CarePrice

Memorial Hospital of Sweetwater County

, Rock Springs

ProcedureCodeCash Price
PNEUMOCOCCAL 20 VACCINE SYR90677< $1
PORCINE IMPLANT, PERMACOL, PER SQUARE CENTIMETERC9364$5
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)J8540$5
HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMENQ0177$5
PRENATAL VITAMINS, 30-DAY SUPPLYS0197$5
PREDNISONE 5 MG TABLETJ7512$5.03
ALBUTEROL INHALATION SOLUTIONJ7613$5.20
PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMENQ0164$5.40
METHYLPREDNISOLONE 4 MG TABLETJ7509$5.51
IPRATROPIUM BROMIDE INHALATIONJ7644$5.88
METHADONE, ORAL, 5 MGS0109$6
DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMENQ0163$6.70
IPRATROPIUM .02% .5MG/2.5J7620$7.39
FINASTERIDE 5MG 5MG TBS0138$7.95
HB CAPILLARY DRAWING CHARGE36416$9.67
PREDNISOLN 5MG 15MG 5ML SUJ7510$10.93
AZATHIOPRINE 50 MG TABLETJ7500$12.06
METHOTREXATE SODIUM 2.5 MG TABLETJ8610$12.53
RT LUNG FUNC (MBC/MVV)94200$13
ADULT/CHILD PSYCH DIAG EVAL90791$13
INITIAL PRENATAL CARE VISIT (REPORT AT FIRST PRENATAL ENCOUNTER WITH HEALTH CARE PROFESSIONAL PROVIDING OBSTETRICAL CARE. REPORT ALSO DATE OF VISIT AND, IN A SEPARATE FIELD, THE DATE OF THE LAST MENSTRUAL PERIOD [LMP]) (PRENATAL)0500F$14
BATH SALTS80101$14
Allg spec ige crude xtrc ea86003$15.45
HB RADIANT-TECHNETIUM TC-99M SUCCIMER/DOSE/TO 10 MCIA9551$16
Misc/exper non-prescript druA9150$16.95
EMOTIONAL BEHAVIORAL ASSESSMT96127$18
HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGEJ1642$18
SUBOXONE 2/0.5 MG SLJ0572$18.47
CIPROFLOXACIN LACTATE/D5W400MG/0.2L IVJ0744$20
INJECTION DIPHENHYDRAMINE HCLJ1200$20
METRONIDAZOLE IN NS IV SYRINGE 5 MG/ML (NICU/PEDS)J1836$20
INJ KETOROLAC TROMETHAMINEJ1885$20
INJECTION PROMETHAZINE HCL TOJ2550$20
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTIONJ2765$20
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTIONJ3490$20
BAMLANIVIMAB 700MG JQ0239$20
Professional ServicesQ0244$20
FUROSEMIDE 10 MG/ML INJECTION SOLUTIONJ1940$20.41
PHENYTOIN SODIUM IV SOLUTION 50 MG/MLJ1165$20.46
INJECTION GARAMYCIN GENTAMICINJ1580$20.54
PHENYLEPH 20MCG 100MCG 1ML SNIJJ2371$21.18
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTIONJ1630$21.54
ADMINISTRATION OF RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE BY INTRAMUSCULAR INJECTION, WITH COUNSELING BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL96380$21.72
ADMINISTRATION OF RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE BY INTRAMUSCULAR INJECTION96381$21.72
INJECTION VITAMIN B-12J3420$21.77
HYDROMORPHONE IN NS (STANDARD) PCA INFUSION 10 MG/50 ML (0.2 MG/ML)J1170$22
HYDROMORPHONE 1MG/ML 1ML SYRINGEJ1171$22
INJECTION LORAZEPAMJ2060$22
MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTIONJ2274$22
INJ ONDANSETRON HYDROCHLORIDEJ2405$22.35
INJ DEXAMETHASONE SOD PHOSPHJ1100$22.63
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$23
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATIONJ7614$23.46
PR STERILE WATER/SALINE, 10 MLA4216$23.67
MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGEJ2175$23.69
INJECTION, PANTOPRAZOLE SODIUM, 40 MGS0164$23.90
CHLAMYDIA ANTIBODY86631$24
Chlamydia igm antibody86632$24
HALLUS-VALGUS NT DYN PRE OTSL3100$24
INFLUENZA VIRUS VACCINE90686$24.50
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTIONJ1160$24.63
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACKJ1450$25.20
CHLORPROMAZINE HYDROCHLORIDE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMENQ0161$26.74
CRYO DESTRUCT LESION 2-1417003$28
Amino acids single quant82131$28
SODIUM CHLORIDE 3% BOLUSJ7131$28.84
Assay of ige82785$29
AMPICILLIN 1 GRAM SOLUTION FOR INJECTIONJ0290$29.44
PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTIONJ2501$30.83
AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE ISO-OSMOTIC IVJ0282$31.06
OCTREOTIDE ACETATE 1 000 MCG/ML INJECTION SOLUTIONJ2354$31.20
LIDOCAINE IN D5W 4 MG/ML INFUSION PREMIX (FOR PAIN)J2001$31.86
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTIONJ7060$32
ADENOSINE 3MG/ML IVJ0153$32.76
HB KAPPA/LAMBDA FREE LIGHT CHAINS SENDOUT83521$33
Assay alkaline phosphatases84080$33
ANTINUCLEAR ANTIBODIES86038$33
Aspergillus antibody86606$33
Epstein-barr antibody86663$33
Epstein-barr nuclear antigen86664$33
Histoplasma antibody86698$33
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MGJ7626$33.07
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACKJ0736$33.28
Complement antigen86160$34
Q fever antibody86638$34
ALLERGEN IMMUNOTHRPY SNGL INJ95115$34
HB DIAB TRAIN GROUP/30 MING0109$34
CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTIONJ0713$34.28
CEFAZOLIN 1 G/10 ML IV (WET SOLR VIAL)J0690$34.39
BUTORPHANOL 2 MG/ML INJECTION SOLUTIONJ0595$34.65
INJ TRIAMCINOLONE ACETONIDEJ3301$34.87
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTIONJ0295$35.36
ANTIBODY CYTOMGALOVIRUS IgM86645$35.50
ANTIBODY EPSTEIN-BARR VIRUS86665$36
Assay of cryoglobulin82595$36
THYROID HORMORNE84479$36
Helminth antibody86682$36
STERILE WATER/SALINE, 500 MLA4217$36.13
Assay nephelometry not spec83883$37
Assay of aldolase82085$37