North Suburban Medical Center top charges
In compliance with federal law, please view pricing information for certain procedures and services at North Suburban Medical Center.
| DRG | Plain Language Description | Average Charge |
|---|---|---|
| 871 | Septicemia or severe sepsis without MV >96 hours with complication | $20,938 |
| 795 | Normal newborn | $2,103 |
| 807 | Vaginal delivery without sterilization or D&C without comorbidity/complication | $7,911 |
| 247 | Percutaneous cardiovascular procedures with drug-eluting stent without complication | $34,449 |
| 872 | Septicemia or severe sepsis without MV >96 hours without complication | $10,922 |
| 794 | Neonate with other significant problems | $3,063 |
| 280 | Acute myocardial infarction, discharged alive with complication | $13,175 |
| 189 | Pulmonary edema and respiratory failure | $13,595 |
| 806 | Vaginal delivery without sterilization or D&C with comorbidity | $8,753 |
| 246 | Percutaneous cardiovascular procedures with drug-eluting stent with complication or 4+ arteries or stents | $42,512 |
| 291 | Heart failure and shock with complication | $9,837 |
| 787 | Cesarean section without sterilization with comorbidity | $16,622 |
| 640 | Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with complication | $1,450 |
| 193 | Simple pneumonia and pleurisy with complication | $11,278 |
| 683 | Renal failure with comorbidity | $9,528 |
| 552 | Medical back problems without complication | $24,130 |
| 682 | Renal failure with complication | $13,884 |
| 177 | Respiratory infections and inflammations with complication | $16,121 |
| 853 | Infectious and parasitic diseases with O.R. procedures with complication | $53,478 |
| 064 | Intracranial hemorrhage or cerebral infarction with complication | $23,009 |
| 637 | Diabetes with complication | $18,290 |
| 281 | Acute myocardial infarction, discharged alive with comorbidity | $13,473 |
| 481 | Hip and femur procedures except major joint with comorbidity | $18,560 |
| 603 | Cellulitis without complication | $10,586 |
| 313 | Chest pain | $22,858 |
| 560 | Aftercare, musculoskeletal system and connective tissue with comorbidity | $2,879 |
| 389 | Gastrointestinal obstruction with comorbidity | $9,583 |
| 065 | Intracranial hemorrhage or cerebral infarction with comorbidity or tPA in 24 hours | $16,437 |
| 793 | Full term neonate with major problems | $12,492 |
| 917 | Poisoning and toxic effects of drugs with complication | $24,534 |
| 788 | Cesarean section without sterilization without comorbidity/complication | $14,236 |
| 698 | Other kidney and urinary tract diagnoses with complication | $14,392 |
| 812 | Red blood cell disorders without complication | $14,787 |
| 194 | Simple pneumonia and pleurisy with comorbidity | $7,820 |
| 870 | Septicemia or severe sepsis with MV >96 hours | $77,491 |
| 951 | Other factors influencing health status | $1,498 |
| 309 | Cardiac arrhythmia and conduction disorders with comorbidity | $6,202 |
| 392 | Esophagitis, gastroenteritis and miscellaneous digestive disorders without complication | $10,161 |
| 208 | Respiratory system diagnosis with ventilator support <=96 hours | $24,993 |
| 638 | Diabetes with comorbidity | $9,726 |
| 086 | Traumatic stupor and coma <1 hour with comorbidity | $23,273 |
| 343 | Appendectomy without complicated principal diagnosis without comorbidity/complication | $25,421 |
| 286 | Circulatory disorders except AMI, with cardiac catheterization with complication | $20,398 |
| 896 | Alcohol, drug abuse or dependence without rehabilitation therapy with complication | $33,300 |
| 243 | Permanent cardiac pacemaker implant with comorbidity | $12,259 |
| 792 | Prematurity without major problems | $11,359 |
| 419 | Laparoscopic cholecystectomy without C.D.E. without comorbidity/complication | $76,248 |
| 433 | Cirrhosis and alcoholic hepatitis with comorbidity | $18,722 |
| 420 | Hepatobiliary diagnostic procedures with complication | $4,227 |
| 480 | Hip and femur procedures except major joint with complication | $22,731 |
| CPT | Plain Language Description | Charge |
|---|---|---|
| 85027 | Complete blood cell count (red cells, white blood cell, platelets), automated test | $693 |
| 99284 | Emergency department visit with moderate level of medical decision making | $11,516 |
| 80053 | Blood test, comprehensive group of blood chemicals | $1,799 |
| 99283 | Emergency department visit with low level of medical decision making | $6,872 |
| 96374 | Injection of drug or substance into vein | $626 |
| 93005 | Routine electrocardiogram (ECG) using at least 12 leads with tracing | $2,093 |
| 71045 | X-ray of chest, 1 view | $962 |
| 84484 | Troponin (protein) analysis, quantitative | $1,111 |
| 80048 | Blood test, basic group of blood chemicals (Calcium, total) | $1,116 |
| 96375 | Injection of additional new drug or substance into vein | $638 |
| 83690 | Lipase (fat enzyme) level | $701 |
| 84703 | Gonadotropin (reproductive hormone) analysis | $811 |
| 74177 | CT scan of abdomen and pelvis with contrast | $11,583 |
| 99285 | Emergency department visit with high level of medical decision making | $13,769 |
| 81001 | Manual urinalysis test with examination using microscope, automated | $503 |
| 70450 | CT scan head or brain without contrast | $11,964 |
| 83605 | Lactic acid level | $767 |
| 81003 | Automated urinalysis test | $410 |
| 96361 | Infusion into a vein for hydration, each additional hour | $318 |
| 77067 | Screening mammography | $1,614 |
| 82077 | Measurement of alcohol level in specimen other than breath or urine | $62 |
| 77063 | Screening 3D breast mammography | $141 |
| 85610 | Blood test, clotting time | $426 |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $63 |
| 99282 | Emergency department visit with straightforward medical decision making | $3,026 |
CPT® copyright 2022 American Medical Association