Intermountain Health Good Samaritan Medical Center — price list

← Hospital overviewVerified from Intermountain Health Good Samaritan Medical Center’s published price file

Includes 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.

247 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
F5 gene analysis, leiden variant Inpatient	81241 CPT	$272	—	$80.17 – $272	—
Tissue culture blood cells Inpatient	88237 CPT	$1,161	—	$342 – $1,161	—
Ab influenza virus Inpatient	86710 CPT	$192	—	$56.64 – $192	—
Ab; HIV-1 diagnostic Inpatient	86701 CPT	$37.13	—	$10.95 – $37.13	—
Ab; HIV-2 diagnostic Inpatient	86702 CPT	$192	—	$56.66 – $192	—
Ab; lcmigg Inpatient	86727 CPT	$270	—	$79.59 – $270	—
Ab;lyme's (wb) igg confirm Inpatient	86617 CPT	$221	—	$65.10 – $221	—
Abl1 gene Inpatient	81170 CPT	$1,311	—	$387 – $1,311	—
Acid phosphatase Inpatient	84060 CPT	$396	—	$117 – $396	—
Actin smooth muscle antibody each Inpatient	86015 CPT	$50.37	—	$14.86 – $50.37	—
Additional banding-fish Inpatient	88271 CPT	$1,196	—	$353 – $1,196	—
Albumin serum Inpatient	82040 CPT	$111	—	$32.86 – $111	—
Alpha 1 antitrypsin phenotype Inpatient	82104 CPT	$66.44	—	$19.60 – $66.44	—
Amino acids plasma quant Inpatient	82131 CPT	$450	—	$133 – $450	—
Ammonia Inpatient	82140 CPT	$72.38	—	$21.35 – $72.38	—
Amphetamines; 5 or more Inpatient	80326 CPT	$400	—	$118 – $400	—
Anti-jo-1 Inpatient	86235 CPT	$305	—	$89.87 – $305	—
Antibody bacterium no elsewhere specified Inpatient	86609 CPT	$307	—	$90.64 – $307	—
Antibody treponema pallidum Inpatient	86780 CPT	$298	—	$87.88 – $298	—
Antibody; epstein-barr, viral capsid, each (a/g/m) Inpatient	86665 CPT	$85.58	—	$25.25 – $85.58	—
Antibody; herpes simplex virus, non-spec Inpatient	86694 CPT	$61.25	—	$18.07 – $61.25	—
Antidepressants class 1 or 2; qual Inpatient	80332 CPT	$192	—	$56.77 – $192	—
Aortic dysfunction/dilation Inpatient	81410 CPT	$1,761	—	$520 – $1,761	—
Assay for calprotectin fecal Inpatient	83993 CPT	$266	—	$78.43 – $266	—
Assay nonendocrine receptor Inpatient	84238 CPT	$170	—	$50.00 – $170	—
Assay thiopurine s-methyltransferase Inpatient	84433 CPT	$153	—	$45.11 – $153	—
Bartonell quintana igm titer Inpatient	86611 CPT	$57.40	—	$16.93 – $57.40	—
Bcr/alb1 gene minor bp Inpatient	81207 CPT	$1,269	—	$374 – $1,269	—
Bld typ ser RBC an not abo/rhd Inpatient	86905 CPT	$403	—	$119 – $403	—
Brca1/brca2 gene analysis; full sequence dup/del Inpatient	81162 CPT	$5,994	—	$1,768 – $5,994	—