Intermountain Health Sanpete Valley Hospital — price list

← Hospital overviewVerified from Intermountain Health Sanpete Valley 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.

93 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
Ablate pulm tumor perq rf Inpatient	25675 CPT	$525	$394	$394 – $499	—
Adult group cdiop Inpatient	64491 CPT	$2,564	$1,923	$1,923 – $2,436	—
Angio intracranial withstent Inpatient	20610 CPT	$849	$637	$637 – $807	—
Bravo reflux w mucosal ph Inpatient	29581 CPT	$341	$256	$256 – $324	—
Bx breast add lesion stereo Inpatient	G0239 CPT	$146	$110	$110 – $139	—
Chemo infusion initial 1st hr Inpatient	23625 CPT	$1,188	$891	$891 – $1,129	—
Chemodenerv musc migraine Inpatient	G0121 CPT	$2,872	$2,154	$2,154 – $2,729	—
Closed rx shldr dislocation bilateral Inpatient	43761 CPT	$893	$670	$670 – $848	—
Closed tx distal radioulnar dislocation withmanj unilateral Inpatient	46083 CPT	$533	$400	$400 – $507	—
Closed tx metatarsal fracture without manipulation Inpatient	73220 CPT	$5,043	$3,782	$3,782 – $4,791	—
Closed tx monteggia fx dislocation elbow withmanj bilateral Inpatient	20552 CPT	$470	$353	$353 – $447	—
Closed tx radial head/neck fx without manipulation Inpatient	23665 CPT	$1,188	$891	$891 – $1,129	—
Closed tx talus fracture withmanipulation unilateral Inpatient	78195 CPT	$1,892	$1,419	$1,419 – $1,797	—
Clsd tx trochantric fx without man Inpatient	97116 CPT	$129	$96.86	$96.86 – $123	—
Cltx carpal bone fx withmanj each bone unilateral Inpatient	G0378 CPT	$139	$104	$104 – $132	—
Cltx fx grt toe phlx/phlg withmanj Inpatient	41009 CPT	$437	$328	$328 – $415	—
Cltx gr hmrl tbrs fx withmnpj bilateral Inpatient	69005 CPT	$437	$328	$328 – $415	—
Cltx gr hmrl tbrs fx withmnpj unilateral Inpatient	50390 CPT	$1,974	$1,480	$1,480 – $1,875	—
Cltx intr/peri/sbtrchntc femoral fx withmanj bilateral Inpatient	26418 CPT	$1,204	$903	$903 – $1,144	—
Cltx metatarsophlngl jt dislc without anes Inpatient	64615 CPT	$525	$394	$394 – $499	—
Cltx sho dslc fx gr hmrl tbr bilateral Inpatient	96413 CPT	$1,085	$814	$814 – $1,031	—
Colonic manometry Inpatient	10160 CPT	$978	$734	$734 – $929	—
Compression wrap lwr leg unilateral Inpatient	19082 CPT	$3,762	$2,821	$2,821 – $3,574	—
Conv perc neph cath to nephuretrl cath via exist neph tr bilateral Inpatient	50434 CPT	$12,766	$9,575	$9,575 – $12,128	—
CT subcutaneous tissue rf ablation Inpatient	29125 CPT	$392	$294	$294 – $372	—
Diagnostic colonoscopy Inpatient	36569 CPT	$3,804	$2,853	$2,853 – $3,614	—
Dialysis central vn stent Inpatient	27648 CPT	$781	$586	$586 – $742	—
Endoluminal bx of ureter and or renal pelvis Inpatient	93303 CPT	$1,949	$1,462	$1,462 – $1,852	—
Fetal contraction stress test Inpatient	32554 CPT	$2,705	$2,029	$2,029 – $2,570	—
First order cath w vertebral angio unilateral Inpatient	17107 CPT	$583	$437	$437 – $554	—