CarePrice

Memorial Hospital of Converse County

, Douglas

ProcedureCodeCash Price
HG A1C LEVEL LT 7.0%3044F< $1
HEMOGLOBIN A1C LEVEL >9.0%3046F< $1
HG A1C>EQUAL 7.0%<8.0%3051F< $1
HG A1C>EQUAL 8.0%<EQUAL 9.0%3052F< $1
METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION FOR INJECTIONJ1010$1.14
METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTIONJ2919$1.71
Injection, donanemab-azbt, 2 mgJ0175$4.56
CAST SUP SHT LEG SPLNT FBRGLQ4046$5.13
Inj, lecanemab-irmb, 1 mgJ0174$5.70
INJECTION GARAMYCIN GENTAMICINJ1580$5.70
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$6.84
PHYSICIAN SERVICE REQUIRED TO ESTABLISH AND DOCUMENT THE NEED FOR A POWER MOBILITY DEVICEG0372$6.84
HB RADIANT-TECH TC 99M PERTECHNETATE PER MCIA9512$7.41
INJ ARIPIPRAZOLE EXT REL 1MGJ0401$7.41
NALBUPHINE 10 MG/ML INJECTION SOLUTIONJ2300$7.41
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$7.55
CULTURE BACT COLONY CT URINE87086$8.84
INJECTION CEFTRIAXONE SODIUMJ0696$8.92
AbobotulinumtoxinAJ0586$9.12
PTO AIRMESH BRACE (SM LEFT)L2999$9.69
CONFORM BAND N/S W>=3"<5"/YDA6443$9.98
HEPARIN PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGEJ1642$10.07
INJECTION PROMETHAZINE HCL TOJ2550$10.44
ANTISTREPTOLYSIN 0 TITER86060$11.12
ADMIN INFLUENZA VIRUS VACCINEG0008$11.12
ADMIN PNEUMOCOCCAL VACCINEG0009$11.12
Urinalysis volume measure81050$11.40
ADMIN HEPATITIS B VACCINEG0010$11.40
ICUT ALLERGY TEST DRUG/BUG95024$11.68
Assay of biotinidase82261$11.69
Galactose transferase test82776$11.69
Assay of neonatal thyroxine84437$11.69
HB MED NUTRITION TX-GRP PER 30 MIN97804$11.97
Deoxyribonuclease antibody86215$12.26
IM ADMIN 1ST/ONLY COMPONENT90460$12.37
INJECTION DIPHENHYDRAMINE HCLJ1200$12.40
Injection, inclisiran, 1 mgJ1306$12.54
INJ KETOROLAC TROMETHAMINEJ1885$13.13
PADDING BANDAGE, NON-ELASTIC, NON-WOVEN/NON-KNITTED, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARDA6441$13.68
SELF-ADHER BAND W>=3" <5"/YDA6454$13.68
Assay of cryofibrinogen82585$14.25
INJ ONDANSETRON HYDROCHLORIDEJ2405$14.30
CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSINGA6207$14.54
LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARDA6449$14.54
PREDNISONE 5 MG TABLETJ7512$15.11
ONDANSETRON 8MG TABQ0162$15.11
PT INFRARED 1UNIT97026$15.96
Glycosylated hb home device83037$15.96
IM ADMIN EACH ADDL COMPONENT90461$15.96
INFLUENZA VIRUS VACCINE90686$16.21
IMMUNIZATION ADMIN 1 VACCINE90471$16.25
INJ DEXAMETHASONE SOD PHOSPHJ1100$16.25
CRYO DESTRUCT LESION 2-1417003$16.37
FLUPHEN DEC 25MG JJ2680$16.53
LAB CLOSTRIDIUM DIFFICILE87324$17.10
Assay of lithium80178$17.67
TRIMMING OF NAILG0127$17.67
IMMUNIZATION ADMIN ADDL VACC90472$18.24
IMMUNIZATION ADMIN ORAL90473$18.24
IMMUNIZATION ADMIN ORAL ADD'L90474$18.24
Inj, durolane 1 mgJ7318$18.24
Assay of phenytoin free80186$18.24
Assay of progesterone84144$18.24
PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATIONG0102$18.24
Syphilis test non-trep quant86593$18.81
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$18.81
SULFAMETHOXAZOLE & TRIMETHOPR 10 MLS0039$18.81
Assay of lipoprotein83718$19.10
METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTIONJ2765$19.17
HB CAPILLARY DRAWING CHARGE36416$19.38
Assay of cryoglobulin82595$19.38
ALLERGEN IMMUNOTHRPY SNGL INJ95115$19.67
FUROSEMIDE 10 MG/ML INJECTION SOLUTIONJ1940$20.31
TRIM NAIL(S) ANY NUMBER11719$20.71
COLLECTION VENOUS BLOOD36415$20.86
Hemoglobin electrophoresis83020$20.90
Assay of aldolase82085$21.09
BLOOD OCCULT PEROX ACTIVITY82270$21.09
Assay of ceruloplasmin82390$21.09
Assay of blood osmolality83930$21.09
PROSTATE SPECIFIC ANTIGEN FREE84154$21.09
Assay of transferrin84466$21.09
Cold agglutinin titer86157$21.09
Feces culture aerobic bact87045$21.09
Hiv-1 ag w/hiv-1 & hiv-2 ab87389$21.09
Leukocyte assessment fecal89055$21.09
ORTHOSIS CALIFORNIA 8 LG COMPRESSIONL0625$21.09
Ccp antibody86200$21.23
X-RAY EXAM OF SALIVARY GLAND70380$21.66
Assay of urine phosphorus84105$21.66
Cold agglutinin screen86156$21.66
Plasma fresh frozen86927$21.66
BRIEF COMMUNICATION TECHNOLOGY-BASED SERVICE (EG, VIRTUAL CHECK-IN) BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL WHO CAN REPORT EVALUATION AND MANAGEMENT SERVICES, PROVIDED TO AN ESTABLISHED PATIENT, NOT ORIGINATING FROM A RELATED EVALUATION AND MANAGEMENT SERVICE PROVIDED WITHIN THE PREVIOUS 7 DAYS NOR LEADING TO AN EVALUATION AND MANAGEMENT SERVICE OR PROCEDURE WITHIN THE NEXT 24 HOURS OR SOONEST AVAILABLE APPOINTMENT, 5-10 MINUTES OF MEDICAL DISCUSSION98016$21.66
EPIFIX, INJ, 1MGQ4145$21.66
DMP F-UP ASSESSMENTS0316$21.66
XR FEMUR 1V73551$22.23
Assay of cadmium82300$22.23
Assay other fluid chlorides82438$22.23
HB RX FLU -IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE (90656)90656$22.23
GLUCOSE BLOOD TEST W/DEVICE82962$22.42