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Cost Estimator
Clark Fork Valley Hospital
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Cash Pricing
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Medication
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Select a Service
Select a service.
You may need to get a specific service code from your provider.
Code
Description
90380
HC PR RX RSV MONOCLONAL ANTIBODY IM 0.5 ML
90619
HC PR RX MENINGOCOCCAL CONJ QUADRIVALENT (MENQUADFI) IM 1 EA
90656
HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS PF IM 0.5 ML
90657
HC PR RX INFLUENZA TRIVALENT IIV3 SPLIT VIRUS IM 0.25 ML
90677
HC PR RX PNEUMOCOCCAL CONJ 20 VALENT VACCINE (PCV20) IM 1 EA
91321
HC PR RX COVID-19 VAC SINGLE DOSE (MODERNA) PF 6M TO 11Y IM 25 MCG/0.25 ML
91322
HC PR RX COVID-19 VACCINE SINGLE DOSE (MODERNA) PF IM 50 MCG/0.5 ML
J0561
HC PR RX PENICILLIN G BENZATHINE INJ 100000 UNITS
J0665
HC PR RX BUPIVACAINE HCL INJ 30 ML
J0690
HC PR RX CEFAZOLIN SODIUM INJ 500 MG
J0696
HC PR RX CEFTRIAXONE SODIUM INJ 250 MG
J0702
HC PR RX BETAMETHASONE ACET&SOD PHOSP INJ 3 MG
J1050
HC PR RX MEDROXYPROGESTERONE ACETATE 1 MG
J1071
HC PR RX TESTOSTERONE CYPIONATE INJ 1 MG
J1200
HC PR RX DIPHENHYDRAMINE HCL INJ 50 MG
J1580
HC PR RX GENTAMICIN INJ 80 MG
J1720
HC PR RX HYDROCORTISONE NA SUCCINATE INJ 100 MG
J1885
HC PR RX KETOROLAC TROMETHAMINE INJ 15 MG
J1950
HC PR RX LEUPROLIDE ACETATE INJ 3.75 MG
J2405
HC PR RX ONDANSETRON HCL INJ 1 MG
J2550
HC PR RX PROMETHAZINE HCL INJ 50 MG
J2765
HC PR RX METOCLOPRAMIDE HCL INJ 10 MG
J2790
HC PR RX RHO D IMMUNE GLOBULIN INJ 300 MCG (1500 IU)
J3301
HC PR RX TRIAMCINOLONE ACETATE INJ 10 MG
J3410
HC PR RX HYDROXYZINE INJ 25 MG
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