Intermountain Health Lutheran Hospital — price list

← Hospital overviewVerified from Intermountain Health Lutheran Hospital’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)
Bct/vir respir dna/rna 22 trgt sarscov2 Inpatient	0202U CPT	$1,939	—	$572 – $1,939	—
17 ketosteroids, urine, total Inpatient	83586 CPT	$355	—	$105 – $355	—
Ab hemophilus influenza Inpatient	86684 CPT	$76.38	—	$22.53 – $76.38	—
Ab toxoplasma igg Inpatient	86777 CPT	$195	—	$57.53 – $195	—
Ab; candida Inpatient	86628 CPT	$34.07	—	$10.05 – $34.07	—
Ab; HIV-2 diagnostic Inpatient	86702 CPT	$193	—	$56.84 – $193	—
Acetylchol block ab Inpatient	83516 CPT	$130	—	$38.46 – $130	—
Acetylcholn rcptr bndng antb Inpatient	86041 CPT	$55.20	—	$16.28 – $55.20	—
Acth stim adrenal insuff Inpatient	80400 CPT	$606	—	$179 – $606	—
Adenovirus antibody Inpatient	86603 CPT	$249	—	$73.47 – $249	—
Aldolase Inpatient	82085 CPT	$192	—	$56.65 – $192	—
Alkaline phosphatase isoenzyme Inpatient	84080 CPT	$303	—	$89.40 – $303	—
Alkaline phosphatase serum Inpatient	84075 CPT	$55.85	—	$16.48 – $55.85	—
Allergen specific ige, each allergen Inpatientapprox. match	86003 CPT	$234	—	$68.97 – $234	—
Alpha-1-antitrypsin Inpatient	82103 CPT	$229	—	$67.49 – $229	—
Aluminum blood Inpatient	82108 CPT	$717	—	$212 – $717	—
Amphetamines; 5 or more Inpatient	80326 CPT	$400	—	$118 – $400	—
Androstenedione level-rl Inpatient	82157 CPT	$94.05	—	$27.74 – $94.05	—
Anna titer Inpatient	86256 CPT	$210	—	$61.97 – $210	—
Anti-nuclear antibodies Inpatient	86038 CPT	$317	—	$93.48 – $317	—
Anti-phospholipid antibodies Inpatient	86148 CPT	$205	—	$60.55 – $205	—
Anti-smooth muscle antibody Inpatient	86255 CPT	$211	—	$62.14 – $211	—
Antibody elution RBC each Inpatient	86860 CPT	$344	—	$101 – $344	—
Antibody treponema pallidum Inpatient	86780 CPT	$298	—	$87.88 – $298	—
Antibody; bartonella, each (a/g/m) Inpatient	86611 CPT	$158	—	$46.48 – $158	—
Antibody; campylobacter Inpatient	86625 CPT	$510	—	$150 – $510	—
Antibody; parvovirus, each (a/g/m) Inpatient	86747 CPT	$229	—	$67.45 – $229	—
Antibody; rickettsia ab, each (a/g/m) Inpatient	86757 CPT	$62.16	—	$18.34 – $62.16	—
Antidepressant not specified; non chromo Inpatient	80338 CPT	$135	—	$39.82 – $135	—
Antidepressant tricyclic and other cyclicals; 1 or 2 Inpatient	80335 CPT	$133	—	$39.18 – $133	—