§ 82-281. Urgent care fees.
Latest version.
The City of New Orleans, through the department of health, is hereby authorized to charge fees for urgent care services and costs provided by the city in cooperation with the Parish Hospital Service District for the Parish of Orleans-A in accordance with the following fee schedule:
Procedure CPT Fee Procedure CPT Fee Procedure CPT Fee Procedure CPT Fee Office Visits X-Ray (cont) Ortho Proc (cont) Inject/Drug (cont) New Level One 99201 $65.00 Orbit Min 4 Views 70200 $113.00 Metatar FX W/O Man 28470 $463.00 Bicillin CR 1.2 MU J0540 $70.00 New Level Two 99202 $123.00 Pelvis AP Only 72170 $70.00 Nursemaids Elbow 24640 $217.00 Bicillin LA 1.2 MU J0570 $65.00 New Level Three 99203 $187.00 Rib Unl. Min 3 Views 71101 $101.00 Rib FX CLSD TX 21800 $260.00 Bicillin LA 600,000U J0560 $39.00 New Level Four 99204 $316.00 Sacrum/Coccyx 72200 $76.00 Shldr Disloc W/Man 23650 $664.00 Celestone 3 MG J0702 $14.00 New Level Five 99205 $407.00 Skull < 4 Views 70250 $95.00 Toe Phal FXCL W/O Min 28510 $286.00 Demerol 50 MG J2175 $5.00 Nurse Visit 99211 $50.00 Shoulder 73030 $79.00 Toe Disloc CLSD TX 28660 $215.00 Dexamethasone 1 mg/ml J1100 $3.00 Est Level One 99212 $63.00 Sinuses Min. 3 Views 70220 $99.00 GRT toe FX TX W/Man 28495 $368.00 Epinephrine up to 1 ml J0170 $39.00 Est Level Two 99213 $123.00 Tibula [Tibia]/Fibula 73590 $71.00 Other Imitrex 6 mg J3030 $194.00 Est Level Three 99214 $190.00 Toes (s) 73660 $75.00 Splint Influenza Vaccine 90658 $20.00 Est Level Fourth 99215 $268.00 T-Spine 72074 $114.00 Applications ADM Flu (Medicare only) G0008 $10.00 Physicals Water View 70210 $79.00 Splint Finger Q4049 $67.00 Insulin 5 units J1815 $10.00 Sports Phys 5—11 yrs 99393 $50.00 Wrist Min. 3 Views 73110 $93.00 Splint Long Arm 29105 $209.00 Phenergan 50 mg J2550 $11.00 Sports Phys 12—17 yrs 99394 $50.00 X-Ray Soft Tissue N/A Splint Long Leg 29505 $118.00 Rocephin 250 mg J0696 $20.00 Suture Removal $30.00 Laceration Repair Splint Short Arm 29125 $106.00 Solumedrol 125 mg J2930 $10.00 Laboratory Scalp/Trunk/Extr (Inc Hand & Foot) Splint Short Leg 29515 $122.00 Tetanus Diptheria 90718 $71.00 Accu-Check 82948 $11.00 Lac SMP 2.5 CM or < 12001 $138.00 Minor Surgery Toradol 15 mg J1885 $13.00 CBC W/3 Part diff 85025 $27.00 Lac SMP 2.6—7.5 CM 12002 $177.00 Avulsion Nail Plate 11730 $131.00 Valium 5 mg J3360 $10.00 EKG 93000 $50.00 Lac SMP 7.4—12.5 CM 12004 $215.00 Debrid Skin PTL Thick 11040 $100.00 Vistaril 25 mg J3410 $10.00 H-Pylori 86677 $41.00 Scalp/Trunk/Extr (Ext Hand & Foot) Drsng/Debr/Sml, Burn 16020 $142.00 Other Influenza 87804 $42.00 Lac SMP 2.5 CM or < 12031 $404.00 Evac Dubung Hemat 11740 $79.00 Nebulizer Treatment Monospot 86308 $18.00 Lac SMP 2.6—7.5 CM 12032 $489.00 Exc Ben Les .5 cm < 11400 $192.00 Nebulizer TX per hour 94640 $41.00 Rapid Strep Screen 87880 $42.00 Lac SMP 7.4—12.5 CM 12034 $509.00 FB RMV Subcut SMP 10120 $227.00 Mouthpiece/Tubing A7003 $10.00 R.S.V. 87807 $42.00 Neck/Hand/Foot I & D Fing ABS SMP (paron) 10060 $232.00 Atrovent Inhal Per/M J7644 $10.00 Specimen Handling fee 99000 $12.00 Lac SMP 2.5 CM or < 12041 $429.00 I & D Hemat/Seroma 10140 $291.00 Albuterol Inhal 1 mg J7613 $10.00 Pulse-Ox 94760 $25.00 Lac SMP 2.6-7.5 CM 12042 $499.00 I & D Comp or Multi 10061 $399.00 Xopenex 17614 $10.00 Pregnancy Test 81025 $22.00 Lac SMP 7.4-12.5 CM 12044 $529.00 I & D Vulva/Perin ABS 56405 $273.00 Pulmicort J7626 $13.00 Urinalysis 81003 $20.00 Face/Ear/Eyelid/Nose/Lip I & D Pilonidal Cyst 10080 $246.00 Vaponefrin J7699 $10.00 Urine Drug Screen 80100 $51.00 Lac SMP 2.5 CM or < 12011 $165.00 Punctr Asp of Hemat 10160 $236.00 Other Supplies Venipuncture 36415 $8.00 Lac SMP 2.5-5 CM 12013 $186.00 Rem Ingrown Nail 11750 $429.00 Ace Wrap A6449 $9.00 X-Ray Lac SMP 5.1-7.5 CM 12014 $231.00 Repair Nail Bed 11760 $327.00 Ankle Brace L1906 $70.00 Abdomen Flat & Erect 74020 $102.00 Lac SMP 7.5-12.5 CM 12015 $283.00 Other Cervical Collar L0120 $90.00 Ankle Min 3 views 73610 $83.00 Lac INT 2.5 CM or < 12051 $456.00 Special Procedures Crutches E0114 $75.00 C-Spine AP & Lat 72040 $100.00 Lac INT 2.6-5 CM OCM 12052 $545.00 Foley Insertion 51701 $151.00 Finger Splint L0889 $20.00 Chest Single View 71010 $60.00 Lac INT 5.1-7.5 CM 12053 $541.00 Peak Flow Meter 94200 $61.00 Ice Pack E0230 $10.00 Chest 2 views 71020 $79.00 Lac INT 7.5-12.5 CM 12054 $568.00 IV Administration Knee Cap Band L1825 $83.00 Clavicle 73000 $73.00 E-ENT Procedures Admin IV Med 90774 $59.00 Knee Immobilizer L1830 $137.00 Elbow Min 3 views 73080 $87.00 Removal Cerumen 69210 $82.00 IV Infusion 1st Hour 90765 $130.00 Post Op Cast Shoe L3260 $70.00 Facial Min 3 Views 70150 $109.00 Epistaxis Control SMP 30901 $241.00 Ea Add Hour 90766 $61.00 Rib Belt L0210 $67.00 Femur 73550 $73.00 FB Removal Ear 69200 $143.00 Normal Saline 1 LTR J7030 $20.00 Shoulder Immobilizer L3660 $80.00 Fingers 73140 $80.00 FB Removal Eye 65210 $131.00 Intra Catheter A4212 $9.00 Sling A4565 $18.00 Foot Min 3 Views 73630 $80.00 FB Removal Cornea 65220 $104.00 IV Tubing A9901 $10.00 Steri Strips A6265 $0.00 Forearm 73090 $71.00 FB Removal Nose 30300 $311.00 Hep Lock 36000 $64.00 Short Leg Walking Boot L4386 $256.00 Hand Min 3 Views 73130 $82.00 New Slit lamp 92002 $117.00 Thumb Spica Splint L3800 $100.00 Hip Unil Min 2 Views 73510 $99.00 Est-Slit Lamp 92012 $127.00 Xeroform 1x8 cp A6222 $3.00 Humerus 73060 $75.00 Ortho Procedures Injections/Drugs Wrist Cock Up Splint L3908 $90.00 Knee 3 Views 73562 $94.00 AP Sep CLS TX W/O Man 23540 $532.00 Admin Antib Inj 90772 $20.00 Kub 74000 $64.00 ASP/Joint Inj Large 20610 $124.00 Admin Other Inj 90772 $20.00 Strappings L-Spine Ap & Lat 72100 $104.00 Clavicle Fx Clsd 23500 $524.00 Admin Vaccine 90471 $20.00 Mandible Min 4 Views 70110 $101.00 CLSD TR Dis RDL Fract 25600 $635.00 Ancef 500 MG J0690 $2.00 Nasal Bone 70160 $84.00 Finger Disloc W/Man 26770 $597.00 Benadryl 50 mg J1200 $2.00 ICD-9 Neck Soft Tissue 70360 $71.00 Finger FX W/Out Man 26750 $430.00 Bentyl up to 20 mg J0500 $53.00 DIAGNOSIS-1 Finger FX CLSD W/Man 26755 $657.00 Bicillin CR 600,000 U J0530 $38.00 DIAGNOSIS-2 Metar FX CLSD W/O Man 26600 $645.00 DIAGNOSIS-3 EAST AFTER HOURS URGENT CARE CENTER;eol;SLIDING FEE SCALE: PERCENTAGE OF MAXIMUM CHARGE;eol;BASED ON ANNUAL FAMILY INCOME 2011
EAST AFTER HOURS URGENT CARE CENTER;eol;SLIDING FEE SCALE: PERCENTAGE OF MAXIMUM CHARGE;eol;BASED ON ANNUAL FAMILY INCOME 201>PAYMENT LEVEL 0 5% 10% 20% 30% 40% 50% 60% 70% FAMILY SIZE 1 0—10,890 10,890—14,710 14,710—18,530 18,530—22,350 22,350—26,170 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 2 10,890—14,710 14,710—18,530 18,530—22,350 22,350—26,170 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 3 14,710—18,530 18,530—22,350 22,350—26,170 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 4 18,530—22,350 22,350—26,170 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 49,090—52,910 5 22,350—26,170 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 49,090—52,910 52,910—56,730 6 26,170—29,990 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 49,090—52,910 52,910—56,730 56,730—60,550 7 29,990—33,810 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 49,090—52,910 52,910—56,730 56,730—60,550 60,550—64,370 8 33,810—37,630 37,630—41,450 41,450—45,270 45,270—49,090 49,090—52,910 52,910—56,730 56,730—60,550 60,550—64,370 64,370—68,190 Add 3,820 for each additional family member
(M.C.S., Ord. No. 24573, § 1, 9-1-11)