Does Intermountain Health Garfield Memorial Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Intermountain Health Garfield Memorial Hospital. In a medical emergency, call 911.

Where is Intermountain Health Garfield Memorial Hospital?

200 North 400 East, Panguitch, UT 84759, in Garfield County, Utah.

What is the phone number of Intermountain Health Garfield Memorial Hospital?

(435) 676-1262, as listed by Medicare (CMS).

What is the Medicare star rating of Intermountain Health Garfield Memorial Hospital?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Intermountain Health Garfield Memorial Hospital

Quick answers

Does Intermountain Health Garfield Memorial Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Intermountain Health Garfield Memorial Hospital. In a medical emergency, call 911.
Where is Intermountain Health Garfield Memorial Hospital?: 200 North 400 East, Panguitch, UT 84759, in Garfield County, Utah.
What is the phone number of Intermountain Health Garfield Memorial Hospital?: (435) 676-1262, as listed by Medicare (CMS).
What is the Medicare star rating of Intermountain Health Garfield Memorial Hospital?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4][5]

Emergency care
Imaging
Laboratory
Nutrition services
Rehabilitation
Surgical services
Women's health
Trauma care
Imaging and radiology

Programs and centers^[4][6]

Community health and wellness classes
Community health and wellness classes (including pregnancy and childbirth, support groups)
Mobile mammography unit
Mobile clinic and pharmacy for rural communities
Intermountain virtual hospital network support

Emergency care (hospital website)^[4][5]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visiting hours are listed as 9 a.m. to 9 p.m^[4]
Patient portal	Intermountain Health patient portal (MyChart)

Recognition^[6]

Critical Access hospital

Doctors and clinicians (82)

82 doctors and other clinicians list Intermountain Health Garfield Memorial 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

Doctors with a page on this site (82)

Alan B. Sanderson, MDNeurology
Alan H. Pearson, NPNurse Practitioner
Alan K. Sutak, MDOrthopedic Surgery
Benjamin E. Bailey, CNACertified Registered Nurse Anesthetist (CRNA)
Benjamin N. Voorhies, MDMedical Oncology
Blake W. Arnold, MDDiagnostic Radiology
Brad S. Webb, DPMPodiatry
Bret D. Hilton, PAPhysician Assistant
Brock Bleazard, DODiagnostic Radiology
Bryce Perkins, DOHematology/Oncology
Carmen Gota, MDRheumatology
Chace Love, NPNurse Practitioner
Christopher H. Strawter, MDPulmonary Disease
Codie BinghamNurse Practitioner
Colin T. Marshall, DOFamily Practice
Colten D. Bracken, MDEmergency Medicine
Daniel M. Palmer, PAPhysician Assistant
Daralee Kjar, NPNurse Practitioner
David T. Cowley, NPNurse Practitioner
Dayne A. JohnsonPhysician Assistant
Don Neer, MDHospitalist
Donald J. Willows, PAPhysician Assistant
Elisa A. Edwards, NPNurse Practitioner
Eric J. Root, DOFamily Practice

And 58 more: the button below opens the full list.

Other emergency rooms nearby

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

Beaver Valley Hospital34 mi · Beaver, UT · Critical Access Hospital
Intermountain Health Cedar City Hospital36 mi · Cedar City, UT · Acute Care Hospital
Milford Memorial Hospital46 mi · Milford, UT · Critical Access Hospital
Kane County Hospital54 mi · Kanab, UT · Critical Access Hospital
Intermountain Health Sevier Valley Hospital69 mi · Richfield, UT · Acute Care Hospital

Other hospitals nearby

Intermountain Health Fillmore Community Hospital78 mi · Fillmore, UT · Critical Access Hospital

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

Garfield County Nursing Home9.5 mi · Panguitch, UT · 4 of 5 stars

All nursing homes 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.

Clinics and urgent care

Garfield Memorial Hospital7.2 mi · Panguitch, UT · Rural health clinic
Parowan Medical Clinic24 mi · Parowan, UT · Rural health clinic

Pharmacies

Samuel I Marshall, P, C.7.2 mi · Panguitch, UT · Community/retail pharmacy

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 Intermountain Health Garfield Memorial 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)	Not reported to Medicare
Overall rating of the hospital	Not reported to Medicare
Would recommend the hospital	Not reported to Medicare
Nurses communicated well	Not reported to Medicare
Doctors communicated well	Not reported to Medicare
Staff explained medicines	Not reported to Medicare
Information about recovery at home	Not reported to Medicare
Room and bathroom kept clean	Not reported to Medicare
Quiet at night	Not reported to Medicare
Rated the hospital 9 or 10 out of 10	91%National average: 72%
Would definitely recommend the hospital	92%National average: 71%
Nurses “always” communicated well	90%National average: 80%
Doctors “always” communicated well	92%National average: 80%
Staff “always” explained medicines before giving them	71%National average: 62%
Were given information about recovery at home	94%National average: 86%
Room and bathroom “always” clean	91%National average: 74%
Area around the room “always” quiet at night	61%National average: 60%
Completed surveys	68Response rate: 34%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 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.

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	Not reported to Medicare

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026.

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 attack patients	Not reported to Medicare
Deaths within 30 days: heart failure patients	Too few cases to report
Deaths within 30 days: pneumonia patients	15.2%
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Not reported to Medicare
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	Not reported to Medicare
Complications after hip or knee replacement	Not reported to Medicare

Source: Complications and Deaths - Hospital — CMS, released September 10, 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)	Not reported to Medicare
Readmitted within 30 days: heart attack	Not reported to Medicare
Readmitted within 30 days: heart failure	Too few cases to report
Readmitted within 30 days: pneumonia	Too few cases to report
Readmitted within 30 days: COPD	Too few cases to report
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Not reported to Medicare

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026.

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)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	94 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	41%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

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 80 common services exactly as Intermountain Health Garfield Memorial 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 →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$126.92 – $320.65
New patient office visit (about 30–44 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $320.65 Aetna — Aetna Medicare HMO: $126.92 Aetna — Aetna Medicare PPO: $126.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $320.65 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31
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	$172.05 – $317.31
New patient office visit (about 30–44 minutes): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $317.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $317.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31 Cigna — PPO/EPO: $317.31 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $317.31
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $80.54 Aetna — Aetna Medicare PPO: $80.54 Health Choice Utah — Health Choice Utah-Medicaid: $80.54 Healthy U — Medicaid: $80.54 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $80.54 Molina — Medicaid: $80.54 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $80.54 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $80.54 SelectHealth — Medicaid: $80.54 SelectHealth — Medicare Advantage: $80.54
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	$126.92 – $320.65
New patient office visit (about 45–59 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $320.65 Aetna — Aetna Medicare HMO: $126.92 Aetna — Aetna Medicare PPO: $126.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $320.65 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31
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	$172.05 – $317.31
New patient office visit (about 45–59 minutes): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $317.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $317.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31 Cigna — PPO/EPO: $317.31 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $317.31
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $129.68 Aetna — Aetna Medicare PPO: $129.68 Health Choice Utah — Health Choice Utah-Medicaid: $129.68 Healthy U — Medicaid: $129.68 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $129.68 Molina — Medicaid: $129.68 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $129.68 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $129.68 SelectHealth — Medicaid: $129.68 SelectHealth — Medicare Advantage: $129.68
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	$126.92 – $320.65
New patient office visit (about 60–74 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $320.65 Aetna — Aetna Medicare HMO: $126.92 Aetna — Aetna Medicare PPO: $126.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $320.65 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31
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	$172.05 – $317.31
New patient office visit (about 60–74 minutes): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $317.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $317.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31 Cigna — PPO/EPO: $317.31 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $317.31
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $176.02 Aetna — Aetna Medicare PPO: $176.02 Health Choice Utah — Health Choice Utah-Medicaid: $176.02 Healthy U — Medicaid: $176.02 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $176.02 Molina — Medicaid: $176.02 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $176.02 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $176.02 SelectHealth — Medicaid: $176.02 SelectHealth — Medicare Advantage: $176.02
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	$170.45	$127.84	$64.77 – $163.63
Established patient office visit (about 20–29 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $163.63 Aetna — Aetna Medicare HMO: $64.77 Aetna — Aetna Medicare PPO: $64.77 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $161.93 Aetna — Aetna Utah Connected Network: $161.93 Aetna — Aetna Whole Health Connected Utah Network: $163.63 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $161.93 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $161.93 BYU Athletic Department — Athletic Services: $161.93 Campbell Scientific — Samera Health: $161.93
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	$170.45	$127.84	$87.80 – $161.93
Established patient office visit (about 20–29 minutes): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $161.93 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $161.93 Aetna — Aetna Utah Connected Network: $161.93 Aetna — Aetna Whole Health Connected Utah Network: $161.93 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $161.93 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $161.93 BYU Athletic Department — Athletic Services: $161.93 Campbell Scientific — Samera Health: $161.93 Cigna — PPO/EPO: $161.93 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $161.93
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $64.24 Aetna — Aetna Medicare PPO: $64.24 Health Choice Utah — Health Choice Utah-Medicaid: $64.24 Healthy U — Medicaid: $64.24 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $64.24 Molina — Medicaid: $64.24 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $64.24 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $64.24 SelectHealth — Medicaid: $64.24 SelectHealth — Medicare Advantage: $64.24
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	$334.01	$250.51	$126.92 – $320.65
Established patient office visit (about 30–39 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $320.65 Aetna — Aetna Medicare HMO: $126.92 Aetna — Aetna Medicare PPO: $126.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $320.65 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31
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	$334.01	$250.51	$172.05 – $317.31
Established patient office visit (about 30–39 minutes): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $317.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $317.31 Aetna — Aetna Utah Connected Network: $317.31 Aetna — Aetna Whole Health Connected Utah Network: $317.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $317.31 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $317.31 BYU Athletic Department — Athletic Services: $317.31 Campbell Scientific — Samera Health: $317.31 Cigna — PPO/EPO: $317.31 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $317.31
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $94.90 Aetna — Aetna Medicare PPO: $94.90 Health Choice Utah — Health Choice Utah-Medicaid: $94.90 Healthy U — Medicaid: $94.90 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $94.90 Molina — Medicaid: $94.90 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $94.90 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $94.90 SelectHealth — Medicaid: $94.90 SelectHealth — Medicare Advantage: $94.90
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREVENTIVE VISIT,NEW,18-39	$262.71	$197.03	$99.83 – $252.20
Preventive checkup, new patient, age 18–39: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $252.20 Aetna — Aetna Medicare HMO: $99.83 Aetna — Aetna Medicare PPO: $99.83 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $249.57 Aetna — Aetna Utah Connected Network: $249.57 Aetna — Aetna Whole Health Connected Utah Network: $252.20 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $249.57 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $249.57 BYU Athletic Department — Athletic Services: $249.57 Campbell Scientific — Samera Health: $249.57
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREVENTIVE VISIT,NEW,18-39	$262.71	$197.03	$135.32 – $249.57
Preventive checkup, new patient, age 18–39: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $249.57 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $249.57 Aetna — Aetna Utah Connected Network: $249.57 Aetna — Aetna Whole Health Connected Utah Network: $249.57 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $249.57 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $249.57 BYU Athletic Department — Athletic Services: $249.57 Campbell Scientific — Samera Health: $249.57 Cigna — PPO/EPO: $249.57 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $249.57
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PREVENTIVE VISIT,NEW,40-64	$517.74	$388.30	$196.74 – $497.03
Preventive checkup, new patient, age 40–64: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $497.03 Aetna — Aetna Medicare HMO: $196.74 Aetna — Aetna Medicare PPO: $196.74 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $491.85 Aetna — Aetna Utah Connected Network: $491.85 Aetna — Aetna Whole Health Connected Utah Network: $497.03 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $491.85 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $491.85 BYU Athletic Department — Athletic Services: $491.85 Campbell Scientific — Samera Health: $491.85
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PREVENTIVE VISIT,NEW,40-64	$517.74	$388.30	$266.69 – $491.85
Preventive checkup, new patient, age 40–64: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $491.85 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $491.85 Aetna — Aetna Utah Connected Network: $491.85 Aetna — Aetna Whole Health Connected Utah Network: $491.85 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $491.85 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $491.85 BYU Athletic Department — Athletic Services: $491.85 Campbell Scientific — Samera Health: $491.85 Cigna — PPO/EPO: $491.85 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $491.85
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM-LEVEL 3	$1,659.54	$1,244.66	$630.63 – $1,593.16
Emergency room visit (moderate): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,593.16 Aetna — Aetna Medicare HMO: $630.63 Aetna — Aetna Medicare PPO: $630.63 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,576.56 Aetna — Aetna Utah Connected Network: $1,576.56 Aetna — Aetna Whole Health Connected Utah Network: $1,593.16 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,576.56 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,576.56 BYU Athletic Department — Athletic Services: $1,576.56 Campbell Scientific — Samera Health: $1,576.56
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 3 W/MOD	$1,659.54	$1,244.66	$630.63 – $1,593.16
Emergency room visit (moderate): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,593.16 Aetna — Aetna Medicare HMO: $630.63 Aetna — Aetna Medicare PPO: $630.63 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,576.56 Aetna — Aetna Utah Connected Network: $1,576.56 Aetna — Aetna Whole Health Connected Utah Network: $1,593.16 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,576.56 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,576.56 BYU Athletic Department — Athletic Services: $1,576.56 Campbell Scientific — Samera Health: $1,576.56
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM-LEVEL 3	$1,659.54	$1,244.66	$854.83 – $1,576.56
Emergency room visit (moderate): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $1,576.56 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,576.56 Aetna — Aetna Utah Connected Network: $1,576.56 Aetna — Aetna Whole Health Connected Utah Network: $1,576.56 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,576.56 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,576.56 BYU Athletic Department — Athletic Services: $1,576.56 Campbell Scientific — Samera Health: $1,576.56 Cigna — PPO/EPO: $1,576.56 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,576.56
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,489.16	$1,866.87	$945.88 – $2,389.59
Emergency room visit (moderately high): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $2,389.59 Aetna — Aetna Medicare HMO: $945.88 Aetna — Aetna Medicare PPO: $945.88 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,364.70 Aetna — Aetna Utah Connected Network: $2,364.70 Aetna — Aetna Whole Health Connected Utah Network: $2,389.59 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,364.70 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,364.70 BYU Athletic Department — Athletic Services: $2,364.70 Campbell Scientific — Samera Health: $2,364.70
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,489.16	$1,866.87	$1,282.17 – $2,364.70
Emergency room visit (moderately high): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,364.70 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,364.70 Aetna — Aetna Utah Connected Network: $2,364.70 Aetna — Aetna Whole Health Connected Utah Network: $2,364.70 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,364.70 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,364.70 BYU Athletic Department — Athletic Services: $2,364.70 Campbell Scientific — Samera Health: $2,364.70 Cigna — PPO/EPO: $2,364.70 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,364.70
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$118.65
Emergency room visit (moderately high): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $118.65 Aetna — Aetna Medicare PPO: $118.65 Health Choice Utah — Health Choice Utah-Medicaid: $118.65 Healthy U — Medicaid: $118.65 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $118.65 Molina — Medicaid: $118.65 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $118.65 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $118.65 SelectHealth — Medicaid: $118.65 SelectHealth — Medicare Advantage: $118.65
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$3,733.69	$2,800.27	$1,418.80 – $3,584.34
Emergency room visit (high): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $3,584.34 Aetna — Aetna Medicare HMO: $1,418.80 Aetna — Aetna Medicare PPO: $1,418.80 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,547.01 Aetna — Aetna Utah Connected Network: $3,547.01 Aetna — Aetna Whole Health Connected Utah Network: $3,584.34 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,547.01 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,547.01 BYU Athletic Department — Athletic Services: $3,547.01 Campbell Scientific — Samera Health: $3,547.01
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$3,733.69	$2,800.27	$1,923.22 – $3,547.01
Emergency room visit (high): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $3,547.01 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,547.01 Aetna — Aetna Utah Connected Network: $3,547.01 Aetna — Aetna Whole Health Connected Utah Network: $3,547.01 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,547.01 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,547.01 BYU Athletic Department — Athletic Services: $3,547.01 Campbell Scientific — Samera Health: $3,547.01 Cigna — PPO/EPO: $3,547.01 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $3,547.01
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$172.65
Emergency room visit (high): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $172.65 Aetna — Aetna Medicare PPO: $172.65 Health Choice Utah — Health Choice Utah-Medicaid: $172.65 Healthy U — Medicaid: $172.65 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $172.65 Molina — Medicaid: $172.65 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $172.65 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $172.65 SelectHealth — Medicaid: $172.65 SelectHealth — Medicare Advantage: $172.65

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$55.02	$41.26	$20.91 – $52.82
Basic metabolic panel (blood test): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $52.82 Aetna — Aetna Medicare HMO: $20.91 Aetna — Aetna Medicare PPO: $20.91 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $52.27 Aetna — Aetna Utah Connected Network: $52.27 Aetna — Aetna Whole Health Connected Utah Network: $52.82 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $52.27 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $52.27 BYU Athletic Department — Athletic Services: $52.27 Campbell Scientific — Samera Health: $52.27
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$55.02	$41.26	$28.34 – $52.27
Basic metabolic panel (blood test): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $52.27 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $52.27 Aetna — Aetna Utah Connected Network: $52.27 Aetna — Aetna Whole Health Connected Utah Network: $52.27 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $52.27 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $52.27 BYU Athletic Department — Athletic Services: $52.27 Campbell Scientific — Samera Health: $52.27 Cigna — PPO/EPO: $52.27 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $52.27
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	$67
Basic metabolic panel (blood test): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $9.31 Aetna — Aetna Medicare PPO: $9.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $67 Aetna — Aetna Utah Connected Network: $67 Aetna — Aetna Whole Health Connected Utah Network: $67 BYU Athletic Department — Athletic Services: $67 Campbell Scientific — Samera Health: $67 Cigna — PPO/EPO: $67 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $67 Deseret Mutual — DMBA: $67
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$81.45	$61.09	$30.95 – $78.19
Comprehensive metabolic panel (blood test): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $78.19 Aetna — Aetna Medicare HMO: $30.95 Aetna — Aetna Medicare PPO: $30.95 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $77.38 Aetna — Aetna Utah Connected Network: $77.38 Aetna — Aetna Whole Health Connected Utah Network: $78.19 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $77.38 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $77.38 BYU Athletic Department — Athletic Services: $77.38 Campbell Scientific — Samera Health: $77.38
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$81.45	$61.09	$41.95 – $77.38
Comprehensive metabolic panel (blood test): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $77.38 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $77.38 Aetna — Aetna Utah Connected Network: $77.38 Aetna — Aetna Whole Health Connected Utah Network: $77.38 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $77.38 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $77.38 BYU Athletic Department — Athletic Services: $77.38 Campbell Scientific — Samera Health: $77.38 Cigna — PPO/EPO: $77.38 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $77.38
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	$95
Comprehensive metabolic panel (blood test): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $11.62 Aetna — Aetna Medicare PPO: $11.62 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $95 Aetna — Aetna Utah Connected Network: $95 Aetna — Aetna Whole Health Connected Utah Network: $95 BYU Athletic Department — Athletic Services: $95 Campbell Scientific — Samera Health: $95 Cigna — PPO/EPO: $95 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $95 Deseret Mutual — DMBA: $95
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$274.04	$205.53	$104.14 – $263.08
Obstetric blood test panel: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $263.08 Aetna — Aetna Medicare HMO: $104.14 Aetna — Aetna Medicare PPO: $104.14 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $260.34 Aetna — Aetna Utah Connected Network: $260.34 Aetna — Aetna Whole Health Connected Utah Network: $263.08 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $260.34 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $260.34 BYU Athletic Department — Athletic Services: $260.34 Campbell Scientific — Samera Health: $260.34
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$274.04	$205.53	$141.16 – $260.34
Obstetric blood test panel: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $260.34 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $260.34 Aetna — Aetna Utah Connected Network: $260.34 Aetna — Aetna Whole Health Connected Utah Network: $260.34 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $260.34 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $260.34 BYU Athletic Department — Athletic Services: $260.34 Campbell Scientific — Samera Health: $260.34 Cigna — PPO/EPO: $260.34 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $260.34
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	$121
Obstetric blood test panel: 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $52.59 Aetna — Aetna Medicare PPO: $52.59 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $129 Aetna — Aetna Utah Connected Network: $129 Aetna — Aetna Whole Health Connected Utah Network: $129 BYU Athletic Department — Athletic Services: $129 Campbell Scientific — Samera Health: $129 Cigna — PPO/EPO: $129 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $129 Deseret Mutual — DMBA: $129
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$80.38	$60.28	$30.54 – $77.16
Cholesterol panel (lipid panel): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $77.16 Aetna — Aetna Medicare HMO: $30.54 Aetna — Aetna Medicare PPO: $30.54 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $76.36 Aetna — Aetna Utah Connected Network: $76.36 Aetna — Aetna Whole Health Connected Utah Network: $77.16 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $76.36 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $76.36 BYU Athletic Department — Athletic Services: $76.36 Campbell Scientific — Samera Health: $76.36
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$80.38	$60.28	$41.40 – $76.36
Cholesterol panel (lipid panel): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $76.36 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $76.36 Aetna — Aetna Utah Connected Network: $76.36 Aetna — Aetna Whole Health Connected Utah Network: $76.36 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $76.36 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $76.36 BYU Athletic Department — Athletic Services: $76.36 Campbell Scientific — Samera Health: $76.36 Cigna — PPO/EPO: $76.36 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $76.36
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	$95
Cholesterol panel (lipid panel): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $14.73 Aetna — Aetna Medicare PPO: $14.73 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $95 Aetna — Aetna Utah Connected Network: $95 Aetna — Aetna Whole Health Connected Utah Network: $95 BYU Athletic Department — Athletic Services: $95 Campbell Scientific — Samera Health: $95 Cigna — PPO/EPO: $95 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $95 Deseret Mutual — DMBA: $95
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$57.42	$43.06	$21.82 – $55.12
Kidney function panel: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $55.12 Aetna — Aetna Medicare HMO: $21.82 Aetna — Aetna Medicare PPO: $21.82 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $54.55 Aetna — Aetna Utah Connected Network: $54.55 Aetna — Aetna Whole Health Connected Utah Network: $55.12 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $54.55 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $54.55 BYU Athletic Department — Athletic Services: $54.55 Campbell Scientific — Samera Health: $54.55
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$57.42	$43.06	$29.58 – $54.55
Kidney function panel: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $54.55 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $54.55 Aetna — Aetna Utah Connected Network: $54.55 Aetna — Aetna Whole Health Connected Utah Network: $54.55 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $54.55 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $54.55 BYU Athletic Department — Athletic Services: $54.55 Campbell Scientific — Samera Health: $54.55 Cigna — PPO/EPO: $54.55 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $54.55
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	$53
Kidney function panel: 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $9.55 Aetna — Aetna Medicare PPO: $9.55 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $53 Aetna — Aetna Utah Connected Network: $53 Aetna — Aetna Whole Health Connected Utah Network: $53 BYU Athletic Department — Athletic Services: $53 Campbell Scientific — Samera Health: $53 Cigna — PPO/EPO: $53 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $53 Deseret Mutual — DMBA: $53
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$53.46	$40.10	$20.31 – $51.32
Liver function panel: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $51.32 Aetna — Aetna Medicare HMO: $20.31 Aetna — Aetna Medicare PPO: $20.31 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $50.79 Aetna — Aetna Utah Connected Network: $50.79 Aetna — Aetna Whole Health Connected Utah Network: $51.32 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $50.79 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $50.79 BYU Athletic Department — Athletic Services: $50.79 Campbell Scientific — Samera Health: $50.79
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$53.46	$40.10	$27.54 – $50.79
Liver function panel: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $50.79 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $50.79 Aetna — Aetna Utah Connected Network: $50.79 Aetna — Aetna Whole Health Connected Utah Network: $50.79 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $50.79 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $50.79 BYU Athletic Department — Athletic Services: $50.79 Campbell Scientific — Samera Health: $50.79 Cigna — PPO/EPO: $50.79 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $50.79
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	$55
Liver function panel: 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $8.99 Aetna — Aetna Medicare PPO: $8.99 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $55 Aetna — Aetna Utah Connected Network: $55 Aetna — Aetna Whole Health Connected Utah Network: $55 BYU Athletic Department — Athletic Services: $55 Campbell Scientific — Samera Health: $55 Cigna — PPO/EPO: $55 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $55 Deseret Mutual — DMBA: $55
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$37.12	$27.84	$14.11 – $35.64
Urine test (automated, with microscope): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $35.64 Aetna — Aetna Medicare HMO: $14.11 Aetna — Aetna Medicare PPO: $14.11 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $35.26 Aetna — Aetna Utah Connected Network: $35.26 Aetna — Aetna Whole Health Connected Utah Network: $35.64 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $35.26 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $35.26 BYU Athletic Department — Athletic Services: $35.26 Campbell Scientific — Samera Health: $35.26
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$37.12	$27.84	$19.12 – $35.26
Urine test (automated, with microscope): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $35.26 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $35.26 Aetna — Aetna Utah Connected Network: $35.26 Aetna — Aetna Whole Health Connected Utah Network: $35.26 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $35.26 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $35.26 BYU Athletic Department — Athletic Services: $35.26 Campbell Scientific — Samera Health: $35.26 Cigna — PPO/EPO: $35.26 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $35.26
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	$52
Urine test (automated, with microscope): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $3.49 Aetna — Aetna Medicare PPO: $3.49 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $52 Aetna — Aetna Utah Connected Network: $52 Aetna — Aetna Whole Health Connected Utah Network: $52 BYU Athletic Department — Athletic Services: $52 Campbell Scientific — Samera Health: $52 Cigna — PPO/EPO: $52 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $52 Deseret Mutual — DMBA: $52
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$23.76	$17.82	$9.03 – $22.81
Urine test (manual, without microscope): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $22.81 Aetna — Aetna Medicare HMO: $9.03 Aetna — Aetna Medicare PPO: $9.03 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $22.57 Aetna — Aetna Utah Connected Network: $22.57 Aetna — Aetna Whole Health Connected Utah Network: $22.81 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $22.57 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $22.57 BYU Athletic Department — Athletic Services: $22.57 Campbell Scientific — Samera Health: $22.57
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$23.76	$17.82	$12.24 – $22.57
Urine test (manual, without microscope): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $22.57 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $22.57 Aetna — Aetna Utah Connected Network: $22.57 Aetna — Aetna Whole Health Connected Utah Network: $22.57 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $22.57 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $22.57 BYU Athletic Department — Athletic Services: $22.57 Campbell Scientific — Samera Health: $22.57 Cigna — PPO/EPO: $22.57 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $22.57
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	$52
Urine test (manual, without microscope): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $3.83 Aetna — Aetna Medicare PPO: $3.83 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $52 Aetna — Aetna Utah Connected Network: $52 Aetna — Aetna Whole Health Connected Utah Network: $52 BYU Athletic Department — Athletic Services: $52 Campbell Scientific — Samera Health: $52 Cigna — PPO/EPO: $52 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $52 Deseret Mutual — DMBA: $52
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	$52.53	$39.40	$19.96 – $50.43
Urine test (automated, without microscope): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $50.43 Aetna — Aetna Medicare HMO: $19.96 Aetna — Aetna Medicare PPO: $19.96 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $49.90 Aetna — Aetna Utah Connected Network: $49.90 Aetna — Aetna Whole Health Connected Utah Network: $50.43 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $49.90 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $49.90 BYU Athletic Department — Athletic Services: $49.90 Campbell Scientific — Samera Health: $49.90
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED	$16.73	$12.55	$6.36 – $16.06
Urine test (automated, without microscope): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $16.06 Aetna — Aetna Medicare HMO: $6.36 Aetna — Aetna Medicare PPO: $6.36 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $15.89 Aetna — Aetna Utah Connected Network: $15.89 Aetna — Aetna Whole Health Connected Utah Network: $16.06 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $15.89 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $15.89 BYU Athletic Department — Athletic Services: $15.89 Campbell Scientific — Samera Health: $15.89
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED POCL/POCBS	$52.53	$39.40	$27.06 – $49.90
Urine test (automated, without microscope): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $49.90 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $49.90 Aetna — Aetna Utah Connected Network: $49.90 Aetna — Aetna Whole Health Connected Utah Network: $49.90 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $49.90 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $49.90 BYU Athletic Department — Athletic Services: $49.90 Campbell Scientific — Samera Health: $49.90 Cigna — PPO/EPO: $49.90 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $49.90
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$108.92	$81.69	$41.39 – $104.56
PSA (prostate specific antigen) blood test: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $104.56 Aetna — Aetna Medicare HMO: $41.39 Aetna — Aetna Medicare PPO: $41.39 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $103.47 Aetna — Aetna Utah Connected Network: $103.47 Aetna — Aetna Whole Health Connected Utah Network: $104.56 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $103.47 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $103.47 BYU Athletic Department — Athletic Services: $103.47 Campbell Scientific — Samera Health: $103.47
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN COMPLEX	$108.92	$81.69	$41.39 – $104.56
PSA (prostate specific antigen) blood test: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $104.56 Aetna — Aetna Medicare HMO: $41.39 Aetna — Aetna Medicare PPO: $41.39 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $103.47 Aetna — Aetna Utah Connected Network: $103.47 Aetna — Aetna Whole Health Connected Utah Network: $104.56 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $103.47 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $103.47 BYU Athletic Department — Athletic Services: $103.47 Campbell Scientific — Samera Health: $103.47
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$108.92	$81.69	$56.10 – $103.47
PSA (prostate specific antigen) blood test: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $103.47 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $103.47 Aetna — Aetna Utah Connected Network: $103.47 Aetna — Aetna Whole Health Connected Utah Network: $103.47 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $103.47 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $103.47 BYU Athletic Department — Athletic Services: $103.47 Campbell Scientific — Samera Health: $103.47 Cigna — PPO/EPO: $103.47 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $103.47
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$99.89	$74.92	$37.96 – $95.89
Thyroid stimulating hormone (TSH) test: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $95.89 Aetna — Aetna Medicare HMO: $37.96 Aetna — Aetna Medicare PPO: $37.96 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $94.90 Aetna — Aetna Utah Connected Network: $94.90 Aetna — Aetna Whole Health Connected Utah Network: $95.89 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $94.90 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $94.90 BYU Athletic Department — Athletic Services: $94.90 Campbell Scientific — Samera Health: $94.90
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$99.89	$74.92	$51.45 – $94.90
Thyroid stimulating hormone (TSH) test: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $94.90 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $94.90 Aetna — Aetna Utah Connected Network: $94.90 Aetna — Aetna Whole Health Connected Utah Network: $94.90 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $94.90 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $94.90 BYU Athletic Department — Athletic Services: $94.90 Campbell Scientific — Samera Health: $94.90 Cigna — PPO/EPO: $94.90 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $94.90
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	$78
Thyroid stimulating hormone (TSH) test: 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $18.48 Aetna — Aetna Medicare PPO: $18.48 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $78 Aetna — Aetna Utah Connected Network: $78 Aetna — Aetna Whole Health Connected Utah Network: $78 BYU Athletic Department — Athletic Services: $78 Campbell Scientific — Samera Health: $78 Cigna — PPO/EPO: $78 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $78 Deseret Mutual — DMBA: $78
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$77.73	$58.30	$29.54 – $74.62
Complete blood count (CBC) with differential: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $74.62 Aetna — Aetna Medicare HMO: $29.54 Aetna — Aetna Medicare PPO: $29.54 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $73.84 Aetna — Aetna Utah Connected Network: $73.84 Aetna — Aetna Whole Health Connected Utah Network: $74.62 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $73.84 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $73.84 BYU Athletic Department — Athletic Services: $73.84 Campbell Scientific — Samera Health: $73.84
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL	$77.73	$58.30	$29.54 – $74.62
Complete blood count (CBC) with differential: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $74.62 Aetna — Aetna Medicare HMO: $29.54 Aetna — Aetna Medicare PPO: $29.54 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $73.84 Aetna — Aetna Utah Connected Network: $73.84 Aetna — Aetna Whole Health Connected Utah Network: $74.62 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $73.84 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $73.84 BYU Athletic Department — Athletic Services: $73.84 Campbell Scientific — Samera Health: $73.84
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$77.73	$58.30	$40.04 – $73.84
Complete blood count (CBC) with differential: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $73.84 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $73.84 Aetna — Aetna Utah Connected Network: $73.84 Aetna — Aetna Whole Health Connected Utah Network: $73.84 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $73.84 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $73.84 BYU Athletic Department — Athletic Services: $73.84 Campbell Scientific — Samera Health: $73.84 Cigna — PPO/EPO: $73.84 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $73.84
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$58.37	$43.78	$22.18 – $56.04
Complete blood count (CBC), automated: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $56.04 Aetna — Aetna Medicare HMO: $22.18 Aetna — Aetna Medicare PPO: $22.18 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $55.45 Aetna — Aetna Utah Connected Network: $55.45 Aetna — Aetna Whole Health Connected Utah Network: $56.04 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $55.45 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $55.45 BYU Athletic Department — Athletic Services: $55.45 Campbell Scientific — Samera Health: $55.45
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$58.37	$43.78	$30.07 – $55.45
Complete blood count (CBC), automated: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $55.45 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $55.45 Aetna — Aetna Utah Connected Network: $55.45 Aetna — Aetna Whole Health Connected Utah Network: $55.45 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $55.45 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $55.45 BYU Athletic Department — Athletic Services: $55.45 Campbell Scientific — Samera Health: $55.45 Cigna — PPO/EPO: $55.45 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $55.45
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	$55
Complete blood count (CBC), automated: 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $7.12 Aetna — Aetna Medicare PPO: $7.12 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $55 Aetna — Aetna Utah Connected Network: $55 Aetna — Aetna Whole Health Connected Utah Network: $55 BYU Athletic Department — Athletic Services: $55 Campbell Scientific — Samera Health: $55 Cigna — PPO/EPO: $55 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $55 Deseret Mutual — DMBA: $55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$100.05	$75.04	$38.02 – $96.05
Blood clotting time test (prothrombin time, PT): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $96.05 Aetna — Aetna Medicare HMO: $38.02 Aetna — Aetna Medicare PPO: $38.02 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $95.05 Aetna — Aetna Utah Connected Network: $95.05 Aetna — Aetna Whole Health Connected Utah Network: $96.05 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $95.05 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $95.05 BYU Athletic Department — Athletic Services: $95.05 Campbell Scientific — Samera Health: $95.05
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$26.06	$19.55	$9.90 – $25.02
Blood clotting time test (prothrombin time, PT): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $25.02 Aetna — Aetna Medicare HMO: $9.90 Aetna — Aetna Medicare PPO: $9.90 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $24.76 Aetna — Aetna Utah Connected Network: $24.76 Aetna — Aetna Whole Health Connected Utah Network: $25.02 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $24.76 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $24.76 BYU Athletic Department — Athletic Services: $24.76 Campbell Scientific — Samera Health: $24.76
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$100.05	$75.04	$51.54 – $95.05
Blood clotting time test (prothrombin time, PT): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $95.05 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $95.05 Aetna — Aetna Utah Connected Network: $95.05 Aetna — Aetna Whole Health Connected Utah Network: $95.05 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $95.05 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $95.05 BYU Athletic Department — Athletic Services: $95.05 Campbell Scientific — Samera Health: $95.05 Cigna — PPO/EPO: $95.05 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $95.05
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$26.06	$19.55	$9.90 – $25.02
Blood clotting test (partial thromboplastin time, PTT): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $25.02 Aetna — Aetna Medicare HMO: $9.90 Aetna — Aetna Medicare PPO: $9.90 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $24.76 Aetna — Aetna Utah Connected Network: $24.76 Aetna — Aetna Whole Health Connected Utah Network: $25.02 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $24.76 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $24.76 BYU Athletic Department — Athletic Services: $24.76 Campbell Scientific — Samera Health: $24.76
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$26.06	$19.55	$13.42 – $24.76
Blood clotting test (partial thromboplastin time, PTT): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $24.76 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $24.76 Aetna — Aetna Utah Connected Network: $24.76 Aetna — Aetna Whole Health Connected Utah Network: $24.76 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $24.76 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $24.76 BYU Athletic Department — Athletic Services: $24.76 Campbell Scientific — Samera Health: $24.76 Cigna — PPO/EPO: $24.76 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $24.76
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	$37
Blood clotting test (partial thromboplastin time, PTT): 10 of 50 insurance plan rates Aetna — Aetna Medicare HMO: $6.61 Aetna — Aetna Medicare PPO: $6.61 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $37 Aetna — Aetna Utah Connected Network: $37 Aetna — Aetna Whole Health Connected Utah Network: $37 BYU Athletic Department — Athletic Services: $37 Campbell Scientific — Samera Health: $37 Cigna — PPO/EPO: $37 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $37 Deseret Mutual — DMBA: $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 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,806.74	$1,355.06	$686.56 – $1,734.47
CT scan of the head or brain, without contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,734.47 Aetna — Aetna Medicare HMO: $686.56 Aetna — Aetna Medicare PPO: $686.56 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,716.40 Aetna — Aetna Utah Connected Network: $1,716.40 Aetna — Aetna Whole Health Connected Utah Network: $1,734.47 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,716.40 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,716.40 BYU Athletic Department — Athletic Services: $1,716.40 Campbell Scientific — Samera Health: $1,716.40
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	$930.65 – $1,716.40
CT scan of the head or brain, without contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $1,716.40 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,716.40 Aetna — Aetna Utah Connected Network: $1,716.40 Aetna — Aetna Whole Health Connected Utah Network: $1,716.40 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,716.40 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,716.40 BYU Athletic Department — Athletic Services: $1,716.40 Campbell Scientific — Samera Health: $1,716.40 Cigna — PPO/EPO: $1,716.40 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,716.40
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	$533
CT scan of the head or brain, without contrast: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $533 Aetna — Aetna Utah Connected Network: $533 Aetna — Aetna Whole Health Connected Utah Network: $533 BYU Athletic Department — Athletic Services: $533 Campbell Scientific — Samera Health: $533 Cigna — PPO/EPO: $533 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $533 Deseret Mutual — DMBA: $533 EMI Health — EMI Health: $533 EMI Health — EMI Health Choice: $533
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	$4,958.07	$3,718.55	$1,884.07 – $4,759.75
MRI of the brain, before and after contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $4,759.75 Aetna — Aetna Medicare HMO: $1,884.07 Aetna — Aetna Medicare PPO: $1,884.07 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,710.17 Aetna — Aetna Utah Connected Network: $4,710.17 Aetna — Aetna Whole Health Connected Utah Network: $4,759.75 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $4,710.17 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $4,710.17 BYU Athletic Department — Athletic Services: $4,710.17 Campbell Scientific — Samera Health: $4,710.17
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI IAC'S W AND W/O CONTRAST LIMITED	$4,958.07	$3,718.55	$1,884.07 – $4,759.75
MRI of the brain, before and after contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $4,759.75 Aetna — Aetna Medicare HMO: $1,884.07 Aetna — Aetna Medicare PPO: $1,884.07 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,710.17 Aetna — Aetna Utah Connected Network: $4,710.17 Aetna — Aetna Whole Health Connected Utah Network: $4,759.75 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $4,710.17 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $4,710.17 BYU Athletic Department — Athletic Services: $4,710.17 Campbell Scientific — Samera Health: $4,710.17
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	$4,958.07	$3,718.55	$2,553.90 – $4,710.17
MRI of the brain, before and after contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $4,710.17 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,710.17 Aetna — Aetna Utah Connected Network: $4,710.17 Aetna — Aetna Whole Health Connected Utah Network: $4,710.17 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $4,710.17 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $4,710.17 BYU Athletic Department — Athletic Services: $4,710.17 Campbell Scientific — Samera Health: $4,710.17 Cigna — PPO/EPO: $4,710.17 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $4,710.17
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$429.41	$322.06	$163.18 – $412.23
Chest X-ray, 2 views: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $412.23 Aetna — Aetna Medicare HMO: $163.18 Aetna — Aetna Medicare PPO: $163.18 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $407.94 Aetna — Aetna Utah Connected Network: $407.94 Aetna — Aetna Whole Health Connected Utah Network: $412.23 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $407.94 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $407.94 BYU Athletic Department — Athletic Services: $407.94 Campbell Scientific — Samera Health: $407.94
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$429.41	$322.06	$221.19 – $407.94
Chest X-ray, 2 views: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $407.94 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $407.94 Aetna — Aetna Utah Connected Network: $407.94 Aetna — Aetna Whole Health Connected Utah Network: $407.94 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $407.94 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $407.94 BYU Athletic Department — Athletic Services: $407.94 Campbell Scientific — Samera Health: $407.94 Cigna — PPO/EPO: $407.94 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $407.94
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	$185 – $197
Chest X-ray, 2 views: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $197 Aetna — Aetna Utah Connected Network: $197 Aetna — Aetna Whole Health Connected Utah Network: $197 BYU Athletic Department — Athletic Services: $197 Campbell Scientific — Samera Health: $197 Cigna — PPO/EPO: $197 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $197 Deseret Mutual — DMBA: $197 EMI Health — EMI Health: $197 EMI Health — EMI Health Choice: $197
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	$234.84 – $593.27
X-ray of the lower spine, at least 4 views: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $593.27 Aetna — Aetna Medicare HMO: $234.84 Aetna — Aetna Medicare PPO: $234.84 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $587.09 Aetna — Aetna Utah Connected Network: $587.09 Aetna — Aetna Whole Health Connected Utah Network: $593.27 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $587.09 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $587.09 BYU Athletic Department — Athletic Services: $587.09 Campbell Scientific — Samera Health: $587.09
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	$318.33 – $587.09
X-ray of the lower spine, at least 4 views: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $587.09 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $587.09 Aetna — Aetna Utah Connected Network: $587.09 Aetna — Aetna Whole Health Connected Utah Network: $587.09 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $587.09 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $587.09 BYU Athletic Department — Athletic Services: $587.09 Campbell Scientific — Samera Health: $587.09 Cigna — PPO/EPO: $587.09 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $587.09
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	$328
X-ray of the lower spine, at least 4 views: 10 of 29 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $328 Aetna — Aetna Utah Connected Network: $328 Aetna — Aetna Whole Health Connected Utah Network: $328 BYU Athletic Department — Athletic Services: $328 Campbell Scientific — Samera Health: $328 Cigna — PPO/EPO: $328 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $328 Deseret Mutual — DMBA: $328 EMI Health — EMI Health: $328 EMI Health — EMI Health Choice: $328
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	$3,507.61	$2,630.71	$1,332.89 – $3,367.31
MRI of the lower back (lumbar spine), without contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $3,367.31 Aetna — Aetna Medicare HMO: $1,332.89 Aetna — Aetna Medicare PPO: $1,332.89 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,332.23 Aetna — Aetna Utah Connected Network: $3,332.23 Aetna — Aetna Whole Health Connected Utah Network: $3,367.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,332.23 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,332.23 BYU Athletic Department — Athletic Services: $3,332.23 Campbell Scientific — Samera Health: $3,332.23
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	$3,507.61	$2,630.71	$1,806.77 – $3,332.23
MRI of the lower back (lumbar spine), without contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $3,332.23 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,332.23 Aetna — Aetna Utah Connected Network: $3,332.23 Aetna — Aetna Whole Health Connected Utah Network: $3,332.23 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,332.23 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,332.23 BYU Athletic Department — Athletic Services: $3,332.23 Campbell Scientific — Samera Health: $3,332.23 Cigna — PPO/EPO: $3,332.23 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $3,332.23
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	$1,064
MRI of the lower back (lumbar spine), without contrast: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,064 Aetna — Aetna Utah Connected Network: $1,064 Aetna — Aetna Whole Health Connected Utah Network: $1,064 BYU Athletic Department — Athletic Services: $1,064 Campbell Scientific — Samera Health: $1,064 Cigna — PPO/EPO: $1,064 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,064 Deseret Mutual — DMBA: $1,064 EMI Health — EMI Health: $1,064 EMI Health — EMI Health Choice: $1,064
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	$1,193.87 – $3,016.09
CT scan of the pelvis, with contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $3,016.09 Aetna — Aetna Medicare HMO: $1,193.87 Aetna — Aetna Medicare PPO: $1,193.87 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,984.67 Aetna — Aetna Utah Connected Network: $2,984.67 Aetna — Aetna Whole Health Connected Utah Network: $3,016.09 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,984.67 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,984.67 BYU Athletic Department — Athletic Services: $2,984.67 Campbell Scientific — Samera Health: $2,984.67
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	$1,618.32 – $2,984.67
CT scan of the pelvis, with contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,984.67 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,984.67 Aetna — Aetna Utah Connected Network: $2,984.67 Aetna — Aetna Whole Health Connected Utah Network: $2,984.67 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,984.67 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,984.67 BYU Athletic Department — Athletic Services: $2,984.67 Campbell Scientific — Samera Health: $2,984.67 Cigna — PPO/EPO: $2,984.67 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,984.67
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	$805
CT scan of the pelvis, with contrast: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $805 Aetna — Aetna Utah Connected Network: $805 Aetna — Aetna Whole Health Connected Utah Network: $805 BYU Athletic Department — Athletic Services: $805 Campbell Scientific — Samera Health: $805 Cigna — PPO/EPO: $805 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $805 Deseret Mutual — DMBA: $805 EMI Health — EMI Health: $805 EMI Health — EMI Health Choice: $805
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	$3,117.90	$2,338.43	$1,184.80 – $2,993.18
MRI of a leg joint (such as the knee), without contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $2,993.18 Aetna — Aetna Medicare HMO: $1,184.80 Aetna — Aetna Medicare PPO: $1,184.80 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,962 Aetna — Aetna Utah Connected Network: $2,962 Aetna — Aetna Whole Health Connected Utah Network: $2,993.18 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,962 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,962 BYU Athletic Department — Athletic Services: $2,962 Campbell Scientific — Samera Health: $2,962
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	$3,117.90	$2,338.43	$1,606.03 – $2,962
MRI of a leg joint (such as the knee), without contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,962 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,962 Aetna — Aetna Utah Connected Network: $2,962 Aetna — Aetna Whole Health Connected Utah Network: $2,962 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,962 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,962 BYU Athletic Department — Athletic Services: $2,962 Campbell Scientific — Samera Health: $2,962 Cigna — PPO/EPO: $2,962 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,962
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	$1,064
MRI of a leg joint (such as the knee), without contrast: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,064 Aetna — Aetna Utah Connected Network: $1,064 Aetna — Aetna Whole Health Connected Utah Network: $1,064 BYU Athletic Department — Athletic Services: $1,064 Campbell Scientific — Samera Health: $1,064 Cigna — PPO/EPO: $1,064 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,064 Deseret Mutual — DMBA: $1,064 EMI Health — EMI Health: $1,064 EMI Health — EMI Health Choice: $1,064
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	$4,285.64	$3,214.23	$1,628.54 – $4,114.21
CT scan of the abdomen and pelvis, with contrast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $4,114.21 Aetna — Aetna Medicare HMO: $1,628.54 Aetna — Aetna Medicare PPO: $1,628.54 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,071.36 Aetna — Aetna Utah Connected Network: $4,071.36 Aetna — Aetna Whole Health Connected Utah Network: $4,114.21 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $4,071.36 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $4,071.36 BYU Athletic Department — Athletic Services: $4,071.36 Campbell Scientific — Samera Health: $4,071.36
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	$4,285.64	$3,214.23	$2,207.53 – $4,071.36
CT scan of the abdomen and pelvis, with contrast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $4,071.36 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,071.36 Aetna — Aetna Utah Connected Network: $4,071.36 Aetna — Aetna Whole Health Connected Utah Network: $4,071.36 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $4,071.36 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $4,071.36 BYU Athletic Department — Athletic Services: $4,071.36 Campbell Scientific — Samera Health: $4,071.36 Cigna — PPO/EPO: $4,071.36 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $4,071.36
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	$1,206
CT scan of the abdomen and pelvis, with contrast: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,206 Aetna — Aetna Utah Connected Network: $1,206 Aetna — Aetna Whole Health Connected Utah Network: $1,206 BYU Athletic Department — Athletic Services: $1,206 Campbell Scientific — Samera Health: $1,206 Cigna — PPO/EPO: $1,206 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,206 Deseret Mutual — DMBA: $1,206 EMI Health — EMI Health: $1,206 EMI Health — EMI Health Choice: $1,206
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$929.33	$697	$353.15 – $892.16
Ultrasound of the abdomen, complete: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $892.16 Aetna — Aetna Medicare HMO: $353.15 Aetna — Aetna Medicare PPO: $353.15 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $882.86 Aetna — Aetna Utah Connected Network: $882.86 Aetna — Aetna Whole Health Connected Utah Network: $892.16 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $882.86 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $882.86 BYU Athletic Department — Athletic Services: $882.86 Campbell Scientific — Samera Health: $882.86
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$929.33	$697	$478.70 – $882.86
Ultrasound of the abdomen, complete: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $882.86 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $882.86 Aetna — Aetna Utah Connected Network: $882.86 Aetna — Aetna Whole Health Connected Utah Network: $882.86 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $882.86 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $882.86 BYU Athletic Department — Athletic Services: $882.86 Campbell Scientific — Samera Health: $882.86 Cigna — PPO/EPO: $882.86 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $882.86
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	$339
Ultrasound of the abdomen, complete: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $339 Aetna — Aetna Utah Connected Network: $339 Aetna — Aetna Whole Health Connected Utah Network: $339 BYU Athletic Department — Athletic Services: $339 Campbell Scientific — Samera Health: $339 Cigna — PPO/EPO: $339 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $339 Deseret Mutual — DMBA: $339 EMI Health — EMI Health: $339 EMI Health — EMI Health Choice: $339
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$854.79	$641.09	$324.82 – $820.60
Pregnancy ultrasound (after the first trimester): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $820.60 Aetna — Aetna Medicare HMO: $324.82 Aetna — Aetna Medicare PPO: $324.82 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $812.05 Aetna — Aetna Utah Connected Network: $812.05 Aetna — Aetna Whole Health Connected Utah Network: $820.60 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $812.05 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $812.05 BYU Athletic Department — Athletic Services: $812.05 Campbell Scientific — Samera Health: $812.05
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$854.79	$641.09	$440.30 – $812.05
Pregnancy ultrasound (after the first trimester): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $812.05 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $812.05 Aetna — Aetna Utah Connected Network: $812.05 Aetna — Aetna Whole Health Connected Utah Network: $812.05 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $812.05 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $812.05 BYU Athletic Department — Athletic Services: $812.05 Campbell Scientific — Samera Health: $812.05 Cigna — PPO/EPO: $812.05 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $812.05
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	$356
Pregnancy ultrasound (after the first trimester): 10 of 29 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $356 Aetna — Aetna Utah Connected Network: $356 Aetna — Aetna Whole Health Connected Utah Network: $356 BYU Athletic Department — Athletic Services: $356 Campbell Scientific — Samera Health: $356 Cigna — PPO/EPO: $356 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $356 Deseret Mutual — DMBA: $356 EMI Health — EMI Health: $356 EMI Health — EMI Health Choice: $356
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$767.30	$575.48	$291.57 – $736.61
Transvaginal ultrasound: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $736.61 Aetna — Aetna Medicare HMO: $291.57 Aetna — Aetna Medicare PPO: $291.57 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $728.94 Aetna — Aetna Utah Connected Network: $728.94 Aetna — Aetna Whole Health Connected Utah Network: $736.61 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $728.94 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $728.94 BYU Athletic Department — Athletic Services: $728.94 Campbell Scientific — Samera Health: $728.94
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$767.30	$575.48	$395.24 – $728.94
Transvaginal ultrasound: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $728.94 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $728.94 Aetna — Aetna Utah Connected Network: $728.94 Aetna — Aetna Whole Health Connected Utah Network: $728.94 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $728.94 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $728.94 BYU Athletic Department — Athletic Services: $728.94 Campbell Scientific — Samera Health: $728.94 Cigna — PPO/EPO: $728.94 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $728.94
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	$339
Transvaginal ultrasound: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $339 Aetna — Aetna Utah Connected Network: $339 Aetna — Aetna Whole Health Connected Utah Network: $339 BYU Athletic Department — Athletic Services: $339 Campbell Scientific — Samera Health: $339 Cigna — PPO/EPO: $339 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $339 Deseret Mutual — DMBA: $339 EMI Health — EMI Health: $339 EMI Health — EMI Health Choice: $339
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$687.34	$515.50	$261.19 – $659.85
Diagnostic mammogram, one breast: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $659.85 Aetna — Aetna Medicare HMO: $261.19 Aetna — Aetna Medicare PPO: $261.19 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $652.97 Aetna — Aetna Utah Connected Network: $652.97 Aetna — Aetna Whole Health Connected Utah Network: $659.85 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $652.97 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $652.97 BYU Athletic Department — Athletic Services: $652.97 Campbell Scientific — Samera Health: $652.97
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$687.34	$515.50	$354.05 – $652.97
Diagnostic mammogram, one breast: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $652.97 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $652.97 Aetna — Aetna Utah Connected Network: $652.97 Aetna — Aetna Whole Health Connected Utah Network: $652.97 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $652.97 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $652.97 BYU Athletic Department — Athletic Services: $652.97 Campbell Scientific — Samera Health: $652.97 Cigna — PPO/EPO: $652.97 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $652.97
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	$118.58 – $339
Diagnostic mammogram, one breast: 10 of 39 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $339 Aetna — Aetna Utah Connected Network: $339 Aetna — Aetna Whole Health Connected Utah Network: $339 BYU Athletic Department — Athletic Services: $339 Campbell Scientific — Samera Health: $339 Cigna — PPO/EPO: $339 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $339 Deseret Mutual — DMBA: $339 EMI Health — EMI Health: $339 EMI Health — EMI Health Choice: $339
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$827.41	$620.56	$314.42 – $794.31
Diagnostic mammogram, both breasts: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $794.31 Aetna — Aetna Medicare HMO: $314.42 Aetna — Aetna Medicare PPO: $314.42 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $786.04 Aetna — Aetna Utah Connected Network: $786.04 Aetna — Aetna Whole Health Connected Utah Network: $794.31 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $786.04 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $786.04 BYU Athletic Department — Athletic Services: $786.04 Campbell Scientific — Samera Health: $786.04
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$827.41	$620.56	$426.20 – $786.04
Diagnostic mammogram, both breasts: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $786.04 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $786.04 Aetna — Aetna Utah Connected Network: $786.04 Aetna — Aetna Whole Health Connected Utah Network: $786.04 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $786.04 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $786.04 BYU Athletic Department — Athletic Services: $786.04 Campbell Scientific — Samera Health: $786.04 Cigna — PPO/EPO: $786.04 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $786.04
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	$150.06 – $339
Diagnostic mammogram, both breasts: 10 of 39 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $339 Aetna — Aetna Utah Connected Network: $339 Aetna — Aetna Whole Health Connected Utah Network: $339 BYU Athletic Department — Athletic Services: $339 Campbell Scientific — Samera Health: $339 Cigna — PPO/EPO: $339 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $339 Deseret Mutual — DMBA: $339 EMI Health — EMI Health: $339 EMI Health — EMI Health Choice: $339
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$651.11	$488.33	$247.42 – $625.07
Screening mammogram, both breasts: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $625.07 Aetna — Aetna Medicare HMO: $247.42 Aetna — Aetna Medicare PPO: $247.42 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $618.55 Aetna — Aetna Utah Connected Network: $618.55 Aetna — Aetna Whole Health Connected Utah Network: $625.07 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $618.55 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $618.55 BYU Athletic Department — Athletic Services: $618.55 Campbell Scientific — Samera Health: $618.55
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$1,202.42	$901.82	$456.92 – $1,154.32
Screening mammogram, both breasts: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,154.32 Aetna — Aetna Medicare HMO: $456.92 Aetna — Aetna Medicare PPO: $456.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,142.30 Aetna — Aetna Utah Connected Network: $1,142.30 Aetna — Aetna Whole Health Connected Utah Network: $1,154.32 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,142.30 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,142.30 BYU Athletic Department — Athletic Services: $1,142.30 Campbell Scientific — Samera Health: $1,142.30
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$651.11	$488.33	$335.39 – $618.55
Screening mammogram, both breasts: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $618.55 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $618.55 Aetna — Aetna Utah Connected Network: $618.55 Aetna — Aetna Whole Health Connected Utah Network: $618.55 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $618.55 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $618.55 BYU Athletic Department — Athletic Services: $618.55 Campbell Scientific — Samera Health: $618.55 Cigna — PPO/EPO: $618.55 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $618.55

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
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	$22.64 – $57.19
Electrocardiogram (ECG/EKG) with reading: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $57.19 Aetna — Aetna Medicare HMO: $22.64 Aetna — Aetna Medicare PPO: $22.64 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $56.59 Aetna — Aetna Utah Connected Network: $56.59 Aetna — Aetna Whole Health Connected Utah Network: $57.19 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $56.59 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $56.59 BYU Athletic Department — Athletic Services: $56.59 Campbell Scientific — Samera Health: $56.59
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EKG W/READ	$59.57	$44.68	$30.68 – $56.59
Electrocardiogram (ECG/EKG) with reading: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $56.59 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $56.59 Aetna — Aetna Utah Connected Network: $56.59 Aetna — Aetna Whole Health Connected Utah Network: $56.59 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $56.59 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $56.59 BYU Athletic Department — Athletic Services: $56.59 Campbell Scientific — Samera Health: $56.59 Cigna — PPO/EPO: $56.59 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $56.59
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $13.88 Aetna — Aetna Medicare PPO: $13.88 Health Choice Utah — Health Choice Utah-Medicaid: $13.88 Healthy U — Medicaid: $13.88 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $13.88 Molina — Medicaid: $13.88 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $13.88 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $13.88 SelectHealth — Medicaid: $13.88 SelectHealth — Medicare Advantage: $13.88
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$8,869.15	$6,651.86	$3,370.28 – $8,514.38
Left heart catheterization (diagnostic): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $8,514.38 Aetna — Aetna Medicare HMO: $3,370.28 Aetna — Aetna Medicare PPO: $3,370.28 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $8,425.69 Aetna — Aetna Utah Connected Network: $8,425.69 Aetna — Aetna Whole Health Connected Utah Network: $8,514.38 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $8,425.69 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $8,425.69 BYU Athletic Department — Athletic Services: $8,425.69 Campbell Scientific — Samera Health: $8,425.69
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$8,869.15	$6,651.86	$4,568.50 – $8,425.69
Left heart catheterization (diagnostic): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $8,425.69 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $8,425.69 Aetna — Aetna Utah Connected Network: $8,425.69 Aetna — Aetna Whole Health Connected Utah Network: $8,425.69 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $8,425.69 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $8,425.69 BYU Athletic Department — Athletic Services: $8,425.69 Campbell Scientific — Samera Health: $8,425.69 Cigna — PPO/EPO: $8,425.69 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $8,425.69
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$224.89
Left heart catheterization (diagnostic): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $224.89 Aetna — Aetna Medicare PPO: $224.89 Health Choice Utah — Health Choice Utah-Medicaid: $224.89 Healthy U — Medicaid: $224.89 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $224.89 Molina — Medicaid: $224.89 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $224.89 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $224.89 SelectHealth — Medicaid: $224.89 SelectHealth — Medicare Advantage: $224.89
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 26 In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$369.33
Heart rhythm study (electrophysiology evaluation): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $369.33 Aetna — Aetna Medicare PPO: $369.33 Health Choice Utah — Health Choice Utah-Medicaid: $369.33 Healthy U — Medicaid: $369.33 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $369.33 Molina — Medicaid: $369.33 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $369.33 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $369.33 SelectHealth — Medicaid: $369.33 SelectHealth — Medicare Advantage: $369.33
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$913.76
Heart rhythm study with ablation for atrial fibrillation: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $913.76 Aetna — Aetna Medicare PPO: $913.76 Health Choice Utah — Health Choice Utah-Medicaid: $913.76 Healthy U — Medicaid: $913.76 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $913.76 Molina — Medicaid: $913.76 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $913.76 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $913.76 SelectHealth — Medicaid: $913.76 SelectHealth — Medicare Advantage: $913.76
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASELINE SLEEP STUDY	$3,950.37	$2,962.78	$1,501.14 – $3,792.36
Sleep study (overnight, in a sleep lab): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $3,792.36 Aetna — Aetna Medicare HMO: $1,501.14 Aetna — Aetna Medicare PPO: $1,501.14 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,752.85 Aetna — Aetna Utah Connected Network: $3,752.85 Aetna — Aetna Whole Health Connected Utah Network: $3,792.36 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,752.85 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,752.85 BYU Athletic Department — Athletic Services: $3,752.85 Campbell Scientific — Samera Health: $3,752.85
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASELINE SLEEP STUDY	$3,950.37	$2,962.78	$2,034.84 – $3,752.85
Sleep study (overnight, in a sleep lab): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $3,752.85 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $3,752.85 Aetna — Aetna Utah Connected Network: $3,752.85 Aetna — Aetna Whole Health Connected Utah Network: $3,752.85 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $3,752.85 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $3,752.85 BYU Athletic Department — Athletic Services: $3,752.85 Campbell Scientific — Samera Health: $3,752.85 Cigna — PPO/EPO: $3,752.85 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $3,752.85
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom 6/> yrs 4/> param	Not listed in the file	Not listed in the file	$1,942
Sleep study (overnight, in a sleep lab): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,942 Aetna — Aetna Utah Connected Network: $1,942 Aetna — Aetna Whole Health Connected Utah Network: $1,942 BYU Athletic Department — Athletic Services: $1,942 Campbell Scientific — Samera Health: $1,942 Cigna — PPO/EPO: $1,942 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,942 Deseret Mutual — DMBA: $1,942 EMI Health — EMI Health: $1,942 EMI Health — EMI Health Choice: $1,942

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT THERAPEUTIC EX PER 15 MIN	$109.46	$82.10	$41.59 – $105.08
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $105.08 Aetna — Aetna Medicare HMO: $41.59 Aetna — Aetna Medicare PPO: $41.59 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $103.99 Aetna — Aetna Utah Connected Network: $103.99 Aetna — Aetna Whole Health Connected Utah Network: $105.08 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $103.99 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $103.99 BYU Athletic Department — Athletic Services: $103.99 Campbell Scientific — Samera Health: $103.99
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ST THERAPEUTIC EXERCISE/15 MIN	$118.55	$88.91	$45.05 – $113.81
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $113.81 Aetna — Aetna Medicare HMO: $45.05 Aetna — Aetna Medicare PPO: $45.05 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $112.62 Aetna — Aetna Utah Connected Network: $112.62 Aetna — Aetna Whole Health Connected Utah Network: $113.81 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $112.62 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $112.62 BYU Athletic Department — Athletic Services: $112.62 Campbell Scientific — Samera Health: $112.62
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OT THERAPEUTIC EX PER 15 MIN	$117.49	$88.12	$44.65 – $112.79
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $112.79 Aetna — Aetna Medicare HMO: $44.65 Aetna — Aetna Medicare PPO: $44.65 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $111.62 Aetna — Aetna Utah Connected Network: $111.62 Aetna — Aetna Whole Health Connected Utah Network: $112.79 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $111.62 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $111.62 BYU Athletic Department — Athletic Services: $111.62 Campbell Scientific — Samera Health: $111.62
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$283.90	$212.92	$107.88 – $272.54
Physical therapy evaluation (low complexity): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $272.54 Aetna — Aetna Medicare HMO: $107.88 Aetna — Aetna Medicare PPO: $107.88 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $269.70 Aetna — Aetna Utah Connected Network: $269.70 Aetna — Aetna Whole Health Connected Utah Network: $272.54 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $269.70 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $269.70 BYU Athletic Department — Athletic Services: $269.70 Campbell Scientific — Samera Health: $269.70
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$283.90	$212.92	$146.24 – $269.70
Physical therapy evaluation (low complexity): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $269.70 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $269.70 Aetna — Aetna Utah Connected Network: $269.70 Aetna — Aetna Whole Health Connected Utah Network: $269.70 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $269.70 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $269.70 BYU Athletic Department — Athletic Services: $269.70 Campbell Scientific — Samera Health: $269.70 Cigna — PPO/EPO: $269.70 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $269.70
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$97.92
Physical therapy evaluation (low complexity): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $97.92 Aetna — Aetna Medicare PPO: $97.92 Health Choice Utah — Health Choice Utah-Medicaid: $97.92 Healthy U — Medicaid: $97.92 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $97.92 Molina — Medicaid: $97.92 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $97.92 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $97.92 SelectHealth — Medicaid: $97.92 SelectHealth — Medicare Advantage: $97.92
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL MODERATE COMPLEXITY	$355.31	$266.48	$135.02 – $341.10
Physical therapy evaluation (moderate complexity): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $341.10 Aetna — Aetna Medicare HMO: $135.02 Aetna — Aetna Medicare PPO: $135.02 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $337.54 Aetna — Aetna Utah Connected Network: $337.54 Aetna — Aetna Whole Health Connected Utah Network: $341.10 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $337.54 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $337.54 BYU Athletic Department — Athletic Services: $337.54 Campbell Scientific — Samera Health: $337.54
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	$355.31	$266.48	$135.02 – $341.10
Physical therapy evaluation (moderate complexity): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $341.10 Aetna — Aetna Medicare HMO: $135.02 Aetna — Aetna Medicare PPO: $135.02 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $337.54 Aetna — Aetna Utah Connected Network: $337.54 Aetna — Aetna Whole Health Connected Utah Network: $341.10 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $337.54 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $337.54 BYU Athletic Department — Athletic Services: $337.54 Campbell Scientific — Samera Health: $337.54
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL MODERATE COMPLEXITY	$355.31	$266.48	$183.02 – $337.54
Physical therapy evaluation (moderate complexity): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $337.54 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $337.54 Aetna — Aetna Utah Connected Network: $337.54 Aetna — Aetna Whole Health Connected Utah Network: $337.54 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $337.54 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $337.54 BYU Athletic Department — Athletic Services: $337.54 Campbell Scientific — Samera Health: $337.54 Cigna — PPO/EPO: $337.54 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $337.54
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$428.66	$321.50	$162.89 – $411.51
Physical therapy evaluation (high complexity): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $411.51 Aetna — Aetna Medicare HMO: $162.89 Aetna — Aetna Medicare PPO: $162.89 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $407.23 Aetna — Aetna Utah Connected Network: $407.23 Aetna — Aetna Whole Health Connected Utah Network: $411.51 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $407.23 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $407.23 BYU Athletic Department — Athletic Services: $407.23 Campbell Scientific — Samera Health: $407.23
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$428.66	$321.50	$220.80 – $407.23
Physical therapy evaluation (high complexity): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $407.23 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $407.23 Aetna — Aetna Utah Connected Network: $407.23 Aetna — Aetna Whole Health Connected Utah Network: $407.23 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $407.23 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $407.23 BYU Athletic Department — Athletic Services: $407.23 Campbell Scientific — Samera Health: $407.23 Cigna — PPO/EPO: $407.23 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $407.23
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$97.92
Physical therapy evaluation (high complexity): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $97.92 Aetna — Aetna Medicare PPO: $97.92 Health Choice Utah — Health Choice Utah-Medicaid: $97.92 Healthy U — Medicaid: $97.92 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $97.92 Molina — Medicaid: $97.92 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $97.92 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $97.92 SelectHealth — Medicaid: $97.92 SelectHealth — Medicare Advantage: $97.92
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$126.87	$95.15	$48.21 – $121.80
Psychotherapy, 30 minutes: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $121.80 Aetna — Aetna Medicare HMO: $48.21 Aetna — Aetna Medicare PPO: $48.21 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $120.53 Aetna — Aetna Utah Connected Network: $120.53 Aetna — Aetna Whole Health Connected Utah Network: $121.80 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $120.53 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $120.53 BYU Athletic Department — Athletic Services: $120.53 Campbell Scientific — Samera Health: $120.53
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$126.87	$95.15	$65.35 – $120.53
Psychotherapy, 30 minutes: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $120.53 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $120.53 Aetna — Aetna Utah Connected Network: $120.53 Aetna — Aetna Whole Health Connected Utah Network: $120.53 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $120.53 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $120.53 BYU Athletic Department — Athletic Services: $120.53 Campbell Scientific — Samera Health: $120.53 Cigna — PPO/EPO: $120.53 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $120.53
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 30 minutes	Not listed in the file	Not listed in the file	$65.68
Psychotherapy, 30 minutes: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $65.68 Aetna — Aetna Medicare PPO: $65.68 Health Choice Utah — Health Choice Utah-Medicaid: $65.68 Healthy U — Medicaid: $65.68 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $65.68 Molina — Medicaid: $65.68 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $65.68 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $65.68 SelectHealth — Medicaid: $65.68 SelectHealth — Medicare Advantage: $65.68
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$315.45	$236.59	$119.87 – $302.83
Psychotherapy, 45 minutes: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $302.83 Aetna — Aetna Medicare HMO: $119.87 Aetna — Aetna Medicare PPO: $119.87 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $299.68 Aetna — Aetna Utah Connected Network: $299.68 Aetna — Aetna Whole Health Connected Utah Network: $302.83 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $299.68 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $299.68 BYU Athletic Department — Athletic Services: $299.68 Campbell Scientific — Samera Health: $299.68
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$315.45	$236.59	$162.49 – $299.68
Psychotherapy, 45 minutes: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $299.68 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $299.68 Aetna — Aetna Utah Connected Network: $299.68 Aetna — Aetna Whole Health Connected Utah Network: $299.68 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $299.68 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $299.68 BYU Athletic Department — Athletic Services: $299.68 Campbell Scientific — Samera Health: $299.68 Cigna — PPO/EPO: $299.68 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $299.68
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 45 minutes	Not listed in the file	Not listed in the file	$87.08
Psychotherapy, 45 minutes: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $87.08 Aetna — Aetna Medicare PPO: $87.08 Health Choice Utah — Health Choice Utah-Medicaid: $87.08 Healthy U — Medicaid: $87.08 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $87.08 Molina — Medicaid: $87.08 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $87.08 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $87.08 SelectHealth — Medicaid: $87.08 SelectHealth — Medicare Advantage: $87.08
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$128
Psychotherapy, 60 minutes: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $128 Aetna — Aetna Medicare PPO: $128 Health Choice Utah — Health Choice Utah-Medicaid: $128 Healthy U — Medicaid: $128 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $128 Molina — Medicaid: $128 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $128 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $128 SelectHealth — Medicaid: $128 SelectHealth — Medicare Advantage: $128
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$94.05
Family psychotherapy, without the patient: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $94.05 Aetna — Aetna Medicare PPO: $94.05 Health Choice Utah — Health Choice Utah-Medicaid: $94.05 Healthy U — Medicaid: $94.05 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $94.05 Molina — Medicaid: $94.05 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $94.05 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $94.05 SelectHealth — Medicaid: $94.05 SelectHealth — Medicare Advantage: $94.05
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $98.07 Aetna — Aetna Medicare PPO: $98.07 Health Choice Utah — Health Choice Utah-Medicaid: $98.07 Healthy U — Medicaid: $98.07 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $98.07 Molina — Medicaid: $98.07 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $98.07 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $98.07 SelectHealth — Medicaid: $98.07 SelectHealth — Medicare Advantage: $98.07
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$110.94	$83.20	$42.16 – $106.50
Group psychotherapy: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $106.50 Aetna — Aetna Medicare HMO: $42.16 Aetna — Aetna Medicare PPO: $42.16 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $105.39 Aetna — Aetna Utah Connected Network: $105.39 Aetna — Aetna Whole Health Connected Utah Network: $106.50 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $105.39 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $105.39 BYU Athletic Department — Athletic Services: $105.39 Campbell Scientific — Samera Health: $105.39
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$110.94	$83.20	$57.15 – $105.39
Group psychotherapy: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $105.39 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $105.39 Aetna — Aetna Utah Connected Network: $105.39 Aetna — Aetna Whole Health Connected Utah Network: $105.39 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $105.39 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $105.39 BYU Athletic Department — Athletic Services: $105.39 Campbell Scientific — Samera Health: $105.39 Cigna — PPO/EPO: $105.39 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $105.39
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$23.09
Group psychotherapy: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $23.09 Aetna — Aetna Medicare PPO: $23.09 Health Choice Utah — Health Choice Utah-Medicaid: $23.09 Healthy U — Medicaid: $23.09 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $23.09 Molina — Medicaid: $23.09 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $23.09 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $23.09 SelectHealth — Medicaid: $23.09 SelectHealth — Medicare Advantage: $23.09

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	$1,250
Removal of breast growth (open surgery): rates for 1 insurance plan UT Cancer Control — Other: $1,250
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $608.06 Aetna — Aetna Medicare PPO: $608.06 Health Choice Utah — Health Choice Utah-Medicaid: $608.06 Healthy U — Medicaid: $608.06 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $608.06 Molina — Medicaid: $608.06 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $608.06 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $608.06 SelectHealth — Medicaid: $608.06 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $287.81 Aetna — Aetna Medicare PPO: $287.81 Health Choice Utah — Health Choice Utah-Medicaid: $287.81 Healthy U — Medicaid: $287.81 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $287.81 Molina — Medicaid: $287.81 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $287.81 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $287.81 SelectHealth — Medicaid: $287.81 SelectHealth — Medicare Advantage: $287.81
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $1,868.51 Aetna — Aetna Medicare PPO: $1,868.51 Health Choice Utah — Health Choice Utah-Medicaid: $1,868.51 Healthy U — Medicaid: $1,868.51 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $1,868.51 Molina — Medicaid: $1,868.51 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $1,868.51 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $1,868.51 SelectHealth — Medicaid: $1,868.51 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $859.51 Aetna — Aetna Medicare PPO: $859.51 Health Choice Utah — Health Choice Utah-Medicaid: $859.51 Healthy U — Medicaid: $859.51 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $859.51 Molina — Medicaid: $859.51 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $859.51 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $859.51 SelectHealth — Medicaid: $859.51 SelectHealth — Medicare Advantage: $859.51
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$199.31
Total hip replacement: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $199.31 Aetna — Aetna Medicare PPO: $199.31 Health Choice Utah — Health Choice Utah-Medicaid: $199.31 Healthy U — Medicaid: $199.31 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $199.31 Molina — Medicaid: $199.31 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $199.31 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $199.31 SelectHealth — Medicaid: $199.31 SelectHealth — Medicare Advantage: $199.31
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $1,866.65 Aetna — Aetna Medicare PPO: $1,866.65 Health Choice Utah — Health Choice Utah-Medicaid: $1,866.65 Healthy U — Medicaid: $1,866.65 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $1,866.65 Molina — Medicaid: $1,866.65 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $1,866.65 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $1,866.65 SelectHealth — Medicaid: $1,866.65 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $858.66 Aetna — Aetna Medicare PPO: $858.66 Health Choice Utah — Health Choice Utah-Medicaid: $858.66 Healthy U — Medicaid: $858.66 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $858.66 Molina — Medicaid: $858.66 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $858.66 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $858.66 SelectHealth — Medicaid: $858.66 SelectHealth — Medicare Advantage: $858.66
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$199.11
Total knee replacement: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $199.11 Aetna — Aetna Medicare PPO: $199.11 Health Choice Utah — Health Choice Utah-Medicaid: $199.11 Healthy U — Medicaid: $199.11 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $199.11 Molina — Medicaid: $199.11 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $199.11 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $199.11 SelectHealth — Medicaid: $199.11 SelectHealth — Medicare Advantage: $199.11
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	$9,135 – $9,729
Shoulder arthroscopy: shaving of shoulder bone: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $9,729 Aetna — Aetna Utah Connected Network: $9,729 Aetna — Aetna Whole Health Connected Utah Network: $9,729 BYU Athletic Department — Athletic Services: $9,729 Campbell Scientific — Samera Health: $9,729 Cigna — PPO/EPO: $9,729 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $9,729 Deseret Mutual — DMBA: $9,729 EMI Health — EMI Health: $9,729 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $250.01 Aetna — Aetna Medicare PPO: $250.01 Health Choice Utah — Health Choice Utah-Medicaid: $250.01 Healthy U — Medicaid: $250.01 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $250.01 Molina — Medicaid: $250.01 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $250.01 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $250.01 SelectHealth — Medicaid: $250.01 SelectHealth — Medicare Advantage: $250.01
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 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 13 insurance plan rates Aetna — Aetna Medicare HMO: $26.67 Aetna — Aetna Medicare PPO: $26.67 Health Choice Utah — Health Choice Utah-Medicaid: $26.67 Healthy U — Medicaid: $26.67 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $26.67 Molina — Medicaid: $26.67 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $26.67 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $26.67 SelectHealth — Medicaid: $26.67 SelectHealth — Medicare Advantage: $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	$6,225
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $6,225 Aetna — Aetna Utah Connected Network: $6,225 Aetna — Aetna Whole Health Connected Utah Network: $6,225 BYU Athletic Department — Athletic Services: $6,225 Campbell Scientific — Samera Health: $6,225 Cigna — PPO/EPO: $6,225 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $6,225 Deseret Mutual — DMBA: $6,225 EMI Health — EMI Health: $6,225 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $790.88 Aetna — Aetna Medicare PPO: $790.88 Health Choice Utah — Health Choice Utah-Medicaid: $790.88 Healthy U — Medicaid: $790.88 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $790.88 Molina — Medicaid: $790.88 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $790.88 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $790.88 SelectHealth — Medicaid: $790.88 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $363.80 Aetna — Aetna Medicare PPO: $363.80 Health Choice Utah — Health Choice Utah-Medicaid: $363.80 Healthy U — Medicaid: $363.80 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $363.80 Molina — Medicaid: $363.80 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $363.80 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $363.80 SelectHealth — Medicaid: $363.80 SelectHealth — Medicare Advantage: $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	$4,247 – $4,523
Removal of tonsils and adenoids (under age 12): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,523 Aetna — Aetna Utah Connected Network: $4,523 Aetna — Aetna Whole Health Connected Utah Network: $4,523 BYU Athletic Department — Athletic Services: $4,523 Campbell Scientific — Samera Health: $4,523 Cigna — PPO/EPO: $4,523 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $4,523 Deseret Mutual — DMBA: $4,523 EMI Health — EMI Health: $4,523 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $230.24 Aetna — Aetna Medicare PPO: $230.24 Health Choice Utah — Health Choice Utah-Medicaid: $230.24 Healthy U — Medicaid: $230.24 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $230.24 Molina — Medicaid: $230.24 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $230.24 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $230.24 SelectHealth — Medicaid: $230.24 SelectHealth — Medicare Advantage: $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	$1,471 – $1,589
Upper GI endoscopy (diagnostic): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,589 Aetna — Aetna Utah Connected Network: $1,589 Aetna — Aetna Whole Health Connected Utah Network: $1,589 BYU Athletic Department — Athletic Services: $1,589 Campbell Scientific — Samera Health: $1,589 Cigna — PPO/EPO: $1,589 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,589 Deseret Mutual — DMBA: $1,589 EMI Health — EMI Health: $1,589 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $117.67 Aetna — Aetna Medicare PPO: $117.67 Health Choice Utah — Health Choice Utah-Medicaid: $117.67 Healthy U — Medicaid: $117.67 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $117.67 Molina — Medicaid: $117.67 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $117.67 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $117.67 SelectHealth — Medicaid: $117.67 SelectHealth — Medicare Advantage: $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	$1,787 – $1,930
Upper GI endoscopy with biopsy: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,930 Aetna — Aetna Utah Connected Network: $1,930 Aetna — Aetna Whole Health Connected Utah Network: $1,930 BYU Athletic Department — Athletic Services: $1,930 Campbell Scientific — Samera Health: $1,930 Cigna — PPO/EPO: $1,930 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,930 Deseret Mutual — DMBA: $1,930 EMI Health — EMI Health: $1,930 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $132.79 Aetna — Aetna Medicare PPO: $132.79 Health Choice Utah — Health Choice Utah-Medicaid: $132.79 Healthy U — Medicaid: $132.79 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $132.79 Molina — Medicaid: $132.79 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $132.79 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $132.79 SelectHealth — Medicaid: $132.79 SelectHealth — Medicare Advantage: $132.79
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,391.97	$1,793.98	$908.95 – $2,296.29
Colonoscopy (diagnostic): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $2,296.29 Aetna — Aetna Medicare HMO: $908.95 Aetna — Aetna Medicare PPO: $908.95 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,272.37 Aetna — Aetna Utah Connected Network: $2,272.37 Aetna — Aetna Whole Health Connected Utah Network: $2,296.29 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,272.37 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,272.37 BYU Athletic Department — Athletic Services: $2,272.37 Campbell Scientific — Samera Health: $2,272.37
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,391.97	$1,793.98	$1,232.10 – $2,272.37
Colonoscopy (diagnostic): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,272.37 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,272.37 Aetna — Aetna Utah Connected Network: $2,272.37 Aetna — Aetna Whole Health Connected Utah Network: $2,272.37 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,272.37 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,272.37 BYU Athletic Department — Athletic Services: $2,272.37 Campbell Scientific — Samera Health: $2,272.37 Cigna — PPO/EPO: $2,272.37 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,272.37
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	$1,345 – $1,453
Colonoscopy (diagnostic): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,453 Aetna — Aetna Utah Connected Network: $1,453 Aetna — Aetna Whole Health Connected Utah Network: $1,453 BYU Athletic Department — Athletic Services: $1,453 Campbell Scientific — Samera Health: $1,453 Cigna — PPO/EPO: $1,453 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,453 Deseret Mutual — DMBA: $1,453 EMI Health — EMI Health: $1,453 EMI Health — EMI Health Choice: $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	$1,499 – $1,589
Colonoscopy with biopsy: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,589 Aetna — Aetna Utah Connected Network: $1,589 Aetna — Aetna Whole Health Connected Utah Network: $1,589 BYU Athletic Department — Athletic Services: $1,589 Campbell Scientific — Samera Health: $1,589 Cigna — PPO/EPO: $1,589 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,589 Deseret Mutual — DMBA: $1,589 EMI Health — EMI Health: $1,589 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $192.84 Aetna — Aetna Medicare PPO: $192.84 Health Choice Utah — Health Choice Utah-Medicaid: $192.84 Healthy U — Medicaid: $192.84 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $192.84 Molina — Medicaid: $192.84 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $192.84 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $192.84 SelectHealth — Medicaid: $192.84 SelectHealth — Medicare Advantage: $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	$1,345 – $1,453
Colonoscopy with removal of polyps (snare): 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,453 Aetna — Aetna Utah Connected Network: $1,453 Aetna — Aetna Whole Health Connected Utah Network: $1,453 BYU Athletic Department — Athletic Services: $1,453 Campbell Scientific — Samera Health: $1,453 Cigna — PPO/EPO: $1,453 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,453 Deseret Mutual — DMBA: $1,453 EMI Health — EMI Health: $1,453 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $244.10 Aetna — Aetna Medicare PPO: $244.10 Health Choice Utah — Health Choice Utah-Medicaid: $244.10 Healthy U — Medicaid: $244.10 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $244.10 Molina — Medicaid: $244.10 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $244.10 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $244.10 SelectHealth — Medicaid: $244.10 SelectHealth — Medicare Advantage: $244.10
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $247.75 Aetna — Aetna Medicare PPO: $247.75 Health Choice Utah — Health Choice Utah-Medicaid: $247.75 Healthy U — Medicaid: $247.75 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $247.75 Molina — Medicaid: $247.75 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $247.75 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $247.75 SelectHealth — Medicaid: $247.75 SelectHealth — Medicare Advantage: $247.75
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$2,872.40	$2,154.30	$1,091.51 – $2,757.50
Screening colonoscopy (not high risk): 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $2,757.50 Aetna — Aetna Medicare HMO: $1,091.51 Aetna — Aetna Medicare PPO: $1,091.51 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,728.78 Aetna — Aetna Utah Connected Network: $2,728.78 Aetna — Aetna Whole Health Connected Utah Network: $2,757.50 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,728.78 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,728.78 BYU Athletic Department — Athletic Services: $2,728.78 Campbell Scientific — Samera Health: $2,728.78
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$2,872.40	$2,154.30	$1,479.57 – $2,728.78
Screening colonoscopy (not high risk): 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,728.78 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,728.78 Aetna — Aetna Utah Connected Network: $2,728.78 Aetna — Aetna Whole Health Connected Utah Network: $2,728.78 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,728.78 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,728.78 BYU Athletic Department — Athletic Services: $2,728.78 Campbell Scientific — Samera Health: $2,728.78 Cigna — PPO/EPO: $2,728.78 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,728.78
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 53 In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$163.67
Screening colonoscopy (not high risk): 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $163.67 Aetna — Aetna Medicare PPO: $163.67 Health Choice Utah — Health Choice Utah-Medicaid: $163.67 Healthy U — Medicaid: $163.67 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $163.67 Molina — Medicaid: $163.67 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $163.67 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $163.67 SelectHealth — Medicaid: $163.67 SelectHealth — Medicare Advantage: $163.67
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	$8,177 – $8,709
Gallbladder removal by laparoscope: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $8,709 Aetna — Aetna Utah Connected Network: $8,709 Aetna — Aetna Whole Health Connected Utah Network: $8,709 BYU Athletic Department — Athletic Services: $8,709 Campbell Scientific — Samera Health: $8,709 Cigna — PPO/EPO: $8,709 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $8,709 Deseret Mutual — DMBA: $8,709 EMI Health — EMI Health: $8,709 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $519.23 Aetna — Aetna Medicare PPO: $519.23 Health Choice Utah — Health Choice Utah-Medicaid: $519.23 Healthy U — Medicaid: $519.23 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $519.23 Molina — Medicaid: $519.23 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $519.23 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $519.23 SelectHealth — Medicaid: $519.23 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $102.56 Aetna — Aetna Medicare PPO: $102.56 Health Choice Utah — Health Choice Utah-Medicaid: $102.56 Healthy U — Medicaid: $102.56 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $102.56 Molina — Medicaid: $102.56 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $102.56 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $102.56 SelectHealth — Medicaid: $102.56 SelectHealth — Medicare Advantage: $102.56
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $763.29 Aetna — Aetna Medicare PPO: $763.29 Health Choice Utah — Health Choice Utah-Medicaid: $763.29 Healthy U — Medicaid: $763.29 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $763.29 Molina — Medicaid: $763.29 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $763.29 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $763.29 SelectHealth — Medicaid: $763.29 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $412.18 Aetna — Aetna Medicare PPO: $412.18 Health Choice Utah — Health Choice Utah-Medicaid: $412.18 Healthy U — Medicaid: $412.18 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $412.18 Molina — Medicaid: $412.18 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $412.18 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $412.18 SelectHealth — Medicaid: $412.18 SelectHealth — Medicare Advantage: $412.18
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 80\|81\|82 In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$81.42
Groin (inguinal) hernia repair, age 5 or older: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $81.42 Aetna — Aetna Medicare PPO: $81.42 Health Choice Utah — Health Choice Utah-Medicaid: $81.42 Healthy U — Medicaid: $81.42 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $81.42 Molina — Medicaid: $81.42 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $81.42 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $81.42 SelectHealth — Medicaid: $81.42 SelectHealth — Medicare Advantage: $81.42
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$857.69	$643.27	$325.92 – $823.38
Prostate biopsy: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $823.38 Aetna — Aetna Medicare HMO: $325.92 Aetna — Aetna Medicare PPO: $325.92 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $814.81 Aetna — Aetna Utah Connected Network: $814.81 Aetna — Aetna Whole Health Connected Utah Network: $823.38 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $814.81 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $814.81 BYU Athletic Department — Athletic Services: $814.81 Campbell Scientific — Samera Health: $814.81
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$857.69	$643.27	$441.80 – $814.81
Prostate biopsy: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $814.81 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $814.81 Aetna — Aetna Utah Connected Network: $814.81 Aetna — Aetna Whole Health Connected Utah Network: $814.81 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $814.81 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $814.81 BYU Athletic Department — Athletic Services: $814.81 Campbell Scientific — Samera Health: $814.81 Cigna — PPO/EPO: $814.81 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $814.81
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $125.21 Aetna — Aetna Medicare PPO: $125.21 Health Choice Utah — Health Choice Utah-Medicaid: $125.21 Healthy U — Medicaid: $125.21 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $125.21 Molina — Medicaid: $125.21 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $125.21 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $125.21 SelectHealth — Medicaid: $125.21 SelectHealth — Medicare Advantage: $125.21
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $958.41 Aetna — Aetna Medicare PPO: $958.41 Health Choice Utah — Health Choice Utah-Medicaid: $958.41 Healthy U — Medicaid: $958.41 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $958.41 Molina — Medicaid: $958.41 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $958.41 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $958.41 SelectHealth — Medicaid: $958.41 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $184.75 Aetna — Aetna Medicare PPO: $184.75 Health Choice Utah — Health Choice Utah-Medicaid: $184.75 Healthy U — Medicaid: $184.75 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $184.75 Molina — Medicaid: $184.75 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $184.75 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $184.75 SelectHealth — Medicaid: $184.75 SelectHealth — Medicare Advantage: $184.75
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 81\|82\|80 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): rates for 1 insurance plan Molina Healthcare of Utah — 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	$5,824 – $6,290
Hysteroscopy with biopsy of the uterus lining: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $6,290 Aetna — Aetna Utah Connected Network: $6,290 Aetna — Aetna Whole Health Connected Utah Network: $6,290 BYU Athletic Department — Athletic Services: $6,290 Campbell Scientific — Samera Health: $6,290 Cigna — PPO/EPO: $6,290 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $6,290 Deseret Mutual — DMBA: $6,290 EMI Health — EMI Health: $6,290 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $139.65 Aetna — Aetna Medicare PPO: $139.65 Health Choice Utah — Health Choice Utah-Medicaid: $139.65 Healthy U — Medicaid: $139.65 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $139.65 Molina — Medicaid: $139.65 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $139.65 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $139.65 SelectHealth — Medicaid: $139.65 SelectHealth — Medicare Advantage: $139.65
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	$2,367.38	$1,775.54	$899.60 – $2,272.68
Spinal injection, lower back (epidural), with imaging guidance: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $2,272.68 Aetna — Aetna Medicare HMO: $899.60 Aetna — Aetna Medicare PPO: $899.60 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,249.01 Aetna — Aetna Utah Connected Network: $2,249.01 Aetna — Aetna Whole Health Connected Utah Network: $2,272.68 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,249.01 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,249.01 BYU Athletic Department — Athletic Services: $2,249.01 Campbell Scientific — Samera Health: $2,249.01
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	$2,367.38	$1,775.54	$1,219.44 – $2,249.01
Spinal injection, lower back (epidural), with imaging guidance: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $2,249.01 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $2,249.01 Aetna — Aetna Utah Connected Network: $2,249.01 Aetna — Aetna Whole Health Connected Utah Network: $2,249.01 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $2,249.01 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $2,249.01 BYU Athletic Department — Athletic Services: $2,249.01 Campbell Scientific — Samera Health: $2,249.01 Cigna — PPO/EPO: $2,249.01 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $2,249.01
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$95.77
Spinal injection, lower back (epidural), with imaging guidance: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $95.77 Aetna — Aetna Medicare PPO: $95.77 Health Choice Utah — Health Choice Utah-Medicaid: $95.77 Healthy U — Medicaid: $95.77 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $95.77 Molina — Medicaid: $95.77 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $95.77 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $95.77 SelectHealth — Medicaid: $95.77 SelectHealth — Medicare Advantage: $95.77
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	$1,623.39	$1,217.54	$616.89 – $1,558.45
Nerve root injection, lower back, with imaging guidance: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,558.45 Aetna — Aetna Medicare HMO: $616.89 Aetna — Aetna Medicare PPO: $616.89 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,542.22 Aetna — Aetna Utah Connected Network: $1,542.22 Aetna — Aetna Whole Health Connected Utah Network: $1,558.45 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,542.22 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,542.22 BYU Athletic Department — Athletic Services: $1,542.22 Campbell Scientific — Samera Health: $1,542.22
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	$1,623.39	$1,217.54	$836.21 – $1,542.22
Nerve root injection, lower back, with imaging guidance: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $1,542.22 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,542.22 Aetna — Aetna Utah Connected Network: $1,542.22 Aetna — Aetna Whole Health Connected Utah Network: $1,542.22 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,542.22 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,542.22 BYU Athletic Department — Athletic Services: $1,542.22 Campbell Scientific — Samera Health: $1,542.22 Cigna — PPO/EPO: $1,542.22 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,542.22
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Njx aa&/strd tfrm epi l/s 1	Not listed in the file	Not listed in the file	$160.50
Nerve root injection, lower back, with imaging guidance: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $160.50 Aetna — Aetna Medicare PPO: $160.50 Health Choice Utah — Health Choice Utah-Medicaid: $160.50 Healthy U — Medicaid: $160.50 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $160.50 Molina — Medicaid: $160.50 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $160.50 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $160.50 SelectHealth — Medicaid: $160.50 SelectHealth — Medicare Advantage: $160.50
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $637.01 Aetna — Aetna Medicare PPO: $637.01 Health Choice Utah — Health Choice Utah-Medicaid: $637.01 Healthy U — Medicaid: $637.01 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $637.01 Molina — Medicaid: $637.01 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $637.01 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $637.01 SelectHealth — Medicaid: $637.01 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $322.75 Aetna — Aetna Medicare PPO: $322.75 Health Choice Utah — Health Choice Utah-Medicaid: $322.75 Healthy U — Medicaid: $322.75 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $322.75 Molina — Medicaid: $322.75 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $322.75 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $322.75 SelectHealth — Medicaid: $322.75 SelectHealth — Medicare Advantage: $322.75
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,312.17	$984.13	$498.62 – $1,259.68
Laser treatment of clouding after cataract surgery: 10 of 68 insurance plan rates Aetna — Aetna Extended Network: $1,259.68 Aetna — Aetna Medicare HMO: $498.62 Aetna — Aetna Medicare PPO: $498.62 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,246.56 Aetna — Aetna Utah Connected Network: $1,246.56 Aetna — Aetna Whole Health Connected Utah Network: $1,259.68 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,246.56 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,246.56 BYU Athletic Department — Athletic Services: $1,246.56 Campbell Scientific — Samera Health: $1,246.56
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,312.17	$984.13	$675.90 – $1,246.56
Laser treatment of clouding after cataract surgery: 10 of 63 insurance plan rates Aetna — Aetna Extended Network: $1,246.56 Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $1,246.56 Aetna — Aetna Utah Connected Network: $1,246.56 Aetna — Aetna Whole Health Connected Utah Network: $1,246.56 BCBS OOS - PPO — BCBS Association-Blue Card PPO Plan: $1,246.56 BCBS OOS -TRAD — BCBS Association-Blue Card Traditional Plan: $1,246.56 BYU Athletic Department — Athletic Services: $1,246.56 Campbell Scientific — Samera Health: $1,246.56 Cigna — PPO/EPO: $1,246.56 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $1,246.56
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$444.66
Laser treatment of clouding after cataract surgery: 10 of 13 insurance plan rates Aetna — Aetna Medicare HMO: $444.66 Aetna — Aetna Medicare PPO: $444.66 Health Choice Utah — Health Choice Utah-Medicaid: $444.66 Healthy U — Medicaid: $444.66 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $444.66 Molina — Medicaid: $444.66 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $444.66 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $444.66 SelectHealth — Medicaid: $444.66 SelectHealth — Medicare Advantage: $444.66
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	$3,819 – $4,182
Cataract removal with lens implant: 10 of 38 insurance plan rates Aetna — Aetna Standard Network AKA Aetna Health Plan Network for Uta: $4,182 Aetna — Aetna Utah Connected Network: $4,182 Aetna — Aetna Whole Health Connected Utah Network: $4,182 BYU Athletic Department — Athletic Services: $4,182 Campbell Scientific — Samera Health: $4,182 Cigna — PPO/EPO: $4,182 Cigna Healthcare — CIGNA Managed Care (HMO or Open Access Plus aka OAP): $4,182 Deseret Mutual — DMBA: $4,182 EMI Health — EMI Health: $4,182 EMI Health — EMI Health Choice: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $778.58 Aetna — Aetna Medicare PPO: $778.58 Health Choice Utah — Health Choice Utah-Medicaid: $778.58 Healthy U — Medicaid: $778.58 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $778.58 Molina — Medicaid: $778.58 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $778.58 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $778.58 SelectHealth — Medicaid: $778.58 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $363.34 Aetna — Aetna Medicare PPO: $363.34 Health Choice Utah — Health Choice Utah-Medicaid: $363.34 Healthy U — Medicaid: $363.34 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $363.34 Molina — Medicaid: $363.34 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $363.34 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $363.34 SelectHealth — Medicaid: $363.34 SelectHealth — Medicare Advantage: $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 13 insurance plan rates Aetna — Aetna Medicare HMO: $2,326.99 Aetna — Aetna Medicare PPO: $2,326.99 Health Choice Utah — Health Choice Utah-Medicaid: $2,326.99 Healthy U — Medicaid: $2,326.99 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $2,326.99 Molina — Medicaid: $2,326.99 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $2,326.99 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $2,326.99 SelectHealth — Medicaid: $2,326.99 SelectHealth — Medicare Advantage: $2,326.99
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $2,572.16 Aetna — Aetna Medicare PPO: $2,572.16 Health Choice Utah — Health Choice Utah-Medicaid: $2,572.16 Healthy U — Medicaid: $2,572.16 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $2,572.16 Molina — Medicaid: $2,572.16 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $2,572.16 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $2,572.16 SelectHealth — Medicaid: $2,572.16 SelectHealth — Medicare Advantage: $2,572.16
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 13 insurance plan rates Aetna — Aetna Medicare HMO: $2,434.98 Aetna — Aetna Medicare PPO: $2,434.98 Health Choice Utah — Health Choice Utah-Medicaid: $2,434.98 Healthy U — Medicaid: $2,434.98 Medicare Intermountain Healthcare Nevada — Medicare Intermountain Healthcare Nevada: $2,434.98 Molina — Medicaid: $2,434.98 Molina Healthcare of Utah — Molina Healthcare Medicaid HMO: $2,434.98 Molina Healthcare of Utah — Molina Medicare Complete Care HMO SNP: $2,434.98 SelectHealth — Medicaid: $2,434.98 SelectHealth — Medicare Advantage: $2,434.98

Source: Intermountain Health Garfield Memorial 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	Critical Access Hospital
Address	200 North 400 East, Panguitch, UT 84759
County	Garfield County
State	Utah
Phone	(435) 676‑1262
Emergency services	Yes
Ownership	Voluntary non-profit - Other
Medicare overall rating	Not rated by CMS
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	461333
Name in Medicare records	INTERMOUNTAIN HEALTH GARFIELD MEMORIAL HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(435) 676‑8811^[4][5]
Name on the hospital’s website	Garfield Memorial Hospital
Official website	intermountainhealth.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
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.

Garfield Memorial Hospital | Care in Panguitch, Utah — intermountainhealth.org
Garfield Memorial Hospital Emergency — intermountainhealth.org
About Garfield Memorial Hospital — intermountainhealth.org

Intermountain Health Garfield Memorial Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas^[4][5]

Programs and centers^[4][6]

Emergency care (hospital website)^[4][5]

Visiting and practical information

Recognition^[6]

Doctors and clinicians (82)

Main specialties

Doctors with a page on this site (82)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Intermountain Health Garfield Memorial Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas[4][5]

Programs and centers[4][6]

Emergency care (hospital website)[4][5]

Visiting and practical information

Recognition[6]

Doctors and clinicians (82)

Main specialties

Doctors with a page on this site (82)

Other emergency rooms nearby

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Community care nearby

Clinics and urgent care

Pharmacies

About the Medicare star rating

Medicare quality data

What patients said (patient survey)

Infections caught in the hospital

Complications and deaths

Return visits to the hospital (readmissions)

Emergency room times and sepsis care

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital information

Sources

From the hospital’s website

Specialties and care areas^[4][5]

Programs and centers^[4][6]

Emergency care (hospital website)^[4][5]

Recognition^[6]