Teton Valley Hospital
120 East Howard Ave
Driggs, ID 83422
Critical Access Hospitals
Overview
- CCN131313
Procedures & prices
- CEFEPIME HCL FOR INJECTIONJ0692$10cashGross $130 payers
- Variable concentration maskA4620$10cashGross $130 payers
- TACROLIMUS IMME REL ORAL 1MGJ7507$10cashGross $130 payers
- Impreg gauze no h20/sal/yardA6266$10cashGross $130 payers
- MEROPENEMJ2185$11cashGross $130 payers
- Prolng clin staff svc 1st hr99415$11cashGross $140 payers
- DEXAMETHASONE SODIUM PHOSJ1100$11cashGross $140 payers
- FLUOROURACIL INJECTIONJ9190$12cashGross $160 payers
- UNCLASSIFIED DRUGS OR BIOLOGC9399$12cashGross $160 payers
- HC UR ALBUMIN SEMIQUANTITATIVE82044$13cashGross $160 payers
| Procedure | Code | Cash↑ | Gross | Negotiated range | Payers |
|---|---|---|---|---|---|
| CEFEPIME HCL FOR INJECTION | J0692 | $10 | $13 | — | 0 |
| Variable concentration mask | A4620 | $10 | $13 | — | 0 |
| TACROLIMUS IMME REL ORAL 1MG | J7507 | $10 | $13 | — | 0 |
| Impreg gauze no h20/sal/yard | A6266 | $10 | $13 | — | 0 |
| MEROPENEM | J2185 | $11 | $13 | — | 0 |
| Prolng clin staff svc 1st hr | 99415 | $11 | $14 | — | 0 |
| DEXAMETHASONE SODIUM PHOS | J1100 | $11 | $14 | — | 0 |
| FLUOROURACIL INJECTION | J9190 | $12 | $16 | — | 0 |
| UNCLASSIFIED DRUGS OR BIOLOG | C9399 | $12 | $16 | — | 0 |
| HC UR ALBUMIN SEMIQUANTITATIVE | 82044 | $13 | $16 | — | 0 |
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