Does American Fork Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at American Fork Hospital. In a medical emergency, call 911.

Where is American Fork Hospital?

170 North 1100 East, American Fork, UT 84003, in Utah County, Utah.

What is the phone number of American Fork Hospital?

(801) 855-3305, as listed by Medicare (CMS).

What is the Medicare star rating of American Fork Hospital?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to American Fork Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for American Fork Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.6512; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

American Fork Hospital — Phone, Address & ER

Quick answers

Does American Fork Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at American Fork Hospital. In a medical emergency, call 911.
Where is American Fork Hospital?: 170 North 1100 East, American Fork, UT 84003, in Utah County, Utah.
What is the phone number of American Fork Hospital?: (801) 855-3305, as listed by Medicare (CMS).
What is the Medicare star rating of American Fork Hospital?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to American Fork Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for American Fork Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -0.6512; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^[5][6][7]

Emergency medicine
Trauma care
Cancer care
Women and newborn care
Neonatal intensive care (Level II NICU)
Surgical services
Gastroenterology
Heart care
Pulmonology
Kidney care
Infectious diseases
Pain medicine
Brain and spine
Wound care
Imaging
Intensive care (ICU)
Labor and delivery

Treatments^[5][7]

Endoscopy
Mammography
Lactation clinic
Nutrition services
Radiation oncology

Programs and centers^[4]

Hospital Level Care at Home

Emergency care (hospital website)^[4][6][7]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Hospital page lists visiting hours of 9 a.m. to 9 p.m^[4]

Recognition^[7]

ASTRO APEx accreditation (Intermountain Cancer Center – American Fork Hospital)

Doctors and clinicians (570)

570 doctors and other clinicians list American Fork Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 546 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Timpanogos Regional Hospital5.6 mi · Orem, UT · Acute Care Hospital
Orem Community Hospital6.3 mi · Orem, UT · Acute Care Hospital
Intermountain Health Utah Valley Hospital11 mi · Provo, UT · Acute Care Hospital
Utah State Hospital12 mi · Provo, UT · Psychiatric Hospital
Lone Peak Hospital12 mi · Draper, UT · Acute Care Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near American Fork

Aspen Grove Behavioral Hospital7.3 mi · Orem, UT · Psychiatric Hospital
Central Utah Rehabilitation Hospital7.7 mi · Provo, UT · Long-Term Acute Care Hospital

Hospitals in Utah County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Monument Healthcare American Fork1.1 mi · American Fork, UT · 3 of 5 stars
Stonehenge of American Fork1.5 mi · American Fork, UT · 4 of 5 stars
Mission at Alpine Rehabilitation Center2.3 mi · Pleasant Grove, UT · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Serenity Hospice of Utah LLC4.6 mi · Pleasant Grove, UT
Embrace Hospice5.6 mi · Orem, UT
First Choice Hospice5.6 mi · Orem, UT

All hospice providers in the state →

Home health agencies

Serenity Home Health of Utah LLC4.6 mi · Pleasant Grove, UT
First Choice Home Health5.6 mi · Orem, UT · 3 of 5 stars
Horizon Home Health (Horizon Pediatric Home Care)5.6 mi · Orem, UT

All home health agencies in the state →

Dialysis facilities

DaVita Traverse Point Dialysis5.9 mi · Lehi, UT · 5 of 5 stars
DaVita Lone Peak Dialysis7.8 mi · American Fork, UT · 5 of 5 stars
DaVita Orem Dialysis7.9 mi · Orem, UT · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Cataract and Lasik Center of Utah4.6 mi · Pleasant Grove, UT
Vineyard Surgery Center, LLC5.4 mi · Vineyard, UT
Central Utah Surgical Center5.6 mi · Orem, UT

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Mountainlands Family Health Center--Wasatch11 mi · Provo, UT · Community health center
East Bay Health Center12 mi · Provo, UT · Community health center
Mountainlands Community Health Center Main Site Clinic13 mi · Provo, UT · Community health center

Clinics and urgent care

Ihc Health Services Inc5.9 mi · Lehi, UT · Urgent care center
After Hours Medical LLC, dba Medallus Medical7.8 mi · American Fork, UT · Urgent care center
After Hours Medical LLC9.6 mi · Draper, UT · Urgent care center

Pharmacies

Taylor Drug of Lindon3.6 mi · Lindon, UT · Community/retail pharmacy
Walmart Inc.3.6 mi · Lindon, UT · Community/retail pharmacy
Maceys Inc4.6 mi · Pleasant Grove, UT · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state license list, by straight-line distance.

Rocky Mountain Care - Grove Creek Assisted Living3.6 mi · Lindon, UT
Spring Gardens of Lindon3.6 mi · Lindon, UT
The Charleston at Cedar Hills4.6 mi · Cedar Hills, UT
Welcome Home Assisted Living American Fork4.6 mi · Pleasant Grove, UT

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What American Fork Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Patients got help quickly from staff	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Restfulness of Environment	2 of 5 stars
Care Coordination	3 of 5 stars
Symptoms After Stay	3 of 5 stars
Rated the hospital 9 or 10 out of 10	73%National average: 72%
Would definitely recommend the hospital	74%National average: 71%
Nurses “always” communicated well	79%National average: 80%
Doctors “always” communicated well	80%National average: 80%
“Always” got help as soon as they wanted	63%National average: 64%
Staff “always” explained medicines before giving them	59%National average: 62%
Were given information about recovery at home	88%National average: 86%
Room and bathroom “always” clean	73%National average: 73%
Completed surveys	1,208Response rate: 25%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Surgical site infections after colon surgery	0.943No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.556No different from the national benchmark
Not reported to Medicare	Central line bloodstream infections (CLABSI); Catheter-associated urinary tract infections (CAUTI); Surgical site infections after abdominal hysterectomy; MRSA bloodstream infections

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart failure patients	12%
Deaths within 30 days: pneumonia patients	14.7%
Serious complications (patient safety indicator PSI-90)	0.9No different from the national rate
Not reported to Medicare	Deaths within 30 days: heart attack patients; Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Deaths within 30 days: COPD patients; Deaths within 30 days: stroke patients; Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	15.1%
Readmitted within 30 days: heart failure	21.6%
Readmitted within 30 days: pneumonia	16.5%
Not reported to Medicare	Readmitted within 30 days: coronary bypass surgery
Too few cases to report	Readmitted within 30 days: heart attack; Readmitted within 30 days: COPD; Readmitted within 30 days: hip or knee replacement

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	141 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	64%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for American Fork Hospital, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-0.6512Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart failure	0.9594Fewer readmissions than expected
Pneumonia	1.0082More readmissions than expected
No result published	Heart attack; COPD (chronic lung disease); Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	39.50 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	15.00 out of 100
Person and community engagement (patient survey)	53.00 out of 100
Safety (infections and sepsis care)	30.00 out of 100
Efficiency and cost reduction (Medicare spending)	60.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	0.88Below the national median hospital (1.00): Medicare spent less

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Utah Best hospitals in Utah

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as American Fork Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

$ 4 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Show the prices of 82 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$334.01	$250.51	$6.01 – $300.61
New patient office visit (about 30–44 minutes): 10 of 56 insurance plan rates Aetna — Connected: $267.21 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $212.10 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $233.81 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $233.81
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$334.01	$250.51	$80.83 – $300.61
New patient office visit (about 30–44 minutes): 10 of 55 insurance plan rates Aetna — Connected: $270.55 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $215.44 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $243.83 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $243.83
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new low 30 min	Not listed in the file	Not listed in the file	$80.54
New patient office visit (about 30–44 minutes): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $80.54 Aetna — Medicare Adv PPO: $80.54 American Health — Medicare Adv UT HMO I-SNP: $80.54 Health Partners of Nevada — Medicare Advantage: $80.54 Health Plan of Nevada — Medicaid: $80.54 Healthy U — Medicaid: $80.54 Humana — Medicare Choice PPO: $80.54 Molina — Medicare Advantage: $80.54 Molina — Medicare Choice Care HMO: $80.54 Molina — Medicare Complete Care HMO SNP: $80.54
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$334.01	$250.51	$6.01 – $300.61
New patient office visit (about 45–59 minutes): 10 of 56 insurance plan rates Aetna — Connected: $267.21 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $212.10 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $233.81 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $233.81
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$334.01	$250.51	$80.83 – $300.61
New patient office visit (about 45–59 minutes): 10 of 55 insurance plan rates Aetna — Connected: $270.55 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $215.44 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $243.83 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $243.83
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new mod 45 min	Not listed in the file	Not listed in the file	$129.68
New patient office visit (about 45–59 minutes): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $129.68 Aetna — Medicare Adv PPO: $129.68 American Health — Medicare Adv UT HMO I-SNP: $129.68 Health Partners of Nevada — Medicare Advantage: $129.68 Health Plan of Nevada — Medicaid: $129.68 Healthy U — Medicaid: $129.68 Humana — Medicare Choice PPO: $129.68 Molina — Medicare Advantage: $129.68 Molina — Medicare Choice Care HMO: $129.68 Molina — Medicare Complete Care HMO SNP: $129.68
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$334.01	$250.51	$6.01 – $300.61
New patient office visit (about 60–74 minutes): 10 of 56 insurance plan rates Aetna — Connected: $267.21 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $212.10 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $233.81 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $233.81
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$334.01	$250.51	$80.83 – $300.61
New patient office visit (about 60–74 minutes): 10 of 55 insurance plan rates Aetna — Connected: $270.55 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 AWH Connected — Connected Utah: $215.44 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $243.83 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91 Corporation of the President — Workers Comp: $243.83
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p new hi 60 min	Not listed in the file	Not listed in the file	$176.02
New patient office visit (about 60–74 minutes): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $176.02 Aetna — Medicare Adv PPO: $176.02 American Health — Medicare Adv UT HMO I-SNP: $176.02 Health Partners of Nevada — Medicare Advantage: $176.02 Health Plan of Nevada — Medicaid: $176.02 Healthy U — Medicaid: $176.02 Humana — Medicare Choice PPO: $176.02 Molina — Medicare Advantage: $176.02 Molina — Medicare Choice Care HMO: $176.02 Molina — Medicare Complete Care HMO SNP: $176.02
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$380.37	$285.28	$6.85 – $342.33
Established patient office visit (about 20–29 minutes): 10 of 56 insurance plan rates Aetna — Connected: $304.30 Aetna — Extended: $323.31 AG Administrators — USU Athletics: $273.87 AWH Connected — Connected Utah: $241.53 BYU Athletics — Commercial: $273.87 BYU Risk Management — Workers Comp: $266.26 Campbell Scientific — Commercial: $273.87 Cigna — Open Access Flex: $239.63 Cigna — PPO/EPO: $323.31 Corporation of the President — Workers Comp: $266.26
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$380.37	$285.28	$92.05 – $342.33
Established patient office visit (about 20–29 minutes): 10 of 55 insurance plan rates Aetna — Connected: $308.10 Aetna — Extended: $323.31 AG Administrators — USU Athletics: $273.87 AWH Connected — Connected Utah: $245.34 BYU Athletics — Commercial: $273.87 BYU Risk Management — Workers Comp: $277.67 Campbell Scientific — Commercial: $273.87 Cigna — Open Access Flex: $239.63 Cigna — PPO/EPO: $323.31 Corporation of the President — Workers Comp: $277.67
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p est low 20 min	Not listed in the file	Not listed in the file	$64.24
Established patient office visit (about 20–29 minutes): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $64.24 Aetna — Medicare Adv PPO: $64.24 American Health — Medicare Adv UT HMO I-SNP: $64.24 Health Partners of Nevada — Medicare Advantage: $64.24 Health Plan of Nevada — Medicaid: $64.24 Healthy U — Medicaid: $64.24 Humana — Medicare Choice PPO: $64.24 Molina — Medicare Advantage: $64.24 Molina — Medicare Choice Care HMO: $64.24 Molina — Medicare Complete Care HMO SNP: $64.24
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$449.60	$337.20	$8.09 – $404.64
Established patient office visit (about 30–39 minutes): 10 of 56 insurance plan rates Aetna — Connected: $359.68 Aetna — Extended: $382.16 AG Administrators — USU Athletics: $323.71 AWH Connected — Connected Utah: $285.50 BYU Athletics — Commercial: $323.71 BYU Risk Management — Workers Comp: $314.72 Campbell Scientific — Commercial: $323.71 Cigna — Open Access Flex: $283.25 Cigna — PPO/EPO: $382.16 Corporation of the President — Workers Comp: $314.72
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$449.60	$337.20	$108.80 – $404.64
Established patient office visit (about 30–39 minutes): 10 of 55 insurance plan rates Aetna — Connected: $364.18 Aetna — Extended: $382.16 AG Administrators — USU Athletics: $323.71 AWH Connected — Connected Utah: $289.99 BYU Athletics — Commercial: $323.71 BYU Risk Management — Workers Comp: $328.21 Campbell Scientific — Commercial: $323.71 Cigna — Open Access Flex: $283.25 Cigna — PPO/EPO: $382.16 Corporation of the President — Workers Comp: $328.21
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Office o/p est mod 30 min	Not listed in the file	Not listed in the file	$94.90
Established patient office visit (about 30–39 minutes): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $94.90 Aetna — Medicare Adv PPO: $94.90 American Health — Medicare Adv UT HMO I-SNP: $94.90 Health Partners of Nevada — Medicare Advantage: $94.90 Health Plan of Nevada — Medicaid: $94.90 Healthy U — Medicaid: $94.90 Humana — Medicare Choice PPO: $94.90 Molina — Medicare Advantage: $94.90 Molina — Medicare Choice Care HMO: $94.90 Molina — Medicare Complete Care HMO SNP: $94.90
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est low 30	Not listed in the file	Not listed in the file	$249.75 – $298
Office consultation with a specialist (moderate): rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $283.81 Intermountain Caregiver Plan — Share Network: $249.75 SelectHealth — CHP: $283.81 SelectHealth — CH{: $283.81 SelectHealth — Commercial: $283.81 SelectHealth — FEHBP: $298 SelectHealth — SelectCare: $298 SelectHealth — SelectShare: $249.75 SelectHealth — SelectValue: $249.75
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est mod 40	Not listed in the file	Not listed in the file	$356.07 – $424.86
Office consultation with a specialist (moderate to high): rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $404.63 Intermountain Caregiver Plan — Share Network: $356.07 SelectHealth — CHP: $404.63 SelectHealth — CH{: $404.63 SelectHealth — Commercial: $404.63 SelectHealth — FEHBP: $424.86 SelectHealth — SelectCare: $424.86 SelectHealth — SelectShare: $356.07 SelectHealth — SelectValue: $356.07
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$90.61 – $342.89
Preventive checkup, new patient, age 18–39: rates for 10 insurance plans Intermountain Caregiver Plan — Med Network: $326.56 Intermountain Caregiver Plan — Share Network: $287.37 SelectHealth — CHP: $326.56 SelectHealth — CH{: $326.56 SelectHealth — Commercial: $326.56 SelectHealth — FEHBP: $342.89 SelectHealth — SelectCare: $342.89 SelectHealth — SelectShare: $287.37 SelectHealth — SelectValue: $287.37 TriWest — Veterans Choice: $90.61
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$109.85 – $395.48
Preventive checkup, new patient, age 40–64: rates for 10 insurance plans Intermountain Caregiver Plan — Med Network: $376.65 Intermountain Caregiver Plan — Share Network: $331.45 SelectHealth — CHP: $376.65 SelectHealth — CH{: $376.65 SelectHealth — Commercial: $376.65 SelectHealth — FEHBP: $395.48 SelectHealth — SelectCare: $395.48 SelectHealth — SelectShare: $331.45 SelectHealth — SelectValue: $331.45 TriWest — Veterans Choice: $109.85
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 3 W/MOD	$1,843.94	$1,382.96	$33.19 – $1,659.55
Emergency room visit (moderate): 10 of 56 insurance plan rates Aetna — Connected: $1,475.15 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 AWH Connected — Connected Utah: $1,170.90 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,290.76 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35 Corporation of the President — Workers Comp: $1,290.76
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM-LEVEL 3	$1,843.94	$1,382.96	$33.19 – $1,659.55
Emergency room visit (moderate): 10 of 56 insurance plan rates Aetna — Connected: $1,475.15 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 AWH Connected — Connected Utah: $1,170.90 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,290.76 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35 Corporation of the President — Workers Comp: $1,290.76
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 3 W/MOD	$1,843.94	$1,382.96	$446.23 – $1,659.55
Emergency room visit (moderate): 10 of 55 insurance plan rates Aetna — Connected: $1,493.59 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 AWH Connected — Connected Utah: $1,189.34 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,346.08 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35 Corporation of the President — Workers Comp: $1,346.08
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,765.74	$2,074.30	$49.78 – $2,489.17
Emergency room visit (moderately high): 10 of 56 insurance plan rates Aetna — Connected: $2,212.59 Aetna — Extended: $2,350.88 AG Administrators — USU Athletics: $1,991.33 AWH Connected — Connected Utah: $1,756.24 BYU Athletics — Commercial: $1,991.33 BYU Risk Management — Workers Comp: $1,936.02 Campbell Scientific — Commercial: $1,991.33 Cigna — Open Access Flex: $1,742.42 Cigna — PPO/EPO: $2,350.88 Corporation of the President — Workers Comp: $1,936.02
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,765.74	$2,074.30	$669.31 – $2,489.17
Emergency room visit (moderately high): 10 of 55 insurance plan rates Aetna — Connected: $2,240.25 Aetna — Extended: $2,350.88 AG Administrators — USU Athletics: $1,991.33 AWH Connected — Connected Utah: $1,783.90 BYU Athletics — Commercial: $1,991.33 BYU Risk Management — Workers Comp: $2,018.99 Campbell Scientific — Commercial: $1,991.33 Cigna — Open Access Flex: $1,742.42 Cigna — PPO/EPO: $2,350.88 Corporation of the President — Workers Comp: $2,018.99
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$346.94 – $3,114
Emergency room visit (moderately high): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $422.19 Aetna — Medicare Adv PPO: $464.40 American Health — Medicare Adv UT HMO I-SNP: $439.07 Health Partners of Nevada — Medicare Advantage: $422.19 Health Plan of Nevada — Medicaid: $346.94 Healthy U — Medicaid: $346.94 Humana — Medicare Choice PPO: $443.29 Intermountain Caregiver Plan — Med Network: $2,966 Intermountain Caregiver Plan — Share Network: $2,462 Molina — Medicare Advantage: $464.40
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$4,148.55	$3,111.41	$74.67 – $3,733.70
Emergency room visit (high): 10 of 56 insurance plan rates Aetna — Connected: $3,318.84 Aetna — Extended: $3,526.27 AG Administrators — USU Athletics: $2,986.96 AWH Connected — Connected Utah: $2,634.33 BYU Athletics — Commercial: $2,986.96 BYU Risk Management — Workers Comp: $2,903.98 Campbell Scientific — Commercial: $2,986.96 Cigna — Open Access Flex: $2,613.59 Cigna — PPO/EPO: $3,526.27 Corporation of the President — Workers Comp: $2,903.98
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$4,148.55	$3,111.41	$1,003.95 – $3,733.70
Emergency room visit (high): 10 of 55 insurance plan rates Aetna — Connected: $3,360.33 Aetna — Extended: $3,526.27 AG Administrators — USU Athletics: $2,986.96 AWH Connected — Connected Utah: $2,675.81 BYU Athletics — Commercial: $2,986.96 BYU Risk Management — Workers Comp: $3,028.44 Campbell Scientific — Commercial: $2,986.96 Cigna — Open Access Flex: $2,613.59 Cigna — PPO/EPO: $3,526.27 Corporation of the President — Workers Comp: $3,028.44
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$499.53 – $5,483
Emergency room visit (high): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $602.48 Aetna — Medicare Adv PPO: $662.72 American Health — Medicare Adv UT HMO I-SNP: $626.57 Health Partners of Nevada — Medicare Advantage: $602.48 Health Plan of Nevada — Medicaid: $499.53 Healthy U — Medicaid: $499.53 Humana — Medicare Choice PPO: $632.60 Intermountain Caregiver Plan — Med Network: $4,453 Intermountain Caregiver Plan — Share Network: $3,697 Molina — Medicare Advantage: $662.72

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$64.73	$48.55	$1.17 – $58.26
Basic metabolic panel (blood test): 10 of 56 insurance plan rates Aetna — Connected: $51.78 Aetna — Extended: $55.02 AG Administrators — USU Athletics: $46.61 AWH Connected — Connected Utah: $41.10 BYU Athletics — Commercial: $46.61 BYU Risk Management — Workers Comp: $45.31 Campbell Scientific — Commercial: $46.61 Cigna — Open Access Flex: $40.78 Cigna — PPO/EPO: $55.02 Corporation of the President — Workers Comp: $45.31
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$64.73	$48.55	$15.66 – $58.26
Basic metabolic panel (blood test): 10 of 55 insurance plan rates Aetna — Connected: $52.43 Aetna — Extended: $55.02 AG Administrators — USU Athletics: $46.61 AWH Connected — Connected Utah: $41.75 BYU Athletics — Commercial: $46.61 BYU Risk Management — Workers Comp: $47.25 Campbell Scientific — Commercial: $46.61 Cigna — Open Access Flex: $40.78 Cigna — PPO/EPO: $55.02 Corporation of the President — Workers Comp: $47.25
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic metabolic pnl total ca	Not listed in the file	Not listed in the file	$7.19 – $67
Basic metabolic panel (blood test): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $8.46 Aetna — Medicare Adv PPO: $9.31 AG Administrators — USU Athletics: $67 American Health — Medicare Adv UT HMO I-SNP: $8.80 AWH Connected — Connected Utah: $67 BYU Athletics — Commercial: $67 Campbell Scientific — Commercial: $67 Deseret Mutual — All Other: $67 Deseret Mutual — Select: $67 EMI — Commercial: $67
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$95.82	$71.86	$1.72 – $86.24
Comprehensive metabolic panel (blood test): 10 of 56 insurance plan rates Aetna — Connected: $76.66 Aetna — Extended: $81.45 AG Administrators — USU Athletics: $68.99 AWH Connected — Connected Utah: $60.85 BYU Athletics — Commercial: $68.99 BYU Risk Management — Workers Comp: $67.07 Campbell Scientific — Commercial: $68.99 Cigna — Open Access Flex: $60.37 Cigna — PPO/EPO: $81.45 Corporation of the President — Workers Comp: $67.07
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$95.82	$71.86	$23.19 – $86.24
Comprehensive metabolic panel (blood test): 10 of 55 insurance plan rates Aetna — Connected: $77.61 Aetna — Extended: $81.45 AG Administrators — USU Athletics: $68.99 AWH Connected — Connected Utah: $61.80 BYU Athletics — Commercial: $68.99 BYU Risk Management — Workers Comp: $69.95 Campbell Scientific — Commercial: $68.99 Cigna — Open Access Flex: $60.37 Cigna — PPO/EPO: $81.45 Corporation of the President — Workers Comp: $69.95
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehen metabolic panel	Not listed in the file	Not listed in the file	$8.97 – $95
Comprehensive metabolic panel (blood test): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $10.56 Aetna — Medicare Adv PPO: $11.62 AG Administrators — USU Athletics: $95 American Health — Medicare Adv UT HMO I-SNP: $10.98 AWH Connected — Connected Utah: $95 BYU Athletics — Commercial: $95 Campbell Scientific — Commercial: $95 Deseret Mutual — All Other: $95 Deseret Mutual — Select: $95 EMI — Commercial: $95
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$322.40	$241.80	$5.80 – $290.16
Obstetric blood test panel: 10 of 56 insurance plan rates Aetna — Connected: $257.92 Aetna — Extended: $274.04 AG Administrators — USU Athletics: $232.13 AWH Connected — Connected Utah: $204.72 BYU Athletics — Commercial: $232.13 BYU Risk Management — Workers Comp: $225.68 Campbell Scientific — Commercial: $232.13 Cigna — Open Access Flex: $203.11 Cigna — PPO/EPO: $274.04 Corporation of the President — Workers Comp: $225.68
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$322.40	$241.80	$78.02 – $290.16
Obstetric blood test panel: 10 of 55 insurance plan rates Aetna — Connected: $261.14 Aetna — Extended: $274.04 AG Administrators — USU Athletics: $232.13 AWH Connected — Connected Utah: $207.95 BYU Athletics — Commercial: $232.13 BYU Risk Management — Workers Comp: $235.35 Campbell Scientific — Commercial: $232.13 Cigna — Open Access Flex: $203.11 Cigna — PPO/EPO: $274.04 Corporation of the President — Workers Comp: $235.35
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric panel	Not listed in the file	Not listed in the file	$40.63 – $129
Obstetric blood test panel: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $47.81 Aetna — Medicare Adv PPO: $52.59 AG Administrators — USU Athletics: $129 American Health — Medicare Adv UT HMO I-SNP: $49.72 AWH Connected — Connected Utah: $129 BYU Athletics — Commercial: $129 Campbell Scientific — Commercial: $129 Deseret Mutual — All Other: $129 Deseret Mutual — Select: $129 EMI — Commercial: $129
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$94.57	$70.93	$1.70 – $85.11
Cholesterol panel (lipid panel): 10 of 56 insurance plan rates Aetna — Connected: $75.66 Aetna — Extended: $80.38 AG Administrators — USU Athletics: $68.09 AWH Connected — Connected Utah: $60.05 BYU Athletics — Commercial: $68.09 BYU Risk Management — Workers Comp: $66.20 Campbell Scientific — Commercial: $68.09 Cigna — Open Access Flex: $59.58 Cigna — PPO/EPO: $80.38 Corporation of the President — Workers Comp: $66.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$94.57	$70.93	$22.89 – $85.11
Cholesterol panel (lipid panel): 10 of 55 insurance plan rates Aetna — Connected: $76.60 Aetna — Extended: $80.38 AG Administrators — USU Athletics: $68.09 AWH Connected — Connected Utah: $61 BYU Athletics — Commercial: $68.09 BYU Risk Management — Workers Comp: $69.04 Campbell Scientific — Commercial: $68.09 Cigna — Open Access Flex: $59.58 Cigna — PPO/EPO: $80.38 Corporation of the President — Workers Comp: $69.04
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$11.38 – $95
Cholesterol panel (lipid panel): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $13.39 Aetna — Medicare Adv PPO: $14.73 AG Administrators — USU Athletics: $95 American Health — Medicare Adv UT HMO I-SNP: $13.93 AWH Connected — Connected Utah: $95 BYU Athletics — Commercial: $95 Campbell Scientific — Commercial: $95 Deseret Mutual — All Other: $95 Deseret Mutual — Select: $95 EMI — Commercial: $95
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$67.55	$50.66	$1.22 – $60.80
Kidney function panel: 10 of 56 insurance plan rates Aetna — Connected: $54.04 Aetna — Extended: $57.42 AG Administrators — USU Athletics: $48.64 AWH Connected — Connected Utah: $42.89 BYU Athletics — Commercial: $48.64 BYU Risk Management — Workers Comp: $47.28 Campbell Scientific — Commercial: $48.64 Cigna — Open Access Flex: $42.56 Cigna — PPO/EPO: $57.42 Corporation of the President — Workers Comp: $47.28
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$67.55	$50.66	$16.35 – $60.80
Kidney function panel: 10 of 55 insurance plan rates Aetna — Connected: $54.72 Aetna — Extended: $57.42 AG Administrators — USU Athletics: $48.64 AWH Connected — Connected Utah: $43.57 BYU Athletics — Commercial: $48.64 BYU Risk Management — Workers Comp: $49.31 Campbell Scientific — Commercial: $48.64 Cigna — Open Access Flex: $42.56 Cigna — PPO/EPO: $57.42 Corporation of the President — Workers Comp: $49.31
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$7.38 – $53
Kidney function panel: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $8.68 Aetna — Medicare Adv PPO: $9.55 AG Administrators — USU Athletics: $53 American Health — Medicare Adv UT HMO I-SNP: $9.03 AWH Connected — Connected Utah: $53 BYU Athletics — Commercial: $53 Campbell Scientific — Commercial: $53 Deseret Mutual — All Other: $53 Deseret Mutual — Select: $53 EMI — Commercial: $53
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$62.89	$47.17	$1.13 – $56.60
Liver function panel: 10 of 56 insurance plan rates Aetna — Connected: $50.31 Aetna — Extended: $53.46 AG Administrators — USU Athletics: $45.28 AWH Connected — Connected Utah: $39.94 BYU Athletics — Commercial: $45.28 BYU Risk Management — Workers Comp: $44.02 Campbell Scientific — Commercial: $45.28 Cigna — Open Access Flex: $39.62 Cigna — PPO/EPO: $53.46 Corporation of the President — Workers Comp: $44.02
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$62.89	$47.17	$15.22 – $56.60
Liver function panel: 10 of 55 insurance plan rates Aetna — Connected: $50.94 Aetna — Extended: $53.46 AG Administrators — USU Athletics: $45.28 AWH Connected — Connected Utah: $40.56 BYU Athletics — Commercial: $45.28 BYU Risk Management — Workers Comp: $45.91 Campbell Scientific — Commercial: $45.28 Cigna — Open Access Flex: $39.62 Cigna — PPO/EPO: $53.46 Corporation of the President — Workers Comp: $45.91
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic function panel	Not listed in the file	Not listed in the file	$6.94 – $55
Liver function panel: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $8.17 Aetna — Medicare Adv PPO: $8.99 AG Administrators — USU Athletics: $55 American Health — Medicare Adv UT HMO I-SNP: $8.50 AWH Connected — Connected Utah: $55 BYU Athletics — Commercial: $55 Campbell Scientific — Commercial: $55 Deseret Mutual — All Other: $55 Deseret Mutual — Select: $55 EMI — Commercial: $55
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$43.67	$32.75	$0.79 – $39.30
Urine test (automated, with microscope): 10 of 56 insurance plan rates Aetna — Connected: $34.94 Aetna — Extended: $37.12 AG Administrators — USU Athletics: $31.44 AWH Connected — Connected Utah: $27.73 BYU Athletics — Commercial: $31.44 BYU Risk Management — Workers Comp: $30.57 Campbell Scientific — Commercial: $31.44 Cigna — Open Access Flex: $27.51 Cigna — PPO/EPO: $37.12 Corporation of the President — Workers Comp: $30.57
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$43.67	$32.75	$10.57 – $39.30
Urine test (automated, with microscope): 10 of 55 insurance plan rates Aetna — Connected: $35.37 Aetna — Extended: $37.12 AG Administrators — USU Athletics: $31.44 AWH Connected — Connected Utah: $28.17 BYU Athletics — Commercial: $31.44 BYU Risk Management — Workers Comp: $31.88 Campbell Scientific — Commercial: $31.44 Cigna — Open Access Flex: $27.51 Cigna — PPO/EPO: $37.12 Corporation of the President — Workers Comp: $31.88
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$2.69 – $52
Urine test (automated, with microscope): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $3.17 Aetna — Medicare Adv PPO: $3.49 AG Administrators — USU Athletics: $52 American Health — Medicare Adv UT HMO I-SNP: $3.30 AWH Connected — Connected Utah: $52 BYU Athletics — Commercial: $52 Campbell Scientific — Commercial: $52 Deseret Mutual — All Other: $52 Deseret Mutual — Select: $52 EMI — Commercial: $52
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$27.95	$20.96	$0.50 – $25.16
Urine test (manual, without microscope): 10 of 56 insurance plan rates Aetna — Connected: $22.36 Aetna — Extended: $23.76 AG Administrators — USU Athletics: $20.12 AWH Connected — Connected Utah: $17.75 BYU Athletics — Commercial: $20.12 BYU Risk Management — Workers Comp: $19.56 Campbell Scientific — Commercial: $20.12 Cigna — Open Access Flex: $17.61 Cigna — PPO/EPO: $23.76 Corporation of the President — Workers Comp: $19.56
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$27.95	$20.96	$6.76 – $25.16
Urine test (manual, without microscope): 10 of 55 insurance plan rates Aetna — Connected: $22.64 Aetna — Extended: $23.76 AG Administrators — USU Athletics: $20.12 AWH Connected — Connected Utah: $18.03 BYU Athletics — Commercial: $20.12 BYU Risk Management — Workers Comp: $20.40 Campbell Scientific — Commercial: $20.12 Cigna — Open Access Flex: $17.61 Cigna — PPO/EPO: $23.76 Corporation of the President — Workers Comp: $20.40
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis nonauto w/o scope	Not listed in the file	Not listed in the file	$2.96 – $52
Urine test (manual, without microscope): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $3.48 Aetna — Medicare Adv PPO: $3.83 AG Administrators — USU Athletics: $52 American Health — Medicare Adv UT HMO I-SNP: $3.62 AWH Connected — Connected Utah: $52 BYU Athletics — Commercial: $52 Campbell Scientific — Commercial: $52 Deseret Mutual — All Other: $52 Deseret Mutual — Select: $52 EMI — Commercial: $52
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED POCL/POCBS	$61.80	$46.35	$1.11 – $55.62
Urine test (automated, without microscope): 10 of 56 insurance plan rates Aetna — Connected: $49.44 Aetna — Extended: $52.53 AG Administrators — USU Athletics: $44.50 AWH Connected — Connected Utah: $39.24 BYU Athletics — Commercial: $44.50 BYU Risk Management — Workers Comp: $43.26 Campbell Scientific — Commercial: $44.50 Cigna — Open Access Flex: $38.93 Cigna — PPO/EPO: $52.53 Corporation of the President — Workers Comp: $43.26
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED	$19.68	$14.76	$0.35 – $17.71
Urine test (automated, without microscope): 10 of 56 insurance plan rates Aetna — Connected: $15.74 Aetna — Extended: $16.73 AG Administrators — USU Athletics: $14.17 AWH Connected — Connected Utah: $12.50 BYU Athletics — Commercial: $14.17 BYU Risk Management — Workers Comp: $13.78 Campbell Scientific — Commercial: $14.17 Cigna — Open Access Flex: $12.40 Cigna — PPO/EPO: $16.73 Corporation of the President — Workers Comp: $13.78
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED POCL/POCBS	$61.80	$46.35	$14.96 – $55.62
Urine test (automated, without microscope): 10 of 55 insurance plan rates Aetna — Connected: $50.06 Aetna — Extended: $52.53 AG Administrators — USU Athletics: $44.50 AWH Connected — Connected Utah: $39.86 BYU Athletics — Commercial: $44.50 BYU Risk Management — Workers Comp: $45.11 Campbell Scientific — Commercial: $44.50 Cigna — Open Access Flex: $38.93 Cigna — PPO/EPO: $52.53 Corporation of the President — Workers Comp: $45.11
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$128.14	$96.10	$2.31 – $115.33
PSA (prostate specific antigen) blood test: 10 of 56 insurance plan rates Aetna — Connected: $102.51 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 AWH Connected — Connected Utah: $81.37 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $89.70 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92 Corporation of the President — Workers Comp: $89.70
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN COMPLEX	$128.14	$96.10	$2.31 – $115.33
PSA (prostate specific antigen) blood test: 10 of 56 insurance plan rates Aetna — Connected: $102.51 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 AWH Connected — Connected Utah: $81.37 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $89.70 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92 Corporation of the President — Workers Comp: $89.70
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$128.14	$96.10	$31.01 – $115.33
PSA (prostate specific antigen) blood test: 10 of 55 insurance plan rates Aetna — Connected: $103.79 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 AWH Connected — Connected Utah: $82.65 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $93.54 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92 Corporation of the President — Workers Comp: $93.54
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$117.52	$88.14	$2.12 – $105.77
Thyroid stimulating hormone (TSH) test: 10 of 56 insurance plan rates Aetna — Connected: $94.02 Aetna — Extended: $99.89 AG Administrators — USU Athletics: $84.61 AWH Connected — Connected Utah: $74.63 BYU Athletics — Commercial: $84.61 BYU Risk Management — Workers Comp: $82.26 Campbell Scientific — Commercial: $84.61 Cigna — Open Access Flex: $74.04 Cigna — PPO/EPO: $99.89 Corporation of the President — Workers Comp: $82.26
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$117.52	$88.14	$28.44 – $105.77
Thyroid stimulating hormone (TSH) test: 10 of 55 insurance plan rates Aetna — Connected: $95.19 Aetna — Extended: $99.89 AG Administrators — USU Athletics: $84.61 AWH Connected — Connected Utah: $75.80 BYU Athletics — Commercial: $84.61 BYU Risk Management — Workers Comp: $85.79 Campbell Scientific — Commercial: $84.61 Cigna — Open Access Flex: $74.04 Cigna — PPO/EPO: $99.89 Corporation of the President — Workers Comp: $85.79
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$14.28 – $78
Thyroid stimulating hormone (TSH) test: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $16.80 Aetna — Medicare Adv PPO: $18.48 AG Administrators — USU Athletics: $78 American Health — Medicare Adv UT HMO I-SNP: $17.47 AWH Connected — Connected Utah: $78 BYU Athletics — Commercial: $78 Campbell Scientific — Commercial: $78 Deseret Mutual — All Other: $78 Deseret Mutual — Select: $78 EMI — Commercial: $78
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$91.45	$68.59	$1.65 – $82.30
Complete blood count (CBC) with differential: 10 of 56 insurance plan rates Aetna — Connected: $73.16 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 AWH Connected — Connected Utah: $58.07 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $64.02 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73 Corporation of the President — Workers Comp: $64.02
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL	$91.45	$68.59	$1.65 – $82.30
Complete blood count (CBC) with differential: 10 of 56 insurance plan rates Aetna — Connected: $73.16 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 AWH Connected — Connected Utah: $58.07 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $64.02 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73 Corporation of the President — Workers Comp: $64.02
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$91.45	$68.59	$22.13 – $82.30
Complete blood count (CBC) with differential: 10 of 55 insurance plan rates Aetna — Connected: $74.07 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 AWH Connected — Connected Utah: $58.99 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $66.76 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73 Corporation of the President — Workers Comp: $66.76
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$68.67	$51.50	$1.24 – $61.80
Complete blood count (CBC), automated: 10 of 56 insurance plan rates Aetna — Connected: $54.94 Aetna — Extended: $58.37 AG Administrators — USU Athletics: $49.44 AWH Connected — Connected Utah: $43.61 BYU Athletics — Commercial: $49.44 BYU Risk Management — Workers Comp: $48.07 Campbell Scientific — Commercial: $49.44 Cigna — Open Access Flex: $43.26 Cigna — PPO/EPO: $58.37 Corporation of the President — Workers Comp: $48.07
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$68.67	$51.50	$16.62 – $61.80
Complete blood count (CBC), automated: 10 of 55 insurance plan rates Aetna — Connected: $55.62 Aetna — Extended: $58.37 AG Administrators — USU Athletics: $49.44 AWH Connected — Connected Utah: $44.29 BYU Athletics — Commercial: $49.44 BYU Risk Management — Workers Comp: $50.13 Campbell Scientific — Commercial: $49.44 Cigna — Open Access Flex: $43.26 Cigna — PPO/EPO: $58.37 Corporation of the President — Workers Comp: $50.13
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$5.50 – $55
Complete blood count (CBC), automated: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $6.47 Aetna — Medicare Adv PPO: $7.12 AG Administrators — USU Athletics: $55 American Health — Medicare Adv UT HMO I-SNP: $6.73 AWH Connected — Connected Utah: $55 BYU Athletics — Commercial: $55 Campbell Scientific — Commercial: $55 Deseret Mutual — All Other: $55 Deseret Mutual — Select: $55 EMI — Commercial: $55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$117.71	$88.28	$2.12 – $105.94
Blood clotting time test (prothrombin time, PT): 10 of 56 insurance plan rates Aetna — Connected: $94.17 Aetna — Extended: $100.05 AG Administrators — USU Athletics: $84.75 AWH Connected — Connected Utah: $74.75 BYU Athletics — Commercial: $84.75 BYU Risk Management — Workers Comp: $82.40 Campbell Scientific — Commercial: $84.75 Cigna — Open Access Flex: $74.16 Cigna — PPO/EPO: $100.05 Corporation of the President — Workers Comp: $82.40
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$30.66	$23	$0.55 – $27.59
Blood clotting time test (prothrombin time, PT): 10 of 56 insurance plan rates Aetna — Connected: $24.53 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 AWH Connected — Connected Utah: $19.47 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $21.46 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06 Corporation of the President — Workers Comp: $21.46
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$117.71	$88.28	$28.49 – $105.94
Blood clotting time test (prothrombin time, PT): 10 of 55 insurance plan rates Aetna — Connected: $95.35 Aetna — Extended: $100.05 AG Administrators — USU Athletics: $84.75 AWH Connected — Connected Utah: $75.92 BYU Athletics — Commercial: $84.75 BYU Risk Management — Workers Comp: $85.93 Campbell Scientific — Commercial: $84.75 Cigna — Open Access Flex: $74.16 Cigna — PPO/EPO: $100.05 Corporation of the President — Workers Comp: $85.93
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$30.66	$23	$0.55 – $27.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 56 insurance plan rates Aetna — Connected: $24.53 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 AWH Connected — Connected Utah: $19.47 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $21.46 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06 Corporation of the President — Workers Comp: $21.46
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$30.66	$23	$7.42 – $27.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 55 insurance plan rates Aetna — Connected: $24.83 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 AWH Connected — Connected Utah: $19.78 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $22.38 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06 Corporation of the President — Workers Comp: $22.38
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$5.11 – $37
Blood clotting test (partial thromboplastin time, PTT): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $6.01 Aetna — Medicare Adv PPO: $6.61 AG Administrators — USU Athletics: $37 American Health — Medicare Adv UT HMO I-SNP: $6.25 AWH Connected — Connected Utah: $37 BYU Athletics — Commercial: $37 Campbell Scientific — Commercial: $37 Deseret Mutual — All Other: $37 Deseret Mutual — Select: $37 EMI — Commercial: $37

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,806.74	$1,355.06	$32.52 – $1,626.07
CT scan of the head or brain, without contrast: 10 of 56 insurance plan rates Aetna — Connected: $1,445.39 Aetna — Extended: $1,535.73 AG Administrators — USU Athletics: $1,300.85 AWH Connected — Connected Utah: $1,147.28 BYU Athletics — Commercial: $1,300.85 BYU Risk Management — Workers Comp: $1,264.72 Campbell Scientific — Commercial: $1,300.85 Cigna — Open Access Flex: $1,138.25 Cigna — PPO/EPO: $1,535.73 Corporation of the President — Workers Comp: $1,264.72
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,806.74	$1,355.06	$437.23 – $1,626.07
CT scan of the head or brain, without contrast: 10 of 55 insurance plan rates Aetna — Connected: $1,463.46 Aetna — Extended: $1,535.73 AG Administrators — USU Athletics: $1,300.85 AWH Connected — Connected Utah: $1,165.35 BYU Athletics — Commercial: $1,300.85 BYU Risk Management — Workers Comp: $1,318.92 Campbell Scientific — Commercial: $1,300.85 Cigna — Open Access Flex: $1,138.25 Cigna — PPO/EPO: $1,535.73 Corporation of the President — Workers Comp: $1,318.92
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct head/brain w/o dye	Not listed in the file	Not listed in the file	$86.64 – $533
CT scan of the head or brain, without contrast: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $533 American Health — Medicare Adv UT HMO I-SNP: $109.30 AWH Connected — Connected Utah: $533 BYU Athletics — Commercial: $533 Campbell Scientific — Commercial: $533 Deseret Mutual — All Other: $533 Deseret Mutual — Select: $533 EMI — Commercial: $533
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI BRAIN W/WO CONTRAST	$5,833.02	$4,374.77	$104.99 – $5,249.72
MRI of the brain, before and after contrast: 10 of 56 insurance plan rates Aetna — Connected: $4,666.42 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 AWH Connected — Connected Utah: $3,703.97 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,083.11 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07 Corporation of the President — Workers Comp: $4,083.11
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI IAC'S W AND W/O CONTRAST LIMITED	$5,833.02	$4,374.77	$104.99 – $5,249.72
MRI of the brain, before and after contrast: 10 of 56 insurance plan rates Aetna — Connected: $4,666.42 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 AWH Connected — Connected Utah: $3,703.97 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,083.11 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07 Corporation of the President — Workers Comp: $4,083.11
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI BRAIN W/WO CONTRAST	$5,833.02	$4,374.77	$1,411.59 – $5,249.72
MRI of the brain, before and after contrast: 10 of 55 insurance plan rates Aetna — Connected: $4,724.75 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 AWH Connected — Connected Utah: $3,762.30 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,258.10 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07 Corporation of the President — Workers Comp: $4,258.10
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$477.12	$357.84	$8.59 – $429.41
Chest X-ray, 2 views: 10 of 56 insurance plan rates Aetna — Connected: $381.70 Aetna — Extended: $405.55 AG Administrators — USU Athletics: $343.53 AWH Connected — Connected Utah: $302.97 BYU Athletics — Commercial: $343.53 BYU Risk Management — Workers Comp: $333.98 Campbell Scientific — Commercial: $343.53 Cigna — Open Access Flex: $300.59 Cigna — PPO/EPO: $405.55 Corporation of the President — Workers Comp: $333.98
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$477.12	$357.84	$115.46 – $429.41
Chest X-ray, 2 views: 10 of 55 insurance plan rates Aetna — Connected: $386.47 Aetna — Extended: $405.55 AG Administrators — USU Athletics: $343.53 AWH Connected — Connected Utah: $307.74 BYU Athletics — Commercial: $343.53 BYU Risk Management — Workers Comp: $348.30 Campbell Scientific — Commercial: $343.53 Cigna — Open Access Flex: $300.59 Cigna — PPO/EPO: $405.55 Corporation of the President — Workers Comp: $348.30
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam chest 2 views	Not listed in the file	Not listed in the file	$71.74 – $220
Chest X-ray, 2 views: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $87.88 Aetna — Medicare Adv PPO: $96.67 AG Administrators — USU Athletics: $197 American Health — Medicare Adv UT HMO I-SNP: $91.39 AWH Connected — Connected Utah: $197 BYU Athletics — Commercial: $197 Campbell Scientific — Commercial: $197 Deseret Mutual — All Other: $197 Deseret Mutual — Select: $197 EMI — Commercial: $197
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DI L SPINE AP/LAT/OBL/OR FLEX/EXT	$617.99	$463.49	$11.12 – $556.19
X-ray of the lower spine, at least 4 views: 10 of 56 insurance plan rates Aetna — Connected: $494.39 Aetna — Extended: $525.29 AG Administrators — USU Athletics: $444.95 AWH Connected — Connected Utah: $392.42 BYU Athletics — Commercial: $444.95 BYU Risk Management — Workers Comp: $432.59 Campbell Scientific — Commercial: $444.95 Cigna — Open Access Flex: $389.33 Cigna — PPO/EPO: $525.29 Corporation of the President — Workers Comp: $432.59
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DI L SPINE AP/LAT/OBL/OR FLEX/EXT	$617.99	$463.49	$149.55 – $556.19
X-ray of the lower spine, at least 4 views: 10 of 55 insurance plan rates Aetna — Connected: $500.57 Aetna — Extended: $525.29 AG Administrators — USU Athletics: $444.95 AWH Connected — Connected Utah: $398.60 BYU Athletics — Commercial: $444.95 BYU Risk Management — Workers Comp: $451.13 Campbell Scientific — Commercial: $444.95 Cigna — Open Access Flex: $389.33 Cigna — PPO/EPO: $525.29 Corporation of the President — Workers Comp: $451.13
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: X-ray exam l-2 spine 4/>vws	Not listed in the file	Not listed in the file	$86.64 – $836.41
X-ray of the lower spine, at least 4 views: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $328 American Health — Medicare Adv UT HMO I-SNP: $109.30 AWH Connected — Connected Utah: $328 BYU Athletics — Commercial: $328 Campbell Scientific — Commercial: $328 Deseret Mutual — All Other: $328 Deseret Mutual — Select: $328 EMI — Commercial: $328
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LUMBAR SPINE W/O CONTRAST	$4,126.60	$3,094.95	$74.28 – $3,713.94
MRI of the lower back (lumbar spine), without contrast: 10 of 56 insurance plan rates Aetna — Connected: $3,301.28 Aetna — Extended: $3,507.61 AG Administrators — USU Athletics: $2,971.15 AWH Connected — Connected Utah: $2,620.39 BYU Athletics — Commercial: $2,971.15 BYU Risk Management — Workers Comp: $2,888.62 Campbell Scientific — Commercial: $2,971.15 Cigna — Open Access Flex: $2,599.76 Cigna — PPO/EPO: $3,507.61 Corporation of the President — Workers Comp: $2,888.62
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LUMBAR SPINE W/O CONTRAST	$4,126.60	$3,094.95	$998.64 – $3,713.94
MRI of the lower back (lumbar spine), without contrast: 10 of 55 insurance plan rates Aetna — Connected: $3,342.55 Aetna — Extended: $3,507.61 AG Administrators — USU Athletics: $2,971.15 AWH Connected — Connected Utah: $2,661.66 BYU Athletics — Commercial: $2,971.15 BYU Risk Management — Workers Comp: $3,012.42 Campbell Scientific — Commercial: $2,971.15 Cigna — Open Access Flex: $2,599.76 Cigna — PPO/EPO: $3,507.61 Corporation of the President — Workers Comp: $3,012.42
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri lumbar spine w/o dye	Not listed in the file	Not listed in the file	$196.94 – $1,269
MRI of the lower back (lumbar spine), without contrast: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $240.99 Aetna — Medicare Adv PPO: $265.09 AG Administrators — USU Athletics: $1,064 American Health — Medicare Adv UT HMO I-SNP: $250.63 AWH Connected — Connected Utah: $1,064 BYU Athletics — Commercial: $1,064 Campbell Scientific — Commercial: $1,064 Deseret Mutual — All Other: $1,064 Deseret Mutual — Select: $1,064 EMI — Commercial: $1,064
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$3,141.76	$2,356.32	$56.55 – $2,827.58
CT scan of the pelvis, with contrast: 10 of 56 insurance plan rates Aetna — Connected: $2,513.41 Aetna — Extended: $2,670.50 AG Administrators — USU Athletics: $2,262.07 AWH Connected — Connected Utah: $1,995.02 BYU Athletics — Commercial: $2,262.07 BYU Risk Management — Workers Comp: $2,199.23 Campbell Scientific — Commercial: $2,262.07 Cigna — Open Access Flex: $1,979.31 Cigna — PPO/EPO: $2,670.50 Corporation of the President — Workers Comp: $2,199.23
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$3,141.76	$2,356.32	$760.31 – $2,827.58
CT scan of the pelvis, with contrast: 10 of 55 insurance plan rates Aetna — Connected: $2,544.83 Aetna — Extended: $2,670.50 AG Administrators — USU Athletics: $2,262.07 AWH Connected — Connected Utah: $2,026.44 BYU Athletics — Commercial: $2,262.07 BYU Risk Management — Workers Comp: $2,293.48 Campbell Scientific — Commercial: $2,262.07 Cigna — Open Access Flex: $1,979.31 Cigna — PPO/EPO: $2,670.50 Corporation of the President — Workers Comp: $2,293.48
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct pelvis w/dye	Not listed in the file	Not listed in the file	$145.04 – $917
CT scan of the pelvis, with contrast: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $177.57 Aetna — Medicare Adv PPO: $195.33 AG Administrators — USU Athletics: $805 American Health — Medicare Adv UT HMO I-SNP: $184.67 AWH Connected — Connected Utah: $805 BYU Athletics — Commercial: $805 Campbell Scientific — Commercial: $805 Deseret Mutual — All Other: $805 Deseret Mutual — Select: $805 EMI — Commercial: $805
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$3,464.36	$2,598.27	$62.36 – $3,117.92
MRI of a leg joint (such as the knee), without contrast: 10 of 56 insurance plan rates Aetna — Connected: $2,771.49 Aetna — Extended: $2,944.71 AG Administrators — USU Athletics: $2,494.34 AWH Connected — Connected Utah: $2,199.87 BYU Athletics — Commercial: $2,494.34 BYU Risk Management — Workers Comp: $2,425.05 Campbell Scientific — Commercial: $2,494.34 Cigna — Open Access Flex: $2,182.55 Cigna — PPO/EPO: $2,944.71 Corporation of the President — Workers Comp: $2,425.05
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$3,464.36	$2,598.27	$838.38 – $3,117.92
MRI of a leg joint (such as the knee), without contrast: 10 of 55 insurance plan rates Aetna — Connected: $2,806.13 Aetna — Extended: $2,944.71 AG Administrators — USU Athletics: $2,494.34 AWH Connected — Connected Utah: $2,234.51 BYU Athletics — Commercial: $2,494.34 BYU Risk Management — Workers Comp: $2,528.98 Campbell Scientific — Commercial: $2,494.34 Cigna — Open Access Flex: $2,182.55 Cigna — PPO/EPO: $2,944.71 Corporation of the President — Workers Comp: $2,528.98
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mri jnt of lwr extre w/o dye	Not listed in the file	Not listed in the file	$196.94 – $1,268
MRI of a leg joint (such as the knee), without contrast: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $240.99 Aetna — Medicare Adv PPO: $265.09 AG Administrators — USU Athletics: $1,064 American Health — Medicare Adv UT HMO I-SNP: $250.63 AWH Connected — Connected Utah: $1,064 BYU Athletics — Commercial: $1,064 Campbell Scientific — Commercial: $1,064 Deseret Mutual — All Other: $1,064 Deseret Mutual — Select: $1,064 EMI — Commercial: $1,064
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABDOMEN & PELVIS W/CONTRAST	$4,761.83	$3,571.37	$85.71 – $4,285.65
CT scan of the abdomen and pelvis, with contrast: 10 of 56 insurance plan rates Aetna — Connected: $3,809.46 Aetna — Extended: $4,047.56 AG Administrators — USU Athletics: $3,428.52 AWH Connected — Connected Utah: $3,023.76 BYU Athletics — Commercial: $3,428.52 BYU Risk Management — Workers Comp: $3,333.28 Campbell Scientific — Commercial: $3,428.52 Cigna — Open Access Flex: $2,999.95 Cigna — PPO/EPO: $4,047.56 Corporation of the President — Workers Comp: $3,333.28
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN & PELVIS W/CONTRAST	$4,761.83	$3,571.37	$1,152.36 – $4,285.65
CT scan of the abdomen and pelvis, with contrast: 10 of 55 insurance plan rates Aetna — Connected: $3,857.08 Aetna — Extended: $4,047.56 AG Administrators — USU Athletics: $3,428.52 AWH Connected — Connected Utah: $3,071.38 BYU Athletics — Commercial: $3,428.52 BYU Risk Management — Workers Comp: $3,476.14 Campbell Scientific — Commercial: $3,428.52 Cigna — Open Access Flex: $2,999.95 Cigna — PPO/EPO: $4,047.56 Corporation of the President — Workers Comp: $3,476.14
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ct abd & pelvis w/contrast	Not listed in the file	Not listed in the file	$290.98 – $1,325
CT scan of the abdomen and pelvis, with contrast: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $352.43 Aetna — Medicare Adv PPO: $387.67 AG Administrators — USU Athletics: $1,206 American Health — Medicare Adv UT HMO I-SNP: $366.52 AWH Connected — Connected Utah: $1,206 BYU Athletics — Commercial: $1,206 Campbell Scientific — Commercial: $1,206 Deseret Mutual — All Other: $1,206 Deseret Mutual — Select: $1,206 EMI — Commercial: $1,206
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$1,093.33	$820	$19.68 – $984
Ultrasound of the abdomen, complete: 10 of 56 insurance plan rates Aetna — Connected: $874.66 Aetna — Extended: $929.33 AG Administrators — USU Athletics: $787.20 AWH Connected — Connected Utah: $694.26 BYU Athletics — Commercial: $787.20 BYU Risk Management — Workers Comp: $765.33 Campbell Scientific — Commercial: $787.20 Cigna — Open Access Flex: $688.80 Cigna — PPO/EPO: $929.33 Corporation of the President — Workers Comp: $765.33
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$1,093.33	$820	$264.59 – $984
Ultrasound of the abdomen, complete: 10 of 55 insurance plan rates Aetna — Connected: $885.60 Aetna — Extended: $929.33 AG Administrators — USU Athletics: $787.20 AWH Connected — Connected Utah: $705.20 BYU Athletics — Commercial: $787.20 BYU Risk Management — Workers Comp: $798.13 Campbell Scientific — Commercial: $787.20 Cigna — Open Access Flex: $688.80 Cigna — PPO/EPO: $929.33 Corporation of the President — Workers Comp: $798.13
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Us exam abdom complete	Not listed in the file	Not listed in the file	$86.64 – $339
Ultrasound of the abdomen, complete: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $109.30 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$1,005.63	$754.22	$18.10 – $905.07
Pregnancy ultrasound (after the first trimester): 10 of 56 insurance plan rates Aetna — Connected: $804.50 Aetna — Extended: $854.79 AG Administrators — USU Athletics: $724.05 AWH Connected — Connected Utah: $638.58 BYU Athletics — Commercial: $724.05 BYU Risk Management — Workers Comp: $703.94 Campbell Scientific — Commercial: $724.05 Cigna — Open Access Flex: $633.55 Cigna — PPO/EPO: $854.79 Corporation of the President — Workers Comp: $703.94
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$1,005.63	$754.22	$243.36 – $905.07
Pregnancy ultrasound (after the first trimester): 10 of 55 insurance plan rates Aetna — Connected: $814.56 Aetna — Extended: $854.79 AG Administrators — USU Athletics: $724.05 AWH Connected — Connected Utah: $648.63 BYU Athletics — Commercial: $724.05 BYU Risk Management — Workers Comp: $734.11 Campbell Scientific — Commercial: $724.05 Cigna — Open Access Flex: $633.55 Cigna — PPO/EPO: $854.79 Corporation of the President — Workers Comp: $734.11
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/ 14 wks sngl fetus	Not listed in the file	Not listed in the file	$63.73 – $356
Pregnancy ultrasound (after the first trimester): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $356 American Health — Medicare Adv UT HMO I-SNP: $109.30 AWH Connected — Connected Utah: $356 BYU Athletics — Commercial: $356 Campbell Scientific — Commercial: $356 Deseret Mutual — All Other: $356 Deseret Mutual — Select: $356 EMI — Commercial: $356
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$902.71	$677.03	$16.25 – $812.44
Transvaginal ultrasound: 10 of 56 insurance plan rates Aetna — Connected: $722.17 Aetna — Extended: $767.30 AG Administrators — USU Athletics: $649.95 AWH Connected — Connected Utah: $573.22 BYU Athletics — Commercial: $649.95 BYU Risk Management — Workers Comp: $631.90 Campbell Scientific — Commercial: $649.95 Cigna — Open Access Flex: $568.71 Cigna — PPO/EPO: $767.30 Corporation of the President — Workers Comp: $631.90
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$902.71	$677.03	$218.46 – $812.44
Transvaginal ultrasound: 10 of 55 insurance plan rates Aetna — Connected: $731.20 Aetna — Extended: $767.30 AG Administrators — USU Athletics: $649.95 AWH Connected — Connected Utah: $582.25 BYU Athletics — Commercial: $649.95 BYU Risk Management — Workers Comp: $658.98 Campbell Scientific — Commercial: $649.95 Cigna — Open Access Flex: $568.71 Cigna — PPO/EPO: $767.30 Corporation of the President — Workers Comp: $658.98
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Transvaginal us non-ob	Not listed in the file	Not listed in the file	$86.64 – $339
Transvaginal ultrasound: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $109.30 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$763.67	$572.75	$13.75 – $687.30
Diagnostic mammogram, one breast: 10 of 56 insurance plan rates Aetna — Connected: $610.94 Aetna — Extended: $649.12 AG Administrators — USU Athletics: $549.84 AWH Connected — Connected Utah: $484.93 BYU Athletics — Commercial: $549.84 BYU Risk Management — Workers Comp: $534.57 Campbell Scientific — Commercial: $549.84 Cigna — Open Access Flex: $481.11 Cigna — PPO/EPO: $649.12 Corporation of the President — Workers Comp: $534.57
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$763.67	$572.75	$184.81 – $687.30
Diagnostic mammogram, one breast: 10 of 55 insurance plan rates Aetna — Connected: $618.57 Aetna — Extended: $649.12 AG Administrators — USU Athletics: $549.84 AWH Connected — Connected Utah: $492.57 BYU Athletics — Commercial: $549.84 BYU Risk Management — Workers Comp: $557.48 Campbell Scientific — Commercial: $549.84 Cigna — Open Access Flex: $481.11 Cigna — PPO/EPO: $649.12 Corporation of the President — Workers Comp: $557.48
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad uni	Not listed in the file	Not listed in the file	$80.99 – $339
Diagnostic mammogram, one breast: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $80.99 Aetna — Medicare Adv PPO: $89.09 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $84.23 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$919.39	$689.54	$16.55 – $827.45
Diagnostic mammogram, both breasts: 10 of 56 insurance plan rates Aetna — Connected: $735.51 Aetna — Extended: $781.48 AG Administrators — USU Athletics: $661.96 AWH Connected — Connected Utah: $583.81 BYU Athletics — Commercial: $661.96 BYU Risk Management — Workers Comp: $643.57 Campbell Scientific — Commercial: $661.96 Cigna — Open Access Flex: $579.22 Cigna — PPO/EPO: $781.48 Corporation of the President — Workers Comp: $643.57
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$919.39	$689.54	$222.49 – $827.45
Diagnostic mammogram, both breasts: 10 of 55 insurance plan rates Aetna — Connected: $744.71 Aetna — Extended: $781.48 AG Administrators — USU Athletics: $661.96 AWH Connected — Connected Utah: $593.01 BYU Athletics — Commercial: $661.96 BYU Risk Management — Workers Comp: $671.15 Campbell Scientific — Commercial: $661.96 Cigna — Open Access Flex: $579.22 Cigna — PPO/EPO: $781.48 Corporation of the President — Workers Comp: $671.15
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Dx mammo incl cad bi	Not listed in the file	Not listed in the file	$103.90 – $339
Diagnostic mammogram, both breasts: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $103.90 Aetna — Medicare Adv PPO: $114.29 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $108.06 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$723.47	$542.60	$13.02 – $651.12
Screening mammogram, both breasts: 10 of 56 insurance plan rates Aetna — Connected: $578.78 Aetna — Extended: $614.95 AG Administrators — USU Athletics: $520.90 AWH Connected — Connected Utah: $459.40 BYU Athletics — Commercial: $520.90 BYU Risk Management — Workers Comp: $506.43 Campbell Scientific — Commercial: $520.90 Cigna — Open Access Flex: $455.79 Cigna — PPO/EPO: $614.95 Corporation of the President — Workers Comp: $506.43
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$1,336.04	$1,002.03	$24.05 – $1,202.44
Screening mammogram, both breasts: 10 of 56 insurance plan rates Aetna — Connected: $1,068.83 Aetna — Extended: $1,135.63 AG Administrators — USU Athletics: $961.95 AWH Connected — Connected Utah: $848.39 BYU Athletics — Commercial: $961.95 BYU Risk Management — Workers Comp: $935.23 Campbell Scientific — Commercial: $961.95 Cigna — Open Access Flex: $841.71 Cigna — PPO/EPO: $1,135.63 Corporation of the President — Workers Comp: $935.23
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$723.47	$542.60	$175.08 – $651.12
Screening mammogram, both breasts: 10 of 55 insurance plan rates Aetna — Connected: $586.01 Aetna — Extended: $614.95 AG Administrators — USU Athletics: $520.90 AWH Connected — Connected Utah: $466.64 BYU Athletics — Commercial: $520.90 BYU Risk Management — Workers Comp: $528.13 Campbell Scientific — Commercial: $520.90 Cigna — Open Access Flex: $455.79 Cigna — PPO/EPO: $614.95 Corporation of the President — Workers Comp: $528.13

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EKG W/READ	$59.57	$44.68	$1.07 – $53.61
Electrocardiogram (ECG/EKG) with reading: 10 of 56 insurance plan rates Aetna — Connected: $47.66 Aetna — Extended: $50.63 AG Administrators — USU Athletics: $42.89 AWH Connected — Connected Utah: $37.83 BYU Athletics — Commercial: $42.89 BYU Risk Management — Workers Comp: $41.70 Campbell Scientific — Commercial: $42.89 Cigna — Open Access Flex: $37.53 Cigna — PPO/EPO: $50.63 Corporation of the President — Workers Comp: $41.70
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EKG W/READ	$59.57	$44.68	$14.42 – $53.61
Electrocardiogram (ECG/EKG) with reading: 10 of 55 insurance plan rates Aetna — Connected: $48.25 Aetna — Extended: $50.63 AG Administrators — USU Athletics: $42.89 AWH Connected — Connected Utah: $38.42 BYU Athletics — Commercial: $42.89 BYU Risk Management — Workers Comp: $43.49 Campbell Scientific — Commercial: $42.89 Cigna — Open Access Flex: $37.53 Cigna — PPO/EPO: $50.63 Corporation of the President — Workers Comp: $43.49
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Electrocardiogram complete	Not listed in the file	Not listed in the file	$13.88
Electrocardiogram (ECG/EKG) with reading: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $13.88 Aetna — Medicare Adv PPO: $13.88 American Health — Medicare Adv UT HMO I-SNP: $13.88 Health Partners of Nevada — Medicare Advantage: $13.88 Health Plan of Nevada — Medicaid: $13.88 Healthy U — Medicaid: $13.88 Humana — Medicare Choice PPO: $13.88 Molina — Medicare Advantage: $13.88 Molina — Medicare Choice Care HMO: $13.88 Molina — Medicare Complete Care HMO SNP: $13.88
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$10,199.53	$7,649.65	$183.59 – $9,179.58
Left heart catheterization (diagnostic): 10 of 56 insurance plan rates Aetna — Connected: $8,159.62 Aetna — Extended: $8,669.60 AG Administrators — USU Athletics: $7,343.66 AWH Connected — Connected Utah: $6,476.70 BYU Athletics — Commercial: $7,343.66 BYU Risk Management — Workers Comp: $7,139.67 Campbell Scientific — Commercial: $7,343.66 Cigna — Open Access Flex: $6,425.70 Cigna — PPO/EPO: $8,669.60 Corporation of the President — Workers Comp: $7,139.67
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$10,199.53	$7,649.65	$2,468.29 – $9,179.58
Left heart catheterization (diagnostic): 10 of 55 insurance plan rates Aetna — Connected: $8,261.62 Aetna — Extended: $8,669.60 AG Administrators — USU Athletics: $7,343.66 AWH Connected — Connected Utah: $6,578.70 BYU Athletics — Commercial: $7,343.66 BYU Risk Management — Workers Comp: $7,445.66 Campbell Scientific — Commercial: $7,343.66 Cigna — Open Access Flex: $6,425.70 Cigna — PPO/EPO: $8,669.60 Corporation of the President — Workers Comp: $7,445.66
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$1,849.15 – $3,610.59
Left heart catheterization (diagnostic): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $3,282.36 Aetna — Medicare Adv PPO: $3,610.59 American Health — Medicare Adv UT HMO I-SNP: $3,413.65 Health Partners of Nevada — Medicare Advantage: $3,282.36 Health Plan of Nevada — Medicaid: $2,620.62 Healthy U — Medicaid: $2,620.62 Humana — Medicare Choice PPO: $3,446.47 Intermountain Caregiver Plan — Med Network: $2,101.31 Intermountain Caregiver Plan — Share Network: $1,849.15 Molina — Medicare Advantage: $3,610.59
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMP EP W/O ARRYTHMIA INDUCTN	$13,193.07	$9,894.80	$237.48 – $11,873.76
Heart rhythm study (electrophysiology evaluation): 10 of 56 insurance plan rates Aetna — Connected: $10,554.46 Aetna — Extended: $11,214.11 AG Administrators — USU Athletics: $9,499.01 AWH Connected — Connected Utah: $8,377.60 BYU Athletics — Commercial: $9,499.01 BYU Risk Management — Workers Comp: $9,235.15 Campbell Scientific — Commercial: $9,499.01 Cigna — Open Access Flex: $8,311.63 Cigna — PPO/EPO: $11,214.11 Corporation of the President — Workers Comp: $9,235.15
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMP EP W/O ARRYTHMIA INDUCTN	$13,193.07	$9,894.80	$3,192.72 – $11,873.76
Heart rhythm study (electrophysiology evaluation): 10 of 55 insurance plan rates Aetna — Connected: $10,686.39 Aetna — Extended: $11,214.11 AG Administrators — USU Athletics: $9,499.01 AWH Connected — Connected Utah: $8,509.53 BYU Athletics — Commercial: $9,499.01 BYU Risk Management — Workers Comp: $9,630.94 Campbell Scientific — Commercial: $9,499.01 Cigna — Open Access Flex: $8,311.63 Cigna — PPO/EPO: $11,214.11 Corporation of the President — Workers Comp: $9,630.94
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$30.25 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $8,686.15
Heart rhythm study (electrophysiology evaluation): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $7,896.50 Aetna — Medicare Adv PPO: $8,686.15 American Health — Medicare Adv UT HMO I-SNP: $8,212.36 Health Partners of Nevada — Medicare Advantage: $7,896.50 Health Plan of Nevada — Medicaid: $6,182.52 Healthy U — Medicaid: $6,182.52 Humana — Medicare Choice PPO: $8,291.32 Intermountain Caregiver Plan — Med Network: $34.38 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Intermountain Caregiver Plan — Share Network: $30.25 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Molina — Medicare Advantage: $8,686.15
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB ABLATE PULM VEIN ISOL	$90,864.19	$68,148.14	$1,635.56 – $81,777.77
Heart rhythm study with ablation for atrial fibrillation: 10 of 56 insurance plan rates Aetna — Connected: $72,691.35 Aetna — Extended: $77,234.56 AG Administrators — USU Athletics: $65,422.22 AWH Connected — Connected Utah: $57,698.76 BYU Athletics — Commercial: $65,422.22 BYU Risk Management — Workers Comp: $63,604.93 Campbell Scientific — Commercial: $65,422.22 Cigna — Open Access Flex: $57,244.44 Cigna — PPO/EPO: $77,234.56 Corporation of the President — Workers Comp: $63,604.93
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB ABLATE PULM VEIN ISOL	$90,864.19	$68,148.14	$21,989.13 – $81,777.77
Heart rhythm study with ablation for atrial fibrillation: 10 of 55 insurance plan rates Aetna — Connected: $73,599.99 Aetna — Extended: $77,234.56 AG Administrators — USU Athletics: $65,422.22 AWH Connected — Connected Utah: $58,607.40 BYU Athletics — Commercial: $65,422.22 BYU Risk Management — Workers Comp: $66,330.86 Campbell Scientific — Commercial: $65,422.22 Cigna — Open Access Flex: $57,244.44 Cigna — PPO/EPO: $77,234.56 Corporation of the President — Workers Comp: $66,330.86
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$2,058.98 – $29,110.96
Heart rhythm study with ablation for atrial fibrillation: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $26,464.51 Aetna — Medicare Adv PPO: $29,110.96 American Health — Medicare Adv UT HMO I-SNP: $27,523.09 Health Partners of Nevada — Medicare Advantage: $26,464.51 Health Plan of Nevada — Medicaid: $19,988.06 Healthy U — Medicaid: $19,988.06 Humana — Medicare Choice PPO: $27,787.73 Intermountain Caregiver Plan — Med Network: $2,339.75 Intermountain Caregiver Plan — Share Network: $2,058.98 Molina — Medicare Advantage: $29,110.96
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SLEEP LAB LIMITED 4-6 HOURS	$5,024.55	$3,768.41	$90.44 – $4,522.10
Sleep study (overnight, in a sleep lab): 10 of 56 insurance plan rates Aetna — Connected: $4,019.64 Aetna — Extended: $4,270.87 AG Administrators — USU Athletics: $3,617.68 AWH Connected — Connected Utah: $3,190.59 BYU Athletics — Commercial: $3,617.68 BYU Risk Management — Workers Comp: $3,517.18 Campbell Scientific — Commercial: $3,617.68 Cigna — Open Access Flex: $3,165.47 Cigna — PPO/EPO: $4,270.87 Corporation of the President — Workers Comp: $3,517.18
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASELINE SLEEP STUDY	$4,937.95	$3,703.46	$88.88 – $4,444.16
Sleep study (overnight, in a sleep lab): 10 of 56 insurance plan rates Aetna — Connected: $3,950.36 Aetna — Extended: $4,197.26 AG Administrators — USU Athletics: $3,555.32 AWH Connected — Connected Utah: $3,135.60 BYU Athletics — Commercial: $3,555.32 BYU Risk Management — Workers Comp: $3,456.56 Campbell Scientific — Commercial: $3,555.32 Cigna — Open Access Flex: $3,110.91 Cigna — PPO/EPO: $4,197.26 Corporation of the President — Workers Comp: $3,456.56
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SLEEP LAB LIMITED 4-6 HOURS	$5,024.55	$3,768.41	$1,215.94 – $4,522.10
Sleep study (overnight, in a sleep lab): 10 of 55 insurance plan rates Aetna — Connected: $4,069.89 Aetna — Extended: $4,270.87 AG Administrators — USU Athletics: $3,617.68 AWH Connected — Connected Utah: $3,240.83 BYU Athletics — Commercial: $3,617.68 BYU Risk Management — Workers Comp: $3,667.92 Campbell Scientific — Commercial: $3,617.68 Cigna — Open Access Flex: $3,165.47 Cigna — PPO/EPO: $4,270.87 Corporation of the President — Workers Comp: $3,667.92

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OT THERAPEUTIC EX PER 15 MIN	$146.87	$110.15	$2.64 – $132.18
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 56 insurance plan rates Aetna — Connected: $117.50 Aetna — Extended: $124.84 AG Administrators — USU Athletics: $105.75 AWH Connected — Connected Utah: $93.26 BYU Athletics — Commercial: $105.75 BYU Risk Management — Workers Comp: $102.81 Campbell Scientific — Commercial: $105.75 Cigna — Open Access Flex: $92.53 Cigna — PPO/EPO: $124.84 Corporation of the President — Workers Comp: $102.81
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT THERAPEUTIC EX PER 15 MIN	$136.83	$102.62	$2.46 – $123.15
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 56 insurance plan rates Aetna — Connected: $109.46 Aetna — Extended: $116.31 AG Administrators — USU Athletics: $98.52 AWH Connected — Connected Utah: $86.89 BYU Athletics — Commercial: $98.52 BYU Risk Management — Workers Comp: $95.78 Campbell Scientific — Commercial: $98.52 Cigna — Open Access Flex: $86.20 Cigna — PPO/EPO: $116.31 Corporation of the President — Workers Comp: $95.78
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ST THERAPEUTIC EXERCISE/15 MIN	$148.19	$111.14	$2.67 – $133.37
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 56 insurance plan rates Aetna — Connected: $118.55 Aetna — Extended: $125.96 AG Administrators — USU Athletics: $106.70 AWH Connected — Connected Utah: $94.10 BYU Athletics — Commercial: $106.70 BYU Risk Management — Workers Comp: $103.73 Campbell Scientific — Commercial: $106.70 Cigna — Open Access Flex: $93.36 Cigna — PPO/EPO: $125.96 Corporation of the President — Workers Comp: $103.73
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$354.86	$266.14	$6.39 – $319.37
Physical therapy evaluation (low complexity): 10 of 56 insurance plan rates Aetna — Connected: $283.89 Aetna — Extended: $301.63 AG Administrators — USU Athletics: $255.50 AWH Connected — Connected Utah: $225.34 BYU Athletics — Commercial: $255.50 BYU Risk Management — Workers Comp: $248.40 Campbell Scientific — Commercial: $255.50 Cigna — Open Access Flex: $223.56 Cigna — PPO/EPO: $301.63 Corporation of the President — Workers Comp: $248.40
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$354.86	$266.14	$85.88 – $319.37
Physical therapy evaluation (low complexity): 10 of 55 insurance plan rates Aetna — Connected: $287.44 Aetna — Extended: $301.63 AG Administrators — USU Athletics: $255.50 AWH Connected — Connected Utah: $228.88 BYU Athletics — Commercial: $255.50 BYU Risk Management — Workers Comp: $259.05 Campbell Scientific — Commercial: $255.50 Cigna — Open Access Flex: $223.56 Cigna — PPO/EPO: $301.63 Corporation of the President — Workers Comp: $259.05
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$80.55 – $266.71
Physical therapy evaluation (low complexity): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $95.06 Aetna — Medicare Adv PPO: $104.57 American Health — Medicare Adv UT HMO I-SNP: $98.86 Health Partners of Nevada — Medicare Advantage: $95.06 Health Plan of Nevada — Medicaid: $80.55 Healthy U — Medicaid: $80.55 Humana — Medicare Choice PPO: $99.81 Intermountain Caregiver Plan — Med Network: $254.01 Intermountain Caregiver Plan — Share Network: $223.53 Molina — Medicare Advantage: $104.57
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CLIENT ONLY HRH PHYSICAL THERAPY EVALUATION PER SESSION	$444.13	$333.10	$7.99 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 56 insurance plan rates Aetna — Connected: $355.30 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 AWH Connected — Connected Utah: $282.02 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $310.89 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51 Corporation of the President — Workers Comp: $310.89
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL MODERATE COMPLEXITY	$444.13	$333.10	$7.99 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 56 insurance plan rates Aetna — Connected: $355.30 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 AWH Connected — Connected Utah: $282.02 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $310.89 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51 Corporation of the President — Workers Comp: $310.89
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CLIENT ONLY HRH PHYSICAL THERAPY EVALUATION PER SESSION	$444.13	$333.10	$107.48 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 55 insurance plan rates Aetna — Connected: $359.75 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 AWH Connected — Connected Utah: $286.46 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $324.21 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51 Corporation of the President — Workers Comp: $324.21
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$535.83	$401.87	$9.64 – $482.25
Physical therapy evaluation (high complexity): 10 of 56 insurance plan rates Aetna — Connected: $428.66 Aetna — Extended: $455.46 AG Administrators — USU Athletics: $385.80 AWH Connected — Connected Utah: $340.25 BYU Athletics — Commercial: $385.80 BYU Risk Management — Workers Comp: $375.08 Campbell Scientific — Commercial: $385.80 Cigna — Open Access Flex: $337.57 Cigna — PPO/EPO: $455.46 Corporation of the President — Workers Comp: $375.08
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$535.83	$401.87	$129.67 – $482.25
Physical therapy evaluation (high complexity): 10 of 55 insurance plan rates Aetna — Connected: $434.02 Aetna — Extended: $455.46 AG Administrators — USU Athletics: $385.80 AWH Connected — Connected Utah: $345.61 BYU Athletics — Commercial: $385.80 BYU Risk Management — Workers Comp: $391.16 Campbell Scientific — Commercial: $385.80 Cigna — Open Access Flex: $337.57 Cigna — PPO/EPO: $455.46 Corporation of the President — Workers Comp: $391.16
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$80.55 – $266.71
Physical therapy evaluation (high complexity): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $95.06 Aetna — Medicare Adv PPO: $104.57 American Health — Medicare Adv UT HMO I-SNP: $98.86 Health Partners of Nevada — Medicare Advantage: $95.06 Health Plan of Nevada — Medicaid: $80.55 Healthy U — Medicaid: $80.55 Humana — Medicare Choice PPO: $99.81 Intermountain Caregiver Plan — Med Network: $254.01 Intermountain Caregiver Plan — Share Network: $223.53 Molina — Medicare Advantage: $104.57
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$158.59	$118.94	$2.85 – $142.73
Psychotherapy, 30 minutes: 10 of 56 insurance plan rates Aetna — Connected: $126.87 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 AWH Connected — Connected Utah: $100.70 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $111.01 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80 Corporation of the President — Workers Comp: $111.01
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$158.59	$118.94	$2.85 – $142.73
Psychotherapy, 30 minutes: 10 of 56 insurance plan rates Aetna — Connected: $126.87 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 AWH Connected — Connected Utah: $100.70 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $111.01 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80 Corporation of the President — Workers Comp: $111.01
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$158.59	$118.94	$38.38 – $142.73
Psychotherapy, 30 minutes: 10 of 55 insurance plan rates Aetna — Connected: $128.46 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 AWH Connected — Connected Utah: $102.29 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $115.77 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80 Corporation of the President — Workers Comp: $115.77
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$394.31	$295.73	$7.10 – $354.88
Psychotherapy, 45 minutes: 10 of 56 insurance plan rates Aetna — Connected: $315.45 Aetna — Extended: $335.16 AG Administrators — USU Athletics: $283.90 AWH Connected — Connected Utah: $250.39 BYU Athletics — Commercial: $283.90 BYU Risk Management — Workers Comp: $276.02 Campbell Scientific — Commercial: $283.90 Cigna — Open Access Flex: $248.42 Cigna — PPO/EPO: $335.16 Corporation of the President — Workers Comp: $276.02
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$224.17	$168.13	$4.04 – $201.75
Psychotherapy, 45 minutes: 10 of 56 insurance plan rates Aetna — Connected: $179.34 Aetna — Extended: $190.54 AG Administrators — USU Athletics: $161.40 AWH Connected — Connected Utah: $142.35 BYU Athletics — Commercial: $161.40 BYU Risk Management — Workers Comp: $156.92 Campbell Scientific — Commercial: $161.40 Cigna — Open Access Flex: $141.23 Cigna — PPO/EPO: $190.54 Corporation of the President — Workers Comp: $156.92
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$394.31	$295.73	$95.42 – $354.88
Psychotherapy, 45 minutes: 10 of 55 insurance plan rates Aetna — Connected: $319.39 Aetna — Extended: $335.16 AG Administrators — USU Athletics: $283.90 AWH Connected — Connected Utah: $254.33 BYU Athletics — Commercial: $283.90 BYU Risk Management — Workers Comp: $287.85 Campbell Scientific — Commercial: $283.90 Cigna — Open Access Flex: $248.42 Cigna — PPO/EPO: $335.16 Corporation of the President — Workers Comp: $287.85
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$396.57	$297.43	$7.14 – $356.91
Psychotherapy, 60 minutes: 10 of 56 insurance plan rates Aetna — Connected: $317.26 Aetna — Extended: $337.08 AG Administrators — USU Athletics: $285.53 AWH Connected — Connected Utah: $251.82 BYU Athletics — Commercial: $285.53 BYU Risk Management — Workers Comp: $277.60 Campbell Scientific — Commercial: $285.53 Cigna — Open Access Flex: $249.84 Cigna — PPO/EPO: $337.08 Corporation of the President — Workers Comp: $277.60
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$396.57	$297.43	$95.97 – $356.91
Psychotherapy, 60 minutes: 10 of 55 insurance plan rates Aetna — Connected: $321.22 Aetna — Extended: $337.08 AG Administrators — USU Athletics: $285.53 AWH Connected — Connected Utah: $255.79 BYU Athletics — Commercial: $285.53 BYU Risk Management — Workers Comp: $289.50 Campbell Scientific — Commercial: $285.53 Cigna — Open Access Flex: $249.84 Cigna — PPO/EPO: $337.08 Corporation of the President — Workers Comp: $289.50
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$130.91 – $427.19
Psychotherapy, 60 minutes: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $186.56 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $130.91 Healthy U — Medicaid: $130.91 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $406.85 Intermountain Caregiver Plan — Share Network: $358.03 Molina — Medicare Advantage: $197.32
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX W/O PT 50 MIN	$208.45	$156.34	$3.75 – $187.60
Family psychotherapy, without the patient: 10 of 56 insurance plan rates Aetna — Connected: $166.76 Aetna — Extended: $177.18 AG Administrators — USU Athletics: $150.08 AWH Connected — Connected Utah: $132.37 BYU Athletics — Commercial: $150.08 BYU Risk Management — Workers Comp: $145.92 Campbell Scientific — Commercial: $150.08 Cigna — Open Access Flex: $131.32 Cigna — PPO/EPO: $177.18 Corporation of the President — Workers Comp: $145.92
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX W/O PT 50 MIN	$208.45	$156.34	$50.44 – $187.60
Family psychotherapy, without the patient: 10 of 55 insurance plan rates Aetna — Connected: $168.84 Aetna — Extended: $177.18 AG Administrators — USU Athletics: $150.08 AWH Connected — Connected Utah: $134.45 BYU Athletics — Commercial: $150.08 BYU Risk Management — Workers Comp: $152.17 Campbell Scientific — Commercial: $150.08 Cigna — Open Access Flex: $131.32 Cigna — PPO/EPO: $177.18 Corporation of the President — Workers Comp: $152.17
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$130.91 – $275.04
Family psychotherapy, without the patient: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $186.56 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $130.91 Healthy U — Medicaid: $130.91 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $261.94 Intermountain Caregiver Plan — Share Network: $230.51 Molina — Medicare Advantage: $197.32
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$130.91 – $286.74
Family psychotherapy, with the patient: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $186.56 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $130.91 Healthy U — Medicaid: $130.91 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $273.09 Intermountain Caregiver Plan — Share Network: $240.32 Molina — Medicare Advantage: $197.32
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$98.07
Family psychotherapy, with the patient: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $98.07 Aetna — Medicare Adv PPO: $98.07 American Health — Medicare Adv UT HMO I-SNP: $98.07 Health Partners of Nevada — Medicare Advantage: $98.07 Health Plan of Nevada — Medicaid: $98.07 Healthy U — Medicaid: $98.07 Humana — Medicare Choice PPO: $98.07 Molina — Medicare Advantage: $98.07 Molina — Medicare Choice Care HMO: $98.07 Molina — Medicare Complete Care HMO SNP: $98.07
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$138.68	$104.01	$2.50 – $124.81
Group psychotherapy: 10 of 56 insurance plan rates Aetna — Connected: $110.94 Aetna — Extended: $117.88 AG Administrators — USU Athletics: $99.85 AWH Connected — Connected Utah: $88.06 BYU Athletics — Commercial: $99.85 BYU Risk Management — Workers Comp: $97.08 Campbell Scientific — Commercial: $99.85 Cigna — Open Access Flex: $87.37 Cigna — PPO/EPO: $117.88 Corporation of the President — Workers Comp: $97.08
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$138.68	$104.01	$33.56 – $124.81
Group psychotherapy: 10 of 55 insurance plan rates Aetna — Connected: $112.33 Aetna — Extended: $117.88 AG Administrators — USU Athletics: $99.85 AWH Connected — Connected Utah: $89.45 BYU Athletics — Commercial: $99.85 BYU Risk Management — Workers Comp: $101.24 Campbell Scientific — Commercial: $99.85 Cigna — Open Access Flex: $87.37 Cigna — PPO/EPO: $117.88 Corporation of the President — Workers Comp: $101.24
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$65.23 – $112.61
Group psychotherapy: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $102.38 Aetna — Medicare Adv PPO: $112.61 American Health — Medicare Adv UT HMO I-SNP: $106.47 Health Partners of Nevada — Medicare Advantage: $102.38 Health Plan of Nevada — Medicaid: $75.37 Healthy U — Medicaid: $75.37 Humana — Medicare Choice PPO: $107.49 Intermountain Caregiver Plan — Med Network: $74.13 Intermountain Caregiver Plan — Share Network: $65.23 Molina — Medicare Advantage: $112.61

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$1,243.42 – $4,360.02
Removal of breast growth (open surgery): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $3,963.65 Aetna — Medicare Adv PPO: $4,360.02 American Health — Medicare Adv UT HMO I-SNP: $4,122.20 Health Partners of Nevada — Medicare Advantage: $3,963.65 Health Plan of Nevada — Medicaid: $3,119.97 Healthy U — Medicaid: $3,119.97 Humana — Medicare Choice PPO: $4,161.83 Intermountain Caregiver Plan — Med Network: $1,412.98 Intermountain Caregiver Plan — Share Network: $1,243.42 Molina — Medicare Advantage: $4,360.02
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$608.06
Removal of breast growth (open surgery): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $608.06 Aetna — Medicare Adv PPO: $608.06 American Health — Medicare Adv UT HMO I-SNP: $608.06 Health Partners of Nevada — Medicare Advantage: $608.06 Health Plan of Nevada — Medicaid: $608.06 Healthy U — Medicaid: $608.06 Humana — Medicare Choice PPO: $608.06 Molina — Medicare Advantage: $608.06 Molina — Medicare Choice Care HMO: $608.06 Molina — Medicare Complete Care HMO SNP: $608.06
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$287.81
Removal of breast growth (open surgery): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $287.81 Aetna — Medicare Adv PPO: $287.81 American Health — Medicare Adv UT HMO I-SNP: $287.81 Health Partners of Nevada — Medicare Advantage: $287.81 Health Plan of Nevada — Medicaid: $287.81 Healthy U — Medicaid: $287.81 Humana — Medicare Choice PPO: $287.81 Molina — Medicare Advantage: $287.81 Molina — Medicare Choice Care HMO: $287.81 Molina — Medicare Complete Care HMO SNP: $287.81
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$3,095 – $14,320.82
Total hip replacement: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $12,998.97 Aetna — Medicare Adv PPO: $14,298.86 American Health — Medicare Adv UT HMO I-SNP: $13,518.92 Health Partners of Nevada — Medicare Advantage: $12,998.97 Health Plan of Nevada — Medicaid: $10,483.44 Healthy U — Medicaid: $10,483.44 Humana — Medicare Choice PPO: $13,648.91 Intermountain Caregiver Plan — Med Network: $3,517.04 Intermountain Caregiver Plan — Share Network: $3,095 Molina — Medicare Advantage: $14,298.86
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$1,868.51
Total hip replacement: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $1,868.51 Aetna — Medicare Adv PPO: $1,868.51 American Health — Medicare Adv UT HMO I-SNP: $1,868.51 Health Partners of Nevada — Medicare Advantage: $1,868.51 Health Plan of Nevada — Medicaid: $1,868.51 Healthy U — Medicaid: $1,868.51 Humana — Medicare Choice PPO: $1,868.51 Molina — Medicare Advantage: $1,868.51 Molina — Medicare Choice Care HMO: $1,868.51 Molina — Medicare Complete Care HMO SNP: $1,868.51
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$859.51
Total hip replacement: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $859.51 Aetna — Medicare Adv PPO: $859.51 American Health — Medicare Adv UT HMO I-SNP: $859.51 Health Partners of Nevada — Medicare Advantage: $859.51 Health Plan of Nevada — Medicaid: $859.51 Healthy U — Medicaid: $859.51 Humana — Medicare Choice PPO: $859.51 Molina — Medicare Advantage: $859.51 Molina — Medicare Choice Care HMO: $859.51 Molina — Medicare Complete Care HMO SNP: $859.51
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$3,091.16 – $14,320.82
Total knee replacement: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $12,998.97 Aetna — Medicare Adv PPO: $14,298.86 American Health — Medicare Adv UT HMO I-SNP: $13,518.92 Health Partners of Nevada — Medicare Advantage: $12,998.97 Health Plan of Nevada — Medicaid: $10,483.44 Healthy U — Medicaid: $10,483.44 Humana — Medicare Choice PPO: $13,648.91 Intermountain Caregiver Plan — Med Network: $3,512.68 Intermountain Caregiver Plan — Share Network: $3,091.16 Molina — Medicare Advantage: $14,298.86
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$1,866.65
Total knee replacement: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $1,866.65 Aetna — Medicare Adv PPO: $1,866.65 American Health — Medicare Adv UT HMO I-SNP: $1,866.65 Health Partners of Nevada — Medicare Advantage: $1,866.65 Health Plan of Nevada — Medicaid: $1,866.65 Healthy U — Medicaid: $1,866.65 Humana — Medicare Choice PPO: $1,866.65 Molina — Medicare Advantage: $1,866.65 Molina — Medicare Choice Care HMO: $1,866.65 Molina — Medicare Complete Care HMO SNP: $1,866.65
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$858.66
Total knee replacement: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $858.66 Aetna — Medicare Adv PPO: $858.66 American Health — Medicare Adv UT HMO I-SNP: $858.66 Health Partners of Nevada — Medicare Advantage: $858.66 Health Plan of Nevada — Medicaid: $858.66 Healthy U — Medicaid: $858.66 Humana — Medicare Choice PPO: $858.66 Molina — Medicare Advantage: $858.66 Molina — Medicare Choice Care HMO: $858.66 Molina — Medicare Complete Care HMO SNP: $858.66
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$9,729
Shoulder arthroscopy: shaving of shoulder bone: 10 of 29 insurance plan rates AG Administrators — USU Athletics: $9,729 AWH Connected — Connected Utah: $9,729 BYU Athletics — Commercial: $9,729 Campbell Scientific — Commercial: $9,729 Deseret Mutual — All Other: $9,729 Deseret Mutual — Select: $9,729 EMI — Commercial: $9,729 EMI Health — Mint: $9,729 EMI Health — Network Care: $9,729 Franklin County — Commercial: $9,729
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$250.01
Shoulder arthroscopy: shaving of shoulder bone: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $250.01 Aetna — Medicare Adv PPO: $250.01 American Health — Medicare Adv UT HMO I-SNP: $250.01 Health Partners of Nevada — Medicare Advantage: $250.01 Health Plan of Nevada — Medicaid: $250.01 Healthy U — Medicaid: $250.01 Humana — Medicare Choice PPO: $250.01 Molina — Medicare Advantage: $250.01 Molina — Medicare Choice Care HMO: $250.01 Molina — Medicare Complete Care HMO SNP: $250.01
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 81\|82\|80 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$26.67
Shoulder arthroscopy: shaving of shoulder bone: 10 of 12 insurance plan rates Aetna — Medicare Adv HMO: $26.67 Aetna — Medicare Adv PPO: $26.67 American Health — Medicare Adv UT HMO I-SNP: $26.67 Health Partners of Nevada — Medicare Advantage: $26.67 Humana — Medicare Choice PPO: $26.67 Molina — Medicare Advantage: $26.67 Molina — Medicare Choice Care HMO: $26.67 Molina — Medicare Complete Care HMO SNP: $26.67 Regence BCBS — MedAdvantage PPO: $26.67 SelectHealth — Med Individual ACA: $26.67
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	Not listed in the file	$2,643.60 – $6,225
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $3,312.25 Aetna — Medicare Adv PPO: $3,643.48 AG Administrators — USU Athletics: $6,225 American Health — Medicare Adv UT HMO I-SNP: $3,444.74 AWH Connected — Connected Utah: $6,225 BYU Athletics — Commercial: $6,225 Campbell Scientific — Commercial: $6,225 Deseret Mutual — All Other: $6,225 Deseret Mutual — Select: $6,225 EMI — Commercial: $6,225
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	Not listed in the file	$790.88
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $790.88 Aetna — Medicare Adv PPO: $790.88 American Health — Medicare Adv UT HMO I-SNP: $790.88 Health Partners of Nevada — Medicare Advantage: $790.88 Health Plan of Nevada — Medicaid: $790.88 Healthy U — Medicaid: $790.88 Humana — Medicare Choice PPO: $790.88 Molina — Medicare Advantage: $790.88 Molina — Medicare Choice Care HMO: $790.88 Molina — Medicare Complete Care HMO SNP: $790.88
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	Not listed in the file	$363.80
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $363.80 Aetna — Medicare Adv PPO: $363.80 American Health — Medicare Adv UT HMO I-SNP: $363.80 Health Partners of Nevada — Medicare Advantage: $363.80 Health Plan of Nevada — Medicaid: $363.80 Healthy U — Medicaid: $363.80 Humana — Medicare Choice PPO: $363.80 Molina — Medicare Advantage: $363.80 Molina — Medicare Choice Care HMO: $363.80 Molina — Medicare Complete Care HMO SNP: $363.80
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$3,958 – $6,593.34
Removal of tonsils and adenoids (under age 12): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $5,993.95 Aetna — Medicare Adv PPO: $6,593.34 AG Administrators — USU Athletics: $4,523 American Health — Medicare Adv UT HMO I-SNP: $6,233.70 AWH Connected — Connected Utah: $4,523 BYU Athletics — Commercial: $4,523 Campbell Scientific — Commercial: $4,523 Deseret Mutual — All Other: $4,523 Deseret Mutual — Select: $4,523 EMI — Commercial: $4,523
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$230.24
Removal of tonsils and adenoids (under age 12): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $230.24 Aetna — Medicare Adv PPO: $230.24 American Health — Medicare Adv UT HMO I-SNP: $230.24 Health Partners of Nevada — Medicare Advantage: $230.24 Health Plan of Nevada — Medicaid: $230.24 Healthy U — Medicaid: $230.24 Humana — Medicare Choice PPO: $230.24 Molina — Medicare Advantage: $230.24 Molina — Medicare Choice Care HMO: $230.24 Molina — Medicare Complete Care HMO SNP: $230.24
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$763.89 – $1,589
Upper GI endoscopy (diagnostic): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $917.76 Aetna — Medicare Adv PPO: $1,009.53 AG Administrators — USU Athletics: $1,589 American Health — Medicare Adv UT HMO I-SNP: $954.47 AWH Connected — Connected Utah: $1,589 BYU Athletics — Commercial: $1,589 Campbell Scientific — Commercial: $1,589 Deseret Mutual — All Other: $1,589 Deseret Mutual — Select: $1,589 EMI — Commercial: $1,589
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$117.67
Upper GI endoscopy (diagnostic): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $117.67 Aetna — Medicare Adv PPO: $117.67 American Health — Medicare Adv UT HMO I-SNP: $117.67 Health Partners of Nevada — Medicare Advantage: $117.67 Health Plan of Nevada — Medicaid: $117.67 Healthy U — Medicaid: $117.67 Humana — Medicare Choice PPO: $117.67 Molina — Medicare Advantage: $117.67 Molina — Medicare Choice Care HMO: $117.67 Molina — Medicare Complete Care HMO SNP: $117.67
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$763.89 – $1,930
Upper GI endoscopy with biopsy: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $917.76 Aetna — Medicare Adv PPO: $1,009.53 AG Administrators — USU Athletics: $1,930 American Health — Medicare Adv UT HMO I-SNP: $954.47 AWH Connected — Connected Utah: $1,930 BYU Athletics — Commercial: $1,930 Campbell Scientific — Commercial: $1,930 Deseret Mutual — All Other: $1,930 Deseret Mutual — Select: $1,930 EMI — Commercial: $1,930
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$132.79
Upper GI endoscopy with biopsy: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $132.79 Aetna — Medicare Adv PPO: $132.79 American Health — Medicare Adv UT HMO I-SNP: $132.79 Health Partners of Nevada — Medicare Advantage: $132.79 Health Plan of Nevada — Medicaid: $132.79 Healthy U — Medicaid: $132.79 Humana — Medicare Choice PPO: $132.79 Molina — Medicare Advantage: $132.79 Molina — Medicare Choice Care HMO: $132.79 Molina — Medicare Complete Care HMO SNP: $132.79
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,657.74	$1,993.30	$47.84 – $2,391.97
Colonoscopy (diagnostic): 10 of 56 insurance plan rates Aetna — Connected: $2,126.19 Aetna — Extended: $2,259.08 AG Administrators — USU Athletics: $1,913.57 AWH Connected — Connected Utah: $1,687.66 BYU Athletics — Commercial: $1,913.57 BYU Risk Management — Workers Comp: $1,860.42 Campbell Scientific — Commercial: $1,913.57 Cigna — Open Access Flex: $1,674.38 Cigna — PPO/EPO: $2,259.08 Corporation of the President — Workers Comp: $1,860.42
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,657.74	$1,993.30	$643.17 – $2,391.97
Colonoscopy (diagnostic): 10 of 55 insurance plan rates Aetna — Connected: $2,152.77 Aetna — Extended: $2,259.08 AG Administrators — USU Athletics: $1,913.57 AWH Connected — Connected Utah: $1,714.24 BYU Athletics — Commercial: $1,913.57 BYU Risk Management — Workers Comp: $1,940.15 Campbell Scientific — Commercial: $1,913.57 Cigna — Open Access Flex: $1,674.38 Cigna — PPO/EPO: $2,259.08 Corporation of the President — Workers Comp: $1,940.15
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Diagnostic colonoscopy	Not listed in the file	Not listed in the file	$742.83 – $1,453
Colonoscopy (diagnostic): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $941.31 Aetna — Medicare Adv PPO: $1,035.44 AG Administrators — USU Athletics: $1,453 American Health — Medicare Adv UT HMO I-SNP: $978.96 AWH Connected — Connected Utah: $1,453 BYU Athletics — Commercial: $1,453 Campbell Scientific — Commercial: $1,453 Deseret Mutual — All Other: $1,453 Deseret Mutual — Select: $1,453 EMI — Commercial: $1,453
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$960.67 – $1,589
Colonoscopy with biopsy: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 AG Administrators — USU Athletics: $1,589 American Health — Medicare Adv UT HMO I-SNP: $1,259.74 AWH Connected — Connected Utah: $1,589 BYU Athletics — Commercial: $1,589 Campbell Scientific — Commercial: $1,589 Deseret Mutual — All Other: $1,589 Deseret Mutual — Select: $1,589 EMI — Commercial: $1,589
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$192.84
Colonoscopy with biopsy: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $192.84 Aetna — Medicare Adv PPO: $192.84 American Health — Medicare Adv UT HMO I-SNP: $192.84 Health Partners of Nevada — Medicare Advantage: $192.84 Health Plan of Nevada — Medicaid: $192.84 Healthy U — Medicaid: $192.84 Humana — Medicare Choice PPO: $192.84 Molina — Medicare Advantage: $192.84 Molina — Medicare Choice Care HMO: $192.84 Molina — Medicare Complete Care HMO SNP: $192.84
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$960.67 – $1,453
Colonoscopy with removal of polyps (snare): 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 AG Administrators — USU Athletics: $1,453 American Health — Medicare Adv UT HMO I-SNP: $1,259.74 AWH Connected — Connected Utah: $1,453 BYU Athletics — Commercial: $1,453 Campbell Scientific — Commercial: $1,453 Deseret Mutual — All Other: $1,453 Deseret Mutual — Select: $1,453 EMI — Commercial: $1,453
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$244.10
Colonoscopy with removal of polyps (snare): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $244.10 Aetna — Medicare Adv PPO: $244.10 American Health — Medicare Adv UT HMO I-SNP: $244.10 Health Partners of Nevada — Medicare Advantage: $244.10 Health Plan of Nevada — Medicaid: $244.10 Healthy U — Medicaid: $244.10 Humana — Medicare Choice PPO: $244.10 Molina — Medicare Advantage: $244.10 Molina — Medicare Choice Care HMO: $244.10 Molina — Medicare Complete Care HMO SNP: $244.10
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$609.53 – $1,332.42
Ultrasound of the lower bowel by endoscope: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 American Health — Medicare Adv UT HMO I-SNP: $1,259.74 Health Partners of Nevada — Medicare Advantage: $1,211.29 Health Plan of Nevada — Medicaid: $960.67 Healthy U — Medicaid: $960.67 Humana — Medicare Choice PPO: $1,271.86 Intermountain Caregiver Plan — Med Network: $692.65 Intermountain Caregiver Plan — Share Network: $609.53 Molina — Medicare Advantage: $1,332.42
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$247.75
Ultrasound of the lower bowel by endoscope: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $247.75 Aetna — Medicare Adv PPO: $247.75 American Health — Medicare Adv UT HMO I-SNP: $247.75 Health Partners of Nevada — Medicare Advantage: $247.75 Health Plan of Nevada — Medicaid: $247.75 Healthy U — Medicaid: $247.75 Humana — Medicare Choice PPO: $247.75 Molina — Medicare Advantage: $247.75 Molina — Medicare Choice Care HMO: $247.75 Molina — Medicare Complete Care HMO SNP: $247.75
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$3,191.55	$2,393.66	$57.45 – $2,872.40
Screening colonoscopy (not high risk): 10 of 56 insurance plan rates Aetna — Connected: $2,553.24 Aetna — Extended: $2,712.82 AG Administrators — USU Athletics: $2,297.92 AWH Connected — Connected Utah: $2,026.63 BYU Athletics — Commercial: $2,297.92 BYU Risk Management — Workers Comp: $2,234.08 Campbell Scientific — Commercial: $2,297.92 Cigna — Open Access Flex: $2,010.68 Cigna — PPO/EPO: $2,712.82 Corporation of the President — Workers Comp: $2,234.08
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$3,191.55	$2,393.66	$772.36 – $2,872.40
Screening colonoscopy (not high risk): 10 of 55 insurance plan rates Aetna — Connected: $2,585.16 Aetna — Extended: $2,712.82 AG Administrators — USU Athletics: $2,297.92 AWH Connected — Connected Utah: $2,058.55 BYU Athletics — Commercial: $2,297.92 BYU Risk Management — Workers Comp: $2,329.83 Campbell Scientific — Commercial: $2,297.92 Cigna — Open Access Flex: $2,010.68 Cigna — PPO/EPO: $2,712.82 Corporation of the President — Workers Comp: $2,329.83
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$742.83 – $1,035.44
Screening colonoscopy (not high risk): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $941.31 Aetna — Medicare Adv PPO: $1,035.44 American Health — Medicare Adv UT HMO I-SNP: $978.96 Health Partners of Nevada — Medicare Advantage: $941.31 Health Plan of Nevada — Medicaid: $742.83 Healthy U — Medicaid: $742.83 Humana — Medicare Choice PPO: $988.38 Intermountain Caregiver Plan — Med Network: $904.69 Intermountain Caregiver Plan — Share Network: $796.13 Molina — Medicare Advantage: $1,035.44
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$4,753.64 – $8,709
Gallbladder removal by laparoscope: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $6,120.78 Aetna — Medicare Adv PPO: $6,732.86 AG Administrators — USU Athletics: $8,709 American Health — Medicare Adv UT HMO I-SNP: $6,365.62 AWH Connected — Connected Utah: $8,709 BYU Athletics — Commercial: $8,709 Campbell Scientific — Commercial: $8,709 Deseret Mutual — All Other: $8,709 Deseret Mutual — Select: $8,709 EMI — Commercial: $8,709
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$519.23
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $519.23 Aetna — Medicare Adv PPO: $519.23 American Health — Medicare Adv UT HMO I-SNP: $519.23 Health Partners of Nevada — Medicare Advantage: $519.23 Health Plan of Nevada — Medicaid: $519.23 Healthy U — Medicaid: $519.23 Humana — Medicare Choice PPO: $519.23 Molina — Medicare Advantage: $519.23 Molina — Medicare Choice Care HMO: $519.23 Molina — Medicare Complete Care HMO SNP: $519.23
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$102.56
Gallbladder removal by laparoscope: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $102.56 Aetna — Medicare Adv PPO: $102.56 American Health — Medicare Adv UT HMO I-SNP: $102.56 Health Partners of Nevada — Medicare Advantage: $102.56 Health Plan of Nevada — Medicaid: $102.56 Healthy U — Medicaid: $102.56 Humana — Medicare Choice PPO: $102.56 Molina — Medicare Advantage: $102.56 Molina — Medicare Choice Care HMO: $102.56 Molina — Medicare Complete Care HMO SNP: $102.56
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$1,266.82 – $3,987.30
Groin (inguinal) hernia repair, age 5 or older: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $3,624.82 Aetna — Medicare Adv PPO: $3,987.30 American Health — Medicare Adv UT HMO I-SNP: $3,769.81 Health Partners of Nevada — Medicare Advantage: $3,624.82 Health Plan of Nevada — Medicaid: $2,875.35 Healthy U — Medicaid: $2,875.35 Humana — Medicare Choice PPO: $3,806.06 Intermountain Caregiver Plan — Med Network: $1,439.57 Intermountain Caregiver Plan — Share Network: $1,266.82 Molina — Medicare Advantage: $3,987.30
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$763.29
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $763.29 Aetna — Medicare Adv PPO: $763.29 American Health — Medicare Adv UT HMO I-SNP: $763.29 Health Partners of Nevada — Medicare Advantage: $763.29 Health Plan of Nevada — Medicaid: $763.29 Healthy U — Medicaid: $763.29 Humana — Medicare Choice PPO: $763.29 Molina — Medicare Advantage: $763.29 Molina — Medicare Choice Care HMO: $763.29 Molina — Medicare Complete Care HMO SNP: $763.29
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$412.18
Groin (inguinal) hernia repair, age 5 or older: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $412.18 Aetna — Medicare Adv PPO: $412.18 American Health — Medicare Adv UT HMO I-SNP: $412.18 Health Partners of Nevada — Medicare Advantage: $412.18 Health Plan of Nevada — Medicaid: $412.18 Healthy U — Medicaid: $412.18 Humana — Medicare Choice PPO: $412.18 Molina — Medicare Advantage: $412.18 Molina — Medicare Choice Care HMO: $412.18 Molina — Medicare Complete Care HMO SNP: $412.18
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$952.99	$714.74	$17.15 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $857.69
Prostate biopsy: 10 of 56 insurance plan rates Aetna — Connected: $762.39 Aetna — Extended: $810.04 AG Administrators — USU Athletics: $686.15 AWH Connected — Connected Utah: $605.15 BYU Athletics — Commercial: $686.15 BYU Risk Management — Workers Comp: $667.09 Campbell Scientific — Commercial: $686.15 Cigna — Open Access Flex: $600.38 Cigna — PPO/EPO: $810.04 Corporation of the President — Workers Comp: $667.09
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$952.99	$714.74	$230.62 – $857.69
Prostate biopsy: 10 of 55 insurance plan rates Aetna — Connected: $771.92 Aetna — Extended: $810.04 AG Administrators — USU Athletics: $686.15 AWH Connected — Connected Utah: $614.68 BYU Athletics — Commercial: $686.15 BYU Risk Management — Workers Comp: $695.68 Campbell Scientific — Commercial: $686.15 Cigna — Open Access Flex: $600.38 Cigna — PPO/EPO: $810.04 Corporation of the President — Workers Comp: $695.68
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Biopsy of prostate	Not listed in the file	Not listed in the file	$125.21
Prostate biopsy: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $125.21 Aetna — Medicare Adv PPO: $125.21 American Health — Medicare Adv UT HMO I-SNP: $125.21 Health Partners of Nevada — Medicare Advantage: $125.21 Health Plan of Nevada — Medicaid: $125.21 Healthy U — Medicaid: $125.21 Humana — Medicare Choice PPO: $125.21 Molina — Medicare Advantage: $125.21 Molina — Medicare Choice Care HMO: $125.21 Molina — Medicare Complete Care HMO SNP: $125.21
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$2,867.76 – $11,838.32
Prostate removal by laparoscope (radical prostatectomy): 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $10,762.11 Aetna — Medicare Adv PPO: $11,838.32 American Health — Medicare Adv UT HMO I-SNP: $11,192.59 Health Partners of Nevada — Medicare Advantage: $10,762.11 Health Plan of Nevada — Medicaid: $8,482.70 Healthy U — Medicaid: $8,482.70 Humana — Medicare Choice PPO: $11,300.21 Intermountain Caregiver Plan — Med Network: $3,258.82 Intermountain Caregiver Plan — Share Network: $2,867.76 Molina — Medicare Advantage: $11,838.32
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$958.41
Prostate removal by laparoscope (radical prostatectomy): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $958.41 Aetna — Medicare Adv PPO: $958.41 American Health — Medicare Adv UT HMO I-SNP: $958.41 Health Partners of Nevada — Medicare Advantage: $958.41 Health Plan of Nevada — Medicaid: $958.41 Healthy U — Medicaid: $958.41 Humana — Medicare Choice PPO: $958.41 Molina — Medicare Advantage: $958.41 Molina — Medicare Choice Care HMO: $958.41 Molina — Medicare Complete Care HMO SNP: $958.41
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$184.75
Prostate removal by laparoscope (radical prostatectomy): 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $184.75 Aetna — Medicare Adv PPO: $184.75 American Health — Medicare Adv UT HMO I-SNP: $184.75 Health Partners of Nevada — Medicare Advantage: $184.75 Health Plan of Nevada — Medicaid: $184.75 Healthy U — Medicaid: $184.75 Humana — Medicare Choice PPO: $184.75 Molina — Medicare Advantage: $184.75 Molina — Medicare Choice Care HMO: $184.75 Molina — Medicare Complete Care HMO SNP: $184.75
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$2,590.57 – $6,290
Hysteroscopy with biopsy of the uterus lining: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $3,276.92 Aetna — Medicare Adv PPO: $3,604.61 AG Administrators — USU Athletics: $6,290 American Health — Medicare Adv UT HMO I-SNP: $3,408 AWH Connected — Connected Utah: $6,290 BYU Athletics — Commercial: $6,290 Campbell Scientific — Commercial: $6,290 Deseret Mutual — All Other: $6,290 Deseret Mutual — Select: $6,290 EMI — Commercial: $6,290
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 62 In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$139.65
Hysteroscopy with biopsy of the uterus lining: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $139.65 Aetna — Medicare Adv PPO: $139.65 American Health — Medicare Adv UT HMO I-SNP: $139.65 Health Partners of Nevada — Medicare Advantage: $139.65 Health Plan of Nevada — Medicaid: $139.65 Healthy U — Medicaid: $139.65 Humana — Medicare Choice PPO: $139.65 Molina — Medicare Advantage: $139.65 Molina — Medicare Choice Care HMO: $139.65 Molina — Medicare Complete Care HMO SNP: $139.65
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$2,785.15	$2,088.86	$50.13 – $2,506.64
Spinal injection, lower back (epidural), with imaging guidance: 10 of 56 insurance plan rates Aetna — Connected: $2,228.12 Aetna — Extended: $2,367.38 AG Administrators — USU Athletics: $2,005.31 AWH Connected — Connected Utah: $1,768.57 BYU Athletics — Commercial: $2,005.31 BYU Risk Management — Workers Comp: $1,949.60 Campbell Scientific — Commercial: $2,005.31 Cigna — Open Access Flex: $1,754.64 Cigna — PPO/EPO: $2,367.38 Corporation of the President — Workers Comp: $1,949.60
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$2,785.15	$2,088.86	$674.01 – $2,506.64
Spinal injection, lower back (epidural), with imaging guidance: 10 of 55 insurance plan rates Aetna — Connected: $2,255.97 Aetna — Extended: $2,367.38 AG Administrators — USU Athletics: $2,005.31 AWH Connected — Connected Utah: $1,796.42 BYU Athletics — Commercial: $2,005.31 BYU Risk Management — Workers Comp: $2,033.16 Campbell Scientific — Commercial: $2,005.31 Cigna — Open Access Flex: $1,754.64 Cigna — PPO/EPO: $2,367.38 Corporation of the President — Workers Comp: $2,033.16
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$564.24 – $785.30
Spinal injection, lower back (epidural), with imaging guidance: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $713.91 Aetna — Medicare Adv PPO: $785.30 American Health — Medicare Adv UT HMO I-SNP: $742.47 Health Partners of Nevada — Medicare Advantage: $713.91 Health Plan of Nevada — Medicaid: $564.24 Healthy U — Medicaid: $564.24 Humana — Medicare Choice PPO: $749.61 Intermountain Caregiver Plan — Med Network: $676.69 Intermountain Caregiver Plan — Share Network: $595.49 Molina — Medicare Advantage: $785.30
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$1,909.87	$1,432.40	$34.38 – $1,718.88
Nerve root injection, lower back, with imaging guidance: 10 of 56 insurance plan rates Aetna — Connected: $1,527.90 Aetna — Extended: $1,623.39 AG Administrators — USU Athletics: $1,375.11 AWH Connected — Connected Utah: $1,212.77 BYU Athletics — Commercial: $1,375.11 BYU Risk Management — Workers Comp: $1,336.91 Campbell Scientific — Commercial: $1,375.11 Cigna — Open Access Flex: $1,203.22 Cigna — PPO/EPO: $1,623.39 Corporation of the President — Workers Comp: $1,336.91
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$1,909.87	$1,432.40	$462.19 – $1,718.88
Nerve root injection, lower back, with imaging guidance: 10 of 55 insurance plan rates Aetna — Connected: $1,546.99 Aetna — Extended: $1,623.39 AG Administrators — USU Athletics: $1,375.11 AWH Connected — Connected Utah: $1,231.87 BYU Athletics — Commercial: $1,375.11 BYU Risk Management — Workers Comp: $1,394.21 Campbell Scientific — Commercial: $1,375.11 Cigna — Open Access Flex: $1,203.22 Cigna — PPO/EPO: $1,623.39 Corporation of the President — Workers Comp: $1,394.21
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx aa&/strd tfrm epi l/s 1	Not listed in the file	Not listed in the file	$570.72 – $990.90
Nerve root injection, lower back, with imaging guidance: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $895.11 Aetna — Medicare Adv PPO: $984.62 American Health — Medicare Adv UT HMO I-SNP: $930.91 Health Partners of Nevada — Medicare Advantage: $895.11 Health Plan of Nevada — Medicaid: $725.38 Healthy U — Medicaid: $725.38 Humana — Medicare Choice PPO: $939.86 Intermountain Caregiver Plan — Med Network: $648.54 Intermountain Caregiver Plan — Share Network: $570.72 Molina — Medicare Advantage: $984.62
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$1,080.17 – $2,174.53
Carpal tunnel release: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $1,976.84 Aetna — Medicare Adv PPO: $2,174.53 American Health — Medicare Adv UT HMO I-SNP: $2,055.92 Health Partners of Nevada — Medicare Advantage: $1,976.84 Health Plan of Nevada — Medicaid: $1,591.05 Healthy U — Medicaid: $1,591.05 Humana — Medicare Choice PPO: $2,075.69 Intermountain Caregiver Plan — Med Network: $1,227.47 Intermountain Caregiver Plan — Share Network: $1,080.17 Molina — Medicare Advantage: $2,174.53
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$637.01
Carpal tunnel release: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $637.01 Aetna — Medicare Adv PPO: $637.01 American Health — Medicare Adv UT HMO I-SNP: $637.01 Health Partners of Nevada — Medicare Advantage: $637.01 Health Plan of Nevada — Medicaid: $637.01 Healthy U — Medicaid: $637.01 Humana — Medicare Choice PPO: $637.01 Molina — Medicare Advantage: $637.01 Molina — Medicare Choice Care HMO: $637.01 Molina — Medicare Complete Care HMO SNP: $637.01
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$322.75
Carpal tunnel release: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $322.75 Aetna — Medicare Adv PPO: $322.75 American Health — Medicare Adv UT HMO I-SNP: $322.75 Health Partners of Nevada — Medicare Advantage: $322.75 Health Plan of Nevada — Medicaid: $322.75 Healthy U — Medicaid: $322.75 Humana — Medicare Choice PPO: $322.75 Molina — Medicare Advantage: $322.75 Molina — Medicare Choice Care HMO: $322.75 Molina — Medicare Complete Care HMO SNP: $322.75
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,457.97	$1,093.48	$26.24 – $1,312.17
Laser treatment of clouding after cataract surgery: 10 of 56 insurance plan rates Aetna — Connected: $1,166.38 Aetna — Extended: $1,239.27 AG Administrators — USU Athletics: $1,049.74 AWH Connected — Connected Utah: $925.81 BYU Athletics — Commercial: $1,049.74 BYU Risk Management — Workers Comp: $1,020.58 Campbell Scientific — Commercial: $1,049.74 Cigna — Open Access Flex: $918.52 Cigna — PPO/EPO: $1,239.27 Corporation of the President — Workers Comp: $1,020.58
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,457.97	$1,093.48	$352.83 – $1,312.17
Laser treatment of clouding after cataract surgery: 10 of 55 insurance plan rates Aetna — Connected: $1,180.96 Aetna — Extended: $1,239.27 AG Administrators — USU Athletics: $1,049.74 AWH Connected — Connected Utah: $940.39 BYU Athletics — Commercial: $1,049.74 BYU Risk Management — Workers Comp: $1,064.32 Campbell Scientific — Commercial: $1,049.74 Cigna — Open Access Flex: $918.52 Cigna — PPO/EPO: $1,239.27 Corporation of the President — Workers Comp: $1,064.32
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$446.98 – $928.14
Laser treatment of clouding after cataract surgery: 10 of 27 insurance plan rates Aetna — Medicare Adv HMO: $556.27 Aetna — Medicare Adv PPO: $611.90 American Health — Medicare Adv UT HMO I-SNP: $578.52 Health Partners of Nevada — Medicare Advantage: $556.27 Health Plan of Nevada — Medicaid: $446.98 Healthy U — Medicaid: $446.98 Humana — Medicare Choice PPO: $584.08 Intermountain Caregiver Plan — Med Network: $883.94 Intermountain Caregiver Plan — Share Network: $777.87 Molina — Medicare Advantage: $611.90
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$1,858.26 – $4,182
Cataract removal with lens implant: 10 of 47 insurance plan rates Aetna — Medicare Adv HMO: $2,336.52 Aetna — Medicare Adv PPO: $2,570.17 AG Administrators — USU Athletics: $4,182 American Health — Medicare Adv UT HMO I-SNP: $2,429.98 AWH Connected — Connected Utah: $4,182 BYU Athletics — Commercial: $4,182 Campbell Scientific — Commercial: $4,182 Deseret Mutual — All Other: $4,182 Deseret Mutual — Select: $4,182 EMI — Commercial: $4,182
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$778.58
Cataract removal with lens implant: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $778.58 Aetna — Medicare Adv PPO: $778.58 American Health — Medicare Adv UT HMO I-SNP: $778.58 Health Partners of Nevada — Medicare Advantage: $778.58 Health Plan of Nevada — Medicaid: $778.58 Healthy U — Medicaid: $778.58 Humana — Medicare Choice PPO: $778.58 Molina — Medicare Advantage: $778.58 Molina — Medicare Choice Care HMO: $778.58 Molina — Medicare Complete Care HMO SNP: $778.58
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$363.34
Cataract removal with lens implant: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $363.34 Aetna — Medicare Adv PPO: $363.34 American Health — Medicare Adv UT HMO I-SNP: $363.34 Health Partners of Nevada — Medicare Advantage: $363.34 Health Plan of Nevada — Medicaid: $363.34 Healthy U — Medicaid: $363.34 Humana — Medicare Choice PPO: $363.34 Molina — Medicare Advantage: $363.34 Molina — Medicare Choice Care HMO: $363.34 Molina — Medicare Complete Care HMO SNP: $363.34

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$2,326.99
Vaginal delivery, with care before and after: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $2,326.99 Aetna — Medicare Adv PPO: $2,326.99 American Health — Medicare Adv UT HMO I-SNP: $2,326.99 Health Partners of Nevada — Medicare Advantage: $2,326.99 Health Plan of Nevada — Medicaid: $2,326.99 Healthy U — Medicaid: $2,326.99 Humana — Medicare Choice PPO: $2,326.99 Molina — Medicare Advantage: $2,326.99 Molina — Medicare Choice Care HMO: $2,326.99 Molina — Medicare Complete Care HMO SNP: $2,326.99
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$5,790.53 – $6,909.16
Vaginal delivery, with care before and after: rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $6,580.15 Intermountain Caregiver Plan — Share Network: $5,790.53 SelectHealth — CHP: $6,580.15 SelectHealth — CH{: $6,580.15 SelectHealth — Commercial: $6,580.15 SelectHealth — FEHBP: $6,909.16 SelectHealth — SelectCare: $6,909.16 SelectHealth — SelectShare: $5,790.53 SelectHealth — SelectValue: $5,790.53
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$2,572.16
Cesarean delivery (C-section), with care before and after: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $2,572.16 Aetna — Medicare Adv PPO: $2,572.16 American Health — Medicare Adv UT HMO I-SNP: $2,572.16 Health Partners of Nevada — Medicare Advantage: $2,572.16 Health Plan of Nevada — Medicaid: $2,572.16 Healthy U — Medicaid: $2,572.16 Humana — Medicare Choice PPO: $2,572.16 Molina — Medicare Advantage: $2,572.16 Molina — Medicare Choice Care HMO: $2,572.16 Molina — Medicare Complete Care HMO SNP: $2,572.16
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$6,431.67 – $7,674.16
Cesarean delivery (C-section), with care before and after: rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $7,308.72 Intermountain Caregiver Plan — Share Network: $6,431.67 SelectHealth — CHP: $7,308.72 SelectHealth — CH{: $7,308.72 SelectHealth — Commercial: $7,308.72 SelectHealth — FEHBP: $7,674.16 SelectHealth — SelectCare: $7,674.16 SelectHealth — SelectShare: $6,431.67 SelectHealth — SelectValue: $6,431.67
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$2,434.98
Vaginal delivery after a previous C-section, with care before and after: 10 of 17 insurance plan rates Aetna — Medicare Adv HMO: $2,434.98 Aetna — Medicare Adv PPO: $2,434.98 American Health — Medicare Adv UT HMO I-SNP: $2,434.98 Health Partners of Nevada — Medicare Advantage: $2,434.98 Health Plan of Nevada — Medicaid: $2,434.98 Healthy U — Medicaid: $2,434.98 Humana — Medicare Choice PPO: $2,434.98 Molina — Medicare Advantage: $2,434.98 Molina — Medicare Choice Care HMO: $2,434.98 Molina — Medicare Complete Care HMO SNP: $2,434.98
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$6,065.10 – $7,236.77
Vaginal delivery after a previous C-section, with care before and after: rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $6,892.16 Intermountain Caregiver Plan — Share Network: $6,065.10 SelectHealth — CHP: $6,892.16 SelectHealth — CH{: $6,892.16 SelectHealth — Commercial: $6,892.16 SelectHealth — FEHBP: $7,236.77 SelectHealth — SelectCare: $7,236.77 SelectHealth — SelectShare: $6,065.10 SelectHealth — SelectValue: $6,065.10

Source: American Fork Hospital’s standard charges file (intermountainhealthcare.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on August 5, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	170 North 1100 East, American Fork, UT 84003
County	Utah County
State	Utah
Phone	(801) 855‑3305
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	460023
Name in Medicare records	AMERICAN FORK HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(801) 855‑3300^[4]
Official website	intermountainhealth.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-31.

American Fork Hospital — intermountainhealth.org
Medical Services - Intermountain Health — intermountainhealth.org
American Fork Hospital Emergency Department — intermountainhealth.org
About American Fork Hospital | American Fork, UT — intermountainhealth.org

American Fork Hospital

Summary

Profile from official sources

At a glance