Professional
Phlebotomy
Nursing Only
Very Simple
Simple
Intermediate
Detailed
Complex
Appointment per 1/4 hr
Other______________
Tests
Blood glucose / urine dip
Rapid Strep / Mono
Urine pregnancy
PPD (TB skin)
Influenza
B chem / CBC / liver panel
Lipid panel / PT (protime)
Comp chem. / Hgb A1C
PSA / TSH
Quant serum preg / FSH
Urine Culture
EKG & Reading
Other______________
Clinic Medications
Albuterol-nebs 1st
Aluterol additional
Ampicillin / Ancef
B-12 inj. / Benadryl
Bicillin CR- 600,000
Bicillin LA- 1.2 mil units
Celstone
Decadron / Solumedrol
Deprmedrol
Flu Shot
Gentamicin
Humulin 70/30 & Insulin R
Ketorolac
Nubain
Ondansetron 4mg
Ondansetron 6mg
Phenergan gel syringe
Pneumovax
Promethazine
Tetanus diptheria
Tet/dipt/pert (Tdap)
Other______________
Discharge Medications
Amoxicillin 500mg #30
Auroto otic drops 10cc
Azithromycin (Zpak)
Carisoprodol 300mg #10
Carisoprodol 300mg #30
Cephalexin 250mg #15
Cephalexin 500mg #30
Clobetasol 0.05% 30gm
Discharge Meds (cont.)
Ciprofloxacin 500mg #10
Doxycycline 100mg
Floucinonide 0.05% 30 gm
Gentamicin eye drops 5cc
Loratadine 10 mg #15
Meloxicam 15mg #30
Ondansetron ODT 4mg #10
Prednisone 20 mg #13
Promethazine 25m #8
Phenazopyridine 200mg #10
Ranitidine 300mg #30
Triamcinalone 0.5% 15gm
Other______________
Procedures
I & D simple . interned
I & D complex
Skin FB rem sin / com
Burn care sim / inter
Ingrown toe nail rem.
Skin biopsy
Simple cut < 1 in
Additional inch
Interned cut < 1 in
Additional inch
Complex cut < 1 in
Additional inch
Wart removal 1, 2 / 3-5
Lesion destruction
Trigger point inj. 4 / 8
Trigger point inj. 12 / 16
Excision lesion - simple
Excision lesion - interned
Eye FB removal simple
Corneal FB removal
Corneal abrasion care
Foreign body removal ear
Earwax removal - one
Earwax removal - both
Joint Injection
IV one bag
IV additional bag
Splints & Braces
Fiberglass splint
Elbow Brace
Bath wrist splint
Metacarpal splint
Finger splint
Other________________
Fees ($)
10
15
30
45
65
85
120
60
5
10
10
10
20
20
20
25
25
30
40
40
20
10
10
10
25
40
15
12
15
25
10
5
12
10
10
15
5
40
10
30
60
5
5
20
5
10
5
10
10
Fees ($)
5
5
5
5
3
5
5
5
8
3
5
5
95 / 145
175
95 / 145
95 / 145
150
250
95
25
135
35
175
50
95 / 135
50
25 / 40
50 / 60
125
175
50
95
75
75
30
40
50
50
25
40
18
18
18
3
