Saint Alphonsus Medical Center Nampa

Cash price

$173

$55 – $2,300

3-DIMENSIONAL RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS

77295

Cash price

$5,564

$394 – $12,717

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

$292

$20 – $2,300

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

$594

$64 – $2,300

58160-0890-52 - influenza virus vaccine, inactivated preservative-free quadrivalent Sus [MEMO]

90675

Cash price

$485

$0.01 – $2,300

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE

49083

Cash price

$1,302

$215 – $2,976

ABL1 (ABL PROTO-ONCOGENE 1, NON-RECEPTOR TYROSINE KINASE) (EG, ACQUIRED IMATINIB TYROSINE KINASE INHIBITOR RESISTANCE), GENE ANALYSIS, VARIANTS IN THE KINASE DOMAIN

81170

Cash price

$411

$255 – $2,300

ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY

50593

Cash price

$8,217

$923 – $29,023

ABLTJ MAL BRST TUM PERQ CRTX

0581T

Cash price

$7,013

$2,300 – $16,029

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTERO

770

Typical

—

$5,466 – $15,535

ABORTION WITHOUT D&C

779

Typical

—

$6,305 – $19,240

ACETAZOLAMIDE LESS THAN500MG 500MG 5MLSNIJ

J1120

Cash price

$103

$25 – $2,300

ACETYLCHOLINE RECEPTOR (ACHR); BINDING ANTIBODY

86041

Cash price

$89

$16 – $2,300

ACETYLCHOLINE RECEPTOR (ACHR); BLOCKING ANTIBODY

86042

Cash price

$89

$16 – $2,300

ACETYLCHOLINE RECEPTOR (ACHR); MODULATING ANTIBODY

86043

Cash price

$89

$10 – $2,300

ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [35100]

J0132

Cash price

$543

$0.63 – $2,300

ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR REMOVAL OF MULTIPLE MILIA, COMEDONES, CYSTS, PUSTULES)

10040

Cash price

$162

$95 – $2,300

ACTIN (SMOOTH MUSCLE) ANTIBODY (ASMA), EACH

86015

Cash price

$47

$10 – $2,300

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNC

880

Typical

—

$630 – $16,694

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

289

Typical

—

$9,161 – $30,363

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

288

Typical

—

$15,230 – $60,733

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

290

Typical

—

$6,698 – $24,227

ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY (86709) HEPATITIS B CORE ANTIBODY (HBCAB), IGM ANTIBODY (86705) HEPATITIS B SURFACE ANTIGEN (HBSAG) (87340) HEPATITIS C ANTIBODY (86803)

80074

Cash price

$134

$35 – $2,300

ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES AGE >17 WITH CC

835

Typical

—

$13,284 – $64,109

ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES AGE >17 WITH MCC

834

Typical

—

$31,587 – $137,914

ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC

836

Typical

—

$7,635 – $33,244

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

121

Typical

—

$8,092 – $24,919

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

122

Typical

—

$5,171 – $14,481

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH

282

Typical

—

$5,027 – $13,967

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH

281

Typical

—

$6,088 – $17,758

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

280

Typical

—

$9,753 – $30,857

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

284

Typical

—

$5,145 – $16,716

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

283

Typical

—

$11,847 – $38,344

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

285

Typical

—

$3,779 – $10,302

ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION [4235]

J0133

Cash price

$21

$0.05 – $2,300

ADAPTOR/EXTENSION, PACING LEAD OR NEUROSTIMULATOR LEAD (IMPLANTABLE)

C1883

Cash price

$460

$73 – $2,698

ADDITION OF JOINT TO UPPER EXTREMITY ORTHOSIS, ANY MATERIAL; PER JOINT

L3956

Cash price

$28

$0.01 – $2,300

ADMINISTRATION OF HEPATITIS B VACCINE

G0010

Cash price

$42

$17 – $2,300

ADMINISTRATION OF INFLUENZA VIRUS VACCINE

G0008

Cash price

$30

$15 – $2,300

ADMINISTRATION OF PNEUMOCOCCAL VACCINE

G0009

Cash price

$29

$15 – $2,300

ADMINISTRATION OF RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, SEASONAL DOSE BY INTRAMUSCULAR INJECTION, WITH COUNSELING BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL

96380

Cash price

$62

$19 – $2,300

ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION [126813]

J9354

Cash price

$10,624

$34 – $16,812

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

614

Typical

—

$13,376 – $43,809

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

615

Typical

—

$9,125 – $28,613

ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL

82024

Cash price

$77

$33 – $2,300

ADVANCE CARE PLANNING INCLUDING THE EXPLANATION AND DISCUSSION OF ADVANCE DIRECTIVES SUCH AS STANDARD FORMS (WITH COMPLETION OF SUCH FORMS, WHEN PERFORMED), BY THE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

99498

Cash price

$50

$36 – $2,300

ADVANCE CARE PLANNING INCLUDING THE EXPLANATION AND DISCUSSION OF ADVANCE DIRECTIVES SUCH AS STANDARD FORMS (WITH COMPLETION OF SUCH FORMS, WHEN PERFORMED), BY THE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL; FIRST 30 MINUTES, FACE-TO-FACE WITH THE PATIENT, FAMILY MEMBER(S), AND/OR SURROGATE

99497

Cash price

$60

$43 – $2,300

AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT OR PROPHYLAXIS

94642

Cash price

$285

$0.01 – $2,300

AFO SPIRAL PREFABRICATED

L1951

Cash price

$540

$386 – $2,300

AFO TIBIAL FRACTURE SOFT

L2112

Cash price

$298

$213 – $2,300