Wyoming Medical Center

, Casper

Procedure	Code	Cash Price
Chloroprocaine hcl injection	J2401	< $1
INJECT TESTOSTERONE CYPIONATE	J1071	< $1
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION	J0461	< $1
IOTHALAMATE MEGLUMINE 17.2 % URETHRAL SOLUTION	Q9958	< $1
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION	J2704	< $1
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION	J0665	< $1
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION	J0878	< $1
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION	J2795	< $1
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTION	J1010	< $1
DAPTOMYCIN 1MG 350MG 7ML PWIJ	J0873	< $1
NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION	J2404	< $1
IOTHALAMT 60 PERC 1ML 50ML SNIJ	Q9961	< $1
Inj, calcium gluconate, nos	J0612	< $1
Calcium glucon (wg critical)	J0613	< $1
GADOTERATE MEGLUMINE 0.5 MMOL/ML 20ML VI	A9575	< $1
IRON SUCROSE IV INJECTION 100 MG/5 ML	J1756	< $1
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION	J0270	< $1
BIVALIRUDIN 1MG 250MG 5ML PWIJ	J0583	< $1
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION	J2919	< $1
LACOSAMIDE 200MG/20M	C9254	< $1
LIDOCAINE IN D5W 4 MG/ML INFUSION PREMIX (FOR PAIN)	J2001	< $1
GADOBUTRL 0.1ML 30MMOL 30ML SN MDV	A9585	< $1
INJ METHYLPREDNISOLONE ACETATE	J1050	< $1
METRONIDAZOLE IN NS IV SYRINGE 5 MG/ML (NICU/PEDS)	J1836	< $1
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION	J1453	< $1
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION	Q9967	< $1
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION	J9263	< $1
MIDAZOL WCC 1MG 50MG 50ML SNIV	J2251	< $1
HB EMS NON-COV MILES PAST CLOSEST FAC	A0888	< $1
DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION	Q9963	< $1
PREDNISONE 5 MG TABLET	J7512	< $1
ESMOLOL 2 000 MG/100 ML (20 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV	J1805	$1.07
GLYCOPYRROL MPI 0.1MG 0.2MG 1MLSNIJ	J1596	$1.08
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE	Q5101	$1.10
PHENYLEPH 20MCG 100MCG 1ML SNIJ	J2371	$1.13
MICAFUNGIN 100 MG INTRAVENOUS SOLUTION	J2248	$1.16
Nivestym	Q5110	$1.17
Ferumoxytol, esrd use	Q0139	$1.17
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)	J8540	$1.22
Inj tbo filgrastim 1 microg	J1447	$1.23
TIGECYCLINE 1MG 50	J3243	$1.26
PACLITAXEL 1MG 30MG 5ML CN MDV	J9267	$1.29
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION	J0209	$1.39
Ferumoxytol, non-esrd	Q0138	$1.47
Argatroban esrd dialysis 1mg	J0884	$1.47
INJ ONDANSETRON HYDROCHLORIDE	J2405	$1.51
Inj esmolol hcl wg crit care	J1806	$1.53
PHENYTOIN SODIUM IV SOLUTION 50 MG/ML	J1165	$1.56
Injection, isavuconazonium	J1833	$1.65
Dexmedetomidine film, 1 mcg	J1105	$1.78
IOPAMIDOL 200 MG IODINE/ML (41 %) INJECTION SOLUTION	Q9966	$1.83
TACROLIMUS XR 0.25MG 1MG TBER	J7503	$1.87
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION	J0132	$1.89
Wilate injection	J7183	$1.90
INJ KETOROLAC TROMETHAMINE	J1885	$1.93
COCAINE 4 % NASAL SOLUTION	C9046	$1.97
BUPRENORPHINE 2 MG	J0571	$2.02
Inj filgrastim excl biosimil	J1442	$2.02
Inj. mycophenolate mofetil	J7519	$2.03
Factor viii	J7190	$2.03
Factor ix recombinant nos	J7195	$2.03
ADENOSINE 3MG/ML IV	J0153	$2.03
ANTIHEMOPHILIC FACTOR-VWF 1 000 UNIT-2 400 UNIT INTRAVENOUS SOLUTION	J7187	$2.07
Argatroban nonesrd use 1mg	J0883	$2.15
METHYLPREDNISOLONE 4 MG TABLET	J7509	$2.17
Inj ferric carboxymaltos 1mg	J1439	$2.21
GADOTERIDOL 1ML 25MMOL 50ML SNIVMDV	A9576	$2.31
Inj, afstyla, 1 i.u.	J7210	$2.42
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION	J9171	$2.44
Inj retacrit esrd on dialysi	Q5105	$2.45
Factor ix complex	J7194	$2.51
Inj, lecanemab-irmb, 1 mg	J0174	$2.58
METHACHOLINE 1MG 63.94MG 18ML SNIH	J7674	$2.59
Inj, cyclophosphamide, nos	J9075	$2.60
COCAINE NUMBRINO 1MG 160MG 4ML SNNS	C9143	$2.73
EPO ALFA ESRD 100U 2KU SNIJ	Q4081	$2.74
Factor viii recombinant NOS	J7192	$2.74
TACROLIMUS 0.5 MG CAPSULE IMMEDIATE-RELEASE	J7507	$2.81
Inj, epinephrine (belcher)	J0173	$2.82
CABERGOLINE 0.25MG 0.5MG TB	J8515	$2.86
INJECTION DIPHENHYDRAMINE HCL	J1200	$2.90
Urinalysis	81005	$2.94
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION	J9351	$3.02
MIDAZOLAM (PF) 5 MG/ML NASAL	J2250	$3.03
NEOSTIGMINE 3MG SIMP	J2710	$3.05
PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION	J2469	$3.07
Injection, peramivir	J2547	$3.19
GADOB DIME 1ML 52.9GM 100ML SNIJMDV	A9578	$3.19
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION	J2720	$3.24
Automated leukocyte count	85048	$3.36
IOHEXOL 180MG 1ML 3.6GM 20ML SNIJ	Q9965	$3.47
INJ DEXAMETHASONE SOD PHOSPH	J1100	$3.51
D5W-NS IV BOLUS	J7042	$3.57
Methylnaltrexone injection	J2212	$3.59
SODIUM CHLORIDE 3% BOLUS	J7131	$3.64
GADOTERIDOL 1ML 5MMOL 10ML SNIJ	A9579	$3.75
SED RATE (ESR)	85652	$3.78
Prothrombin complex Kcentra	J7168	$3.80
DEGARELIX 120 MG SUBCUTANEOUS SOLUTION	J9155	$3.80
MSTEM MICROMTRIX\\MG	Q4118	$3.87