Clavicle/Scapula Repair - Non-Surgical
The Mount Sinai Hospital
What goes into a price?
Prices across providers
Self pay or cash prices vary by provider when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts providers 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 Clavicle/Scapula Repair - Non-Surgical Standard Service Package (SSP MS028). 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 23505 | Base Code | Clavicle/Scapula Repair - Non-Surgical |
| HCPCS 23505 | Professional Fee | Clavicle/Scapula Repair - Non-Surgical |
| HCPCS 99283 | Professional Fee | Ed visit for moderate complexity assessment, history, exam, & counseling |
| HCPCS 73030 | Facility Fee | 2D x-ray imaging of shoulder for diagnosis |
| RC 0320 | Facility Fee | Radiology Diagnostic - General |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Facility Fee | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| HCPCS 72110 | Professional Fee | X-ray imaging of lower spine, 4 views |
| RC 0450 | Facility Fee | Emergency Room - General |
| RC 0450 | Facility Fee | Emergency Room - General |
| RC 0450 | Facility Fee | Emergency Room - General |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS 99283 | Facility Fee | Ed visit for moderate complexity assessment, history, exam, & counseling |
| HCPCS 99283 | Facility Fee | Ed visit for moderate complexity assessment, history, exam, & counseling |
| HCPCS 99283 | Facility Fee | Ed visit for moderate complexity assessment, history, exam, & counseling |
| HCPCS 99283 | Facility Fee | Ed visit for moderate complexity assessment, history, exam, & counseling |
| HCPCS J3010 | Optional Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J3010 | Optional Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS 85025 | Optional Fee | Complete blood count (CBC) with differential WBC |