Supplies, drugs & other prices at Mountain View Hospital

Idaho Falls, ID · every code in this section with a posted price and a Medicare benchmark.

50 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral (0581T) $6,092 $6,092 1.6×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $5,530 $5,530 2.9×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T) $10,084 $10,084 1.2×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $5,530 $5,530 2.9×
Admin influenza virus vac (G0008) $48 $48 1.0×
Admin pneumococcal vaccine (G0009) $48 $48 1.0×
Ca screen;flexi sigmoidscope (G0104) $773 $773 0.8×
Ca screen;pelvic/breast exam (G0101) $217 $217 2.2×
Colon ca scrn not hi rsk ind (G0121) $2,228.50 $2,228.50 2.4×
Colorectal scrn; hi risk ind (G0105) $1,472 $1,472 1.6×
Cysto impl 4 or more (C9740) $24,000 $24,000 2.6×
Cysto, litho, vacuum kidney (C9761) $18,950 $18,950 2.0×
Depression screen annual (G0444) $33 $33 0.9×
Drug test def 1-7 classes (G0480) $115.50 $115.50 1.0×
Drug test def 22+ classes (G0483) $137.50 $137.50 0.6×
Drug test def 8-14 classes (G0481) $499 $499 3.2×
Elec stim other than wound (G0283) $30 $30 2.4×
Esophag muc integ w/eso egd (C9777) $8,500 $8,500 2.2×
Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie,… (0184T) $5,800 $5,800 1.0×
Hbot, full body chamber, 30m (G0277) $1,717.50 $1,717.50 12.6×
Home sleep test/type 3 porta (G0399) $450 $450 2.1×
Hospital outpt clinic visit (G0463) $154 $154 1.2×
Iliac Atherectomy (0238T) $16,000 $16,000 0.9×
Impltj ant sgm io nbiodegradable rx eluting sys (0660T) $4,800 $4,800 1.2×
Initial preventive exam (G0402) $112 $112 0.9×
Inj for sacroiliac jt anesth (G0260) $1,287.50 $1,287.50 1.8×
Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) $6,550 $6,550 2.0×
Insertion of sinus tarsi implant (0335T) $7,000 $7,000 1.0×
Neuro csf prion prtn qual (0035U) $1,082 $1,082 2.0×
Njx pltlt plasma w/img harvest/preparation (0232T) $597.50 $597.50 1.4×
Noncontact r-t fluor wnd img 1st anatomic site (0598T) $600 $600 2.8×
Onc merkel cell carc detcj antb serum reprtd +/- (0059U) $662.50 $662.50 2.1×
Onc Merkel Cll Carc Srm Quan (0058U) $683 $683 2.1×
Open insj/rplcmt integrated nstimj sys ptn subq (0816T)
unusually low: confirm this is the full procedure
$7,600 $7,600 0.4×
Percutaneous implantation or replacement of integrated single device neurostimulation system including electrode array… (0587T) $7,000 $7,000 1.1×
Perq Sacral Augmt Bilat Inj (0201T) $5,802 $5,802 0.8×
Perq Sacral Augmt Unilat Inj (0200T) $4,624 $4,624 0.6×
Prolonged iv inf, req pump (C8957) $650 $650 3.1×
Prostate biopsy, any mthd (G0416) $1,003.50 $1,003.50 2.8×
Psa screening (G0103) $49 $49 2.5×
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $792 $792 1.1×
Revasc lithotrip-stent-ather (C9767) $25,000 $25,000 1.4×
Revision or removal of integrated single device neurostimulation system including electrode array and receiver or pulse… (0588T) $2,800 $2,800 0.8×
Spine device implant surgery (C9757) $34,000 $34,000 2.7×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) $22,000 $22,000 1.2×
Tomosynthesis, mammo (G0279) $87 $87 6.9×
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation;… (0236T) $10,400 $10,400 0.9×
Trim nail(s) (G0127) $28 $28 0.5×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $10,400 $10,400 0.9×
Trluml Peripheral Atherectomy Renal Artery Ea (0234T) $10,400 $10,400 0.9×