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Cost Estimator
Coulee Medical Center
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Nursing Charges
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You may need to get a specific service code from your provider.
Code
Description
Epifix Per Sq cm
Q3014 TELEHEALTH ORIGINATING SITE Charge
11000
Debridement of extensive eczematous or infected skin, up to 10% of body surface
15271
Application of skin graft to trunk, arms, legs, up to 100 sq cm; first 25 sq cm
15272
Application of skin graft to trunk,arms,legs, up to 100 sq cm; ea add 25 sq cm
15275
Application of skin graft to face, neck, genitalia, hands, feet, up to 100 sq cm; first 25 sq
15276
APPLY SKIN SUB - FEET, EACH ADD 25 SQ CM Wound
16000
Initial treatment, first degree burn, when no more than local treatment is required;
29580
APPL OF UNNA BOOT
36556
INSERT NON-TUNNEL CV CATH >5YO Charge
36569
INSERT PICC W/O SQ PUMP > 5YO Charge
36589
REMOVE TUNNELED CVC WO PUMP Charge
36593
Declotting by Thrombolytic Agent of Implanted Vascular Access Device or Catheter Tech
62270
SPINAL PUNCTURE LUMBAR DIAGNOSTIC OUTPATIENT
62323
Caudal/Lumbar Interlaminar Epidural Steroid injection WITH Fluro Tech
90460
IMMUN ADMIN INITIAL - 18YRS CHARGE
90461
IMMUN ADMIN EACH ADD COMP-18YR CHARGE
90471
ADM FEE INFLUENZA CHARGE
90472
IMMUNIZATION ADMIN EACH ADD Charge
96523
VENOUS ACCESS DEVICE FLUSH Charge
97597
Debridement, open wound, first 20 sq cm or less
97598
Debridement, open wound, each additional 20 sq cm, or part thereof
97602
Remove devitalized tissue from wound(s), non-selective debridement, w/o anesthesia, per sessio
97605
Negative pressure wound therapy, total wound(s) surface area less than or equal to 50 sq cm
97606
Negative pressure wound therapy, total wound(s) surface area greater than 50 sq cm
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