CarePrice

Memorial Hospital of Carbon County

, Rawlins

ProcedureCodeCash Price
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)J8540$3.08
ALBUTEROL INHALATION SOLUTIONJ7613$4.88
FUROSEMIDE 10 MG/ML INJECTION SOLUTIONJ1940$5.36
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATIONJ7614$6.70
IPRATROPIUM BROMIDE INHALATIONJ7644$6.75
INJECTION PROMETHAZINE HCL TOJ2550$8.32
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTIONJ0665$8.59
PREDNISOLN 5MG 15MG 5ML SUJ7510$9.02
REMOVAL OF SUTURES; BY A PHYSICIAN OTHER THAN THE PHYSICIAN WHO ORIGINALLY CLOSED THE WOUNDS0630$10.50
Fibrinogen test85370$10.50
ICUT ALLERGY TEST DRUG/BUG95024$12
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTIONJ3490$12.49
AMB LEVALBUTEROL 1.25MG/0.5ML INHALATIONJ7615$12.58
PERCUT ALLERGY SKIN TESTS95004$12.75
HB CAPILLARY DRAWING CHARGE36416$12.75
Assay of phosphorus84100$12.75
CRYO DESTRUCT LESION 2-1417003$12.90
NON-COVERED ITEM OR SERVICEA9270$13.09
LIDOCAINE IN D5W 4 MG/ML INFUSION PREMIX (FOR PAIN)J2001$13.39
MSTEM MICROMTRIX\\MGQ4118$13.50
SUTURE PROLENE 4-0 V-5 L36IN MONOFILAMENT BLUE41893$15
TRANSCUTANEOUS BILIRUBIN88720$15
99997 Repair of split ear lobe (not traumatic) = Level 199997$15
INJ ONDANSETRON HYDROCHLORIDEJ2405$15.38
IM ADMIN 1ST/ONLY COMPONENT90460$16.28
IM ADMIN EACH ADDL COMPONENT90461$16.28
PROLONGED CLINICAL STAFF SERVICE (THE SERVICE BEYOND THE HIGHEST TIME IN THE RANGE OF TOTAL TIME OF THE SERVICE) DURING AN EVALUATION AND MANAGEMENT SERVICE IN THE OFFICE OR OUTPATIENT SETTING, DIRECT PATIENT CONTACT WITH PHYSICIAN SUPERVISION; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PROLONGED SERVICE)99416$16.50
Nasal smear for eosinophils89190$16.50
SUTURE PROLENE 1 XLH DA 30 IN BLUE41679$17.25
MICROSCOPIC EXAM OF URINE81015$18
HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE OFFICE TO A LABORATORY99000$18
INJ DEXAMETHASONE SOD PHOSPHJ1100$18.17
SUTURE VICRYL 3-0 TIES 18IN UNDYED43309$18.75
Ur albumin semiquantitative82044$19.50
BLOOD COUNT HEMATOCRIT85014$19.50
HB RADIANT-SCREEN DIGITAL BREAST TOMOSYNTHESIS-BILATERAL77063$20.25
HB BREAST TOMO UNI DIAG77061$20.25
HB BREAST TOMO BILAT DIAG77062$20.25
EPINEPHRINE 1 MG/ML INJECTION SOLUTIONJ0171$21.48
ANTIGEN THERAPY SERVICES95165$21.75
HB TISSUE TRANSGLUTAMINASE, EA IG86364$21.75
REMOVAL SUT/STAP W/O ANES15853$22.50
PF CRNA VENIPUNCT FEM JUG 0 2YRS36400$22.50
GLUCOSE BLOOD82947$22.50
COLLECTION VENOUS BLOOD36415$22.50
HB ANCA TITER, EA AB SENDOUT86037$22.50
HB ENDOMYSIAL ANTIBODY SENDOUT86231$22.50
INJ KETOROLAC TROMETHAMINEJ1885$23.16
Alcohol/sub misuse assessG2011$23.25
METHYLPREDNISOLONE 20 MG INJJ1020$23.78
MASK LARYNGEAL SIZE 131191$24
BILIRUBIN DIRECT82248$24
SUTURE VICRYL 3-0 TAPERPOINT SH42291$24.75
Depression screen annualG0444$25.50
IOPAMIDOL 200 MG IODINE/ML (41 %) INJECTION SOLUTIONQ9966$25.50
Annual alcohol screen 15 minG0442$26.25
Assay of triglycerides84478$26.25
CULTURE BACTERIAL AERBIC ISOLT87077$26.25
ALLERGEN IMMUNOTHRPY SNGL INJ95115$26.25
HB EMS NON-COV MILES PAST CLOSEST FACA0888$26.25
SERVICES PROVIDED IN THE OFFICE AT TIMES OTHER THAN REGULARLY SCHEDULED OFFICE HOURS, OR DAYS WHEN THE OFFICE IS NORMALLY CLOSED (EG, HOLIDAYS, SATURDAY OR SUNDAY), IN ADDITION TO BASIC SERVICE99050$26.25
LIPID PANEL80061$26.53
OASIS WOUND MATRIX, PER SQUARE CENTIMETERQ4102$27
METHYL PRED SS 40MG JJ2920$27.23
EXCISION LESION MOUTH ROOF42106$27.75
SUTURE PLAIN GUT TIES 3-042135$27.75
Assay of protein serum84155$27.75
Assay of serum sodium84295$27.75
Immunoassay infectious agent86317$27.75
PROLONGED CLINICAL STAFF SERVICE (THE SERVICE BEYOND THE HIGHEST TIME IN THE RANGE OF TOTAL TIME OF THE SERVICE) DURING AN EVALUATION AND MANAGEMENT SERVICE IN THE OFFICE OR OUTPATIENT SETTING, DIRECT PATIENT CONTACT WITH PHYSICIAN SUPERVISION; FIRST HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR OUTPATIENT EVALUATION AND MANAGEMENT SERVICE)99415$28.50
SUTURE CHROMIC TIES 2-042102$28.50
Assay of lactic acid83605$28.50
HB EMS-GROUND MILEAGEA0425$28.50
HB RADIANT-TECH TC 99M PERTECHNETATE PER MCIA9512$28.50
CAST PROTECTOR ARM ADULT43815$29.25
Assay of serum potassium84132$29.25
Cytopath fl nongyn smears88104$30
Cytopath concentrate tech88108$30
Cytp dx eval fna 1st ea site88172$30
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTIONQ9967$30.25
AEROCHAMBER41758$30.75
SUTURE ETHIBOND V-37 5-042117$30.75
SUTURE ETHIBOND EXCEL V-3741960$31.50
Dna antibody native86225$31.50
SKIN TEST TUBERCULOSIS86580$31.50
HB MISC MINIMAL LAB HANDLING99001$31.50
URINALYSIS81003$32.25
ALLERGEN IMMUNOTHERAPY 2+ INJ95117$32.25
PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATIONG0102$32.63
SMOKING/TOBACCO CESSATION99406$32.63
ALL TSTG PERQ&IQ DRUGS/BIOL95018$33
TRIMMING OF NAILG0127$33
REMOTE EVALUATION OF RECORDED VIDEO AND/OR IMAGES SUBMITTED BY AN ESTABLISHED PATIENT (E.G., STORE AND FORWARD), INCLUDING INTERPRETATION WITH FOLLOW-UP WITH THE PATIENT WITHIN 24 BUSINESS HOURS, NOT ORIGINATING FROM A RELATED E/M SERVICE PROVIDED WITHIN G2010$33
BILIRUBIN TOTAL82247$33
ESTABLISH PATIENT LVL 199211$33.11
Smear complex stain87209$33.75
SKIN SUB GRAFT T/A/L ADD-ON15272$34.50
CREATININE BLOOD82565$34.50
Assay bld/serum cholesterol82465$34.50
GONADOTROPIN CHORIONIC HCG QL84702$34.50