Intermountain Health Intermountain Medical Center — price list

← Hospital overviewVerified from Intermountain Health Intermountain Medical Center’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.

88 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
3-d reconstruct withworkstation Inpatient	76377 CPT	$596	$447	$7.15 – $536	—
Ablation bone tumor rf perq withimg gdn when done Inpatient	20982 CPT	$12,396	$9,297	$149 – $11,157	—
Airway inhalation treatment Inpatient	94640 CPT	$150	$112	$1.80 – $135	—
Amniocentesis therapeutic Inpatient	59001 CPT	$1,448	$1,086	$17.37 – $1,303	—
Biopsy abd/retroperitoneal Inpatient	49180 CPT	$2,114	$1,585	$25.37 – $1,902	—
Bone marrow aspiration only unilateral Inpatient	38220 CPT	$447	$336	$5.37 – $403	—
Brain imaging with flow study Inpatient	78606 CPT	$1,675	$1,256	$20.10 – $1,507	—
Bronch withendobronchial bx Inpatient	3611016197 CDM	$7,379	$5,534	$88.54 – $6,641	—
Bronchoscopy withbrushing Inpatient	3611019197 CDM	$4,324	$3,243	$51.89 – $3,892	—
Bx breast 1st lesion MRI guide Inpatientapprox. match	19085 CPT	$6,555	$4,916	$78.66 – $5,900	—
Cath placement aorta translum Inpatient	36160 CPT	$1,350	$1,013	$16.20 – $1,215	—
Chem caut granulation tiss Inpatient	17250 CPT	$790	$592	$9.48 – $711	—
Closed tx mandibular fracture withmanipulation Inpatient	21451 CPT	$1,702	$1,276	$20.42 – $1,531	—
Closed tx radial head/neck fx without manipulation Inpatient	24650 CPT	$643	$482	$7.72 – $579	—
Closed tx radial shaft fracture withmanipulation Inpatient	25505 CPT	$1,702	$1,276	$20.42 – $1,531	—
Closed tx radial shaft fracture without manipulation Inpatient	25500 CPT	$643	$482	$7.72 – $579	—
Clsd tx pelvic ring fx Inpatient	27198 CPT	$643	$482	$7.72 – $579	—
Cltx fem fx prox end nck without manj bilateral Inpatient	27230 CPT	$643	$482	$7.72 – $579	—
Cltx post hip arthrp dislc req anes unilateral Inpatient	27266 CPT	$584	$438	$7.01 – $526	—
Cmplx rpr f/c/c/m/n/ax/g/h/f Inpatient	13133 CPT	$999	$749	$11.99 – $899	—
Cmplx rpr trunk addl 5cm/< Inpatient	13102 CPT	$999	$749	$11.99 – $899	—
CT facet joint aspiration Inpatient	64999 CPT	$4,424	$3,318	$53.08 – $3,981	—
CT lung rf ablation bilateral inc image guide Inpatient	32998 CPT	$28,363	$21,272	$340 – $25,527	—
EEG without video by tech 2-12hr continuous r-t mntr Inpatient	95707 CPT	$947	$710	$11.36 – $852	—
Elbow arthro inject unilateral Inpatient	24220 CPT	$635	$476	$7.62 – $571	—
Emergency room - level 4 withmod Inpatient	99284 CPT	$3,678	$2,759	$44.14 – $3,311	—
Fecal microbiota prep with instill any method Inpatient	G0455 CPT	$4,420	$3,315	$53.04 – $3,978	—
Home dialysis training capd per training session Inpatient	90993 CPT	$353	$265	$4.24 – $318	—
Home dialysis training ccpd per training session Inpatient	90993 CPT	$339	$254	$4.07 – $305	—
Immunization admin;one vaccine Inpatient	90471 CPT	$35.27	$26.45	$0.42 – $31.74	—