Intermountain Health LDS Hospital — price list

← Hospital overviewVerified from Intermountain Health LDS 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.

87 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
Abdomen 1st order cath place bilateral Inpatient	36245 CPT	$4,953	$3,715	$64.39 – $4,458	—
Admin hepatitis b as second vaccine Inpatient	90472 CPT	$20.27	$15.20	$0.26 – $18.24	—
Admin influenza vaccine Inpatient	90471 CPT	$38.20	$28.65	$0.50 – $34.38	—
Aep threshold estimation mlt frequencies i&r Inpatient	92652 CPT	$1,416	$1,062	$18.41 – $1,274	—
Anesthesia per minute Inpatient	3701005597 CDM	$10.54	$7.90	$0.14 – $9.49	—
Bone marrow diagnostic; biopsy(ies) & aspiration(s) bilateral Inpatient	38222 CPT	$4,772	$3,579	$62.03 – $4,295	—
Bronch withendobronchial bx Inpatient	3611016197 CDM	$6,416	$4,812	$83.41 – $5,775	—
Bronch withtransbronch bx single lobe Inpatient	3611016597 CDM	$8,017	$6,013	$104 – $7,216	—
Bronchoscopy withtx asp init withfluoro Inpatient	3611019597 CDM	$6,416	$4,812	$83.41 – $5,775	—
Cath plcmnt main pul artery Inpatient	36013 CPT	$1,435	$1,076	$18.65 – $1,291	—
Chemo intra arterial push Inpatient	96420 CPT	$892	$669	$11.60 – $803	—
Chemo IV push each addl Inpatient	96411 CPT	$332	$249	$4.31 – $298	—
Chemo prolonged with pump Inpatient	96416 CPT	$866	$650	$11.26 – $780	—
Chemo sq or IM non-hormonal Inpatient	96401 CPT	$459	$345	$5.97 – $413	—
Closed tx talotarsal joint dislc without anes bilateral Inpatient	28570 CPT	$484	$363	$6.29 – $435	—
Cltx acromclav dislc withmnpj bilateral Inpatient	23545 CPT	$484	$363	$6.29 – $435	—
Cltx fem fx dstl end medial/lat condyle withmanj unilateral Inpatient	27510 CPT	$1,320	$990	$17.16 – $1,188	—
Cltx fem fx prox end nck without manj bilateral Inpatient	27230 CPT	$484	$363	$6.29 – $435	—
Cltx fx phlx/phlg oth/thn grt toe without manj Inpatient	28510 CPT	$484	$363	$6.29 – $435	—
Cltx metacarpal fx withmanipulation each bone Inpatient	26605 CPT	$484	$363	$6.29 – $435	—
Cltx phlngl fx prox/middle px/f/t without manj each Inpatient	26720 CPT	$484	$363	$6.29 – $435	—
Cltx prox tibfib jt dislc req anes unilateral Inpatient	27831 CPT	$1,320	$990	$17.16 – $1,188	—
Cltx thigh fx bilateral Inpatient	27267 CPT	$1,320	$990	$17.16 – $1,188	—
Cmplx rpr s/a/l 1.1-2.5 cm Inpatient	13120 CPT	$751	$563	$9.76 – $676	—
Continuous neb med each addl hr Inpatient	94645 CPT	$176	$132	$2.29 – $158	—
Doppler color flow Inpatient	93325 CPT	$489	$367	$6.36 – $441	—
Drainage of forearm lesion unilateral Inpatient	25028 CPT	$1,338	$1,003	$17.39 – $1,204	—
Duplex a,ivc, il/bpg; compl Inpatient	93978 CPT	$1,492	$1,119	$19.40 – $1,343	—
Echo 3d img&pst-pxessing tee/tte cgen car anomal Inpatient	93319 CPT	$1,320	$990	$17.15 – $1,188	—
Echo tee for intervention guidance Inpatient	93355 CPT	$5,756	$4,317	$74.82 – $5,180	—