters, Per Session (76100009) | $1,174.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy Surface Area Less Than Or Equal To 50 Square Centimeters Per Session (76100023) | $1,021.00 |
N/A
|
|
||
| Viral Illness W/o Mcc (866) | $32,565.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy Surface Area Less Than Or Equal To 50 Square Centimeters Per Session (76100026) | $1,021.00 |
N/A
|
|
||
| Viral Illness W Mcc (865) | $43,608.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy Surface Area Greater Than 50 Square Centimeters (76100024) | $1,021.00 |
N/A
|
|
||
| Ventricular Shunt Procedures W Mcc (031) | $113,713.00 |
N/A
|
|
||
| Treatment Room - Negative Pressure Wound Therapy Surface Area Greater Than 50 Square Centimeters (76100027) | $1,021.00 |
N/A
|
|
||
| Ventricular Shunt Procedures W Cc (032) | $94,882.00 |
N/A
|
|
||
| Treatment Room - Insertion Of Temporary Bladder Catheter (36100266) | $346.00 |
N/A
|
|
||
| Vaginal Delivery W/o Sterilization/d&c W/o Cc/mcc (807) | $28,470.00 |
N/A
|
|
||
| Treatment Room - Insertion Of Needle Into Vein, Patient 3 Years Or Older (76100031) | $1,860.00 |
N/A
|
|
||
| Vaginal Delivery W/o Sterilization/d&c W Mcc (805) | $33,513.00 |
N/A
|
|
||
| Treatment Room - Insertion Of Indwelling Bladder Catheter (36100267) | $346.00 |
N/A
|
|
||
| Vaginal Delivery W/o Sterilization/d&c W Cc (806) | $29,995.00 |
N/A
|
|
||
| Vaginal Delivery W/o Complicating Diagnoses (775) | $30,129.00 |
N/A
|
|
||
| Treatment Room - Insertion Of Catheter Into Navel Vein, Newborn (76100029) | $287.00 |
N/A
|
|
||
| Treatment Room - Insertion Of Catheter Into An Artery In Navel, Newborn (76100030) | $242.00 |
N/A
|
|
||
| Vaginal Delivery W Sterilization/d&c Wo Cc/mcc (798) | $27,223.00 |
N/A
|
|
||
| Vaginal Delivery W Sterilization/d&c W Mcc (796) | $95,480.00 |
N/A
|
|
||
| Treatment Room - Infusion Of Clot-Busting Drug Into Implanted Vascular Catheter (36100169) | $937.00 |
N/A
|
|
||
| Treatment Room - Established Patient Office Or Other Outpatient, Visit Typically 40 Minutes (76100017) | $504.00 |
N/A
|
|
||
| Vaginal Delivery W Sterilization &/or D&c (767) | $29,473.00 |
N/A
|
|
||
| Treatment Room - Established Patient Office Or Other Outpatient, Visit Typically 25 Minutes (76100016) | $376.00 |
N/A
|
|
||
| Vaginal Delivery W O.r. Proc Except Steril &/or D&c (768) | $40,466.00 |
N/A
|
|
||
| Treatment Room - Established Patient Office Or Other Outpatient Visit, Typically 5 Minutes (76100013) | $79.00 |
N/A
|
|
||
| Vaginal Delivery W Complicating Diagnoses (774) | $34,897.00 |
N/A
|
|
||
| Treatment Room - Established Patient Office Or Other Outpatient Visit, Typically 15 Minutes (76100015) | $257.00 |
N/A
|
|
||
| Vagina, Cervix & Vulva Procedures W/o Cc/mcc (747) | $29,934.00 |
N/A
|
|
||
| Treatment Room - Established Patient Office Or Other Outpatient Visit, Typically 10 Minutes (76100014) | $157.00 |
N/A
|
|
||
| Uterine,adnexa Proc For Non-Ovarian/adnexal Malig W/o Cc/mcc (741) | $59,186.00 |
N/A
|
|
||
| Treatment Room - Electronic Analysis, Reprogramming, And Refill Of Spinal Canal Drug Infusion Pump (76100003) | $911.00 |
N/A
|
|
||
| Uterine,adnexa Proc For Non-Ovarian/adnexal Malig W Cc (740) | $87,176.00 |
N/A
|
|
||
| Treatment Room - Electronic Analysis, Reprogramming And Refill Of Spinal Canal Drug Infusion Pump (76100004) | $911.00 |
N/A
|
|
||
| Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Mcc (736) | $335,081.00 |
N/A
|
|
||
| Treatment Room - Electronic Analysis Of Spinal Canal Drug Infusion Pump (76100001) | $1,048.00 |
N/A
|
|
||
| Uterine & Adnexa Proc For Ovarian Or Adnexal Malignancy W Cc (737) | $89,581.00 |
N/A
|
|
||
| Treatment Room - Electronic Analysis Of Implanted Brain, Spinal Cord Or Peripheral Stimulation Device (76100019) | $346.00 |
N/A
|
|
||
| Uterine & Adnexa Proc For Non-Malignancy W/o Cc/mcc (743) | $53,743.00 |
N/A
|
|
||
| Treatment Room - Electronic Analysis And Reprogramming Of Spinal Canal Drug Infusion Pump (76100002) | $911.00 |
N/A
|
|
||
| Uterine & Adnexa Proc For Non-Malignancy W Cc/mcc (742) | $76,137.00 |
N/A
|
|
||
| Urinary Stones W/o Esw Lithotripsy W/o Mcc (694) | $31,377.00 |
N/A
|
|
||
| Therapeutic Services - Therapeutic Removal Of Whole Blood To Correct Blood Level Imbalance (94000014) | $612.00 |
N/A
|
|
||
| Therapeutic Services - Therapeutic Removal Of Whole Blood To Correct Blood Level Imbalance (94000011) | $532.00 |
N/A
|
|
||
| Urethral Procedures W/o Cc/mcc (672) | $37,795.00 |
N/A
|
|
||
| Therapeutic Services - Smoking And Tobacco Use Intermediate Counseling, Greater Than 3 Minutes Up To 10 Minutes (94000042) | $15.00 |
N/A
|
|
||
| Upper Limb & Toe Amputation For Circ System Disorders W Mcc (255) | $70,104.00 |
N/A
|
|
||
| Therapeutic Services - Smoking And Tobacco Use Intensive Counseling, Greater Than 10 Minutes (94000040) | $75.00 |
N/A
|
|
||
| Upper Limb & Toe Amputation For Circ System Disorders W Cc (256) | $48,645.00 |
N/A
|
|
||
| Therapeutic Services - Smoking And Tobacco Use Intensive Counseling, Greater Than 10 Minutes (94000041) | $45.00 |
N/A
|
|
||
| Uncomplicated Peptic Ulcer W/o Mcc (384) | $40,077.00 |
N/A
|
|
||
| Uncomplicated Peptic Ulcer W Mcc (383) | $91,310.00 |
N/A
|
|
||
| Therapeutic Services - Refilling And Maintenance Of Portable Pump (94000010) | $1,076.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma >1 Hr W/o Cc/mcc (084) | $32,386.00 |
N/A
|
|
||
| Therapeutic Services - Refilling And Maintenance Of Implantable Pump Or Reservoir For Drug Delivery (94000015) | $936.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma >1 Hr W Mcc (082) | $116,999.00 |
N/A
|
|
||
| Therapeutic Services - Medical Nutrition Re-Assessment And Intervention, Each 15 Minutes (94000017) | $197.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma >1 Hr W Cc (083) | $45,406.00 |
N/A
|
|
||
| Therapeutic Services - Medical Nutrition Assessment And Intervention, Each 15 Minutes (94000016) | $226.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma <1 Hr W/o Cc/mcc (087) | $30,863.00 |
N/A
|
|
||
| Therapeutic Services - Mechanical Separation Of White Blood Cells (94000001) | $6,235.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma <1 Hr W Mcc (085) | $40,856.00 |
N/A
|
|
||
| Therapeutic Services - Mechanical Separation Of Red Blood Cells (94000002) | $6,235.00 |
N/A
|
|
||
| Traumatic Stupor & Coma, Coma <1 Hr W Cc (086) | $53,930.00 |
N/A
|
|
||
| Therapeutic Services - Mechanical Separation Of Plasma And Abnormal Antibodies From Blood (94000003) | $19,613.00 |
N/A
|
|
||
| Traumatic Injury W/o Mcc (914) | $25,945.00 |
N/A
|
|
||
| Therapeutic Services - Irrigation Of Implanted Venous Access Drug Delivery Device (94000012) | $280.00 |
N/A
|
|
||
| Trauma To The Skin, Subcut Tiss & Breast W/o Mcc (605) | $44,187.00 |
N/A
|
|
||
| Therapeutic Services - Injection Therapy For Diagnosis Or Prevention, Under The Skin Or Into Muscle (94000005) | $344.00 |
N/A
|
|
||
| Trauma To The Skin, Subcut Tiss & Breast W Mcc (604) | $44,201.00 |
N/A
|
|
||
| Therapeutic Services - Injection Therapy For Diagnosis Or Prevention, Into Vein (94000007) | $866.00 |
N/A
|
|
||
| Transurethral Prostatectomy W/o Cc/mcc (714) | $33,849.00 |
N/A
|
|
||
| Therapeutic Services - Injection Therapy For Diagnosis Or Prevention, Into Artery (94000006) | $936.00 |
N/A
|
|
||
| Therapeutic Services - Injection Therapy For Diagnosis Or Prevention, Additional Sequential Injection Of Same Substance Into Vein (94000009) | $443.00 |
N/A
|
|
||
| Transurethral Prostatectomy W Cc/mcc (713) | $48,701.00 |
N/A
|
|
||
| Therapeutic Services - Injection Therapy For Diagnosis Or Prevention, Additional Sequential Injection Of New Substance Into Vein (94000008) | $540.00 |
N/A
|
|
||
| Transurethral Procedures W/o Cc/mcc (670) | $36,340.00 |
N/A
|
|
||
| Therapeutic Services - Application Of On-Body Injector For Timed Injection Under Skin (94000065) | $218.00 |
N/A
|
|
||
| Transurethral Procedures W Mcc (668) | $208,950.00 |
N/A
|
|
||
| Therapeutic Services - Acupuncture 1 Or More Needles, First 15 Minutes (94000018) | $51.00 |
N/A
|
|
||
| Transurethral Procedures W Cc (669) | $81,425.00 |
N/A
|
|
||
| Therapeutic Services - Acupuncture 1 Or More Needles, Additional 15 Minute Increment(S) (94000019) | $41.00 |
N/A
|
|
||
| Transient Ischemia W/o Thrombolytic (069) | $36,585.00 |
N/A
|
|
||
| Therapeutic Services - Acupuncture 1 Or More Needles With Electrical Stimulation, First 15 Minutes (94000063) | $64.00 |
N/A
|
|
||
| Trach W Mv >96 Hrs Or Pdx Exc Face, Mouth & Neck W/o Maj O.r. (004) | $382,471.00 |
N/A
|
|
||
| Therapeutic Services - Acupuncture 1 Or More Needles With Electrical Stimulation And Re-Insertion Of Needles (94000064) | $53.00 |
N/A
|
|
||
| Thyroid, Parathyroid & Thyroglossal Procedures W/o Cc/mcc (627) | $40,319.00 |
N/A
|
|
||
| Therapeutic Services (94000031) | $650.00 |
N/A
|
|
||
| Threatened Abortion (778) | $8,634.00 |
N/A
|
|
||
| Therapeutic Services (94000039) | $650.00 |
N/A
|
|
||
| Testes Procedures W/o Cc/mcc (712) | $40,276.00 |
N/A
|
|
||
| Therapeutic Services (94000059) | $650.00 |
N/A
|
|
||
| Tendonitis, Myositis & Bursitis W/o Mcc (558) | $29,374.00 |
N/A
|
|
||
| Therapeutic Services (94000027) | $650.00 |
N/A
|
|
||
| Tendonitis, Myositis & Bursitis W Mcc (557) | $53,270.00 |
N/A
|
|
||
| Therapeutic Services (94000023) | $650.00 |
N/A
|
|
||
| Syncope & Collapse (312) | $32,598.00 |
N/A
|
|
||
| Stomach, Esophageal & Duodenal Proc W/o Cc/mcc (328) | $98,769.00 |
N/A
|
|
||
| Therapeutic Services (94000048) | $650.00 |
N/A
|
|
||
| Stomach, Esophageal & Duodenal Proc W Mcc (326) | $302,192.00 |
N/A
|
|
||
| Therapeutic Services (94000044) | $650.00 |
N/A
|
|
||
| Stomach, Esophageal & Duodenal Proc W Cc (327) | $90,174.00 |
N/A
|
|
||
| Therapeutic Services (94000056) | $600.00 |
N/A
|
|
||
| Sprains, Strains, & Dislocations Of Hip, Pelvis & Thigh W/o Cc/mcc (538) | $36,156.00 |
N/A
|
|
||
| Therapeutic Services (94000058) | $150.00 |
N/A
|
|
||
| Sprains, Strains, & Dislocations Of Hip, Pelvis & Thigh W Cc/mcc (537) | $30,310.00 |
N/A
|
|
||
| Therapeutic Services (94000033) | $85.00 |
N/A
|
|
||
| Spinal Procedures W/o Cc/mcc (030) | $92,879.00 |
N/A
|
|
||
| Therapeutic Services (94000050) | $85.00 |
N/A
|
|
||
| Spinal Procedures W Mcc (028) | $223,421.00 |
N/A
|
|
||
| Therapeutic Services (94000066) | $75.00 |
N/A
|
|
||
| Spinal Procedures W Cc Or Spinal Neurostimulators (029) | $120,182.00 |
N/A
|
|
||
| Therapeutic Services (94000038) | $75.00 |
N/A
|
|
||
| Therapeutic Services (94000052) | $75.00 |
N/A
|
|
||
| Spinal Fusion Except Cervical W/o Mcc (460) | $163,491.00 |
N/A
|
|
||
| Therapeutic Services (94000035) | $75.00 |
N/A
|
|
||
| Spinal Fusion Except Cervical W Mcc (459) | $309,335.00 |
N/A
|
|
||
| Therapeutic Services (94000060) | $75.00 |
N/A
|
|
||
| Spinal Fus Exc Cerv W Spinal Curv/malig/infec Or Ext Fus W/o Cc/mcc (458) | $186,538.00 |
N/A
|
|
||
| Therapeutic Services (94000029) | $75.00 |
N/A
|
|
||
| Spinal Fus Exc Cerv W Spinal Curv/malig/infec Or Ext Fus W Mcc (456) | $415,948.00 |
N/A
|
|
||
| Therapeutic Services (94000022) | $75.00 |
N/A
|
|
||
| Spinal Fus Exc Cerv W Spinal Curv/malig/infec Or Ext Fus W Cc (457) | $248,039.00 |
N/A
|
|
||
| Therapeutic Services (94000026) | $75.00 |
N/A
|
|
||
| Spinal Disorders & Injuries W Cc/mcc (052) | $125,429.00 |
N/A
|
|
||
| Therapeutic Services (94000045) | $75.00 |
N/A
|
|
||
| Soft Tissue Procedures W/o Cc/mcc (502) | $50,200.00 |
N/A
|
|
||
| Therapeutic Services (94000053) | $70.00 |
N/A
|
|
||
| Soft Tissue Procedures W Mcc (500) | $127,656.00 |
N/A
|
|
||
| Therapeutic Services (94000037) | $65.00 |
N/A
|
|
||
| Soft Tissue Procedures W Cc (501) | $57,865.00 |
N/A
|
|
||
| Therapeutic Services (94000032) | $65.00 |
N/A
|
|
||
| Skin Ulcers W Mcc (592) | $50,044.00 |
N/A
|
|
||
| Therapeutic Services (94000043) | $65.00 |
N/A
|
|
||
| Skin Ulcers W Cc (593) | $37,334.00 |
N/A
|
|
||
| Therapeutic Services (94000024) | $65.00 |
N/A
|
|
||
| Skin Grafts For Injuries W Cc/mcc (904) | $129,195.00 |
N/A
|
|
||
| Therapeutic Services (94000028) | $65.00 |
N/A
|
|
||
| Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis W Mcc (622) | $149,599.00 |
N/A
|
|
||
| Therapeutic Services (94000047) | $65.00 |
N/A
|
|
||
| Skin Grafts & Wound Debrid For Endoc, Nutrit & Metab Dis W Cc (623) | $100,674.00 |
N/A
|
|
||
| Therapeutic Services (94000062) | $65.00 |
N/A
|
|
||
| Skin Graft For Skin Ulcer Or Cellulitis W Cc (574) | $121,998.00 |
N/A
|
|
||
| Therapeutic Services (94000055) | $60.00 |
N/A
|
|
||
| Skin Debridement W Mcc (570) | $64,658.00 |
N/A
|
|
||
| Therapeutic Services (94000020) | $55.00 |
N/A
|
|
||
| Skin Debridement W Cc (571) | $54,876.00 |
N/A
|
|
||
| Therapeutic Services (94000049) | $55.00 |
N/A
|
|
||
| Simple Pneumonia & Pleurisy W/o Cc/mcc (195) | $30,968.00 |
N/A
|
|
||
| Therapeutic Services (94000034) | $50.00 |
N/A
|
|
||
| Simple Pneumonia & Pleurisy W Mcc (193) | $57,229.00 |
N/A
|
|
||
| Therapeutic Services (94000061) | $50.00 |
N/A
|
|
||
| Simple Pneumonia & Pleurisy W Cc (194) | $36,198.00 |
N/A
|
|
||
| Therapeutic Services (94000051) | $50.00 |
N/A
|
|
||
| Signs & Symptoms W/o Mcc (948) | $37,723.00 |
N/A
|
|
||
| Therapeutic Services (94000036) | $45.00 |
N/A
|
|
||
| Signs & Symptoms W Mcc (947) | $39,498.00 |
N/A
|
|
||
| Therapeutic Services (94000025) | $45.00 |
N/A
|
|
||
| Signs & Symptoms Of Musculoskeletal System & Conn Tissue W/o Mcc (556) | $29,292.00 |
N/A
|
|
||
| Therapeutic Services (94000021) | $45.00 |
N/A
|
|
||
| Shoulder,elbow Or Forearm Proc,exc Major Joint Proc W/o Cc/mcc (512) | $73,504.00 |
N/A
|
|
||
| Therapeutic Services (94000046) | $45.00 |
N/A
|
|
||
| Shoulder,elbow Or Forearm Proc,exc Major Joint Proc W Cc (511) | $62,986.00 |
N/A
|
|
||
| Therapeutic Services (94000030) | $45.00 |
N/A
|
|
||
| Septicemia Or Severe Sepsis W/o Mv >96 Hours W/o Mcc (872) | $45,173.00 |
N/A
|
|
||
| Therapeutic Services (94000054) | $40.00 |
N/A
|
|
||
| Septicemia Or Severe Sepsis W/o Mv >96 Hours W Mcc (871) | $73,799.00 |
N/A
|
|
||
| Therapeutic Services (94000057) | $20.00 |
N/A
|
|
||
| Septicemia Or Severe Sepsis W Mv >96 Hours Or Peripheral Extracorporeal Membrane Oxygenation (Ecmo) (870) | $210,070.00 |
N/A
|
|
||
| Sterile Supplies - Vena Cava Filter (27800147) | $5,025.00 |
N/A
|
|
||
| Septic Arthritis W Cc (549) | $63,495.00 |
N/A
|
|
||
| Sterile Supplies - Vascular Closure Device (27800137) | $2,100.00 |
N/A
|
|
||
| Seizures W/o Mcc (101) | $39,891.00 |
N/A
|
|
||
| Sterile Supplies - Vascular Closure Device (27800115) | $1,304.00 |
N/A
|
|
||
| Seizures W Mcc (100) | $70,331.00 |
N/A
|
|
||
| Sterile Supplies - Vascular Closure Device (27800155) | $1,129.00 |
N/A
|
|
||
| Revision Of Hip Or Knee Replacement W/o Cc/mcc (468) | $115,410.00 |
N/A
|
|
||
| Sterile Supplies - Vascular Closure Device (27800152) | $853.00 |
N/A
|
|
||
| Revision Of Hip Or Knee Replacement W Mcc (466) | $268,822.00 |
N/A
|
|
||
| Revision Of Hip Or Knee Replacement W Cc (467) | $142,135.00 |
N/A
|
|
||
| Sterile Supplies - Uterus Support Device (27200350) | $126.00 |
N/A
|
|
||
| Reticuloendothelial & Immunity Disorders W/o Cc/mcc (816) | $39,281.00 |
N/A
|
|
||
| Sterile Supplies - Ultrasound Catheter (27200180) | $3,325.00 |
N/A
|
|
||
| Reticuloendothelial & Immunity Disorders W Mcc (814) | $97,113.00 |
N/A
|
|
||
| Sterile Supplies - Stent (27800220) | $42,559.00 |
N/A
|
|
||
| Sterile Supplies - Stent (27800234) | $34,169.00 |
N/A
|
|
||
| Reticuloendothelial & Immunity Disorders W Cc (815) | $29,475.00 |
N/A
|
|
||
| Respiratory System Diagnosis W Ventilator Support >96 Hours Or Peripheral Extracorporeal Membrane Oxygenation (Ecmo) (207) | $250,406.00 |
N/A
|
|
||
| Sterile Supplies - Stent (27800233) | $15,778.00 |
N/A
|
|
||
