Summit Medical LLC

, Casper

Procedure	Code	Cash Price
FUROSEMIDE 10MG/ML IV	J1938	< $1
Chloroprocaine hcl injection	J2401	< $1
CALCIUM CHLORIDE 100 MG/ML IV	J0618	< $1
VANCOMYCIN HCL 1G IV	J3373	< $1
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION	J0878	< $1
LIDOCAINE HCL 20MG/ML INJECT	J2003	< $1
DILTIAZEM HCL 5MG/ML INJ	J1163	< $1
INJ ONDANSETRON HYDROCHLORIDE	J2405	< $1
ACETAMINOPHEN1000MG/100 INJ	J0131	< $1
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION	J1010	< $1
METOPROLOL TARTRATE5 5MG/5 ML IV	J0616	< $1
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION	J2795	< $1
VANCO 1G PREMIXEDBAG	J3375	< $1
Inj, calcium gluconate, nos	J0612	< $1
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION	J2704	< $1
INJ DEXAMETHASONE SOD PHOSPH	J1100	< $1
NALOXONE HCL 0.4MG/ML INJ	J2312	< $1
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION	J0461	< $1
EPLERENONE 25 MG TAB	44023	< $1
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE ISO-OSMOTIC IV	J0282	< $1
ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV	J1805	< $1
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION	J2248	$1.02
HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE	J1642	$1.03
ADENOSINE 3MG/ML IV	J0153	$1.04
IPRATROPIUM BROMIDE INHALATION	J7644	$1.14
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION	J2919	$1.24
IRON SUCROSE IV INJECTION 100 MG/5 ML	J1756	$1.25
INSULIN LISPRO PROTAMINE-LISPRO 100 UNIT/ML (75-25) SUBCUTANEOUS PEN	J1815	$1.27
HYDROMORPHONE 1MG/ML 1ML SYRINGE	J1171	$1.29
TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE	J7507	$1.56
MYCOPHENOLATE 250 MG	J7517	$1.64
FLUOXETINE	80332	$1.64
OPIOIDS	80363	$1.64
IPRATROPIUM .02% .5MG/2.5	J7620	$1.92
VASOPRESSIN 20 UNIT	J2599	$2.02
MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SYRINGE	J3475	$2.23
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE	J1650	$2.24
EPINEPHRINE 1 MG/ML IV	J0165	$2.27
PHENYTOIN SODIUM IV SOLUTION 50 MG/ML	J1165	$2.43
LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK	J1956	$2.48
HB CYTOPATH EVAL FNA IMMEDIATE EACH ADD EPISODE	88177	$2.87
Methylnaltrexone injection	J2212	$2.93
EPINEPHRINE 1MG/ML AMP BPI	J0166	$3.14
INJ TRIAMCINOLONE ACETONIDE	J3301	$3.17
SUBOXONE 2/0.5 MG SL	J0572	$3.19
AMPICILLIN 1 GRAM SOLUTION FOR INJECTION	J0290	$3.31
INJ KETOROLAC TROMETHAMINE	J1885	$3.41
BUPRENORPHINE 2 MG	J0571	$3.48
D5W-NS IV BOLUS	J7042	$3.58
BUPIVACAINE LIPOSOME/PF 266MG/20ML INJEC	J0666	$3.63
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION	J2765	$3.73
INJECTION, EPINEPHRINE(INTERNATIONAL MED	J0168	$3.98
INJECTION GARAMYCIN GENTAMICIN	J1580	$4.32
SDS ANTIDEPRESSANT	80337	$4.37
SDS ZOLPIDEM	80368	$4.37
SDS SKELETAL MUSCLE RELAXANT	80370	$4.37
SDS NEFAZODONE	80338	$4.72
INJECTION DIPHENHYDRAMINE HCL	J1200	$5.15
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION	J2590	$5.74
SDS ANTIDEPRESSANTS SEROTONERGIC	80333	$5.74
SDS ANTIEPILEPTICS	80340	$5.74
SDS ANTIPSYCHOTICS	80344	$5.74
SDS GABAPENTIN	80355	$5.74
SDS KETAMINE	80357	$5.74
SDS OPIOIDS	80364	$5.74
SDS PREGABALIN	80366	$5.74
SDS TAPENTADOL	80372	$5.74
Tox Screen - Propoxyphene	80367	$5.74
FENTANYL INFUSION 2500 MCG/50 ML	J3010	$5.82
NEOSTIGMINE 3MG SIMP	J2710	$6.02
Microbe susceptible enzyme	87185	$6.15
Deoxyribonuclease antibody	86215	$6.15
MIDAZOLAM (PF) 5 MG/ML NASAL	J2250	$6.33
INJECTION CEFTRIAXONE SODIUM	J0696	$6.38
INJECTION PROMETHAZINE HCL TO	J2550	$6.43
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION	J0330	$7.13
SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK	J7050	$7.21
NORMAL SALINE INFUSION 500 ML	J7040	$7.21
HEPARIN (PORCINE) 5 000 UNIT/ML INJECTION SOLUTION	J1644	$7.23
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION	J3411	$7.29
MORPHINE 2 MG/ML SDV	J2272	$7.64
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION	J7121	$7.66
HYDRALAZINE 20 MG/ML INJECTION SOLUTION	J0360	$7.76
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION	J2543	$7.78
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	J7060	$7.83
NORMAL SALINE SOLUTION 1000CC	J7030	$8
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION	J3260	$8.07
LACTATED RINGERS INTRAVENOUS SOLUTION	J7120	$8.17
HB RX FLU -IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE (90656)	90656	$8.54
MACROSCOPIC XM DSJ&PREP TISS	88387	$8.61
MICROSCOPIC EXAM OF URINE	81015	$9.02
Assay of biotinidase	82261	$9.02
Assay of neonatal thyroxine	84437	$9.02
Galactose transferase test	82776	$9.02
INJECTION LORAZEPAM	J2060	$9.17
Hemoglobin copper sulfate	83026	$9.84
Microbe susceptible disk	87184	$9.84
CEFAZOLIN 1 G/10 ML IV (WET SOLR VIAL)	J0690	$9.92
Skin fungi culture	87101	$10.25
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION	J0295	$10.38