Intermountain Health Spanish Fork Hospital — price list

← Hospital overviewVerified from Intermountain Health Spanish Fork 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)
3d mapping Inpatient	93613 CPT	$7,575	$5,681	$492 – $6,818	—
Ablate pulm tumor perq rf Inpatient	32998 CPT	$14,182	$10,636	$922 – $12,763	—
Admin hepatitis b as second vaccine Inpatient	90472 CPT	$20.27	$15.20	$1.32 – $18.24	—
Atrioventric noted ablation Inpatient	93650 CPT	$15,636	$11,727	$1,016 – $14,072	—
Balloon pump insert Inpatient	33967 CPT	$10,945	$8,209	$711 – $9,850	—
Cath placement seg pul art unilateral Inpatient	36015 CPT	$1,845	$1,384	$120 – $1,661	—
Cerebral vascular flow only Inpatient	78610 CPT	$2,310	$1,732	$150 – $2,079	—
Closed rx elbow dislocatn,anesthesia bilateral Inpatient	24605 CPT	$1,188	$891	$77.22 – $1,069	—
Closed rx mc-p disloc Inpatient	26700 CPT	$589	$442	$38.28 – $530	—
Closed rx shldr disloc,anesthesia bilateral Inpatient	23655 CPT	$1,188	$891	$77.22 – $1,069	—
Closed rx shldr dislocation unilateral Inpatient	23650 CPT	$589	$442	$38.28 – $530	—
Cltx carpo/metacarpal dislocation thumb withmanj Inpatient	26641 CPT	$589	$442	$38.28 – $530	—
Cltx fem fx prox end nck without manj unilateral Inpatient	27230 CPT	$589	$442	$38.28 – $530	—
Cltx prox tibfib jt dislc req anes unilateral Inpatient	27831 CPT	$1,188	$891	$77.22 – $1,069	—
Cltx rdcrpl/intercarpl dislc 1/> bones withmanj unilateral Inpatient	25660 CPT	$589	$442	$38.28 – $530	—
Cmplx rpr f/c/c/m/n/ax/g/h/f Inpatient	13133 CPT	$751	$563	$48.81 – $676	—
Com con nerve block injection Inpatient	3611179197 CDM	$1,166	$875	$75.81 – $1,050	—
Core needle bx lung/mediastinum perq withimg Inpatient	32408 CPT	$1,846	$1,384	$120 – $1,661	—
Drainage of eyelid abscess unilateral Inpatient	67700 CPT	$546	$410	$35.50 – $492	—
Drainage of forearm bursa bilateral Inpatient	25031 CPT	$546	$410	$35.50 – $492	—
Drainage scrotal wall abscess Inpatient	55100 CPT	$546	$410	$35.50 – $492	—
Drsg/debride partl thick burn-small Inpatient	16020 CPT	$484	$363	$31.47 – $436	—
Echo 3d img&pst-pxessing tee/tte cgen car anomal Inpatient	93319 CPT	$1,320	$990	$85.77 – $1,188	—
EGD addl intervention Inpatient	7501059297 CDM	$2,623	$1,967	$171 – $2,361	—
EGD withpeg placement Inpatient	43246 CPT	$2,995	$2,246	$195 – $2,695	—
Endoluminal bx biliary tree perc w img s&i singl/mult Inpatient	47543 CPT	$3,001	$2,251	$195 – $2,701	—
ER critical care-'addl 30 min Inpatient	99292 CPT	$2,862	$2,147	$186 – $2,576	—
Flex sig witheus fna Inpatient	7501063797 CDM	$3,891	$2,918	$253 – $3,502	—
Foley catheter insertion Inpatient	51702 CPT	$526	$395	$34.21 – $474	—
Full trauma activation Inpatient	G0390 CPT	$5,701	$4,275	$371 – $5,130	—