UCSF Medical Center at Mount Zion
Hospital
400 Parnassus Ave, San Francisco, CA 94143
How this provider stacks up
$639
This provider's rate
Lowest
$249
Highest
$3,030
This is this provider's self-pay (cash) rate. See how it compares to rates from other providers in this area.
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Forearm/Wrist Repair - Non-Surgical Overview
This list includes the services and fees bundled into the Forearm/Wrist Repair - Non-Surgical Standard Service Package (SSP MS010). 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 21315 | Base Code | Forearm/Wrist Repair - Non-Surgical |
| RC 0710 | Facility | Recovery Room - General |
| RC 0710 | Facility | Recovery Room - General |
| RC 0360 | Facility | Operating Room Services - General |
| RC 0360 | Facility | Operating Room Services - General |
| RC 0250 | Facility | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0250 | Facility | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0370 | Facility | Anesthesia - General |
| RC 0370 | Facility | Anesthesia - General |
| HCPCS J3010 | Facility | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J3010 | Facility | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J2405 | Facility | Intramuscular injection of ondansetron hydrochloride, 1mg |
| HCPCS J2405 | Facility | Intramuscular injection of ondansetron hydrochloride, 1mg |
| RC 0636 | Facility | Pharmacy - Extension of 025X - Drugs requiring detailed coding |
| RC 0636 | Facility | Pharmacy - Extension of 025X - Drugs requiring detailed coding |
| HCPCS 99284 | Professional | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS 99284 | Professional | Emergency department visit for moderate complexity evaluation and management with counseling/coordination of care |
| HCPCS J2704 | Facility | Intramuscular injection of 10mg propofol |
| HCPCS J2704 | Facility | Intramuscular injection of 10mg propofol |
| HCPCS J1100 | Facility | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| HCPCS J1100 | Facility | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| RC 0272 | Facility | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - Sterile |
| HCPCS 99282 | Professional | Emergency department visit for low complexity E/M with expanded history and exam |
| HCPCS J0690 | Facility | Intramuscular injection cefazolin sodium, 500mg |
| HCPCS J2250 | Facility | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS J2250 | Facility | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS 00190 | Professional | Chronic Airflow Obstruction with Mcc Onset |
| HCPCS 01400 | Professional | Anesthesia for Knee Arthroscopic Surgery, Unspecified |
| HCPCS J7120 | Optional | Intravenous infusion of 1000cc of ringer's lactate solution |
| HCPCS J1885 | Optional | Intramuscular injection of 15mg ketorolac tromethamine |
| RC 0272 | Optional | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - Sterile |
Your Right to Know (and Save)
The No Surprises Act requires healthcare providers to give you a cost estimate for certain services. We've made it easier by grouping common services into Standard Service Packages (SSPs), so you can see the typical services and costs that are usually bundled together. Here's how to use this estimate to avoid surprise bills and shop around confidently:
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Review this estimate and others nearby to see how costs can vary for the full procedure.
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Ask for a “Good Faith Estimate” and reference the CPT code we provide.
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