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
Celestone
Ceftriaxone
Decadron / Solumedrol
Deprmedrol

Gentamicin
Humulin 70/30 & Insulin R
Ketorolac
Nubain
Ondansetron 4mg
Ondansetron 6mg
Phenergan gel syringe

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
30
40
 
 
 
 
  20
10
10
10
15
20
12
15
25
10
5
12
10
10
15
5

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


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