Eastern Idaho Regional Medical Center

Typical

—

$2 – $2.66

"""""""POUCH OSTOMY 12"""""""" DRAINABLE 18006"""""""

A5063

Cash price

$21

$3 – $115

"""""""POUCH OSTOMY 12"""""""" DRAINABLE 18193"""""""

A4425

Cash price

$24

$4 – $115

"""""""UNNA BOOT W/CALAZIME 4"""""""" X 10 Y"""""""

A6456

Typical

—

$1 – $1.74

1 pc ost pou w built-in conv

A5057

Cash price

$65

$11 – $115

1 pc ost pouch w filter

A5056

Typical

—

$5 – $6.51

1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRNK

36468

Typical

—

$274 – $8,162

1150

Typical

—

$20 – $21

12-24hr sealed lead acid

K0733

Typical

—

$3.34 – $35

1274

Typical

—

$6,086 – $6,208

1440

Typical

—

$5.42 – $5.53

1486

Typical

—

$3.59 – $3.66

1500

Typical

—

$44 – $45

1502

Typical

—

$72 – $74

1656

Typical

—

$2.34 – $2.39

1670

Typical

—

$582 – $593

1829

Typical

—

$24 – $25

1844

Typical

—

$2.1 – $2.14

1850

Typical

—

$50 – $51

1852

Typical

—

$1,911 – $1,949

1ST PLMT DRUG ELUT OC INS

0444T

Typical

—

$8,162 – $8,162

1pc ost pch drain hgh output

A4435

Cash price

$250

$7 – $115

2 pc drainable ost pouch

A4413

Typical

—

$6 – $7.67

2.5MM THREAD GUIDE WIRE

705

DRG

Typical

—

$110 – $112

2019-NCOV CORONAVIRUS, SARS-COV-2/2019-NCOV (COVID-19), ANY TECHNIQUE, MULTIPLE TYPES OR SUBTYPES (INCLUDES ALL TARGETS), NON-CDC

U0002

Cash price

$146

$46 – $115

22nf nonsealed leadacid

E2360

Typical

—

$14 – $142

22nf sealed leadacid battery

E2361

Typical

—

$16 – $138

29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STA

29125

Cash price

$243

$55 – $8,162

29130 ed proc application of finger splint static

29130

Cash price

$149

$34 – $8,162

29131 ed proc application finger splint dynamic

29131

Typical

—

$44 – $8,162

3-DIMENSIONAL RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS

77295

Cash price

$11,486

$115 – $2,681

3.2MM DRILL BIT 195MM

706

DRG

Typical

—

$68 – $69

110014

Cash price

$1,398

$115 – $115

110058

Cash price

$4,525

$115 – $115

110026

Cash price

$4,039

$115 – $115

110062

Cash price

$2,442

$115 – $115

110066

Cash price

$6,575

$115 – $115

110077

Cash price

$6,933

$115 – $115

110021

Cash price

$4,909

$115 – $115

110057

Cash price

$4,525

$115 – $115

110061

Cash price

$256

$115 – $115

36000 ed proc introduction of needle or intracathe

36000

Typical

—

$21 – $8,162

37799 ed proc vascular surgery unlisted proc

37799

Typical

—

$542 – $4,109

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

76376

Cash price

$1,507

$7 – $115

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

76377

Cash price

$639

$31 – $115

4-bar link above knee w/swng

L5614

Typical

—

$1,747 – $1,981

110076

Cash price

$4,231

$115 – $115

110063

Cash price

$3,982

$115 – $115

110047

Cash price

$14,748

$115 – $115

110075

Cash price

$1,400

$115 – $115