Tricyclic antidepressant drug level test

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

"ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYCLICALS, 3-5 , IMIPRAMINE"

Medicaid pricing summary

Low

Average

$27

Median

$27

High

$89

Medicaid rate distribution

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36 hospital rates

#		Plans
1	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient	1	$15	$15	—	—	—	$15 – $15
2	Clarion Hospital Clarion, PA facility · fee schedule · outpatient	1	$15	$15	—	—	—	$15 – $15
3	Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient	1	$7	$7	—	—	—	$7 – $7
4	HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA fee schedule · both	1	$25	$25	—	—	—	$25 – $25
5	HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA percent of total billed charges · bothfrom % of charges	1	$43	$43	—	—	—	$43 – $43
6	INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient	1	$7	$7	—	—	—	$7 – $7
7	Lake Charles Memorial Hospital Charles., LA percent of total billed charges · outpatientfrom % of charges	1	$19	$19	—	—	—	$19 – $19
8	Lancaster General Health Lancaster, PA facility · fee schedule · outpatient	1	$15	$15	—	—	—	$15 – $15
9	MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges	1	$69	$69	—	—	—	$69 – $69
10	Mercy Hospital Columbus Columbus, KS facility · fee schedule · outpatient	1	$66	$66	—	—	—	$66 – $66
11	Mercy Hospital Aurora Aurora, MO facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
12	Mercy Hospital Berryville Berryville, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
13	Mercy Hospital Booneville Booneville, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
14	Mercy Hospital Cassville Knob, MO facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
15	Mercy Hospital Fort Smith Smith, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
16	Mercy Hospital Fort Smith Smith, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
17	Mercy Hospital Jefferson Imperial, MO facility · percent of total billed charges · outpatientfrom % of charges	1	$23	$23	—	—	—	$23 – $23
18	Mercy Hospital Joplin dba Mercy Hospital Joplin Joplin, MO facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
19	Mercy Hospital Lincoln Troy, MO facility · percent of total billed charges · outpatientfrom % of charges	1	$26	$26	—	—	—	$26 – $26
20	Mercy Hospital Oklahoma City Inc City, OK facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
21	Mercy Hospital Ozark Ozark, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
22	Mercy Hospital Paris Paris, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
23	Mercy Hospital Rogers dba Mercy Hospital Northwest Arkansas Rogers, AR facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27
24	Mercy Hospital South Louis, MO facility · percent of total billed charges · outpatientfrom % of charges	1	$26	$26	—	—	—	$26 – $26
25	Mercy Hospital Springfield Ozark, MO facility · fee schedule · outpatient	1	$27	$27	—	—	—	$27 – $27