|
---|
Unclassified drugs
$22.50 See All Rates |
Injection, hydromorphone, up to 4 mg
$45.31 See All Rates |
Injection, diphenhydramine hcl, up to 50 mg
$24.31 See All Rates |
Ambulance service, basic life support, emergency transport (bls-emergency)
$598.00 See All Rates |
Injection, azithromycin, 500 mg
$27.10 See All Rates |
Injection, magnesium sulfate, per 500 mg
$24.21 See All Rates |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)
$12.00 See All Rates |
Injection, fentanyl citrate, 0.1 mg
$42.42 See All Rates |
Infusion, normal saline solution, sterile (500 ml = 1 unit)
$66.70 See All Rates |
Injection, propofol, 10 mg
$28.17 See All Rates |
Injection, morphine sulfate, up to 10 mg
$45.41 See All Rates |
Injection, dexamethasone sodium phosphate, 1 mg
$23.16 See All Rates |
Injection, denosumab, 1 mg
$3,451.70 See All Rates |
Posterior chamber intraocular lens
$124.00 See All Rates |
Infusion, normal saline solution, 250 cc
$65.26 See All Rates |
Injection, ketorolac tromethamine, per 15 mg
$22.83 See All Rates |
Injection, insulin, per 5 units
$32.80 See All Rates |
Injection, midazolam hydrochloride, per 1 mg
$41.09 See All Rates |
Injection, potassium chloride, per 2 meq
$23.55 See All Rates |
Injection, acetaminophen, 10 mg
$34.78 See All Rates |
5% dextrose/water (500 ml = 1 unit)
$66.28 See All Rates |
Esketamine, nasal spray, 1 mg
$2,938.16 See All Rates |
Injection, cefazolin sodium, 500 mg
$23.31 See All Rates |
Injection, ondansetron hydrochloride, per 1 mg
$20.96 See All Rates |
Injection, furosemide, up to 20 mg
$23.68 See All Rates |
Injection, enoxaparin sodium, 10 mg
$26.50 See All Rates |
Hospital outpatient clinic visit for assessment and management of a patient
$200.00 See All Rates |
Ground mileage, per statute mile
$2.00 See All Rates |
Ringers lactate infusion, up to 1000 cc
$66.80 See All Rates |
Injection, infliximab, excludes biosimilar, 10 mg
$973.38 See All Rates |
Infusion, normal saline solution , 1000 cc
$66.80 See All Rates |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg
$32.51 See All Rates |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
$172.76 See All Rates |
Injection, lidocaine hcl for intravenous infusion, 10 mg
$23.11 See All Rates |
Injection, iron sucrose, 1 mg
$140.90 See All Rates |
Injection, lorazepam, 2 mg
$44.20 See All Rates |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)
$464.00 See All Rates |
Injection, omalizumab, 5 mg
$1,484.96 See All Rates |
Injection, heparin sodium, (heparin lock flush), per 10 units
$21.27 See All Rates |
Injection, ceftriaxone sodium, per 250 mg
$23.86 See All Rates |
Injection, ropivacaine hydrochloride, 1 mg
$38.39 See All Rates |
Direct admission of patient for hospital observation care
$460.00 See All Rates |
Hospital observation service, per hour
$62.00 See All Rates |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)
$889.00 See All Rates |
Non-covered item or service
$1.03 See All Rates |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed
$139.00 See All Rates |