Primary Children's Hospital
100 North Mario Capecchi Drive
Salt Lake City, UT 84113
Overview
- CCN463301
Procedures & prices
- CEFTAROLINE FOSAMIL INJJ0712$10cashGross $140 payers
- Surgical boot each childL3209$12cashGross $160 payers
- Surgical boot each juniorL3211$12cashGross $160 payers
- Surgical boot each infantL3208$12cashGross $160 payers
- Hydrogel dsg<=16 sq inA6231$13cashGross $170 payers
- IN GEMCITABINE HCL NOS 200MGJ9201$13cashGross $170 payers
- GRANISETRON HCL 1 MG ORALQ0166$13cashGross $170 payers
- HC N-AUTOM URINALYS WO MICRO81002$14cashGross $180 payers
- HC ASSAY OF BODY FLUID ACIDITY83986$14cashGross $190 payers
- Hydrogel dsg>16<=48 sq inA6232$14cashGross $190 payers
| Procedure | Code | Cash↑ | Gross | Negotiated range | Payers |
|---|---|---|---|---|---|
| CEFTAROLINE FOSAMIL INJ | J0712 | $10 | $14 | — | 0 |
| Surgical boot each child | L3209 | $12 | $16 | — | 0 |
| Surgical boot each junior | L3211 | $12 | $16 | — | 0 |
| Surgical boot each infant | L3208 | $12 | $16 | — | 0 |
| Hydrogel dsg<=16 sq in | A6231 | $13 | $17 | — | 0 |
| IN GEMCITABINE HCL NOS 200MG | J9201 | $13 | $17 | — | 0 |
| GRANISETRON HCL 1 MG ORAL | Q0166 | $13 | $17 | — | 0 |
| HC N-AUTOM URINALYS WO MICRO | 81002 | $14 | $18 | — | 0 |
| HC ASSAY OF BODY FLUID ACIDITY | 83986 | $14 | $19 | — | 0 |
| Hydrogel dsg>16<=48 sq in | A6232 | $14 | $19 | — | 0 |
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