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All Services Other

CPT J1940

Injection, furosemide, up to 20 mg

$14.00 Standard Charge

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CPT J3370

Injection, vancomycin hcl, 500 mg

$29.00 Standard Charge

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CPT J3010

Injection, fentanyl citrate, 0.1 mg

$26.00 Standard Charge

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CPT J7050

Infusion, normal saline solution, 250 cc

$9.00 Standard Charge

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CPT J3360

Injection, diazepam, up to 5 mg

$46.00 Standard Charge

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CPT J3480

Injection, potassium chloride, per 2 meq

$19.00 Standard Charge

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CPT J1885

Injection, ketorolac tromethamine, per 15 mg

$26.00 Standard Charge

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CPT J0878

Injection, daptomycin, 1 mg

$231.00 Standard Charge

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CPT J1644

Injection, heparin sodium, per 1000 units

$26.00 Standard Charge

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CPT J2543

Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)

$37.00 Standard Charge

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CPT J3301

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$35.00 Standard Charge

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CPT J0692

Injection, cefepime hydrochloride, 500 mg

$69.00 Standard Charge

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CPT J2060

Injection, lorazepam, 2 mg

$14.00 Standard Charge

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CPT J2550

Injection, promethazine hcl, up to 50 mg

$8.00 Standard Charge

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CPT J2405

Injection, ondansetron hydrochloride, per 1 mg

$26.00 Standard Charge

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CPT J1642

Injection, heparin sodium, (heparin lock flush), per 10 units

$26.00 Standard Charge

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CPT J1100

Injection, dexamethasone sodium phosphate, 1 mg

$26.00 Standard Charge

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CPT J1170

Injection, hydromorphone, up to 4 mg

$26.00 Standard Charge

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CPT J1650

Injection, enoxaparin sodium, 10 mg

$32.00 Standard Charge

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CPT J2930

Injection, methylprednisolone sodium succinate, up to 125 mg

$40.00 Standard Charge

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CPT J0696

Injection, ceftriaxone sodium, per 250 mg

$26.00 Standard Charge

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CPT J2704

Injection, propofol, 10 mg

$24.00 Standard Charge

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CPT J0690

Injection, cefazolin sodium, 500 mg

$26.00 Standard Charge

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CPT G0378

Hospital observation service, per hour

$49.00 Standard Charge

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CPT J3475

Injection, magnesium sulfate, per 500 mg

$26.00 Standard Charge

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CPT J1200

Injection, diphenhydramine hcl, up to 50 mg

$26.00 Standard Charge

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CPT J2250

Injection, midazolam hydrochloride, per 1 mg

$26.00 Standard Charge

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CPT J1815

Injection, insulin, per 5 units

$5.00 Standard Charge

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CPT J7620

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme

$8.00 Standard Charge

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CPT J2765

Injection, metoclopramide hcl, up to 10 mg

$26.00 Standard Charge

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CPT J7040

Infusion, normal saline solution, sterile (500 ml = 1 unit)

$22.00 Standard Charge

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CPT J7030

Infusion, normal saline solution , 1000 cc

$22.00 Standard Charge

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CPT J1335

Injection, ertapenem sodium, 500 mg

$333.00 Standard Charge

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CPT J0456

Injection, azithromycin, 500 mg

$36.00 Standard Charge

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CPT J7120

Ringers lactate infusion, up to 1000 cc

$22.00 Standard Charge

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CPT Q9967

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

$177.60 Standard Charge

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CPT J2270

Injection, morphine sulfate, up to 10 mg

$26.00 Standard Charge

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