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Cost Estimator
Sweetwater Memorial Clinics
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Cash Pricing
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Misc.
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Select a Service
Select a service.
You may need to get a specific service code from your provider.
Code
Description
A4248 Chlorhexidine containing antiseptic, 1 ml
A4467 Belt, strap, sleeve, garment, or covering, a
A4550 Surgical trays
A4561 Pessary, rubber
A4561 RUBBER PESSARY ANY TYPE
A4565 Arm Sling
A6448 Light compression bandage, elastic, knitted/
A6530 Gradient compression stocking, below knee, 1
E0105 Cane, quad or three prong, includes all mate
E0110 Crutches, forearm, includes crutches of vari
E0114 Crutches underarm, other than wood, adjustab
E0190 Positioning cushion/pillow/wedge, any shape
E0191 Heel or elbow protector, each
G0008 Administration of influenza virus vaccine
G0009 Administration of pneumococcal vaccine
G0010 HEPATITIS ADMIN- MEDICARE CHARGE
J0561 Injection, penicillin g benzathine, 100,000
J0585 Injection, onabotulinumtoxina, 1 unit
J0696 Injection, ceftriaxone sodium, per 250 mg
J0702 Betamethasone injection, per 3mg
J0725 Injection, chorionic gonadotropin
J0881 Injection, darbepoetin alfa, 1 microgram
J0897 Injection, denosumab, 1 mg
J1030 Injection, methylprednisolone acetate, 40 mg
J1040 Injection, methylprednisolone acetate, 80 mg
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