Intermountain Health Fillmore Community Hospital — price list

← Hospital overviewVerified from Intermountain Health Fillmore Community Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

92 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
Aep scr auditory potential withstimuli auto alys Inpatient	92650 CPT	$325	$244	$244 – $309	—
Apply forearm cast Inpatient	29075 CPT	$596	$447	$447 – $566	—
Apply rigid contact total leg cast bilateral Inpatient	29445 CPT	$1,882	$1,412	$1,412 – $1,788	—
Bone marrow diagnostic; biopsy(ies) & aspiration(s) bilateral Inpatient	38222 CPT	$4,056	$3,042	$3,042 – $3,853	—
Bronch including fluor guide; ebus sampling 3 or more nodes Inpatient	31653 CPT	$12,346	$9,260	$9,260 – $11,729	—
Capsule endoscopy esoph through ileum Inpatient	91110 CPT	$4,245	$3,184	$3,184 – $4,033	—
Chemo IV infusion concurrent Inpatient	96549 CPT	$517	$388	$388 – $491	—
Closed rx shldr disloc,anesthesia unilateral Inpatient	23655 CPT	$1,188	$891	$891 – $1,129	—
Closed tx carpal scaphoid fracture without manj Inpatient	25622 CPT	$588	$441	$441 – $558	—
Closed tx metatarsal fracture without manipulation Inpatient	28470 CPT	$588	$441	$441 – $558	—
Closed tx monteggia fx dislocation elbow withmanj bilateral Inpatient	24620 CPT	$1,188	$891	$891 – $1,129	—
Closed tx radial head/neck fx without manipulation Inpatient	24650 CPT	$588	$441	$441 – $558	—
Closed tx talotarsal joint dislc without anes bilateral Inpatient	28570 CPT	$588	$441	$441 – $558	—
Closed tx ulnar fracture proximal end withmanj bilateral Inpatient	24675 CPT	$1,188	$891	$891 – $1,129	—
Closed tx ulnar fracture proximal end withmanj unilateral Inpatient	24675 CPT	$1,188	$891	$891 – $1,129	—
Cltx humeral epicondylar fx medial/lat withmanj bilateral Inpatient	24565 CPT	$1,188	$891	$891 – $1,129	—
Cltx humeral shft fx withmanj withwithout skeletal tracj unilateral Inpatient	24505 CPT	$1,188	$891	$891 – $1,129	—
Cltx medial malleolus fx without manipulation Inpatient	27760 CPT	$588	$441	$441 – $558	—
CT lung rf ablation bilateral inc image guide Inpatient	32998 CPT	$24,109	$18,081	$18,081 – $22,903	—
Deb musc/fascia 20sq cm/< Inpatient	11043 CPT	$1,211	$908	$908 – $1,150	—
Duplex vascular scan limited Inpatient	93976 CPT	$804	$603	$603 – $764	—
Epidrm a-grft f/n/hf/g addl Inpatient	15116 CPT	$1,249	$937	$937 – $1,187	—
ER critical care withmod Inpatient	99291 CPT	$5,600	$4,200	$4,200 – $5,320	—
ER critical care-'addl 30 min Inpatient	99292 CPT	$2,862	$2,147	$2,147 – $2,719	—
Evasc rpr ta dplmnt aort-artc tub ndgft xcov lsa Inpatient	33881 CPT	$11,769	$8,827	$8,827 – $11,181	—
Evasc rpr ta dplmnt aort-artc tube ndgft cov lsa Inpatient	33880 CPT	$5,682	$4,262	$4,262 – $5,398	—
Exchange drainage cathe abd Inpatient	49423 CPT	$2,656	$1,992	$1,992 – $2,523	—
Fetal non-stress test Inpatient	59025 CPT	$815	$612	$612 – $775	—
First order cerv/cereb carotid angio unilateral Inpatient	36223 CPT	$10,988	$8,241	$8,241 – $10,438	—
Flex sig witheus fna Inpatient	7501063797 CDM	$3,502	$2,626	$2,626 – $3,327	—