INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
210658	INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION	$193,618	—	—	—	8
210658	INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION	$193,618	—	—	—	34
216356	LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN	$186,212	—	—	—	8
216356	LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN	$186,212	—	—	—	34
2722109771	HC PERCUTANEOUS VENTRICULAR ASSIST DEVICE LVL 71	$156,179	—	—	—	8
2782649771	HC VALVE IMPLANT LVL 71	$156,179	—	—	—	8
2722109771	HC PERCUTANEOUS VENTRICULAR ASSIST DEVICE LVL 71	$156,179	—	—	—	34
2782649771	HC VALVE IMPLANT LVL 71	$156,179	—	—	—	34
2721649601	HC KIT PUMP DEVICE CARDIAC VENTRICULAR SMARTASSIST 5.5 S2	$149,908	—	—	—	8
2721649601	HC KIT PUMP DEVICE CARDIAC VENTRICULAR SMARTASSIST 5.5 S2	$149,908	—	—	—	34
278TRIG470	HC NTAP TRICLIP G4 VLV RPR SYSTM	$148,742	—	—	—	8
2782649770	HC VALVE IMPLANT LVL 70	$148,742	—	—	—	8
278TRIG470	HC NTAP TRICLIP G4 VLV RPR SYSTM	$148,742	—	—	—	34
2782649770	HC VALVE IMPLANT LVL 70	$148,742	—	—	—	34
2721649701	HC PUMP BLOOD VAD W/ VALVES	$148,702	—	—	—	8
2721649701	HC PUMP BLOOD VAD W/ VALVES	$148,702	—	—	—	34
7613724101	HC VASC EMBOLIZE/OCCLUDE VENOUS	$137,684	—	—	—	8
7613724101	HC VASC EMBOLIZE/OCCLUDE VENOUS	$137,684	—	—	—	34
275C188267	HC ICD BIV/CRT-D LVL 67	$128,489	—	—	—	8
275C188267	HC ICD BIV/CRT-D LVL 67	$128,489	—	—	—	34
183256	RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN	$123,080	—	—	—	8
183256	RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN	$123,080	—	—	—	34
2782649766	HC VALVE IMPLANT LVL 66	$122,370	—	—	—	8
278C182366	HC NEUROSTIM GENERATOR/LEAD LVL 66	$122,370	—	—	—	8
278C188966	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 66	$122,370	—	—	—	8
2782649766	HC VALVE IMPLANT LVL 66	$122,370	—	—	—	34
278C182366	HC NEUROSTIM GENERATOR/LEAD LVL 66	$122,370	—	—	—	34
278C188966	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 66	$122,370	—	—	—	34
2782649765	HC VALVE IMPLANT LVL 65	$116,543	—	—	—	8
2782649765	HC VALVE IMPLANT LVL 65	$116,543	—	—	—	34
7613724201	HC VASC EMBOLIZE/OCCLUDE ARTERY	$113,870	—	—	—	8
7613724201	HC VASC EMBOLIZE/OCCLUDE ARTERY	$113,870	—	—	—	34
2782649764	HC VALVE IMPLANT LVL 64	$110,993	—	—	—	8
2782669764	HC VASCULAR STENT GRAFT IMPLANT LVL 64	$110,993	—	—	—	8
2782649764	HC VALVE IMPLANT LVL 64	$110,993	—	—	—	34
2782669764	HC VASCULAR STENT GRAFT IMPLANT LVL 64	$110,993	—	—	—	34
192637	FLUTEMETAMOL F-18 5 MCI (185 MBQ) INTRAVENOUS SOLUTION	$108,002	—	—	—	8
192637	FLUTEMETAMOL F-18 5 MCI (185 MBQ) INTRAVENOUS SOLUTION	$108,002	—	—	—	34
278C188963	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 63	$105,708	—	—	—	8
2782649763	HC VALVE IMPLANT LVL 63	$105,708	—	—	—	8
278C188963	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 63	$105,708	—	—	—	34
2782649763	HC VALVE IMPLANT LVL 63	$105,708	—	—	—	34
168829	PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION	$101,795	—	—	—	8
168829	PEGLOTICASE 8 MG/ML INTRAVENOUS SOLUTION	$101,795	—	—	—	34
278C187462	HC STENT COATED/COVERED IMPLANT LVL 62	$100,674	—	—	—	8
278C188962	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 62	$100,674	—	—	—	8
2782669762	HC VASCULAR STENT GRAFT IMPLANT LVL 62	$100,674	—	—	—	8
278C187462	HC STENT COATED/COVERED IMPLANT LVL 62	$100,674	—	—	—	34
278C188962	HC IMPLANTABLE-INSERTABLE DEVICE NOC LVL 62	$100,674	—	—	—	34
2782669762	HC VASCULAR STENT GRAFT IMPLANT LVL 62	$100,674	—	—	—	34

Showing top 50 of 29,067 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.