EMERGENCY LEVEL I | $391.00 |
EMERGENCY LEVEL II | $611.00 |
EMERGENCY LEVEL III | $732.00 |
EMERGENCY LEVEL IV | $1,096.00 |
EMERGENCY LEVEL V | $1,509.00 |
ER NEW/EST BRIEF | $398.00 |
ER NEW/EST LIMITED | $605.00 |
ER NEW/EST INTERMED | $673.00 |
ER NEW/EST EXTENDED | $818.00 |
LACERATION REPAIR/SIMP-UP TO 2.5 CM | $485.00 |
LACERATION TRAY | $90.00 |
ACCUCHECK | $11.00 |
ACE 2 | $3.30 |
ACE 3 | $3.30 |
ACE 4 | $3.30 |
Acetomenophen 500mg TABLET | $3.85 |
ADM IMM/TOXOID SUB/IM | $148.00 |
ADM/IV DRUG – IV PUSH | $148.00 |
ADM/THER DRUG SUB/IM | $148.00 |
ALBERTOL | $4.80 |
Amoxicillian 250 mg Cap | $149.00 |
Amoxicillian 250mg/5mL SUSP | $10.62 |
ARM SLING UNIVERSAL | $47.70 |
ASA 81 mg Chewable | $3.85 |
CARDIAC MONITOR E/R | $544.00 |
CATH IV 20GX1 | $16.11 |
CATH IV 22GX1 | $16.11 |
CRUTCHES REGULAR ADULT | $87.73 |
DEXAMETHASONE (DECADRO | $15.85 |
DRESSING TEGADERM 1624 | $3.30 |
EMESIS BAG UM | $3.30 |
EXTENSION SET | $14.49 |
HYDROcodone / APAP 7.5 | $5.31 |
HYDROcodone/APAP 5 mg | $3.85 |
HYDROmorphone (DILAUDI | $11.00 |
IBUPROFEN (CHILDRENS) | $5.85 |
IPRATRO/ALBUTEROL(DUON | $13.24 |
IV INFUSION THERAPY EACH | $85.00 |
IV INFUSION THERAPY IN | $440.00 |
IV PRIMARY SET | $25.92 |
IV PUSH ADDITIONAL DOS | $85.00 |
IV PUSH SEQUENT – EA. | $120.00 |
KETOROLAC 30 MG / ML V | $36.00 |
KETOROLAC 60 MG / 2 ML | $45.00 |
KLING 2 | $3.30 |
KLING 3 | $3.30 |
LIDOCAINE (XYLOCAINE) | $20.52 |
LIDOCAINE 5 ML 1% INJ | $24.41 |
LORAZEPAM (ATIVAN) 2 M | $18.30 |
MASK NEBULIZER ADULT | $10.40 |
METHOCARBAMOL 500 MG T | $3.85 |
methylPREDNISolone 125 | $38.50 |
NALBUPHINE 10 MG AMP I | $23.65 |
NEBUL TREATMENT EACH | $73.00 |
NEBULIZER MTHPC W/TP | $8.78 |
ONDANSETRON 2 MG / ML | $14.40 |
ONDANSETRON ODT(ZOFRAN | $122.61 |
OXYGEN ER | $39.00 |
predniSONE 20 MG TAB | $1.70 |
Promethazine 25 mg AMP | $11.00 |
SENSOR O’2 PEDIATRIC | $93.33 |
SODIUM CHL 10 ML SYR F | $3.30 |
SOL NACL IRR 500ML , 6 | $30.00 |
SOL NS-1000ml, 7983-09 | $60.00 |
SPECIMEN CONT STERILE | $3.30 |
SPECIMEN MIDSTRM KIT | $3.30 |
SPONGES 4X4X10 STERILE | $3.30 |
TET/DIP/TOX/ACEL/PERT | $228.10 |
XEROFORM 1X8 | $3.63 |
ACCUCHECK | $11.00 |
ACETAMINOPHEN (TYLENOL | $3.85 |
ACETAMINOPHEN(TYLENOL | $3.85 |
ALBUTEROL (VENTOLIN)2. | $4.80 |
AMLODIPINE (NORVASC) 5 | $3.85 |
ASPIRIN 81 MG CHEWABLE | $3.85 |
ASPIRIN 81 MG EC TAB | $3.85 |
ATORVASTATIN (LIPITOR) | $3.00 |
CARVEDILOL(COREG) 3.12 | $12.60 |
CLOPIDOGREL(PLAVIX) 75 | $26.17 |
DIAPER, XL 59X66 | $3.30 |
DIAPERS PULL UP X. LAR | $3.30 |
DILTIAZEM CD (CARDIZEM | $8.98 |
DOCUSATE(COLACE) 100 M | $3.85 |
DONEPEZIL(ARICEPT) 5 M | $46.73 |
FUROSEMIDE (LASIX) 20 | $3.85 |
GABAPENTIN (NEURONTIN) | $9.96 |
HEPARIN SODIUM 5,000 U | $14.80 |
HYDRALAZINE (APRESOLIN | $3.85 |
INSULIN LANTUS 100 U/M | $3.30 |
INSULIN novoLOG ASPAR | $3.30 |
IPRATRO/ALBUTEROL(DUON | $13.24 |
IPRATROPIUM (ATROVENT) | $7.92 |
ISOSORBIDE DINIT 5 MG | $5.91 |
IV INFUSION THER EACH | $85.00 |
LACTOBACILLUS GG(CULTU | $3.30 |
LACTULOSE(CEPHULACE ) | $5.85 |
LEVOFLOXACIN 250 MG TA | $90.71 |
LEVOTHYROXINE 50 MCG T | $7.92 |
LIPITOR | $3.00 |
MED PASS 4 OZ ORIGINAL | $3.30 |
METFORMIN 500 MG TAB | $3.85 |
METHOCARBAMOL 500 MG T | $3.85 |
METOPROLOL 25 MG TAB | $3.85 |
METOPROLOL (TOPROL XL) | $8.58 |
MULTIVITAMIN TABLET | $3.85 |
NEBUL TREATMENT EACH | $73.00 |
OMEPRAZOLE 20 MG CAP | $6.68 |
OXYCODONE IR 5 MG TAB | $3.85 |
OXYGEN PER 24HR | $513.00 |
PANTOPRAZOLE SOD DR 40 | $2.06 |
POTASSIUM CHLOR ER 20 | $5.58 |
PRAVASTATIN 20 MG TABL | $19.60 |
PREDNISONE 20 MG TAB | $1.70 |
RANITIDINE 150 MG TAB | $3.85 |
SODIUM CHL 10 ML SYR F | $3.30 |
TAMSULOSIN(FLOMAX) 0.4 | $2.84 |
TRAMADol (ULTRAM) 50 M | $3.85 |
WARFARIN(COUMADIN) 2.5 | $3.85 |
ARTERIAL BLOOD GAS | $273.00 |
BIPAP SETUP | $410.00 |
CARDIAC MONITOR E/R | $544.00 |
CPAP SETUP | $385.00 |
EKG | $341.00 |
INCENTIVE SPIROMETER TRTMT | $101.00 |
MDI TREATMENT EACH | $89.00 |
NEB SUBSEQUENT EACH AD | $70.15 |
NEB, MDI, IPPB EDUCATI | $99.00 |
NEBULIZER TREATMENT EACH | $73.00 |
OXYGEN PER 24HR | $513.00 |
OXYGEN PRN (PER 24HR) | $408.00 |
PULMONARY FUNCTION TEST | $447.00 |
PULMONARY STRESS TEST | $132.00 |
PULSE OXIMETER MULTIPL | $139.00 |
PULSE OXIMETRY SINGLE | $519.00 |
SIMPLE SPIROMETRY TEST | $132.00 |
TELEMETRY DAILY | $380.50 |
TELEMETRY SET UP | $184.45 |
ADL Self Care 15 mins | $66.00 |
Balance | $99.00 |
Dressing Change | $55.00 |
E Stim | $83.00 |
Electrode | $30.00 |
Gait Training | $121.00 |
Hot-Cold Packs | $44.00 |
Initial Evaluation | $186.00 |
Manual Therapy/Back | $15.00 |
Manual Therapy Tech | $89.00 |
Neuromuscular Re-Ed | $99.00 |
Orthotic/Prost Use per 15 mins | $140.00 |
Re-Eval | $125.00 |
TENS | $57.00 |
Ther Act | $103.00 |
Ther Ex | $76.00 |
Traction | $48.00 |
Ultrasound per 15 mins | $61.00 |
Whirlpool | $105.00 |
ADL Self-Care | $103.00 |
Contrast Bath | $54.00 |
Dressing Change | $44.00 |
Heat/Cold Packs | $33.00 |
Initial Evaluation | $253.00 |
Iontophoresis | $192.00 |
Manual Therapy Tech | $89.00 |
Neuromuscular Re-ed | $198.00 |
Orthotic/Prosthetic Use (Initial) | $113.00 |
Orthotic/Prosthetic Use (Established) | $140.00 |
Re-eval | $99.00 |
Ther Act | $103.00 |
Ther Ex | $288.00 |
Ultrasound | $50.00 |
C-Splint/Hand-Based | $210.00 |
IP Gutter Splint | $85.00 |
Thumb Spica Splint | $285.00 |
WHFO Wrist Support Splint | $420.00 |
Evaluate Swallowing per hour | $286.00 |
Cognitive Skills Dev each 15 mins | $110.00 |
Eval/Re-eval per hour | $173.00 |
Treatment per hour | $237.00 |
Swallowing/Feed Treatment per hour | $256.00 |
AC Joints | $304.00 |
Abd 1 view | $326.00 |
Abd 2 view | $244.00 |
Abd Series | $506.00 |
Ankle | $309.00 |
C Spine | $347.00 |
C Spine Complete | $386.00 |
Chest 2v | $311.00 |
Chest 1v | $266.00 |
Clavicle | $365.00 |
Elbow | $271.00 |
Facial Bones | $365.00 |
Femur | $365.00 |
Fingers | $264.00 |
Foot | $304.00 |
Forearm | $347.00 |
Hand | $304.00 |
Hip | $413.00 |
Humerus | $334.00 |
Knee | $413.00 |
L Spine | $405.00 |
Mandible | $405.00 |
Mastoids | $448.00 |
Neck Soft Tissue | $235.00 |
Orbit | $341.00 |
Pelvis | $295.00 |
Ribs Bilat | $537.00 |
Ribs Unilat | $365.00 |
Sacrum & Coccyx | $386.00 |
SI Joints | $326.00 |
Scapula | $304.00 |
Shoulder | $339.00 |
Sinuses | $457.00 |
Skull | $365.00 |
Scoliosis Series | $271.00 |
Sternum | $285.00 |
TMJ | $330.00 |
T Spine | $426.00 |
Tib Fib | $365.00 |
Toe | $264.00 |
Wrist | $347.00 |
Abdomen | $847.00 |
Aorta | $810.00 |
Arterial Extremity | $880.00 |
Arterial Extremity- Bilat | $1,075.00 |
Breast | $494.00 |
Carotid | $833.00 |
Echo | $1,212.00 |
Pelvic | $659.00 |
Renal | $254.00 |
Thyroid | $601.00 |
Venous Bilat | $1,205.00 |
Venous Unilat | $800.00 |
Transvaginal | $659.00 |
Establish Patient Preventative Visit <1 yr of age | $167.00 |
Establish Patient Preventative Visit 1 – 4 yrs of age | $182.00 |
Establish Patient Preventative Visit 5 – 11 yrs of age | $182.00 |
Establish Patient Preventative Visit 12 -17 yrs of age | $196.00 |
Establish Patient Preventative Visit 18 – 39 yrs of age | $196.00 |
Establish Patient Preventative Visit 40 – 64 yrs of age | $196.00 |
Establish Patient Preventative Visit >65 yrs of age | $196.00 |
Establish Patient Visit Brief | $42.00 |
Establish Patient Visit Minimal | $70.00 |
Establish Patient Visit Moderate | $98.00 |
Establish Patient Visit Complex | $142.00 |
New Patient Preventative Visit <1 yr of age | $175.00 |
New Patient Preventative Visit 1 – 4 yrs of age | $188.00 |
New Patient Preventative Visit 5 -11 yrs of age | $188.00 |
New Patient Preventative Visit 12 – 17 yrs of age | $196.00 |
New Patient Preventative Visit 18 – 39 yrs of age | $202.00 |
New Patient Preventative Visit 40 – 64 yrs of age | $209.00 |
New Patient Preventative Visit >65 yrs of age | $196.00 |
New Patient Visit Minimal Visit | $133.00 |
New Patient Visit Moderate Visit | $196.00 |
Pap Smear | $70.00 |
Rapid Strep Test | $20.00 |
Urine Dipstick Test | $11.00 |
Accucheck | $12.00 |
Pregnancy Test | $11.00 |
Immunization – DTAP | $188.00 |
Immunization – Hep A Peds | $253.00 |
Immunization – Hep B up to age 11 | $194.00 |
Immunization – HIB | $198.00 |
Immunization – HPV | $760.00 |
Immunization – Influenza | $98.00 |
Immunization – Influenza 6 -35 months | $86.00 |
Immunization – IPV (Polio) | $198.00 |
Immunization – Kentrix (DTAP/Polio) | $308.00 |
Immunization – MMR | $303.00 |
Immunization – PCV 0-5 | $29.00 |
Immunization – Pentacel (DTAP, Polio, HIB) | $473.00 |
Immunization – Rotovirus | $506.00 |
Immunization – TDAP | $293.00 |
Immunization – VZV (Varicella) | $84.00 |
Injection fee for Immunizations | $105.00 |
Injection fee for therapeutics | $66.00 |
Injection – B12 | $18.00 |
Injection – Decadron | $22.88 |
Injection – Depo Provera | $362.52 |
Injection – Phenergan | $15.00 |
Injection – Rocephin | $112.00 |
Injection – Solumedrol | $28.00 |
Injection – Toradol | $65.00 |
Psychotherapy Services | $196.00 |
LABORATORY: IN-HOUSE TESTING | INPATIENT CHARGE | OUTPATIENT CHARGE |
CBC W/ auto DIFF | $209.30 | $67.00 |
CBC /Hemogram | $120.00 | $51.00 |
Manual Diff | $91.00 | $28.00 |
Basic Metabolic Panel | $366.00 | $74.00 |
Comprehensive Metabolic Panel | $435.00 | $105.00 |
Urine dipstick only | $72.00 | $25.00 |
Urine microscopic, complete | $114.00 | $42.00 |
Troponin I | $165.00 | $165.00 |
CKMB | $125.00 | $125.00 |
Myoglobin | $195.00 | $195.00 |
Lipase | $197.00 | $64.00 |
HCG urine qual | $91.00 | $11.00 |
Amylase | $178.00 | $46.00 |
Magnesium | $167.00 | $33.00 |
Creatine Kinase | $161.00 | $36.00 |
PTINR | $125.00 | $44.00 |
urine drug screens | $136.00 | $83.00 |
BNP | $318.00 | $202.00 |
APTT | $142.00 | $58.00 |
Influenza A/B | $277.00 | $54.00 |
Strep A test | $119.00 | $46.00 |
Lipid Panel | $182.00 | $83.00 |
Phosphorus | $106.00 | $28.00 |