Pricing effective if paid at time of service and there is no insurance to be billed.
*As of 5/3/2017
| OFFICE VISITS |
|
ORTHO |
|
| Office Visit |
$110.00 |
Finger Splint Application |
$11.00 |
| Sports/Camp/Day Care Physical |
$30.00 |
Short Arm Application |
$41.00 |
| DOT/Pre-Employment Physical |
$85.00 |
Short Leg Application |
$52.00 |
| |
|
Long Arm Application |
$52.00 |
| IMMUNIZATIONS |
|
Short Arm Splint Supplies |
$26.00 |
| TB-Mantoux |
$25.00 |
Short Leg Splint Supplies |
$26.00 |
| Tdap |
$67.00 |
Long Arm Splint Supplies |
$36.00 |
| Influenza |
$25.00 |
Finger Splint (Stack/Tip Protector) |
$6.00 |
| |
|
Radial Head Sublexion |
$52.00 |
| MEDICATIONS |
|
Shoulder Dislocation |
$430.00 |
| Depomedrol 40mg |
$15.00 |
IP Joint Hand Dislocation |
$156.00 |
| Depomedrol 80mg |
$18.00 |
Patellar Dislocation |
$156.00 |
| Epinephrine 25 |
$13.00 |
|
|
| GI Cocktail |
$6.00 |
SUPPLIES |
|
| Morphine up to 10mg |
$12.00 |
Ace Wraps (3-5” wide) |
$3.00 |
| Phenergan 25mg |
$11.00 |
Ace Wraps (>5” wide) |
$6.00 |
| Rocephin 1gm |
$14.00 |
Adhesive Tape (1 roll) |
$3.00 |
| Rocephin 250 mg |
$12.00 |
Silvadene Dressing |
$5.00 |
| Solumedrol 125mg |
$16.00 |
Gauze Rolls (1 roll) |
$2.00 |
| Toradol 60mg/2ml |
$11.00 |
Telfa (non-adherent dressing) |
$5.00 |
| Ancef 1gm |
$11.00 |
Steri Strips |
$5.00 |
| Diphenhydramine 50mg/ml |
$8.00 |
Cavit |
$12.00 |
| Zofran 4mg/2ml |
$31.00 |
|
|
| Zofran ODT |
$5.00 |
IV THERAPY |
|
| Decadron 8mg |
$13.00 |
IV insertion/injection |
$80.00 |
| Decadron 4mg |
$10.00 |
2nd liter NS |
$30.00 |
| |
|
|
|
| RESPIRATORY |
|
PROCEDURES/I&D |
|
| Inhalation Treatment – 1st Dose |
$40.00 |
EKG Complete |
$62.00 |
| Inhalation Treatment – 2nd Dose |
$10.00 |
Ear Wash/Wax Removal |
$41.00 |
| Spirometry |
$52.00 |
Suture Removal |
$15.00 |
| Atrovent/Albuterol |
$4.00 |
Trigger Point Injection |
$52.00 |
| Albuterol |
$4.00 |
I & D Abscess – Simple |
$103.00 |
| |
|
I & D Abscess – Comp/Multi |
$155.00 |
| IN HOUSE LABS |
|
I & D Paronychia |
$93.00 |
| Urinalysis Dipstick |
$10.00 |
Eye Foreign Body Rem-Cornea |
$75.00 |
| Urine Drug Screen |
$31.00 |
Nail Removal |
$109.00 |
| Blood Sugar |
$16.00 |
Nasal Hemorrhage |
$75.00 |
| Breath Alcohol |
$46.00 |
Wart Removal |
$50.00 |
| Strep |
$15.00 |
Ext. Hemorrhoid Thrombosed |
$210.00 |
| Fecal Occult Blood |
$16.00 |
Arthrocentesis Joint |
$105.00 |
| Mono Test |
$12.00 |
Skin Tag Removal |
$55.00 |
| Urine Pregnancy Test |
$6.00 |
Subungual Hematoma |
$22.00 |
| Rapid Influenza Test (includes A&B) |
$38.00 |
Burn (Dressing &/or Debridement) |
|
| Phlebotomy Fee |
$20.00 |
1st Degree |
$78.00 |
| |
|
2nd or 3rd Degree (small) |
$92.00 |
| X-RAYS |
|
Manipulation |
$100.00 |
| Abdomen, flat & upright |
$87.00 |
|
|
| Ankle |
$64.00 |
LACERATIONS |
|
| Ankle – Complete |
$73.00 |
Simple (All Face Except Scalp) |
|
| Chest PA & LAT |
$76.00 |
<=2.5 cm |
$77.00 |
| Clavicle – Complete |
$66.00 |
2.6-5.0 cm |
$129.00 |
| C-Spine |
$80.00 |
5.1-7.5 cm |
$180.00 |
| Elbow |
$64.00 |
Simple (Scalp, Trunk, Extremities) |
|
| Elbow – Complete |
$78.00 |
<=2.5 cm |
$77.00 |
| Femur |
$75.00 |
2.6-7.5 cm |
$129.00 |
| Finger, minimum 2 views |
$55.00 |
7.6-12.5 cm |
$180.00 |
| Foot |
$68.00 |
Debridement Skin |
$136.00 |
| Foot – Complete |
$71.00 |
Digit Block |
$41.00 |
| Forearm – AP & LAT |
$67.00 |
Nail Bed Repair |
$103.00 |
| Hand |
$59.00 |
Foreign Body Removal –SC |
$77.00 |
| Hand – 3+ Views |
$73.00 |
|
|
| Hip |
$78.00 |
|
|
| Humerus – 2+ Views |
$75.00 |
|
|
| Knee – AP & LAT |
$69.00 |
|
|
| Knee, Complete, Min. 4 Views |
$93.00 |
|
|
| KUB |
$66.00 |
|
|
| Pelvis |
$67.00 |
|
|
| Ribs, 2 Views |
$78.00 |
|
|
| Shoulder – Complete |
$80.00 |
|
|
| Skull-3 views |
$109.0 |
|
|
| Tib-Fib- AP & LAT |
$79.00 |
|
|
| Toes, Minimum 2 Views |
$52.00 |
|
|
| T-Spine |
$33.00 |
|
|
| Wrist |
$62.00 |
|
|
| Wrist – Complete |
$71.00 |
|
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