Does LDS Hospital have an emergency room?

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

Where is LDS Hospital?

8th Avenue and C Street, Salt Lake City, UT 84143, in Salt Lake County, Utah.

What is the phone number of LDS Hospital?

(801) 408-1100, as listed by Medicare (CMS).

What is the Medicare star rating of LDS Hospital?

5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

LDS Hospital — Salt Lake City, UT

Quick answers

Does LDS Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at LDS Hospital. In a medical emergency, call 911.
Where is LDS Hospital?: 8th Avenue and C Street, Salt Lake City, UT 84143, in Salt Lake County, Utah.
What is the phone number of LDS Hospital?: (801) 408-1100, as listed by Medicare (CMS).
What is the Medicare star rating of LDS Hospital?: 5 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[5][6][7][8]

Emergency medicine
Trauma care
Cardiology
Pulmonology
Infectious diseases
Behavioral health
Oncology
Medical oncology
Radiation oncology
Surgical oncology
Hematology
Maternal fetal medicine
Maternity
Labor and delivery
Women's health
Palliative care
Genetic counseling
Nutrition services
Hyperbaric medicine
Wound care
Imaging
Endoscopy
Sleep medicine

Conditions treated^[6][7][8]

Blood cancers
Breast cancer
Lung cancer
Gastrointestinal cancers
Genitourinary cancers
Rare tumors
Complex blood disorders
Substance withdrawal
Mental health crisis

Treatments^[6][8]

Chemotherapy
Immunotherapy
Targeted therapy
BiTE therapy
Radiation therapy
Image-guided external beam radiation
Stereotactic radiosurgery
Brachytherapy
Infusion therapy
Palliative and supportive oncology
Oncology nutrition
Hyperbaric medicine
Wound care
Withdrawal management
Phase 1 clinical trials

Procedures^[6][8]

Cancer surgery (minimally invasive options)
Same-day surgery
Total joint replacement
Surgical weight loss
Endoscopy
Mammography
Diagnostic imaging
Sleep testing
Blood and marrow transplant

Programs and centers^[4][6][7][8]

Behavioral Health Access Center (mental health crisis care)
Oncology / cancer care
Intermountain Health Cancer Center - LDS
Blood & Marrow Transplant/Acute Leukemia Program
Loveland Clinic for Blood Cancer Therapy
Total Joint Replacement Center
Surgical Weight Loss
Special Care Nursery
Sleep Testing Center
Withdrawal management
Cancer navigation and survivorship services
Genetic counseling and high-risk cancer prevention
Hospital classes and support groups

Emergency care (hospital website)^[4]

Emergency room	Yes

Visiting and practical information

Visiting	Visiting hours 9 a.m.-9 p.m^[4]
Patient portal	Intermountain Health patient portal

Recognition^[8][9]

Commission on Cancer accreditation (cancer center)
ASTRO APEx accreditation (radiation oncology, Intermountain Cancer Center - LDS Hospital)

Doctors and clinicians (702)

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

Main specialties

And 678 more: the button below opens the full list.

Other emergency rooms nearby

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

Holy Cross Hospital - Salt Lake1.2 mi · Salt Lake City, UT · Acute Care Hospital
University of Utah Hospital and Clinics2.3 mi · Salt Lake City, UT · Acute Care Hospital
Primary Children's Hospital2.7 mi · Salt Lake City, UT · Children's Hospital
VA Salt Lake City Healthcare - George E. Wahlen VA Medical Center2.9 mi · Salt Lake City, UT · Federal/VA Acute Care Hospital
St Mark's Hospital6.4 mi · Salt Lake City, UT · Acute Care Hospital

Other hospitals nearby

Marian Center3.5 mi · Salt Lake City, UT · Psychiatric Hospital
Salt Lake Behavioral Health6.2 mi · Salt Lake City, UT · Psychiatric 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

Maple Ridge Rehabilitation and Nursing1.4 mi · Salt Lake City, UT · 1 of 5 stars
City Creek Post Acute1.6 mi · Salt Lake City, UT · 4 of 5 stars
Midtown Manor2.2 mi · Salt Lake City, UT · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Hospice for Utah LLC4.4 mi · South Salt Lake, UT
True North Hospice4.4 mi · South Salt Lake, UT
CNS Community Hospice6.4 mi · West Valley City, UT · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Cascade Springs Home Healthcare3.0 mi · Salt Lake City, UT · 2 of 5 stars
True North Home Health4.4 mi · South Salt Lake, UT · 4 of 5 stars
Community Nursing Services6.4 mi · West Valley City, UT

All home health agencies in the state →

Dialysis facilities

462320 Primary Children's Dialysis Center2.7 mi · Salt Lake City, UT
462530 Fresenius Kidney Care Wasatch4.4 mi · Salt Lake City, UT · 4 of 5 stars
463502 Utah Dialysis Lab4.4 mi · Salt Lake City, UT · 3 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

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

The Center for Surgical Arts1.6 mi · Salt Lake City, UT
Intermountain Surgery Center - Avenues2.5 mi · Salt Lake City, UT
Lakeview Endoscopy Center7.0 mi · Bountiful, UT

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Magnolia Apartments0.9 mi · Salt Lake City, UT · Community health center
Central City Medical Clinic1.6 mi · Salt Lake City, UT · Community health center
Sacred Circle Health Care1.6 mi · Salt Lake, UT · Community health center

Clinics and urgent care

American Current Care P.A.5.7 mi · Salt Lake City, UT · Urgent care center
American Current Care P.A.5.7 mi · Salt Lake City, UT · Urgent care center
Utah Carenow Urgent Care, LLC5.7 mi · Salt Lake City, UT · Urgent care center

Pharmacies

Medical Center Pharmacy Inc1.6 mi · Salt Lake City, UT · Community/retail pharmacy
Planned Parenthood1.6 mi · Salt Lake City, UT · Clinic pharmacy
Planned Parenthood Association of Utah1.6 mi · Salt Lake City, UT · Clinic pharmacy

Assisted living nearby

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

Capitol Hill Senior Living1.6 mi · Salt Lake City, UT
Sarah Daft Home1.6 mi · Salt Lake City, UT
The INN Between3.0 mi · Salt Lake City, UT
Rosewood Assisted Care4.4 mi · South Salt Lake, UT

About the Medicare star rating

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

Medicare quality data

What LDS 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)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	5 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	73%National average: 72%
Would definitely recommend the hospital	75%National average: 71%
Nurses “always” communicated well	79%National average: 80%
Doctors “always” communicated well	83%National average: 80%
Staff “always” explained medicines before giving them	62%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	81%National average: 74%
Area around the room “always” quiet at night	63%National average: 60%
Completed surveys	1,168Response rate: 24%

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)	0.623No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.227No different from the national benchmark
Surgical site infections after colon surgery	0Better than the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0.414No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.326Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

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

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	10.8%
Deaths within 30 days: pneumonia patients	16.4%
Deaths within 30 days: COPD patients	Too few cases to report
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.91No different from the national rate
Complications after hip or knee replacement	4.2%

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	21.4%
Readmitted within 30 days: pneumonia	17.2%
Readmitted within 30 days: COPD	19.8%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	4.8%

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

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

Emergency room volume (patients per year)	Medium (20,000–39,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	176 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	62%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 Salt Lake City Best hospitals in Salt Lake City

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 82 common services exactly as LDS 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 →

$ 5 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 3	$484.57	$363.43	$6.30 – $436.11
New patient office visit (about 30–44 minutes): 10 of 61 insurance plan rates Aetna — Connected: $387.66 Aetna — Extended: $411.88 AG Administrators — USU Athletics: $348.89 Altius MHNet Behavioral Health — Behavioral Health: $411.88 AWH Connected — Connected Utah: $307.70 BYU Athletics — Commercial: $348.89 BYU Risk Management — Workers Comp: $339.20 Campbell Scientific — Commercial: $348.89 Cigna — Open Access Flex: $305.28 Cigna — PPO/EPO: $411.88
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	$484.57	$363.43	$125.50 – $436.11
New patient office visit (about 30–44 minutes): 10 of 61 insurance plan rates Aetna — Connected: $392.50 Aetna — Extended: $411.88 AG Administrators — USU Athletics: $348.89 Altius MHNet Behavioral Health — Behavioral Health: $411.88 AWH Connected — Connected Utah: $312.55 BYU Athletics — Commercial: $348.89 BYU Risk Management — Workers Comp: $353.74 Campbell Scientific — Commercial: $348.89 Cigna — Open Access Flex: $305.28 Cigna — PPO/EPO: $411.88
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 15 insurance plan rates Aetna — Medicare Adv HMO: $80.54 Aetna — Medicare Adv PPO: $80.54 American Health — Medicare Adv UT HMO I-SNP: $80.54 Health Partners of Nevada — Medicare Advantage: $80.54 Humana — Medicare Choice PPO: $80.54 Molina — Medicare Advantage: $80.54 Molina — Medicare Choice Care HMO: $80.54 Molina — Medicare Complete Care HMO SNP: $80.54 Regence BCBS — MedAdvantage PPO: $80.54 SelectHealth — Med Individual ACA: $80.54
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 4	$484.57	$363.43	$6.30 – $436.11
New patient office visit (about 45–59 minutes): 10 of 61 insurance plan rates Aetna — Connected: $387.66 Aetna — Extended: $411.88 AG Administrators — USU Athletics: $348.89 Altius MHNet Behavioral Health — Behavioral Health: $411.88 AWH Connected — Connected Utah: $307.70 BYU Athletics — Commercial: $348.89 BYU Risk Management — Workers Comp: $339.20 Campbell Scientific — Commercial: $348.89 Cigna — Open Access Flex: $305.28 Cigna — PPO/EPO: $411.88
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	$484.57	$363.43	$125.50 – $436.11
New patient office visit (about 45–59 minutes): 10 of 61 insurance plan rates Aetna — Connected: $392.50 Aetna — Extended: $411.88 AG Administrators — USU Athletics: $348.89 Altius MHNet Behavioral Health — Behavioral Health: $411.88 AWH Connected — Connected Utah: $312.55 BYU Athletics — Commercial: $348.89 BYU Risk Management — Workers Comp: $353.74 Campbell Scientific — Commercial: $348.89 Cigna — Open Access Flex: $305.28 Cigna — PPO/EPO: $411.88
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 15 insurance plan rates Aetna — Medicare Adv HMO: $129.68 Aetna — Medicare Adv PPO: $129.68 American Health — Medicare Adv UT HMO I-SNP: $129.68 Health Partners of Nevada — Medicare Advantage: $129.68 Humana — Medicare Choice PPO: $129.68 Molina — Medicare Advantage: $129.68 Molina — Medicare Choice Care HMO: $129.68 Molina — Medicare Complete Care HMO SNP: $129.68 Regence BCBS — MedAdvantage PPO: $129.68 SelectHealth — Med Individual ACA: $129.68
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT NEW LEVEL 5	$334.01	$250.51	$4.34 – $300.61
New patient office visit (about 60–74 minutes): 10 of 61 insurance plan rates Aetna — Connected: $267.21 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 Altius MHNet Behavioral Health — Behavioral Health: $283.91 AWH Connected — Connected Utah: $212.10 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $233.81 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91
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	$86.51 – $300.61
New patient office visit (about 60–74 minutes): 10 of 61 insurance plan rates Aetna — Connected: $270.55 Aetna — Extended: $283.91 AG Administrators — USU Athletics: $240.49 Altius MHNet Behavioral Health — Behavioral Health: $283.91 AWH Connected — Connected Utah: $215.44 BYU Athletics — Commercial: $240.49 BYU Risk Management — Workers Comp: $243.83 Campbell Scientific — Commercial: $240.49 Cigna — Open Access Flex: $210.43 Cigna — PPO/EPO: $283.91
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 15 insurance plan rates Aetna — Medicare Adv HMO: $176.02 Aetna — Medicare Adv PPO: $176.02 American Health — Medicare Adv UT HMO I-SNP: $176.02 Health Partners of Nevada — Medicare Advantage: $176.02 Humana — Medicare Choice PPO: $176.02 Molina — Medicare Advantage: $176.02 Molina — Medicare Choice Care HMO: $176.02 Molina — Medicare Complete Care HMO SNP: $176.02 Regence BCBS — MedAdvantage PPO: $176.02 SelectHealth — Med Individual ACA: $176.02
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$380.37	$285.28	$4.94 – $342.33
Established patient office visit (about 20–29 minutes): 10 of 61 insurance plan rates Aetna — Connected: $304.30 Aetna — Extended: $323.31 AG Administrators — USU Athletics: $273.87 Altius MHNet Behavioral Health — Behavioral Health: $323.31 AWH Connected — Connected Utah: $241.53 BYU Athletics — Commercial: $273.87 BYU Risk Management — Workers Comp: $266.26 Campbell Scientific — Commercial: $273.87 Cigna — Open Access Flex: $239.63 Cigna — PPO/EPO: $323.31
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 3	$380.37	$285.28	$98.52 – $342.33
Established patient office visit (about 20–29 minutes): 10 of 61 insurance plan rates Aetna — Connected: $308.10 Aetna — Extended: $323.31 AG Administrators — USU Athletics: $273.87 Altius MHNet Behavioral Health — Behavioral Health: $323.31 AWH Connected — Connected Utah: $245.34 BYU Athletics — Commercial: $273.87 BYU Risk Management — Workers Comp: $277.67 Campbell Scientific — Commercial: $273.87 Cigna — Open Access Flex: $239.63 Cigna — PPO/EPO: $323.31
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 15 insurance plan rates Aetna — Medicare Adv HMO: $64.24 Aetna — Medicare Adv PPO: $64.24 American Health — Medicare Adv UT HMO I-SNP: $64.24 Health Partners of Nevada — Medicare Advantage: $64.24 Humana — Medicare Choice PPO: $64.24 Molina — Medicare Advantage: $64.24 Molina — Medicare Choice Care HMO: $64.24 Molina — Medicare Complete Care HMO SNP: $64.24 Regence BCBS — MedAdvantage PPO: $64.24 SelectHealth — Med Individual ACA: $64.24
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$449.60	$337.20	$5.84 – $404.64
Established patient office visit (about 30–39 minutes): 10 of 61 insurance plan rates Aetna — Connected: $359.68 Aetna — Extended: $382.16 AG Administrators — USU Athletics: $323.71 Altius MHNet Behavioral Health — Behavioral Health: $382.16 AWH Connected — Connected Utah: $285.50 BYU Athletics — Commercial: $323.71 BYU Risk Management — Workers Comp: $314.72 Campbell Scientific — Commercial: $323.71 Cigna — Open Access Flex: $283.25 Cigna — PPO/EPO: $382.16
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OFFICE/OUTPATIENT VISIT EST LEVEL 4	$449.60	$337.20	$116.45 – $404.64
Established patient office visit (about 30–39 minutes): 10 of 61 insurance plan rates Aetna — Connected: $364.18 Aetna — Extended: $382.16 AG Administrators — USU Athletics: $323.71 Altius MHNet Behavioral Health — Behavioral Health: $382.16 AWH Connected — Connected Utah: $289.99 BYU Athletics — Commercial: $323.71 BYU Risk Management — Workers Comp: $328.21 Campbell Scientific — Commercial: $323.71 Cigna — Open Access Flex: $283.25 Cigna — PPO/EPO: $382.16
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 15 insurance plan rates Aetna — Medicare Adv HMO: $94.90 Aetna — Medicare Adv PPO: $94.90 American Health — Medicare Adv UT HMO I-SNP: $94.90 Health Partners of Nevada — Medicare Advantage: $94.90 Humana — Medicare Choice PPO: $94.90 Molina — Medicare Advantage: $94.90 Molina — Medicare Choice Care HMO: $94.90 Molina — Medicare Complete Care HMO SNP: $94.90 Regence BCBS — MedAdvantage PPO: $94.90 SelectHealth — Med Individual ACA: $94.90
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est low 30	Not listed in the file	Not listed in the file	$249.75 – $298
Office consultation with a specialist (moderate): rates for 8 insurance plans Intermountain Caregiver Plan — Med Network: $283.81 Intermountain Caregiver Plan — Share Network: $249.75 SelectHealth — CHP: $283.81 SelectHealth — Commercial: $283.81 SelectHealth — FEHBP: $298 SelectHealth — SelectCare: $298 SelectHealth — SelectShare: $249.75 SelectHealth — SelectValue: $249.75
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Off/op cnsltj new/est mod 40	Not listed in the file	Not listed in the file	$356.07 – $424.86
Office consultation with a specialist (moderate to high): rates for 8 insurance plans Intermountain Caregiver Plan — Med Network: $404.63 Intermountain Caregiver Plan — Share Network: $356.07 SelectHealth — CHP: $404.63 SelectHealth — Commercial: $404.63 SelectHealth — FEHBP: $424.86 SelectHealth — SelectCare: $424.86 SelectHealth — SelectShare: $356.07 SelectHealth — SelectValue: $356.07
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 18-39	Not listed in the file	Not listed in the file	$90.61 – $342.89
Preventive checkup, new patient, age 18–39: rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $326.56 Intermountain Caregiver Plan — Share Network: $287.37 SelectHealth — CHP: $326.56 SelectHealth — Commercial: $326.56 SelectHealth — FEHBP: $342.89 SelectHealth — SelectCare: $342.89 SelectHealth — SelectShare: $287.37 SelectHealth — SelectValue: $287.37 TriWest — Veterans Choice: $90.61
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prev visit new age 40-64	Not listed in the file	Not listed in the file	$109.85 – $395.48
Preventive checkup, new patient, age 40–64: rates for 9 insurance plans Intermountain Caregiver Plan — Med Network: $376.65 Intermountain Caregiver Plan — Share Network: $331.45 SelectHealth — CHP: $376.65 SelectHealth — Commercial: $376.65 SelectHealth — FEHBP: $395.48 SelectHealth — SelectCare: $395.48 SelectHealth — SelectShare: $331.45 SelectHealth — SelectValue: $331.45 TriWest — Veterans Choice: $109.85
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM-LEVEL 3	$1,843.94	$1,382.96	$23.97 – $1,659.55
Emergency room visit (moderate): 10 of 61 insurance plan rates Aetna — Connected: $1,475.15 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 Altius MHNet Behavioral Health — Behavioral Health: $1,567.35 AWH Connected — Connected Utah: $1,170.90 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,290.76 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35
Emergency room visit (moderate) CPT 99283 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 3 W/MOD	$1,843.94	$1,382.96	$23.97 – $1,659.55
Emergency room visit (moderate): 10 of 61 insurance plan rates Aetna — Connected: $1,475.15 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 Altius MHNet Behavioral Health — Behavioral Health: $1,567.35 AWH Connected — Connected Utah: $1,170.90 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,290.76 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM-LEVEL 3	$1,843.94	$1,382.96	$477.58 – $1,659.55
Emergency room visit (moderate): 10 of 61 insurance plan rates Aetna — Connected: $1,493.59 Aetna — Extended: $1,567.35 AG Administrators — USU Athletics: $1,327.64 Altius MHNet Behavioral Health — Behavioral Health: $1,567.35 AWH Connected — Connected Utah: $1,189.34 BYU Athletics — Commercial: $1,327.64 BYU Risk Management — Workers Comp: $1,346.08 Campbell Scientific — Commercial: $1,327.64 Cigna — Open Access Flex: $1,161.68 Cigna — PPO/EPO: $1,567.35
Emergency room visit (moderately high) CPT 99284 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,765.74	$2,074.30	$35.95 – $2,489.17
Emergency room visit (moderately high): 10 of 61 insurance plan rates Aetna — Connected: $2,212.59 Aetna — Extended: $2,350.88 AG Administrators — USU Athletics: $1,991.33 Altius MHNet Behavioral Health — Behavioral Health: $2,350.88 AWH Connected — Connected Utah: $1,756.24 BYU Athletics — Commercial: $1,991.33 BYU Risk Management — Workers Comp: $1,936.02 Campbell Scientific — Commercial: $1,991.33 Cigna — Open Access Flex: $1,742.42 Cigna — PPO/EPO: $2,350.88
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 4 W/MOD	$2,765.74	$2,074.30	$716.33 – $2,489.17
Emergency room visit (moderately high): 10 of 61 insurance plan rates Aetna — Connected: $2,240.25 Aetna — Extended: $2,350.88 AG Administrators — USU Athletics: $1,991.33 Altius MHNet Behavioral Health — Behavioral Health: $2,350.88 AWH Connected — Connected Utah: $1,783.90 BYU Athletics — Commercial: $1,991.33 BYU Risk Management — Workers Comp: $2,018.99 Campbell Scientific — Commercial: $1,991.33 Cigna — Open Access Flex: $1,742.42 Cigna — PPO/EPO: $2,350.88
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit mod mdm	Not listed in the file	Not listed in the file	$403.22 – $3,211
Emergency room visit (moderately high): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $422.19 Aetna — Medicare Adv PPO: $464.40 American Health — Medicare Adv UT HMO I-SNP: $422.19 Health Partners of Nevada — Medicare Advantage: $422.19 Health Plan of Nevada — Medicaid: $422.19 Healthy U — Medicaid: $422.19 Humana — Medicare Choice PPO: $443.29 Intermountain Caregiver Plan — Med Network: $2,966 Intermountain Caregiver Plan — Share Network: $2,462 Molina — Medicaid: $422.19
Emergency room visit (high) CPT 99285 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$4,148.55	$3,111.41	$53.93 – $3,733.70
Emergency room visit (high): 10 of 61 insurance plan rates Aetna — Connected: $3,318.84 Aetna — Extended: $3,526.27 AG Administrators — USU Athletics: $2,986.96 Altius MHNet Behavioral Health — Behavioral Health: $3,526.27 AWH Connected — Connected Utah: $2,634.33 BYU Athletics — Commercial: $2,986.96 BYU Risk Management — Workers Comp: $2,903.98 Campbell Scientific — Commercial: $2,986.96 Cigna — Open Access Flex: $2,613.59 Cigna — PPO/EPO: $3,526.27
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC EMERGENCY ROOM - LEVEL 5 W/MOD	$4,148.55	$3,111.41	$1,074.47 – $3,733.70
Emergency room visit (high): 10 of 61 insurance plan rates Aetna — Connected: $3,360.33 Aetna — Extended: $3,526.27 AG Administrators — USU Athletics: $2,986.96 Altius MHNet Behavioral Health — Behavioral Health: $3,526.27 AWH Connected — Connected Utah: $2,675.81 BYU Athletics — Commercial: $2,986.96 BYU Risk Management — Workers Comp: $3,028.44 Campbell Scientific — Commercial: $2,986.96 Cigna — Open Access Flex: $2,613.59 Cigna — PPO/EPO: $3,526.27
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Emergency dept visit hi mdm	Not listed in the file	Not listed in the file	$584.74 – $4,825
Emergency room visit (high): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $602.48 Aetna — Medicare Adv PPO: $662.72 American Health — Medicare Adv UT HMO I-SNP: $602.48 Health Partners of Nevada — Medicare Advantage: $602.48 Health Plan of Nevada — Medicaid: $602.48 Healthy U — Medicaid: $602.48 Humana — Medicare Choice PPO: $632.60 Intermountain Caregiver Plan — Med Network: $4,453 Intermountain Caregiver Plan — Share Network: $3,697 Molina — Medicaid: $602.48

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$64.73	$48.55	$0.84 – $58.26
Basic metabolic panel (blood test): 10 of 61 insurance plan rates Aetna — Connected: $51.78 Aetna — Extended: $55.02 AG Administrators — USU Athletics: $46.61 Altius MHNet Behavioral Health — Behavioral Health: $55.02 AWH Connected — Connected Utah: $41.10 BYU Athletics — Commercial: $46.61 BYU Risk Management — Workers Comp: $45.31 Campbell Scientific — Commercial: $46.61 Cigna — Open Access Flex: $40.78 Cigna — PPO/EPO: $55.02
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASIC METABOLIC PANEL	$64.73	$48.55	$16.77 – $58.26
Basic metabolic panel (blood test): 10 of 61 insurance plan rates Aetna — Connected: $52.43 Aetna — Extended: $55.02 AG Administrators — USU Athletics: $46.61 Altius MHNet Behavioral Health — Behavioral Health: $55.02 AWH Connected — Connected Utah: $41.75 BYU Athletics — Commercial: $46.61 BYU Risk Management — Workers Comp: $47.25 Campbell Scientific — Commercial: $46.61 Cigna — Open Access Flex: $40.78 Cigna — PPO/EPO: $55.02
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic metabolic pnl total ca	Not listed in the file	Not listed in the file	$7.54 – $67
Basic metabolic panel (blood test): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $8.46 Aetna — Medicare Adv PPO: $9.31 AG Administrators — USU Athletics: $67 American Health — Medicare Adv UT HMO I-SNP: $8.46 AWH Connected — Connected Utah: $67 BYU Athletics — Commercial: $67 Campbell Scientific — Commercial: $67 Deseret Mutual — All Other: $67 Deseret Mutual — Select: $67 EMI — Commercial: $67
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$95.82	$71.86	$1.25 – $86.24
Comprehensive metabolic panel (blood test): 10 of 61 insurance plan rates Aetna — Connected: $76.66 Aetna — Extended: $81.45 AG Administrators — USU Athletics: $68.99 Altius MHNet Behavioral Health — Behavioral Health: $81.45 AWH Connected — Connected Utah: $60.85 BYU Athletics — Commercial: $68.99 BYU Risk Management — Workers Comp: $67.07 Campbell Scientific — Commercial: $68.99 Cigna — Open Access Flex: $60.37 Cigna — PPO/EPO: $81.45
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMPREHENSIVE METABOLIC PANEL	$95.82	$71.86	$24.82 – $86.24
Comprehensive metabolic panel (blood test): 10 of 61 insurance plan rates Aetna — Connected: $77.61 Aetna — Extended: $81.45 AG Administrators — USU Athletics: $68.99 Altius MHNet Behavioral Health — Behavioral Health: $81.45 AWH Connected — Connected Utah: $61.80 BYU Athletics — Commercial: $68.99 BYU Risk Management — Workers Comp: $69.95 Campbell Scientific — Commercial: $68.99 Cigna — Open Access Flex: $60.37 Cigna — PPO/EPO: $81.45
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	$9.41 – $95
Comprehensive metabolic panel (blood test): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $10.56 Aetna — Medicare Adv PPO: $11.62 AG Administrators — USU Athletics: $95 American Health — Medicare Adv UT HMO I-SNP: $10.56 AWH Connected — Connected Utah: $95 BYU Athletics — Commercial: $95 Campbell Scientific — Commercial: $95 Deseret Mutual — All Other: $95 Deseret Mutual — Select: $95 EMI — Commercial: $95
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$322.40	$241.80	$4.19 – $290.16
Obstetric blood test panel: 10 of 61 insurance plan rates Aetna — Connected: $257.92 Aetna — Extended: $274.04 AG Administrators — USU Athletics: $232.13 Altius MHNet Behavioral Health — Behavioral Health: $274.04 AWH Connected — Connected Utah: $204.72 BYU Athletics — Commercial: $232.13 BYU Risk Management — Workers Comp: $225.68 Campbell Scientific — Commercial: $232.13 Cigna — Open Access Flex: $203.11 Cigna — PPO/EPO: $274.04
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC OBSTETRIC PANEL	$322.40	$241.80	$83.50 – $290.16
Obstetric blood test panel: 10 of 61 insurance plan rates Aetna — Connected: $261.14 Aetna — Extended: $274.04 AG Administrators — USU Athletics: $232.13 Altius MHNet Behavioral Health — Behavioral Health: $274.04 AWH Connected — Connected Utah: $207.95 BYU Athletics — Commercial: $232.13 BYU Risk Management — Workers Comp: $235.35 Campbell Scientific — Commercial: $232.13 Cigna — Open Access Flex: $203.11 Cigna — PPO/EPO: $274.04
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	$47.81 – $129
Obstetric blood test panel: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $47.81 Aetna — Medicare Adv PPO: $52.59 AG Administrators — USU Athletics: $129 American Health — Medicare Adv UT HMO I-SNP: $47.81 AWH Connected — Connected Utah: $129 BYU Athletics — Commercial: $129 Campbell Scientific — Commercial: $129 Deseret Mutual — All Other: $129 Deseret Mutual — Select: $121 EMI — Commercial: $129
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$94.57	$70.93	$1.23 – $85.11
Cholesterol panel (lipid panel): 10 of 61 insurance plan rates Aetna — Connected: $75.66 Aetna — Extended: $80.38 AG Administrators — USU Athletics: $68.09 Altius MHNet Behavioral Health — Behavioral Health: $80.38 AWH Connected — Connected Utah: $60.05 BYU Athletics — Commercial: $68.09 BYU Risk Management — Workers Comp: $66.20 Campbell Scientific — Commercial: $68.09 Cigna — Open Access Flex: $59.58 Cigna — PPO/EPO: $80.38
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LIPID PANEL	$94.57	$70.93	$24.49 – $85.11
Cholesterol panel (lipid panel): 10 of 61 insurance plan rates Aetna — Connected: $76.60 Aetna — Extended: $80.38 AG Administrators — USU Athletics: $68.09 Altius MHNet Behavioral Health — Behavioral Health: $80.38 AWH Connected — Connected Utah: $61 BYU Athletics — Commercial: $68.09 BYU Risk Management — Workers Comp: $69.04 Campbell Scientific — Commercial: $68.09 Cigna — Open Access Flex: $59.58 Cigna — PPO/EPO: $80.38
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid panel	Not listed in the file	Not listed in the file	$11.93 – $95
Cholesterol panel (lipid panel): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $13.39 Aetna — Medicare Adv PPO: $14.73 AG Administrators — USU Athletics: $95 American Health — Medicare Adv UT HMO I-SNP: $13.39 AWH Connected — Connected Utah: $95 BYU Athletics — Commercial: $95 Campbell Scientific — Commercial: $95 Deseret Mutual — All Other: $95 Deseret Mutual — Select: $95 EMI — Commercial: $95
Kidney function panel CPT 80069 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$67.55	$50.66	$0.88 – $60.80
Kidney function panel: 10 of 61 insurance plan rates Aetna — Connected: $54.04 Aetna — Extended: $57.42 AG Administrators — USU Athletics: $48.64 Altius MHNet Behavioral Health — Behavioral Health: $57.42 AWH Connected — Connected Utah: $42.89 BYU Athletics — Commercial: $48.64 BYU Risk Management — Workers Comp: $47.28 Campbell Scientific — Commercial: $48.64 Cigna — Open Access Flex: $42.56 Cigna — PPO/EPO: $57.42
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC RENAL FUNCTION PANEL	$67.55	$50.66	$17.50 – $60.80
Kidney function panel: 10 of 61 insurance plan rates Aetna — Connected: $54.72 Aetna — Extended: $57.42 AG Administrators — USU Athletics: $48.64 Altius MHNet Behavioral Health — Behavioral Health: $57.42 AWH Connected — Connected Utah: $43.57 BYU Athletics — Commercial: $48.64 BYU Risk Management — Workers Comp: $49.31 Campbell Scientific — Commercial: $48.64 Cigna — Open Access Flex: $42.56 Cigna — PPO/EPO: $57.42
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal function panel	Not listed in the file	Not listed in the file	$7.73 – $53
Kidney function panel: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $8.68 Aetna — Medicare Adv PPO: $9.55 AG Administrators — USU Athletics: $53 American Health — Medicare Adv UT HMO I-SNP: $8.68 AWH Connected — Connected Utah: $53 BYU Athletics — Commercial: $53 Campbell Scientific — Commercial: $53 Deseret Mutual — All Other: $53 Deseret Mutual — Select: $53 EMI — Commercial: $53
Liver function panel CPT 80076 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$62.89	$47.17	$0.82 – $56.60
Liver function panel: 10 of 61 insurance plan rates Aetna — Connected: $50.31 Aetna — Extended: $53.46 AG Administrators — USU Athletics: $45.28 Altius MHNet Behavioral Health — Behavioral Health: $53.46 AWH Connected — Connected Utah: $39.94 BYU Athletics — Commercial: $45.28 BYU Risk Management — Workers Comp: $44.02 Campbell Scientific — Commercial: $45.28 Cigna — Open Access Flex: $39.62 Cigna — PPO/EPO: $53.46
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC HEPATIC FUNCTION PANEL	$62.89	$47.17	$16.29 – $56.60
Liver function panel: 10 of 61 insurance plan rates Aetna — Connected: $50.94 Aetna — Extended: $53.46 AG Administrators — USU Athletics: $45.28 Altius MHNet Behavioral Health — Behavioral Health: $53.46 AWH Connected — Connected Utah: $40.56 BYU Athletics — Commercial: $45.28 BYU Risk Management — Workers Comp: $45.91 Campbell Scientific — Commercial: $45.28 Cigna — Open Access Flex: $39.62 Cigna — PPO/EPO: $53.46
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	$7.28 – $55
Liver function panel: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $8.17 Aetna — Medicare Adv PPO: $8.99 AG Administrators — USU Athletics: $55 American Health — Medicare Adv UT HMO I-SNP: $8.17 AWH Connected — Connected Utah: $55 BYU Athletics — Commercial: $55 Campbell Scientific — Commercial: $55 Deseret Mutual — All Other: $55 Deseret Mutual — Select: $55 EMI — Commercial: $55
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$43.67	$32.75	$0.57 – $39.30
Urine test (automated, with microscope): 10 of 61 insurance plan rates Aetna — Connected: $34.94 Aetna — Extended: $37.12 AG Administrators — USU Athletics: $31.44 Altius MHNet Behavioral Health — Behavioral Health: $37.12 AWH Connected — Connected Utah: $27.73 BYU Athletics — Commercial: $31.44 BYU Risk Management — Workers Comp: $30.57 Campbell Scientific — Commercial: $31.44 Cigna — Open Access Flex: $27.51 Cigna — PPO/EPO: $37.12
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/MICROSCOPY	$43.67	$32.75	$11.31 – $39.30
Urine test (automated, with microscope): 10 of 61 insurance plan rates Aetna — Connected: $35.37 Aetna — Extended: $37.12 AG Administrators — USU Athletics: $31.44 Altius MHNet Behavioral Health — Behavioral Health: $37.12 AWH Connected — Connected Utah: $28.17 BYU Athletics — Commercial: $31.44 BYU Risk Management — Workers Comp: $31.88 Campbell Scientific — Commercial: $31.44 Cigna — Open Access Flex: $27.51 Cigna — PPO/EPO: $37.12
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis auto w/scope	Not listed in the file	Not listed in the file	$2.82 – $52
Urine test (automated, with microscope): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $3.17 Aetna — Medicare Adv PPO: $3.49 AG Administrators — USU Athletics: $52 American Health — Medicare Adv UT HMO I-SNP: $3.17 AWH Connected — Connected Utah: $52 BYU Athletics — Commercial: $52 Campbell Scientific — Commercial: $52 Deseret Mutual — All Other: $52 Deseret Mutual — Select: $52 EMI — Commercial: $52
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$27.95	$20.96	$0.36 – $25.16
Urine test (manual, without microscope): 10 of 61 insurance plan rates Aetna — Connected: $22.36 Aetna — Extended: $23.76 AG Administrators — USU Athletics: $20.12 Altius MHNet Behavioral Health — Behavioral Health: $23.76 AWH Connected — Connected Utah: $17.75 BYU Athletics — Commercial: $20.12 BYU Risk Management — Workers Comp: $19.56 Campbell Scientific — Commercial: $20.12 Cigna — Open Access Flex: $17.61 Cigna — PPO/EPO: $23.76
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC N-AUTOM URINALYS WO MICRO	$27.95	$20.96	$7.24 – $25.16
Urine test (manual, without microscope): 10 of 61 insurance plan rates Aetna — Connected: $22.64 Aetna — Extended: $23.76 AG Administrators — USU Athletics: $20.12 Altius MHNet Behavioral Health — Behavioral Health: $23.76 AWH Connected — Connected Utah: $18.03 BYU Athletics — Commercial: $20.12 BYU Risk Management — Workers Comp: $20.40 Campbell Scientific — Commercial: $20.12 Cigna — Open Access Flex: $17.61 Cigna — PPO/EPO: $23.76
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	$3.10 – $52
Urine test (manual, without microscope): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $3.48 Aetna — Medicare Adv PPO: $3.83 AG Administrators — USU Athletics: $52 American Health — Medicare Adv UT HMO I-SNP: $3.48 AWH Connected — Connected Utah: $52 BYU Athletics — Commercial: $52 Campbell Scientific — Commercial: $52 Deseret Mutual — All Other: $52 Deseret Mutual — Select: $52 EMI — Commercial: $52
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED POCL/POCBS	$61.80	$46.35	$0.80 – $55.62
Urine test (automated, without microscope): 10 of 61 insurance plan rates Aetna — Connected: $49.44 Aetna — Extended: $52.53 AG Administrators — USU Athletics: $44.50 Altius MHNet Behavioral Health — Behavioral Health: $52.53 AWH Connected — Connected Utah: $39.24 BYU Athletics — Commercial: $44.50 BYU Risk Management — Workers Comp: $43.26 Campbell Scientific — Commercial: $44.50 Cigna — Open Access Flex: $38.93 Cigna — PPO/EPO: $52.53
Urine test (automated, without microscope) CPT 81003 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED	$19.68	$14.76	$0.26 – $17.71
Urine test (automated, without microscope): 10 of 61 insurance plan rates Aetna — Connected: $15.74 Aetna — Extended: $16.73 AG Administrators — USU Athletics: $14.17 Altius MHNet Behavioral Health — Behavioral Health: $16.73 AWH Connected — Connected Utah: $12.50 BYU Athletics — Commercial: $14.17 BYU Risk Management — Workers Comp: $13.78 Campbell Scientific — Commercial: $14.17 Cigna — Open Access Flex: $12.40 Cigna — PPO/EPO: $16.73
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC URINALYSIS W/O MICRO AUTOMATED POCL/POCBS	$61.80	$46.35	$16.01 – $55.62
Urine test (automated, without microscope): 10 of 61 insurance plan rates Aetna — Connected: $50.06 Aetna — Extended: $52.53 AG Administrators — USU Athletics: $44.50 Altius MHNet Behavioral Health — Behavioral Health: $52.53 AWH Connected — Connected Utah: $39.86 BYU Athletics — Commercial: $44.50 BYU Risk Management — Workers Comp: $45.11 Campbell Scientific — Commercial: $44.50 Cigna — Open Access Flex: $38.93 Cigna — PPO/EPO: $52.53
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$128.14	$96.10	$1.67 – $115.33
PSA (prostate specific antigen) blood test: 10 of 61 insurance plan rates Aetna — Connected: $102.51 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 Altius MHNet Behavioral Health — Behavioral Health: $108.92 AWH Connected — Connected Utah: $81.37 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $89.70 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROSTATE SPECIFIC ANTIGEN COMPLEX	$128.14	$96.10	$1.67 – $115.33
PSA (prostate specific antigen) blood test: 10 of 61 insurance plan rates Aetna — Connected: $102.51 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 Altius MHNet Behavioral Health — Behavioral Health: $108.92 AWH Connected — Connected Utah: $81.37 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $89.70 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROSTATIC SPECIFIC ANTIGEN TOTAL	$128.14	$96.10	$33.19 – $115.33
PSA (prostate specific antigen) blood test: 10 of 61 insurance plan rates Aetna — Connected: $103.79 Aetna — Extended: $108.92 AG Administrators — USU Athletics: $92.26 Altius MHNet Behavioral Health — Behavioral Health: $108.92 AWH Connected — Connected Utah: $82.65 BYU Athletics — Commercial: $92.26 BYU Risk Management — Workers Comp: $93.54 Campbell Scientific — Commercial: $92.26 Cigna — Open Access Flex: $80.73 Cigna — PPO/EPO: $108.92
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$117.52	$88.14	$1.53 – $105.77
Thyroid stimulating hormone (TSH) test: 10 of 61 insurance plan rates Aetna — Connected: $94.02 Aetna — Extended: $99.89 AG Administrators — USU Athletics: $84.61 Altius MHNet Behavioral Health — Behavioral Health: $99.89 AWH Connected — Connected Utah: $74.63 BYU Athletics — Commercial: $84.61 BYU Risk Management — Workers Comp: $82.26 Campbell Scientific — Commercial: $84.61 Cigna — Open Access Flex: $74.04 Cigna — PPO/EPO: $99.89
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC THYROID STIMULATING HORMONE	$117.52	$88.14	$30.44 – $105.77
Thyroid stimulating hormone (TSH) test: 10 of 61 insurance plan rates Aetna — Connected: $95.19 Aetna — Extended: $99.89 AG Administrators — USU Athletics: $84.61 Altius MHNet Behavioral Health — Behavioral Health: $99.89 AWH Connected — Connected Utah: $75.80 BYU Athletics — Commercial: $84.61 BYU Risk Management — Workers Comp: $85.79 Campbell Scientific — Commercial: $84.61 Cigna — Open Access Flex: $74.04 Cigna — PPO/EPO: $99.89
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Assay thyroid stim hormone	Not listed in the file	Not listed in the file	$14.97 – $78
Thyroid stimulating hormone (TSH) test: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $16.80 Aetna — Medicare Adv PPO: $18.48 AG Administrators — USU Athletics: $78 American Health — Medicare Adv UT HMO I-SNP: $16.80 AWH Connected — Connected Utah: $78 BYU Athletics — Commercial: $78 Campbell Scientific — Commercial: $78 Deseret Mutual — All Other: $78 Deseret Mutual — Select: $78 EMI — Commercial: $78
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$91.45	$68.59	$1.19 – $82.30
Complete blood count (CBC) with differential: 10 of 61 insurance plan rates Aetna — Connected: $73.16 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 Altius MHNet Behavioral Health — Behavioral Health: $77.73 AWH Connected — Connected Utah: $58.07 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $64.02 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL	$91.45	$68.59	$1.19 – $82.30
Complete blood count (CBC) with differential: 10 of 61 insurance plan rates Aetna — Connected: $73.16 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 Altius MHNet Behavioral Health — Behavioral Health: $77.73 AWH Connected — Connected Utah: $58.07 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $64.02 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC/PLT AUTO DIFFERENTIAL POC	$91.45	$68.59	$23.69 – $82.30
Complete blood count (CBC) with differential: 10 of 61 insurance plan rates Aetna — Connected: $74.07 Aetna — Extended: $77.73 AG Administrators — USU Athletics: $65.84 Altius MHNet Behavioral Health — Behavioral Health: $77.73 AWH Connected — Connected Utah: $58.99 BYU Athletics — Commercial: $65.84 BYU Risk Management — Workers Comp: $66.76 Campbell Scientific — Commercial: $65.84 Cigna — Open Access Flex: $57.61 Cigna — PPO/EPO: $77.73
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$68.67	$51.50	$0.89 – $61.80
Complete blood count (CBC), automated: 10 of 61 insurance plan rates Aetna — Connected: $54.94 Aetna — Extended: $58.37 AG Administrators — USU Athletics: $49.44 Altius MHNet Behavioral Health — Behavioral Health: $58.37 AWH Connected — Connected Utah: $43.61 BYU Athletics — Commercial: $49.44 BYU Risk Management — Workers Comp: $48.07 Campbell Scientific — Commercial: $49.44 Cigna — Open Access Flex: $43.26 Cigna — PPO/EPO: $58.37
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CBC W/O DIFFERENTIAL	$68.67	$51.50	$17.79 – $61.80
Complete blood count (CBC), automated: 10 of 61 insurance plan rates Aetna — Connected: $55.62 Aetna — Extended: $58.37 AG Administrators — USU Athletics: $49.44 Altius MHNet Behavioral Health — Behavioral Health: $58.37 AWH Connected — Connected Utah: $44.29 BYU Athletics — Commercial: $49.44 BYU Risk Management — Workers Comp: $50.13 Campbell Scientific — Commercial: $49.44 Cigna — Open Access Flex: $43.26 Cigna — PPO/EPO: $58.37
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Complete cbc automated	Not listed in the file	Not listed in the file	$5.76 – $55
Complete blood count (CBC), automated: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $6.47 Aetna — Medicare Adv PPO: $7.12 AG Administrators — USU Athletics: $55 American Health — Medicare Adv UT HMO I-SNP: $6.47 AWH Connected — Connected Utah: $55 BYU Athletics — Commercial: $55 Campbell Scientific — Commercial: $55 Deseret Mutual — All Other: $55 Deseret Mutual — Select: $55 EMI — Commercial: $55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$117.71	$88.28	$1.53 – $105.94
Blood clotting time test (prothrombin time, PT): 10 of 61 insurance plan rates Aetna — Connected: $94.17 Aetna — Extended: $100.05 AG Administrators — USU Athletics: $84.75 Altius MHNet Behavioral Health — Behavioral Health: $100.05 AWH Connected — Connected Utah: $74.75 BYU Athletics — Commercial: $84.75 BYU Risk Management — Workers Comp: $82.40 Campbell Scientific — Commercial: $84.75 Cigna — Open Access Flex: $74.16 Cigna — PPO/EPO: $100.05
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME	$30.66	$23	$0.40 – $27.59
Blood clotting time test (prothrombin time, PT): 10 of 61 insurance plan rates Aetna — Connected: $24.53 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 Altius MHNet Behavioral Health — Behavioral Health: $26.06 AWH Connected — Connected Utah: $19.47 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $21.46 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PROTHROMBIN TIME POCL/POCBS	$117.71	$88.28	$30.49 – $105.94
Blood clotting time test (prothrombin time, PT): 10 of 61 insurance plan rates Aetna — Connected: $95.35 Aetna — Extended: $100.05 AG Administrators — USU Athletics: $84.75 Altius MHNet Behavioral Health — Behavioral Health: $100.05 AWH Connected — Connected Utah: $75.92 BYU Athletics — Commercial: $84.75 BYU Risk Management — Workers Comp: $85.93 Campbell Scientific — Commercial: $84.75 Cigna — Open Access Flex: $74.16 Cigna — PPO/EPO: $100.05
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$30.66	$23	$0.40 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $27.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 61 insurance plan rates Aetna — Connected: $24.53 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 Altius MHNet Behavioral Health — Behavioral Health: $26.06 AWH Connected — Connected Utah: $19.47 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $21.46 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PARTIAL THROMBOPLASTIN TIME	$30.66	$23	$7.94 – $27.59
Blood clotting test (partial thromboplastin time, PTT): 10 of 61 insurance plan rates Aetna — Connected: $24.83 Aetna — Extended: $26.06 AG Administrators — USU Athletics: $22.08 Altius MHNet Behavioral Health — Behavioral Health: $26.06 AWH Connected — Connected Utah: $19.78 BYU Athletics — Commercial: $22.08 BYU Risk Management — Workers Comp: $22.38 Campbell Scientific — Commercial: $22.08 Cigna — Open Access Flex: $19.32 Cigna — PPO/EPO: $26.06
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Thromboplastin time partial	Not listed in the file	Not listed in the file	$5.35 – $37
Blood clotting test (partial thromboplastin time, PTT): 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $6.01 Aetna — Medicare Adv PPO: $6.61 AG Administrators — USU Athletics: $37 American Health — Medicare Adv UT HMO I-SNP: $6.01 AWH Connected — Connected Utah: $37 BYU Athletics — Commercial: $37 Campbell Scientific — Commercial: $37 Deseret Mutual — All Other: $37 Deseret Mutual — Select: $37 EMI — Commercial: $37

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT HEAD/BRAIN W/O CONTRAST	$1,806.74	$1,355.06	$23.49 – $1,626.07
CT scan of the head or brain, without contrast: 10 of 61 insurance plan rates Aetna — Connected: $1,445.39 Aetna — Extended: $1,535.73 AG Administrators — USU Athletics: $1,300.85 Altius MHNet Behavioral Health — Behavioral Health: $1,535.73 AWH Connected — Connected Utah: $1,147.28 BYU Athletics — Commercial: $1,300.85 BYU Risk Management — Workers Comp: $1,264.72 Campbell Scientific — Commercial: $1,300.85 Cigna — Open Access Flex: $1,138.25 Cigna — PPO/EPO: $1,535.73
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	$467.95 – $1,626.07
CT scan of the head or brain, without contrast: 10 of 61 insurance plan rates Aetna — Connected: $1,463.46 Aetna — Extended: $1,535.73 AG Administrators — USU Athletics: $1,300.85 Altius MHNet Behavioral Health — Behavioral Health: $1,535.73 AWH Connected — Connected Utah: $1,165.35 BYU Athletics — Commercial: $1,300.85 BYU Risk Management — Workers Comp: $1,318.92 Campbell Scientific — Commercial: $1,300.85 Cigna — Open Access Flex: $1,138.25 Cigna — PPO/EPO: $1,535.73
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	$100.09 – $533
CT scan of the head or brain, without contrast: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $533 American Health — Medicare Adv UT HMO I-SNP: $105.09 AWH Connected — Connected Utah: $533 BYU Athletics — Commercial: $533 Campbell Scientific — Commercial: $533 Deseret Mutual — All Other: $533 Deseret Mutual — Select: $533 EMI — Commercial: $533
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI BRAIN W/WO CONTRAST	$5,833.02	$4,374.77	$75.83 – $5,249.72
MRI of the brain, before and after contrast: 10 of 61 insurance plan rates Aetna — Connected: $4,666.42 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 Altius MHNet Behavioral Health — Behavioral Health: $4,958.07 AWH Connected — Connected Utah: $3,703.97 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,083.11 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI IAC'S W AND W/O CONTRAST LIMITED	$5,833.02	$4,374.77	$75.83 – $5,249.72
MRI of the brain, before and after contrast: 10 of 61 insurance plan rates Aetna — Connected: $4,666.42 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 Altius MHNet Behavioral Health — Behavioral Health: $4,958.07 AWH Connected — Connected Utah: $3,703.97 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,083.11 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI BRAIN W/WO CONTRAST	$5,833.02	$4,374.77	$1,510.75 – $5,249.72
MRI of the brain, before and after contrast: 10 of 61 insurance plan rates Aetna — Connected: $4,724.75 Aetna — Extended: $4,958.07 AG Administrators — USU Athletics: $4,199.77 Altius MHNet Behavioral Health — Behavioral Health: $4,958.07 AWH Connected — Connected Utah: $3,762.30 BYU Athletics — Commercial: $4,199.77 BYU Risk Management — Workers Comp: $4,258.10 Campbell Scientific — Commercial: $4,199.77 Cigna — Open Access Flex: $3,674.80 Cigna — PPO/EPO: $4,958.07
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$477.12	$357.84	$6.20 – $429.41
Chest X-ray, 2 views: 10 of 61 insurance plan rates Aetna — Connected: $381.70 Aetna — Extended: $405.55 AG Administrators — USU Athletics: $343.53 Altius MHNet Behavioral Health — Behavioral Health: $405.55 AWH Connected — Connected Utah: $302.97 BYU Athletics — Commercial: $343.53 BYU Risk Management — Workers Comp: $333.98 Campbell Scientific — Commercial: $343.53 Cigna — Open Access Flex: $300.59 Cigna — PPO/EPO: $405.55
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DI CHEST 2 VIEWS	$477.12	$357.84	$123.57 – $429.41
Chest X-ray, 2 views: 10 of 61 insurance plan rates Aetna — Connected: $386.47 Aetna — Extended: $405.55 AG Administrators — USU Athletics: $343.53 Altius MHNet Behavioral Health — Behavioral Health: $405.55 AWH Connected — Connected Utah: $307.74 BYU Athletics — Commercial: $343.53 BYU Risk Management — Workers Comp: $348.30 Campbell Scientific — Commercial: $343.53 Cigna — Open Access Flex: $300.59 Cigna — PPO/EPO: $405.55
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	$82.72 – $220
Chest X-ray, 2 views: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $87.88 Aetna — Medicare Adv PPO: $96.67 AG Administrators — USU Athletics: $197 American Health — Medicare Adv UT HMO I-SNP: $87.88 AWH Connected — Connected Utah: $197 BYU Athletics — Commercial: $197 Campbell Scientific — Commercial: $197 Deseret Mutual — All Other: $197 Deseret Mutual — Select: $185 EMI — Commercial: $197
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DI L SPINE AP/LAT/OBL/OR FLEX/EXT	$617.99	$463.49	$8.03 – $556.19
X-ray of the lower spine, at least 4 views: 10 of 61 insurance plan rates Aetna — Connected: $494.39 Aetna — Extended: $525.29 AG Administrators — USU Athletics: $444.95 Altius MHNet Behavioral Health — Behavioral Health: $525.29 AWH Connected — Connected Utah: $392.42 BYU Athletics — Commercial: $444.95 BYU Risk Management — Workers Comp: $432.59 Campbell Scientific — Commercial: $444.95 Cigna — Open Access Flex: $389.33 Cigna — PPO/EPO: $525.29
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	$160.06 – $556.19
X-ray of the lower spine, at least 4 views: 10 of 61 insurance plan rates Aetna — Connected: $500.57 Aetna — Extended: $525.29 AG Administrators — USU Athletics: $444.95 Altius MHNet Behavioral Health — Behavioral Health: $525.29 AWH Connected — Connected Utah: $398.60 BYU Athletics — Commercial: $444.95 BYU Risk Management — Workers Comp: $451.13 Campbell Scientific — Commercial: $444.95 Cigna — Open Access Flex: $389.33 Cigna — PPO/EPO: $525.29
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	$100.09 – $836.41
X-ray of the lower spine, at least 4 views: 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $328 American Health — Medicare Adv UT HMO I-SNP: $105.09 AWH Connected — Connected Utah: $328 BYU Athletics — Commercial: $328 Campbell Scientific — Commercial: $328 Deseret Mutual — All Other: $328 Deseret Mutual — Select: $308 EMI — Commercial: $328
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LUMBAR SPINE W/O CONTRAST	$4,126.60	$3,094.95	$53.65 – $3,713.94
MRI of the lower back (lumbar spine), without contrast: 10 of 61 insurance plan rates Aetna — Connected: $3,301.28 Aetna — Extended: $3,507.61 AG Administrators — USU Athletics: $2,971.15 Altius MHNet Behavioral Health — Behavioral Health: $3,507.61 AWH Connected — Connected Utah: $2,620.39 BYU Athletics — Commercial: $2,971.15 BYU Risk Management — Workers Comp: $2,888.62 Campbell Scientific — Commercial: $2,971.15 Cigna — Open Access Flex: $2,599.76 Cigna — PPO/EPO: $3,507.61
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LUMBAR SPINE W/O CONTRAST	$4,126.60	$3,094.95	$1,068.79 – $3,713.94
MRI of the lower back (lumbar spine), without contrast: 10 of 61 insurance plan rates Aetna — Connected: $3,342.55 Aetna — Extended: $3,507.61 AG Administrators — USU Athletics: $2,971.15 Altius MHNet Behavioral Health — Behavioral Health: $3,507.61 AWH Connected — Connected Utah: $2,661.66 BYU Athletics — Commercial: $2,971.15 BYU Risk Management — Workers Comp: $3,012.42 Campbell Scientific — Commercial: $2,971.15 Cigna — Open Access Flex: $2,599.76 Cigna — PPO/EPO: $3,507.61
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	$223.07 – $1,269
MRI of the lower back (lumbar spine), without contrast: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $240.99 Aetna — Medicare Adv PPO: $265.09 AG Administrators — USU Athletics: $1,064 American Health — Medicare Adv UT HMO I-SNP: $240.99 AWH Connected — Connected Utah: $1,064 BYU Athletics — Commercial: $1,064 Campbell Scientific — Commercial: $1,064 Deseret Mutual — All Other: $1,064 Deseret Mutual — Select: $1,064 EMI — Commercial: $1,064
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT PELVIS W/CONTRAST	$3,141.76	$2,356.32	$40.84 – $2,827.58
CT scan of the pelvis, with contrast: 10 of 61 insurance plan rates Aetna — Connected: $2,513.41 Aetna — Extended: $2,670.50 AG Administrators — USU Athletics: $2,262.07 Altius MHNet Behavioral Health — Behavioral Health: $2,670.50 AWH Connected — Connected Utah: $1,995.02 BYU Athletics — Commercial: $2,262.07 BYU Risk Management — Workers Comp: $2,199.23 Campbell Scientific — Commercial: $2,262.07 Cigna — Open Access Flex: $1,979.31 Cigna — PPO/EPO: $2,670.50
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	$813.72 – $2,827.58
CT scan of the pelvis, with contrast: 10 of 61 insurance plan rates Aetna — Connected: $2,544.83 Aetna — Extended: $2,670.50 AG Administrators — USU Athletics: $2,262.07 Altius MHNet Behavioral Health — Behavioral Health: $2,670.50 AWH Connected — Connected Utah: $2,026.44 BYU Athletics — Commercial: $2,262.07 BYU Risk Management — Workers Comp: $2,293.48 Campbell Scientific — Commercial: $2,262.07 Cigna — Open Access Flex: $1,979.31 Cigna — PPO/EPO: $2,670.50
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	$167.27 – $917
CT scan of the pelvis, with contrast: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $177.57 Aetna — Medicare Adv PPO: $195.33 AG Administrators — USU Athletics: $805 American Health — Medicare Adv UT HMO I-SNP: $177.57 AWH Connected — Connected Utah: $805 BYU Athletics — Commercial: $805 Campbell Scientific — Commercial: $805 Deseret Mutual — All Other: $805 Deseret Mutual — Select: $805 EMI — Commercial: $805
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$3,464.36	$2,598.27	$45.04 – $3,117.92
MRI of a leg joint (such as the knee), without contrast: 10 of 61 insurance plan rates Aetna — Connected: $2,771.49 Aetna — Extended: $2,944.71 AG Administrators — USU Athletics: $2,494.34 Altius MHNet Behavioral Health — Behavioral Health: $2,944.71 AWH Connected — Connected Utah: $2,199.87 BYU Athletics — Commercial: $2,494.34 BYU Risk Management — Workers Comp: $2,425.05 Campbell Scientific — Commercial: $2,494.34 Cigna — Open Access Flex: $2,182.55 Cigna — PPO/EPO: $2,944.71
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC MRI LOWER JOINT UNILATERAL W/O CONTRAST	$3,464.36	$2,598.27	$897.27 – $3,117.92
MRI of a leg joint (such as the knee), without contrast: 10 of 61 insurance plan rates Aetna — Connected: $2,806.13 Aetna — Extended: $2,944.71 AG Administrators — USU Athletics: $2,494.34 Altius MHNet Behavioral Health — Behavioral Health: $2,944.71 AWH Connected — Connected Utah: $2,234.51 BYU Athletics — Commercial: $2,494.34 BYU Risk Management — Workers Comp: $2,528.98 Campbell Scientific — Commercial: $2,494.34 Cigna — Open Access Flex: $2,182.55 Cigna — PPO/EPO: $2,944.71
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	$223.07 – $1,268
MRI of a leg joint (such as the knee), without contrast: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $240.99 Aetna — Medicare Adv PPO: $265.09 AG Administrators — USU Athletics: $1,064 American Health — Medicare Adv UT HMO I-SNP: $240.99 AWH Connected — Connected Utah: $1,064 BYU Athletics — Commercial: $1,064 Campbell Scientific — Commercial: $1,064 Deseret Mutual — All Other: $1,064 Deseret Mutual — Select: $1,064 EMI — Commercial: $1,064
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CT ABDOMEN & PELVIS W/CONTRAST	$4,761.83	$3,571.37	$61.90 – $4,285.65
CT scan of the abdomen and pelvis, with contrast: 10 of 61 insurance plan rates Aetna — Connected: $3,809.46 Aetna — Extended: $4,047.56 AG Administrators — USU Athletics: $3,428.52 Altius MHNet Behavioral Health — Behavioral Health: $4,047.56 AWH Connected — Connected Utah: $3,023.76 BYU Athletics — Commercial: $3,428.52 BYU Risk Management — Workers Comp: $3,333.28 Campbell Scientific — Commercial: $3,428.52 Cigna — Open Access Flex: $2,999.95 Cigna — PPO/EPO: $4,047.56
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CT ABDOMEN & PELVIS W/CONTRAST	$4,761.83	$3,571.37	$1,233.31 – $4,285.65
CT scan of the abdomen and pelvis, with contrast: 10 of 61 insurance plan rates Aetna — Connected: $3,857.08 Aetna — Extended: $4,047.56 AG Administrators — USU Athletics: $3,428.52 Altius MHNet Behavioral Health — Behavioral Health: $4,047.56 AWH Connected — Connected Utah: $3,071.38 BYU Athletics — Commercial: $3,428.52 BYU Risk Management — Workers Comp: $3,476.14 Campbell Scientific — Commercial: $3,428.52 Cigna — Open Access Flex: $2,999.95 Cigna — PPO/EPO: $4,047.56
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	$342.37 – $1,325
CT scan of the abdomen and pelvis, with contrast: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $352.43 Aetna — Medicare Adv PPO: $387.67 AG Administrators — USU Athletics: $1,206 American Health — Medicare Adv UT HMO I-SNP: $352.43 AWH Connected — Connected Utah: $1,206 BYU Athletics — Commercial: $1,206 Campbell Scientific — Commercial: $1,206 Deseret Mutual — All Other: $1,206 Deseret Mutual — Select: $1,206 EMI — Commercial: $1,206
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$1,093.33	$820	$14.21 – $984
Ultrasound of the abdomen, complete: 10 of 61 insurance plan rates Aetna — Connected: $874.66 Aetna — Extended: $929.33 AG Administrators — USU Athletics: $787.20 Altius MHNet Behavioral Health — Behavioral Health: $929.33 AWH Connected — Connected Utah: $694.26 BYU Athletics — Commercial: $787.20 BYU Risk Management — Workers Comp: $765.33 Campbell Scientific — Commercial: $787.20 Cigna — Open Access Flex: $688.80 Cigna — PPO/EPO: $929.33
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC ULTRASOUND ABDOMEN COMPLETE	$1,093.33	$820	$283.17 – $984
Ultrasound of the abdomen, complete: 10 of 61 insurance plan rates Aetna — Connected: $885.60 Aetna — Extended: $929.33 AG Administrators — USU Athletics: $787.20 Altius MHNet Behavioral Health — Behavioral Health: $929.33 AWH Connected — Connected Utah: $705.20 BYU Athletics — Commercial: $787.20 BYU Risk Management — Workers Comp: $798.13 Campbell Scientific — Commercial: $787.20 Cigna — Open Access Flex: $688.80 Cigna — PPO/EPO: $929.33
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	$100.09 – $339
Ultrasound of the abdomen, complete: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $105.09 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$1,005.63	$754.22	$13.07 – $905.07
Pregnancy ultrasound (after the first trimester): 10 of 61 insurance plan rates Aetna — Connected: $804.50 Aetna — Extended: $854.79 AG Administrators — USU Athletics: $724.05 Altius MHNet Behavioral Health — Behavioral Health: $854.79 AWH Connected — Connected Utah: $638.58 BYU Athletics — Commercial: $724.05 BYU Risk Management — Workers Comp: $703.94 Campbell Scientific — Commercial: $724.05 Cigna — Open Access Flex: $633.55 Cigna — PPO/EPO: $854.79
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US PREG 2ND/3RD TRIMESTER	$1,005.63	$754.22	$260.46 – $905.07
Pregnancy ultrasound (after the first trimester): 10 of 61 insurance plan rates Aetna — Connected: $814.56 Aetna — Extended: $854.79 AG Administrators — USU Athletics: $724.05 Altius MHNet Behavioral Health — Behavioral Health: $854.79 AWH Connected — Connected Utah: $648.63 BYU Athletics — Commercial: $724.05 BYU Risk Management — Workers Comp: $734.11 Campbell Scientific — Commercial: $724.05 Cigna — Open Access Flex: $633.55 Cigna — PPO/EPO: $854.79
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ob us >/ 14 wks sngl fetus	Not listed in the file	Not listed in the file	$63.73 – $356
Pregnancy ultrasound (after the first trimester): 10 of 48 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $356 American Health — Medicare Adv UT HMO I-SNP: $105.09 AWH Connected — Connected Utah: $356 BYU Athletics — Commercial: $356 Campbell Scientific — Commercial: $356 Deseret Mutual — All Other: $356 Deseret Mutual — Select: $356 EMI — Commercial: $356
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$902.71	$677.03	$11.74 – $812.44
Transvaginal ultrasound: 10 of 61 insurance plan rates Aetna — Connected: $722.17 Aetna — Extended: $767.30 AG Administrators — USU Athletics: $649.95 Altius MHNet Behavioral Health — Behavioral Health: $767.30 AWH Connected — Connected Utah: $573.22 BYU Athletics — Commercial: $649.95 BYU Risk Management — Workers Comp: $631.90 Campbell Scientific — Commercial: $649.95 Cigna — Open Access Flex: $568.71 Cigna — PPO/EPO: $767.30
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC US TRANSVAGINAL NON-OB S&I	$902.71	$677.03	$233.80 – $812.44
Transvaginal ultrasound: 10 of 61 insurance plan rates Aetna — Connected: $731.20 Aetna — Extended: $767.30 AG Administrators — USU Athletics: $649.95 Altius MHNet Behavioral Health — Behavioral Health: $767.30 AWH Connected — Connected Utah: $582.25 BYU Athletics — Commercial: $649.95 BYU Risk Management — Workers Comp: $658.98 Campbell Scientific — Commercial: $649.95 Cigna — Open Access Flex: $568.71 Cigna — PPO/EPO: $767.30
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	$100.09 – $339
Transvaginal ultrasound: 10 of 51 insurance plan rates Aetna — Medicare Adv HMO: $105.09 Aetna — Medicare Adv PPO: $115.60 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $105.09 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$763.67	$572.75	$9.93 – $687.30
Diagnostic mammogram, one breast: 10 of 61 insurance plan rates Aetna — Connected: $610.94 Aetna — Extended: $649.12 AG Administrators — USU Athletics: $549.84 Altius MHNet Behavioral Health — Behavioral Health: $649.12 AWH Connected — Connected Utah: $484.93 BYU Athletics — Commercial: $549.84 BYU Risk Management — Workers Comp: $534.57 Campbell Scientific — Commercial: $549.84 Cigna — Open Access Flex: $481.11 Cigna — PPO/EPO: $649.12
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$763.67	$572.75	$197.79 – $687.30
Diagnostic mammogram, one breast: 10 of 61 insurance plan rates Aetna — Connected: $618.57 Aetna — Extended: $649.12 AG Administrators — USU Athletics: $549.84 Altius MHNet Behavioral Health — Behavioral Health: $649.12 AWH Connected — Connected Utah: $492.57 BYU Athletics — Commercial: $549.84 BYU Risk Management — Workers Comp: $557.48 Campbell Scientific — Commercial: $549.84 Cigna — Open Access Flex: $481.11 Cigna — PPO/EPO: $649.12
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	$81.37 – $339
Diagnostic mammogram, one breast: 10 of 50 insurance plan rates Aetna — Medicare Adv HMO: $117.98 Aetna — Medicare Adv PPO: $129.78 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $117.98 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$919.39	$689.54	$11.95 – $827.45
Diagnostic mammogram, both breasts: 10 of 61 insurance plan rates Aetna — Connected: $735.51 Aetna — Extended: $781.48 AG Administrators — USU Athletics: $661.96 Altius MHNet Behavioral Health — Behavioral Health: $781.48 AWH Connected — Connected Utah: $583.81 BYU Athletics — Commercial: $661.96 BYU Risk Management — Workers Comp: $643.57 Campbell Scientific — Commercial: $661.96 Cigna — Open Access Flex: $579.22 Cigna — PPO/EPO: $781.48
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAG MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$919.39	$689.54	$238.12 – $827.45
Diagnostic mammogram, both breasts: 10 of 61 insurance plan rates Aetna — Connected: $744.71 Aetna — Extended: $781.48 AG Administrators — USU Athletics: $661.96 Altius MHNet Behavioral Health — Behavioral Health: $781.48 AWH Connected — Connected Utah: $593.01 BYU Athletics — Commercial: $661.96 BYU Risk Management — Workers Comp: $671.15 Campbell Scientific — Commercial: $661.96 Cigna — Open Access Flex: $579.22 Cigna — PPO/EPO: $781.48
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	$104.35 – $339
Diagnostic mammogram, both breasts: 10 of 50 insurance plan rates Aetna — Medicare Adv HMO: $149.42 Aetna — Medicare Adv PPO: $164.36 AG Administrators — USU Athletics: $339 American Health — Medicare Adv UT HMO I-SNP: $149.42 AWH Connected — Connected Utah: $339 BYU Athletics — Commercial: $339 Campbell Scientific — Commercial: $339 Deseret Mutual — All Other: $339 Deseret Mutual — Select: $339 EMI — Commercial: $339
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$723.47	$542.60	$9.41 – $651.12
Screening mammogram, both breasts: 10 of 61 insurance plan rates Aetna — Connected: $578.78 Aetna — Extended: $614.95 AG Administrators — USU Athletics: $520.90 Altius MHNet Behavioral Health — Behavioral Health: $614.95 AWH Connected — Connected Utah: $459.40 BYU Athletics — Commercial: $520.90 BYU Risk Management — Workers Comp: $506.43 Campbell Scientific — Commercial: $520.90 Cigna — Open Access Flex: $455.79 Cigna — PPO/EPO: $614.95
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, BILATERAL INCL CAD WHEN PERFORMED	$1,336.04	$1,002.03	$17.37 – $1,202.44
Screening mammogram, both breasts: 10 of 61 insurance plan rates Aetna — Connected: $1,068.83 Aetna — Extended: $1,135.63 AG Administrators — USU Athletics: $961.95 Altius MHNet Behavioral Health — Behavioral Health: $1,135.63 AWH Connected — Connected Utah: $848.39 BYU Athletics — Commercial: $961.95 BYU Risk Management — Workers Comp: $935.23 Campbell Scientific — Commercial: $961.95 Cigna — Open Access Flex: $841.71 Cigna — PPO/EPO: $1,135.63
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREEN MAMMO, UNILATERAL INCL CAD WHEN PERFORMED	$723.47	$542.60	$187.38 – $651.12
Screening mammogram, both breasts: 10 of 61 insurance plan rates Aetna — Connected: $586.01 Aetna — Extended: $614.95 AG Administrators — USU Athletics: $520.90 Altius MHNet Behavioral Health — Behavioral Health: $614.95 AWH Connected — Connected Utah: $466.64 BYU Athletics — Commercial: $520.90 BYU Risk Management — Workers Comp: $528.13 Campbell Scientific — Commercial: $520.90 Cigna — Open Access Flex: $455.79 Cigna — PPO/EPO: $614.95

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC EKG W/READ	$59.57	$44.68	$0.77 – $53.61
Electrocardiogram (ECG/EKG) with reading: 10 of 61 insurance plan rates Aetna — Connected: $47.66 Aetna — Extended: $50.63 AG Administrators — USU Athletics: $42.89 Altius MHNet Behavioral Health — Behavioral Health: $50.63 AWH Connected — Connected Utah: $37.83 BYU Athletics — Commercial: $42.89 BYU Risk Management — Workers Comp: $41.70 Campbell Scientific — Commercial: $42.89 Cigna — Open Access Flex: $37.53 Cigna — PPO/EPO: $50.63
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	$15.43 – $53.61
Electrocardiogram (ECG/EKG) with reading: 10 of 61 insurance plan rates Aetna — Connected: $48.25 Aetna — Extended: $50.63 AG Administrators — USU Athletics: $42.89 Altius MHNet Behavioral Health — Behavioral Health: $50.63 AWH Connected — Connected Utah: $38.42 BYU Athletics — Commercial: $42.89 BYU Risk Management — Workers Comp: $43.49 Campbell Scientific — Commercial: $42.89 Cigna — Open Access Flex: $37.53 Cigna — PPO/EPO: $50.63
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 15 insurance plan rates Aetna — Medicare Adv HMO: $13.88 Aetna — Medicare Adv PPO: $13.88 American Health — Medicare Adv UT HMO I-SNP: $13.88 Health Partners of Nevada — Medicare Advantage: $13.88 Humana — Medicare Choice PPO: $13.88 Molina — Medicare Advantage: $13.88 Molina — Medicare Choice Care HMO: $13.88 Molina — Medicare Complete Care HMO SNP: $13.88 Regence BCBS — MedAdvantage PPO: $13.88 SelectHealth — Med Individual ACA: $13.88
Left heart catheterization (diagnostic) CPT 93452 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$10,199.53	$7,649.65	$132.59 – $9,179.58
Left heart catheterization (diagnostic): 10 of 61 insurance plan rates Aetna — Connected: $8,159.62 Aetna — Extended: $8,669.60 AG Administrators — USU Athletics: $7,343.66 Altius MHNet Behavioral Health — Behavioral Health: $8,669.60 AWH Connected — Connected Utah: $6,476.70 BYU Athletics — Commercial: $7,343.66 BYU Risk Management — Workers Comp: $7,139.67 Campbell Scientific — Commercial: $7,343.66 Cigna — Open Access Flex: $6,425.70 Cigna — PPO/EPO: $8,669.60
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC LT HEART CATH W/VGRAM	$10,199.53	$7,649.65	$2,641.68 – $9,179.58
Left heart catheterization (diagnostic): 10 of 61 insurance plan rates Aetna — Connected: $8,261.62 Aetna — Extended: $8,669.60 AG Administrators — USU Athletics: $7,343.66 Altius MHNet Behavioral Health — Behavioral Health: $8,669.60 AWH Connected — Connected Utah: $6,578.70 BYU Athletics — Commercial: $7,343.66 BYU Risk Management — Workers Comp: $7,445.66 Campbell Scientific — Commercial: $7,343.66 Cigna — Open Access Flex: $6,425.70 Cigna — PPO/EPO: $8,669.60
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Left hrt cath w/ventrclgrphy	Not listed in the file	Not listed in the file	$1,849.15 – $3,817.38
Left heart catheterization (diagnostic): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $3,282.36 Aetna — Medicare Adv PPO: $3,610.59 American Health — Medicare Adv UT HMO I-SNP: $3,282.36 Health Partners of Nevada — Medicare Advantage: $3,282.36 Health Plan of Nevada — Medicaid: $3,282.36 Healthy U — Medicaid: $3,282.36 Humana — Medicare Choice PPO: $3,446.47 Intermountain Caregiver Plan — Med Network: $2,101.31 Intermountain Caregiver Plan — Share Network: $1,849.15 Molina — Medicaid: $3,282.36
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC COMP EP W/O ARRYTHMIA INDUCTN	$13,193.07	$9,894.80	$171.51 – $11,873.76
Heart rhythm study (electrophysiology evaluation): 10 of 61 insurance plan rates Aetna — Connected: $10,554.46 Aetna — Extended: $11,214.11 AG Administrators — USU Athletics: $9,499.01 Altius MHNet Behavioral Health — Behavioral Health: $11,214.11 AWH Connected — Connected Utah: $8,377.60 BYU Athletics — Commercial: $9,499.01 BYU Risk Management — Workers Comp: $9,235.15 Campbell Scientific — Commercial: $9,499.01 Cigna — Open Access Flex: $8,311.63 Cigna — PPO/EPO: $11,214.11
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC COMP EP W/O ARRYTHMIA INDUCTN	$13,193.07	$9,894.80	$3,417.01 – $11,873.76
Heart rhythm study (electrophysiology evaluation): 10 of 61 insurance plan rates Aetna — Connected: $10,686.39 Aetna — Extended: $11,214.11 AG Administrators — USU Athletics: $9,499.01 Altius MHNet Behavioral Health — Behavioral Health: $11,214.11 AWH Connected — Connected Utah: $8,509.53 BYU Athletics — Commercial: $9,499.01 BYU Risk Management — Workers Comp: $9,630.94 Campbell Scientific — Commercial: $9,499.01 Cigna — Open Access Flex: $8,311.63 Cigna — PPO/EPO: $11,214.11
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive ep evaluation	Not listed in the file	Not listed in the file	$30.25 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $9,183.63
Heart rhythm study (electrophysiology evaluation): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $7,896.50 Aetna — Medicare Adv PPO: $8,686.15 American Health — Medicare Adv UT HMO I-SNP: $7,896.50 Health Partners of Nevada — Medicare Advantage: $7,896.50 Health Plan of Nevada — Medicaid: $7,896.50 Healthy U — Medicaid: $7,896.50 Humana — Medicare Choice PPO: $8,291.32 Intermountain Caregiver Plan — Med Network: $34.38 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Intermountain Caregiver Plan — Share Network: $30.25 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) Molina — Medicaid: $7,896.50
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB ABLATE PULM VEIN ISOL	$90,864.19	$68,148.14	$1,181.23 – $81,777.77
Heart rhythm study with ablation for atrial fibrillation: 10 of 61 insurance plan rates Aetna — Connected: $72,691.35 Aetna — Extended: $77,234.56 AG Administrators — USU Athletics: $65,422.22 Altius MHNet Behavioral Health — Behavioral Health: $77,234.56 AWH Connected — Connected Utah: $57,698.76 BYU Athletics — Commercial: $65,422.22 BYU Risk Management — Workers Comp: $63,604.93 Campbell Scientific — Commercial: $65,422.22 Cigna — Open Access Flex: $57,244.44 Cigna — PPO/EPO: $77,234.56
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC TX ATRIAL FIB ABLATE PULM VEIN ISOL	$90,864.19	$68,148.14	$23,533.83 – $81,777.77
Heart rhythm study with ablation for atrial fibrillation: 10 of 61 insurance plan rates Aetna — Connected: $73,599.99 Aetna — Extended: $77,234.56 AG Administrators — USU Athletics: $65,422.22 Altius MHNet Behavioral Health — Behavioral Health: $77,234.56 AWH Connected — Connected Utah: $58,607.40 BYU Athletics — Commercial: $65,422.22 BYU Risk Management — Workers Comp: $66,330.86 Campbell Scientific — Commercial: $65,422.22 Cigna — Open Access Flex: $57,244.44 Cigna — PPO/EPO: $77,234.56
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Compre ep eval abltj atr fib	Not listed in the file	Not listed in the file	$2,058.98 – $30,778.22
Heart rhythm study with ablation for atrial fibrillation: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $26,464.51 Aetna — Medicare Adv PPO: $29,110.96 American Health — Medicare Adv UT HMO I-SNP: $26,464.51 Health Partners of Nevada — Medicare Advantage: $26,464.51 Health Plan of Nevada — Medicaid: $26,464.51 Healthy U — Medicaid: $26,464.51 Humana — Medicare Choice PPO: $27,787.73 Intermountain Caregiver Plan — Med Network: $2,339.75 Intermountain Caregiver Plan — Share Network: $2,058.98 Molina — Medicaid: $26,464.51
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC BASELINE SLEEP STUDY	$4,937.95	$3,703.46	$64.19 – $4,444.16
Sleep study (overnight, in a sleep lab): 10 of 61 insurance plan rates Aetna — Connected: $3,950.36 Aetna — Extended: $4,197.26 AG Administrators — USU Athletics: $3,555.32 Altius MHNet Behavioral Health — Behavioral Health: $4,197.26 AWH Connected — Connected Utah: $3,135.60 BYU Athletics — Commercial: $3,555.32 BYU Risk Management — Workers Comp: $3,456.56 Campbell Scientific — Commercial: $3,555.32 Cigna — Open Access Flex: $3,110.91 Cigna — PPO/EPO: $4,197.26
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC BASELINE SLEEP STUDY	$4,937.95	$3,703.46	$1,278.93 – $4,444.16
Sleep study (overnight, in a sleep lab): 10 of 61 insurance plan rates Aetna — Connected: $3,999.74 Aetna — Extended: $4,197.26 AG Administrators — USU Athletics: $3,555.32 Altius MHNet Behavioral Health — Behavioral Health: $4,197.26 AWH Connected — Connected Utah: $3,184.98 BYU Athletics — Commercial: $3,555.32 BYU Risk Management — Workers Comp: $3,604.70 Campbell Scientific — Commercial: $3,555.32 Cigna — Open Access Flex: $3,110.91 Cigna — PPO/EPO: $4,197.26
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	$868.83 – $1,942
Sleep study (overnight, in a sleep lab): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $868.83 Aetna — Medicare Adv PPO: $955.72 AG Administrators — USU Athletics: $1,942 American Health — Medicare Adv UT HMO I-SNP: $868.83 AWH Connected — Connected Utah: $1,942 BYU Athletics — Commercial: $1,942 Campbell Scientific — Commercial: $1,942 Deseret Mutual — All Other: $1,942 Deseret Mutual — Select: $1,942 EMI — Commercial: $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 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC OT THERAPEUTIC EX PER 15 MIN	$146.87	$110.15	$1.91 – $132.18
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 61 insurance plan rates Aetna — Connected: $117.50 Aetna — Extended: $124.84 AG Administrators — USU Athletics: $105.75 Altius MHNet Behavioral Health — Behavioral Health: $124.84 AWH Connected — Connected Utah: $93.26 BYU Athletics — Commercial: $105.75 BYU Risk Management — Workers Comp: $102.81 Campbell Scientific — Commercial: $105.75 Cigna — Open Access Flex: $92.53 Cigna — PPO/EPO: $124.84
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC ST THERAPEUTIC EXERCISE/15 MIN	$148.19	$111.14	$1.93 – $133.37
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 61 insurance plan rates Aetna — Connected: $118.55 Aetna — Extended: $125.96 AG Administrators — USU Athletics: $106.70 Altius MHNet Behavioral Health — Behavioral Health: $125.96 AWH Connected — Connected Utah: $94.10 BYU Athletics — Commercial: $106.70 BYU Risk Management — Workers Comp: $103.73 Campbell Scientific — Commercial: $106.70 Cigna — Open Access Flex: $93.36 Cigna — PPO/EPO: $125.96
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT THERAPEUTIC EX PER 15 MIN	$136.83	$102.62	$1.78 – $123.15
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 61 insurance plan rates Aetna — Connected: $109.46 Aetna — Extended: $116.31 AG Administrators — USU Athletics: $98.52 Altius MHNet Behavioral Health — Behavioral Health: $116.31 AWH Connected — Connected Utah: $86.89 BYU Athletics — Commercial: $98.52 BYU Risk Management — Workers Comp: $95.78 Campbell Scientific — Commercial: $98.52 Cigna — Open Access Flex: $86.20 Cigna — PPO/EPO: $116.31
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$354.86	$266.14	$4.61 – $319.37
Physical therapy evaluation (low complexity): 10 of 61 insurance plan rates Aetna — Connected: $283.89 Aetna — Extended: $301.63 AG Administrators — USU Athletics: $255.50 Altius MHNet Behavioral Health — Behavioral Health: $301.63 AWH Connected — Connected Utah: $225.34 BYU Athletics — Commercial: $255.50 BYU Risk Management — Workers Comp: $248.40 Campbell Scientific — Commercial: $255.50 Cigna — Open Access Flex: $223.56 Cigna — PPO/EPO: $301.63
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL LOW COMPLEXITY	$354.86	$266.14	$91.91 – $319.37
Physical therapy evaluation (low complexity): 10 of 61 insurance plan rates Aetna — Connected: $287.44 Aetna — Extended: $301.63 AG Administrators — USU Athletics: $255.50 Altius MHNet Behavioral Health — Behavioral Health: $301.63 AWH Connected — Connected Utah: $228.88 BYU Athletics — Commercial: $255.50 BYU Risk Management — Workers Comp: $259.05 Campbell Scientific — Commercial: $255.50 Cigna — Open Access Flex: $223.56 Cigna — PPO/EPO: $301.63
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval low complex 20 min	Not listed in the file	Not listed in the file	$95.06 – $266.71
Physical therapy evaluation (low complexity): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $95.06 Aetna — Medicare Adv PPO: $104.57 American Health — Medicare Adv UT HMO I-SNP: $95.06 Health Partners of Nevada — Medicare Advantage: $95.06 Health Plan of Nevada — Medicaid: $95.06 Healthy U — Medicaid: $95.06 Humana — Medicare Choice PPO: $99.81 Intermountain Caregiver Plan — Med Network: $254.01 Intermountain Caregiver Plan — Share Network: $223.53 Molina — Medicaid: $95.06
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC CLIENT ONLY HRH PHYSICAL THERAPY EVALUATION PER SESSION	$444.13	$333.10	$5.77 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 61 insurance plan rates Aetna — Connected: $355.30 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 Altius MHNet Behavioral Health — Behavioral Health: $377.51 AWH Connected — Connected Utah: $282.02 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $310.89 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL MODERATE COMPLEXITY	$444.13	$333.10	$5.77 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 61 insurance plan rates Aetna — Connected: $355.30 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 Altius MHNet Behavioral Health — Behavioral Health: $377.51 AWH Connected — Connected Utah: $282.02 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $310.89 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC CLIENT ONLY HRH PHYSICAL THERAPY EVALUATION PER SESSION	$444.13	$333.10	$115.03 – $399.72
Physical therapy evaluation (moderate complexity): 10 of 61 insurance plan rates Aetna — Connected: $359.75 Aetna — Extended: $377.51 AG Administrators — USU Athletics: $319.77 Altius MHNet Behavioral Health — Behavioral Health: $377.51 AWH Connected — Connected Utah: $286.46 BYU Athletics — Commercial: $319.77 BYU Risk Management — Workers Comp: $324.21 Campbell Scientific — Commercial: $319.77 Cigna — Open Access Flex: $279.80 Cigna — PPO/EPO: $377.51
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$535.83	$401.87	$6.97 – $482.25
Physical therapy evaluation (high complexity): 10 of 61 insurance plan rates Aetna — Connected: $428.66 Aetna — Extended: $455.46 AG Administrators — USU Athletics: $385.80 Altius MHNet Behavioral Health — Behavioral Health: $455.46 AWH Connected — Connected Utah: $340.25 BYU Athletics — Commercial: $385.80 BYU Risk Management — Workers Comp: $375.08 Campbell Scientific — Commercial: $385.80 Cigna — Open Access Flex: $337.57 Cigna — PPO/EPO: $455.46
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PT EVAL HIGH COMPLEXITY	$535.83	$401.87	$138.78 – $482.25
Physical therapy evaluation (high complexity): 10 of 61 insurance plan rates Aetna — Connected: $434.02 Aetna — Extended: $455.46 AG Administrators — USU Athletics: $385.80 Altius MHNet Behavioral Health — Behavioral Health: $455.46 AWH Connected — Connected Utah: $345.61 BYU Athletics — Commercial: $385.80 BYU Risk Management — Workers Comp: $391.16 Campbell Scientific — Commercial: $385.80 Cigna — Open Access Flex: $337.57 Cigna — PPO/EPO: $455.46
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt eval high complex 45 min	Not listed in the file	Not listed in the file	$95.06 – $266.71
Physical therapy evaluation (high complexity): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $95.06 Aetna — Medicare Adv PPO: $104.57 American Health — Medicare Adv UT HMO I-SNP: $95.06 Health Partners of Nevada — Medicare Advantage: $95.06 Health Plan of Nevada — Medicaid: $95.06 Healthy U — Medicaid: $95.06 Humana — Medicare Choice PPO: $99.81 Intermountain Caregiver Plan — Med Network: $254.01 Intermountain Caregiver Plan — Share Network: $223.53 Molina — Medicaid: $95.06
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$158.59	$118.94	$2.06 – $142.73
Psychotherapy, 30 minutes: 10 of 61 insurance plan rates Aetna — Connected: $126.87 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 Altius MHNet Behavioral Health — Behavioral Health: $134.80 AWH Connected — Connected Utah: $100.70 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $111.01 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 30 MINUTES	$158.59	$118.94	$2.06 – $142.73
Psychotherapy, 30 minutes: 10 of 61 insurance plan rates Aetna — Connected: $126.87 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 Altius MHNet Behavioral Health — Behavioral Health: $134.80 AWH Connected — Connected Utah: $100.70 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $111.01 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX PT&/FAMILY 30 MINUTES	$158.59	$118.94	$41.07 – $142.73
Psychotherapy, 30 minutes: 10 of 61 insurance plan rates Aetna — Connected: $128.46 Aetna — Extended: $134.80 AG Administrators — USU Athletics: $114.18 Altius MHNet Behavioral Health — Behavioral Health: $134.80 AWH Connected — Connected Utah: $102.29 BYU Athletics — Commercial: $114.18 BYU Risk Management — Workers Comp: $115.77 Campbell Scientific — Commercial: $114.18 Cigna — Open Access Flex: $99.91 Cigna — PPO/EPO: $134.80
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$394.31	$295.73	$5.13 – $354.88
Psychotherapy, 45 minutes: 10 of 61 insurance plan rates Aetna — Connected: $315.45 Aetna — Extended: $335.16 AG Administrators — USU Athletics: $283.90 Altius MHNet Behavioral Health — Behavioral Health: $335.16 AWH Connected — Connected Utah: $250.39 BYU Athletics — Commercial: $283.90 BYU Risk Management — Workers Comp: $276.02 Campbell Scientific — Commercial: $283.90 Cigna — Open Access Flex: $248.42 Cigna — PPO/EPO: $335.16
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 45 MINUTES	$224.17	$168.13	$2.91 – $201.75
Psychotherapy, 45 minutes: 10 of 61 insurance plan rates Aetna — Connected: $179.34 Aetna — Extended: $190.54 AG Administrators — USU Athletics: $161.40 Altius MHNet Behavioral Health — Behavioral Health: $190.54 AWH Connected — Connected Utah: $142.35 BYU Athletics — Commercial: $161.40 BYU Risk Management — Workers Comp: $156.92 Campbell Scientific — Commercial: $161.40 Cigna — Open Access Flex: $141.23 Cigna — PPO/EPO: $190.54
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC PSYTX, 45 MIN WITH PATIENT	$394.31	$295.73	$102.13 – $354.88
Psychotherapy, 45 minutes: 10 of 61 insurance plan rates Aetna — Connected: $319.39 Aetna — Extended: $335.16 AG Administrators — USU Athletics: $283.90 Altius MHNet Behavioral Health — Behavioral Health: $335.16 AWH Connected — Connected Utah: $254.33 BYU Athletics — Commercial: $283.90 BYU Risk Management — Workers Comp: $287.85 Campbell Scientific — Commercial: $283.90 Cigna — Open Access Flex: $248.42 Cigna — PPO/EPO: $335.16
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$396.57	$297.43	$5.16 – $356.91
Psychotherapy, 60 minutes: 10 of 61 insurance plan rates Aetna — Connected: $317.26 Aetna — Extended: $337.08 AG Administrators — USU Athletics: $285.53 Altius MHNet Behavioral Health — Behavioral Health: $337.08 AWH Connected — Connected Utah: $251.82 BYU Athletics — Commercial: $285.53 BYU Risk Management — Workers Comp: $277.60 Campbell Scientific — Commercial: $285.53 Cigna — Open Access Flex: $249.84 Cigna — PPO/EPO: $337.08
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: PBB PSYCHOTHERAPY W/PATIENT 60 MINUTES	$396.57	$297.43	$102.71 – $356.91
Psychotherapy, 60 minutes: 10 of 61 insurance plan rates Aetna — Connected: $321.22 Aetna — Extended: $337.08 AG Administrators — USU Athletics: $285.53 Altius MHNet Behavioral Health — Behavioral Health: $337.08 AWH Connected — Connected Utah: $255.79 BYU Athletics — Commercial: $285.53 BYU Risk Management — Workers Comp: $289.50 Campbell Scientific — Commercial: $285.53 Cigna — Open Access Flex: $249.84 Cigna — PPO/EPO: $337.08
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psytx w pt 60 minutes	Not listed in the file	Not listed in the file	$145.15 – $427.19
Psychotherapy, 60 minutes: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $179.38 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $179.38 Healthy U — Medicaid: $179.38 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $406.85 Intermountain Caregiver Plan — Share Network: $358.03 Molina — Medicaid: $179.38
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX W/O PT 50 MIN	$208.45	$156.34	$2.71 – $187.60
Family psychotherapy, without the patient: 10 of 61 insurance plan rates Aetna — Connected: $166.76 Aetna — Extended: $177.18 AG Administrators — USU Athletics: $150.08 Altius MHNet Behavioral Health — Behavioral Health: $177.18 AWH Connected — Connected Utah: $132.37 BYU Athletics — Commercial: $150.08 BYU Risk Management — Workers Comp: $145.92 Campbell Scientific — Commercial: $150.08 Cigna — Open Access Flex: $131.32 Cigna — PPO/EPO: $177.18
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC FAMILY PSYTX W/O PT 50 MIN	$208.45	$156.34	$53.99 – $187.60
Family psychotherapy, without the patient: 10 of 61 insurance plan rates Aetna — Connected: $168.84 Aetna — Extended: $177.18 AG Administrators — USU Athletics: $150.08 Altius MHNet Behavioral Health — Behavioral Health: $177.18 AWH Connected — Connected Utah: $134.45 BYU Athletics — Commercial: $150.08 BYU Risk Management — Workers Comp: $152.17 Campbell Scientific — Commercial: $150.08 Cigna — Open Access Flex: $131.32 Cigna — PPO/EPO: $177.18
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/o pt 50 min	Not listed in the file	Not listed in the file	$145.15 – $275.04
Family psychotherapy, without the patient: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $179.38 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $179.38 Healthy U — Medicaid: $179.38 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $261.94 Intermountain Caregiver Plan — Share Network: $230.51 Molina — Medicaid: $179.38
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Family psytx w/pt 50 min	Not listed in the file	Not listed in the file	$145.15 – $286.74
Family psychotherapy, with the patient: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $179.38 Aetna — Medicare Adv PPO: $197.32 American Health — Medicare Adv UT HMO I-SNP: $179.38 Health Partners of Nevada — Medicare Advantage: $179.38 Health Plan of Nevada — Medicaid: $179.38 Healthy U — Medicaid: $179.38 Humana — Medicare Choice PPO: $188.35 Intermountain Caregiver Plan — Med Network: $273.09 Intermountain Caregiver Plan — Share Network: $240.32 Molina — Medicaid: $179.38
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 15 insurance plan rates Aetna — Medicare Adv HMO: $98.07 Aetna — Medicare Adv PPO: $98.07 American Health — Medicare Adv UT HMO I-SNP: $98.07 Health Partners of Nevada — Medicare Advantage: $98.07 Humana — Medicare Choice PPO: $98.07 Molina — Medicare Advantage: $98.07 Molina — Medicare Choice Care HMO: $98.07 Molina — Medicare Complete Care HMO SNP: $98.07 Regence BCBS — MedAdvantage PPO: $98.07 SelectHealth — Med Individual ACA: $98.07
Group psychotherapy CPT 90853 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$138.68	$104.01	$1.80 – $124.81
Group psychotherapy: 10 of 61 insurance plan rates Aetna — Connected: $110.94 Aetna — Extended: $117.88 AG Administrators — USU Athletics: $99.85 Altius MHNet Behavioral Health — Behavioral Health: $117.88 AWH Connected — Connected Utah: $88.06 BYU Athletics — Commercial: $99.85 BYU Risk Management — Workers Comp: $97.08 Campbell Scientific — Commercial: $99.85 Cigna — Open Access Flex: $87.37 Cigna — PPO/EPO: $117.88
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC GROUP THERAPY	$138.68	$104.01	$35.92 – $124.81
Group psychotherapy: 10 of 61 insurance plan rates Aetna — Connected: $112.33 Aetna — Extended: $117.88 AG Administrators — USU Athletics: $99.85 Altius MHNet Behavioral Health — Behavioral Health: $117.88 AWH Connected — Connected Utah: $89.45 BYU Athletics — Commercial: $99.85 BYU Risk Management — Workers Comp: $101.24 Campbell Scientific — Commercial: $99.85 Cigna — Open Access Flex: $87.37 Cigna — PPO/EPO: $117.88
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Group psychotherapy	Not listed in the file	Not listed in the file	$65.23 – $119.06
Group psychotherapy: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $102.38 Aetna — Medicare Adv PPO: $112.61 American Health — Medicare Adv UT HMO I-SNP: $102.38 Health Partners of Nevada — Medicare Advantage: $102.38 Health Plan of Nevada — Medicaid: $102.38 Healthy U — Medicaid: $102.38 Humana — Medicare Choice PPO: $107.49 Intermountain Caregiver Plan — Med Network: $74.13 Intermountain Caregiver Plan — Share Network: $65.23 Molina — Medicaid: $102.38

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Removal of breast lesion	Not listed in the file	Not listed in the file	$1,243.42 – $4,609.73
Removal of breast growth (open surgery): 10 of 29 insurance plan rates Aetna — Medicare Adv HMO: $3,963.65 Aetna — Medicare Adv PPO: $4,360.02 American Health — Medicare Adv UT HMO I-SNP: $3,963.65 Health Partners of Nevada — Medicare Advantage: $3,963.65 Health Plan of Nevada — Medicaid: $3,963.65 Healthy U — Medicaid: $3,963.65 Humana — Medicare Choice PPO: $4,161.83 Intermountain Caregiver Plan — Med Network: $1,412.98 Intermountain Caregiver Plan — Share Network: $1,243.42 Molina — Medicaid: $3,963.65
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 15 insurance plan rates Aetna — Medicare Adv HMO: $608.06 Aetna — Medicare Adv PPO: $608.06 American Health — Medicare Adv UT HMO I-SNP: $608.06 Health Partners of Nevada — Medicare Advantage: $608.06 Humana — Medicare Choice PPO: $608.06 Molina — Medicare Advantage: $608.06 Molina — Medicare Choice Care HMO: $608.06 Molina — Medicare Complete Care HMO SNP: $608.06 Regence BCBS — MedAdvantage PPO: $608.06 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $287.81 Aetna — Medicare Adv PPO: $287.81 American Health — Medicare Adv UT HMO I-SNP: $287.81 Health Partners of Nevada — Medicare Advantage: $287.81 Humana — Medicare Choice PPO: $287.81 Molina — Medicare Advantage: $287.81 Molina — Medicare Choice Care HMO: $287.81 Molina — Medicare Complete Care HMO SNP: $287.81 Regence BCBS — MedAdvantage PPO: $287.81 SelectHealth — Med Individual ACA: $287.81
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total hip arthroplasty	Not listed in the file	Not listed in the file	$3,095 – $15,117.80
Total hip replacement: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $12,998.97 Aetna — Medicare Adv PPO: $14,298.86 American Health — Medicare Adv UT HMO I-SNP: $12,998.97 Health Partners of Nevada — Medicare Advantage: $12,998.97 Health Plan of Nevada — Medicaid: $12,998.97 Healthy U — Medicaid: $12,998.97 Humana — Medicare Choice PPO: $13,648.91 Intermountain Caregiver Plan — Med Network: $3,517.04 Intermountain Caregiver Plan — Share Network: $3,095 Molina — Medicaid: $12,998.97
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 15 insurance plan rates Aetna — Medicare Adv HMO: $1,868.51 Aetna — Medicare Adv PPO: $1,868.51 American Health — Medicare Adv UT HMO I-SNP: $1,868.51 Health Partners of Nevada — Medicare Advantage: $1,868.51 Humana — Medicare Choice PPO: $1,868.51 Molina — Medicare Advantage: $1,868.51 Molina — Medicare Choice Care HMO: $1,868.51 Molina — Medicare Complete Care HMO SNP: $1,868.51 Regence BCBS — MedAdvantage PPO: $1,868.51 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $859.51 Aetna — Medicare Adv PPO: $859.51 American Health — Medicare Adv UT HMO I-SNP: $859.51 Health Partners of Nevada — Medicare Advantage: $859.51 Humana — Medicare Choice PPO: $859.51 Molina — Medicare Advantage: $859.51 Molina — Medicare Choice Care HMO: $859.51 Molina — Medicare Complete Care HMO SNP: $859.51 Regence BCBS — MedAdvantage PPO: $859.51 SelectHealth — Med Individual ACA: $859.51
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Total knee arthroplasty	Not listed in the file	Not listed in the file	$3,091.16 – $15,117.80
Total knee replacement: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $12,998.97 Aetna — Medicare Adv PPO: $14,298.86 American Health — Medicare Adv UT HMO I-SNP: $12,998.97 Health Partners of Nevada — Medicare Advantage: $12,998.97 Health Plan of Nevada — Medicaid: $12,998.97 Healthy U — Medicaid: $12,998.97 Humana — Medicare Choice PPO: $13,648.91 Intermountain Caregiver Plan — Med Network: $3,512.68 Intermountain Caregiver Plan — Share Network: $3,091.16 Molina — Medicaid: $12,998.97
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 15 insurance plan rates Aetna — Medicare Adv HMO: $1,866.65 Aetna — Medicare Adv PPO: $1,866.65 American Health — Medicare Adv UT HMO I-SNP: $1,866.65 Health Partners of Nevada — Medicare Advantage: $1,866.65 Humana — Medicare Choice PPO: $1,866.65 Molina — Medicare Advantage: $1,866.65 Molina — Medicare Choice Care HMO: $1,866.65 Molina — Medicare Complete Care HMO SNP: $1,866.65 Regence BCBS — MedAdvantage PPO: $1,866.65 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $858.66 Aetna — Medicare Adv PPO: $858.66 American Health — Medicare Adv UT HMO I-SNP: $858.66 Health Partners of Nevada — Medicare Advantage: $858.66 Humana — Medicare Choice PPO: $858.66 Molina — Medicare Advantage: $858.66 Molina — Medicare Choice Care HMO: $858.66 Molina — Medicare Complete Care HMO SNP: $858.66 Regence BCBS — MedAdvantage PPO: $858.66 SelectHealth — Med Individual ACA: $858.66
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$9,135 – $9,729
Shoulder arthroscopy: shaving of shoulder bone: 10 of 29 insurance plan rates AG Administrators — USU Athletics: $9,729 AWH Connected — Connected Utah: $9,729 BYU Athletics — Commercial: $9,729 Campbell Scientific — Commercial: $9,729 Deseret Mutual — All Other: $9,729 Deseret Mutual — Select: $9,135 EMI — Commercial: $9,729 EMI Health — Mint: $9,729 EMI Health — Network Care: $9,729 Franklin County — Commercial: $9,729
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$250.01
Shoulder arthroscopy: shaving of shoulder bone: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $250.01 Aetna — Medicare Adv PPO: $250.01 American Health — Medicare Adv UT HMO I-SNP: $250.01 Health Partners of Nevada — Medicare Advantage: $250.01 Humana — Medicare Choice PPO: $250.01 Molina — Medicare Advantage: $250.01 Molina — Medicare Choice Care HMO: $250.01 Molina — Medicare Complete Care HMO SNP: $250.01 Regence BCBS — MedAdvantage PPO: $250.01 SelectHealth — Med Individual ACA: $250.01
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 81\|82\|80 In the file: Sho arthrs srg decompression	Not listed in the file	Not listed in the file	$26.67
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates Aetna — Medicare Adv HMO: $26.67 Aetna — Medicare Adv PPO: $26.67 American Health — Medicare Adv UT HMO I-SNP: $26.67 Health Partners of Nevada — Medicare Advantage: $26.67 Humana — Medicare Choice PPO: $26.67 Molina — Medicare Advantage: $26.67 Molina — Medicare Choice Care HMO: $26.67 Molina — Medicare Complete Care HMO SNP: $26.67 Regence BCBS — MedAdvantage PPO: $26.67 SelectHealth — Med Individual ACA: $26.67
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	Not listed in the file	$2,946.73 – $6,225
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $3,312.25 Aetna — Medicare Adv PPO: $3,643.48 AG Administrators — USU Athletics: $6,225 American Health — Medicare Adv UT HMO I-SNP: $3,312.25 AWH Connected — Connected Utah: $6,225 BYU Athletics — Commercial: $6,225 Campbell Scientific — Commercial: $6,225 Deseret Mutual — All Other: $6,225 Deseret Mutual — Select: $6,225 EMI — Commercial: $6,225
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Arthrs kne srg mnisectmy m/l	Not listed in the file	Not listed in the file	$790.88
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $790.88 Aetna — Medicare Adv PPO: $790.88 American Health — Medicare Adv UT HMO I-SNP: $790.88 Health Partners of Nevada — Medicare Advantage: $790.88 Humana — Medicare Choice PPO: $790.88 Molina — Medicare Advantage: $790.88 Molina — Medicare Choice Care HMO: $790.88 Molina — Medicare Complete Care HMO SNP: $790.88 Regence BCBS — MedAdvantage PPO: $790.88 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $363.80 Aetna — Medicare Adv PPO: $363.80 American Health — Medicare Adv UT HMO I-SNP: $363.80 Health Partners of Nevada — Medicare Advantage: $363.80 Humana — Medicare Choice PPO: $363.80 Molina — Medicare Advantage: $363.80 Molina — Medicare Choice Care HMO: $363.80 Molina — Medicare Complete Care HMO SNP: $363.80 Regence BCBS — MedAdvantage PPO: $363.80 SelectHealth — Med Individual ACA: $363.80
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$3,958 – $6,970.96
Removal of tonsils and adenoids (under age 12): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $5,993.95 Aetna — Medicare Adv PPO: $6,593.34 AG Administrators — USU Athletics: $4,523 American Health — Medicare Adv UT HMO I-SNP: $5,993.95 AWH Connected — Connected Utah: $4,523 BYU Athletics — Commercial: $4,523 Campbell Scientific — Commercial: $4,523 Deseret Mutual — All Other: $4,523 Deseret Mutual — Select: $4,247 EMI — Commercial: $4,523
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Remove tonsils and adenoids	Not listed in the file	Not listed in the file	$230.24
Removal of tonsils and adenoids (under age 12): 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $230.24 Aetna — Medicare Adv PPO: $230.24 American Health — Medicare Adv UT HMO I-SNP: $230.24 Health Partners of Nevada — Medicare Advantage: $230.24 Humana — Medicare Choice PPO: $230.24 Molina — Medicare Advantage: $230.24 Molina — Medicare Choice Care HMO: $230.24 Molina — Medicare Complete Care HMO SNP: $230.24 Regence BCBS — MedAdvantage PPO: $230.24 SelectHealth — Med Individual ACA: $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	$825.24 – $1,589
Upper GI endoscopy (diagnostic): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $917.76 Aetna — Medicare Adv PPO: $1,009.53 AG Administrators — USU Athletics: $1,589 American Health — Medicare Adv UT HMO I-SNP: $917.76 AWH Connected — Connected Utah: $1,589 BYU Athletics — Commercial: $1,589 Campbell Scientific — Commercial: $1,589 Deseret Mutual — All Other: $1,589 Deseret Mutual — Select: $1,471 EMI — Commercial: $1,589
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd diagnostic brush wash	Not listed in the file	Not listed in the file	$117.67
Upper GI endoscopy (diagnostic): 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $117.67 Aetna — Medicare Adv PPO: $117.67 American Health — Medicare Adv UT HMO I-SNP: $117.67 Health Partners of Nevada — Medicare Advantage: $117.67 Humana — Medicare Choice PPO: $117.67 Molina — Medicare Advantage: $117.67 Molina — Medicare Choice Care HMO: $117.67 Molina — Medicare Complete Care HMO SNP: $117.67 Regence BCBS — MedAdvantage PPO: $117.67 SelectHealth — Med Individual ACA: $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	$825.24 – $1,930
Upper GI endoscopy with biopsy: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $917.76 Aetna — Medicare Adv PPO: $1,009.53 AG Administrators — USU Athletics: $1,930 American Health — Medicare Adv UT HMO I-SNP: $917.76 AWH Connected — Connected Utah: $1,930 BYU Athletics — Commercial: $1,930 Campbell Scientific — Commercial: $1,930 Deseret Mutual — All Other: $1,930 Deseret Mutual — Select: $1,787 EMI — Commercial: $1,930
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Egd biopsy single/multiple	Not listed in the file	Not listed in the file	$132.79
Upper GI endoscopy with biopsy: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $132.79 Aetna — Medicare Adv PPO: $132.79 American Health — Medicare Adv UT HMO I-SNP: $132.79 Health Partners of Nevada — Medicare Advantage: $132.79 Humana — Medicare Choice PPO: $132.79 Molina — Medicare Advantage: $132.79 Molina — Medicare Choice Care HMO: $132.79 Molina — Medicare Complete Care HMO SNP: $132.79 Regence BCBS — MedAdvantage PPO: $132.79 SelectHealth — Med Individual ACA: $132.79
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,657.74	$1,993.30	$34.55 – $2,391.97
Colonoscopy (diagnostic): 10 of 61 insurance plan rates Aetna — Connected: $2,126.19 Aetna — Extended: $2,259.08 AG Administrators — USU Athletics: $1,913.57 Altius MHNet Behavioral Health — Behavioral Health: $2,259.08 AWH Connected — Connected Utah: $1,687.66 BYU Athletics — Commercial: $1,913.57 BYU Risk Management — Workers Comp: $1,860.42 Campbell Scientific — Commercial: $1,913.57 Cigna — Open Access Flex: $1,674.38 Cigna — PPO/EPO: $2,259.08
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC DIAGNOSTIC COLONOSCOPY	$2,657.74	$1,993.30	$688.35 – $2,391.97
Colonoscopy (diagnostic): 10 of 61 insurance plan rates Aetna — Connected: $2,152.77 Aetna — Extended: $2,259.08 AG Administrators — USU Athletics: $1,913.57 Altius MHNet Behavioral Health — Behavioral Health: $2,259.08 AWH Connected — Connected Utah: $1,714.24 BYU Athletics — Commercial: $1,913.57 BYU Risk Management — Workers Comp: $1,940.15 Campbell Scientific — Commercial: $1,913.57 Cigna — Open Access Flex: $1,674.38 Cigna — PPO/EPO: $2,259.08
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	$832.05 – $1,453
Colonoscopy (diagnostic): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $941.31 Aetna — Medicare Adv PPO: $1,035.44 AG Administrators — USU Athletics: $1,453 American Health — Medicare Adv UT HMO I-SNP: $941.31 AWH Connected — Connected Utah: $1,453 BYU Athletics — Commercial: $1,453 Campbell Scientific — Commercial: $1,453 Deseret Mutual — All Other: $1,453 Deseret Mutual — Select: $1,345 EMI — Commercial: $1,453
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$1,074.31 – $1,589
Colonoscopy with biopsy: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 AG Administrators — USU Athletics: $1,589 American Health — Medicare Adv UT HMO I-SNP: $1,211.29 AWH Connected — Connected Utah: $1,589 BYU Athletics — Commercial: $1,589 Campbell Scientific — Commercial: $1,589 Deseret Mutual — All Other: $1,589 Deseret Mutual — Select: $1,499 EMI — Commercial: $1,589
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy and biopsy	Not listed in the file	Not listed in the file	$192.84
Colonoscopy with biopsy: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $192.84 Aetna — Medicare Adv PPO: $192.84 American Health — Medicare Adv UT HMO I-SNP: $192.84 Health Partners of Nevada — Medicare Advantage: $192.84 Humana — Medicare Choice PPO: $192.84 Molina — Medicare Advantage: $192.84 Molina — Medicare Choice Care HMO: $192.84 Molina — Medicare Complete Care HMO SNP: $192.84 Regence BCBS — MedAdvantage PPO: $192.84 SelectHealth — Med Individual ACA: $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	$1,074.31 – $1,453
Colonoscopy with removal of polyps (snare): 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 AG Administrators — USU Athletics: $1,453 American Health — Medicare Adv UT HMO I-SNP: $1,211.29 AWH Connected — Connected Utah: $1,453 BYU Athletics — Commercial: $1,453 Campbell Scientific — Commercial: $1,453 Deseret Mutual — All Other: $1,453 Deseret Mutual — Select: $1,345 EMI — Commercial: $1,453
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Colonoscopy w/lesion removal	Not listed in the file	Not listed in the file	$244.10
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $244.10 Aetna — Medicare Adv PPO: $244.10 American Health — Medicare Adv UT HMO I-SNP: $244.10 Health Partners of Nevada — Medicare Advantage: $244.10 Humana — Medicare Choice PPO: $244.10 Molina — Medicare Advantage: $244.10 Molina — Medicare Choice Care HMO: $244.10 Molina — Medicare Complete Care HMO SNP: $244.10 Regence BCBS — MedAdvantage PPO: $244.10 SelectHealth — Med Individual ACA: $244.10
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colonoscopy w/endoscope us	Not listed in the file	Not listed in the file	$609.53 – $1,408.73
Ultrasound of the lower bowel by endoscope: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $1,211.29 Aetna — Medicare Adv PPO: $1,332.42 American Health — Medicare Adv UT HMO I-SNP: $1,211.29 Health Partners of Nevada — Medicare Advantage: $1,211.29 Health Plan of Nevada — Medicaid: $1,211.29 Healthy U — Medicaid: $1,211.29 Humana — Medicare Choice PPO: $1,271.86 Intermountain Caregiver Plan — Med Network: $692.65 Intermountain Caregiver Plan — Share Network: $609.53 Molina — Medicaid: $1,211.29
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 15 insurance plan rates Aetna — Medicare Adv HMO: $247.75 Aetna — Medicare Adv PPO: $247.75 American Health — Medicare Adv UT HMO I-SNP: $247.75 Health Partners of Nevada — Medicare Advantage: $247.75 Humana — Medicare Choice PPO: $247.75 Molina — Medicare Advantage: $247.75 Molina — Medicare Choice Care HMO: $247.75 Molina — Medicare Complete Care HMO SNP: $247.75 Regence BCBS — MedAdvantage PPO: $247.75 SelectHealth — Med Individual ACA: $247.75
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$3,191.55	$2,393.66	$41.49 – $2,872.40
Screening colonoscopy (not high risk): 10 of 61 insurance plan rates Aetna — Connected: $2,553.24 Aetna — Extended: $2,712.82 AG Administrators — USU Athletics: $2,297.92 Altius MHNet Behavioral Health — Behavioral Health: $2,712.82 AWH Connected — Connected Utah: $2,026.63 BYU Athletics — Commercial: $2,297.92 BYU Risk Management — Workers Comp: $2,234.08 Campbell Scientific — Commercial: $2,297.92 Cigna — Open Access Flex: $2,010.68 Cigna — PPO/EPO: $2,712.82
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC SCREENING COLONOSCOPY LOW RISK	$3,191.55	$2,393.66	$826.61 – $2,872.40
Screening colonoscopy (not high risk): 10 of 61 insurance plan rates Aetna — Connected: $2,585.16 Aetna — Extended: $2,712.82 AG Administrators — USU Athletics: $2,297.92 Altius MHNet Behavioral Health — Behavioral Health: $2,712.82 AWH Connected — Connected Utah: $2,058.55 BYU Athletics — Commercial: $2,297.92 BYU Risk Management — Workers Comp: $2,329.83 Campbell Scientific — Commercial: $2,297.92 Cigna — Open Access Flex: $2,010.68 Cigna — PPO/EPO: $2,712.82
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Colon ca scrn not hi rsk ind	Not listed in the file	Not listed in the file	$796.13 – $1,094.74
Screening colonoscopy (not high risk): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $941.31 Aetna — Medicare Adv PPO: $1,035.44 American Health — Medicare Adv UT HMO I-SNP: $941.31 Health Partners of Nevada — Medicare Advantage: $941.31 Health Plan of Nevada — Medicaid: $941.31 Healthy U — Medicaid: $941.31 Humana — Medicare Choice PPO: $988.38 Intermountain Caregiver Plan — Med Network: $904.69 Intermountain Caregiver Plan — Share Network: $796.13 Molina — Medicaid: $941.31
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	$5,252.83 – $8,709
Gallbladder removal by laparoscope: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $6,120.78 Aetna — Medicare Adv PPO: $6,732.86 AG Administrators — USU Athletics: $8,709 American Health — Medicare Adv UT HMO I-SNP: $6,120.78 AWH Connected — Connected Utah: $8,709 BYU Athletics — Commercial: $8,709 Campbell Scientific — Commercial: $8,709 Deseret Mutual — All Other: $8,709 Deseret Mutual — Select: $8,177 EMI — Commercial: $8,709
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 78 In the file: Laparoscopic cholecystectomy	Not listed in the file	Not listed in the file	$519.23
Gallbladder removal by laparoscope: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $519.23 Aetna — Medicare Adv PPO: $519.23 American Health — Medicare Adv UT HMO I-SNP: $519.23 Health Partners of Nevada — Medicare Advantage: $519.23 Humana — Medicare Choice PPO: $519.23 Molina — Medicare Advantage: $519.23 Molina — Medicare Choice Care HMO: $519.23 Molina — Medicare Complete Care HMO SNP: $519.23 Regence BCBS — MedAdvantage PPO: $519.23 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $102.56 Aetna — Medicare Adv PPO: $102.56 American Health — Medicare Adv UT HMO I-SNP: $102.56 Health Partners of Nevada — Medicare Advantage: $102.56 Humana — Medicare Choice PPO: $102.56 Molina — Medicare Advantage: $102.56 Molina — Medicare Choice Care HMO: $102.56 Molina — Medicare Complete Care HMO SNP: $102.56 Regence BCBS — MedAdvantage PPO: $102.56 SelectHealth — Med Individual ACA: $102.56
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prp i/hern init reduc >5 yr	Not listed in the file	Not listed in the file	$1,266.82 – $4,215.66
Groin (inguinal) hernia repair, age 5 or older: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $3,624.82 Aetna — Medicare Adv PPO: $3,987.30 American Health — Medicare Adv UT HMO I-SNP: $3,624.82 Health Partners of Nevada — Medicare Advantage: $3,624.82 Health Plan of Nevada — Medicaid: $3,624.82 Healthy U — Medicaid: $3,624.82 Humana — Medicare Choice PPO: $3,806.06 Intermountain Caregiver Plan — Med Network: $1,439.57 Intermountain Caregiver Plan — Share Network: $1,266.82 Molina — Medicaid: $3,624.82
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 15 insurance plan rates Aetna — Medicare Adv HMO: $763.29 Aetna — Medicare Adv PPO: $763.29 American Health — Medicare Adv UT HMO I-SNP: $763.29 Health Partners of Nevada — Medicare Advantage: $763.29 Humana — Medicare Choice PPO: $763.29 Molina — Medicare Advantage: $763.29 Molina — Medicare Choice Care HMO: $763.29 Molina — Medicare Complete Care HMO SNP: $763.29 Regence BCBS — MedAdvantage PPO: $763.29 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $412.18 Aetna — Medicare Adv PPO: $412.18 American Health — Medicare Adv UT HMO I-SNP: $412.18 Health Partners of Nevada — Medicare Advantage: $412.18 Humana — Medicare Choice PPO: $412.18 Molina — Medicare Advantage: $412.18 Molina — Medicare Choice Care HMO: $412.18 Molina — Medicare Complete Care HMO SNP: $412.18 Regence BCBS — MedAdvantage PPO: $412.18 SelectHealth — Med Individual ACA: $412.18
Prostate biopsy CPT 55700 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$952.99	$714.74	$12.39 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $857.69
Prostate biopsy: 10 of 61 insurance plan rates Aetna — Connected: $762.39 Aetna — Extended: $810.04 AG Administrators — USU Athletics: $686.15 Altius MHNet Behavioral Health — Behavioral Health: $810.04 AWH Connected — Connected Utah: $605.15 BYU Athletics — Commercial: $686.15 BYU Risk Management — Workers Comp: $667.09 Campbell Scientific — Commercial: $686.15 Cigna — Open Access Flex: $600.38 Cigna — PPO/EPO: $810.04
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HCD PROSTATE BIOPSY NEEDLE	$952.99	$714.74	$246.82 – $857.69
Prostate biopsy: 10 of 61 insurance plan rates Aetna — Connected: $771.92 Aetna — Extended: $810.04 AG Administrators — USU Athletics: $686.15 Altius MHNet Behavioral Health — Behavioral Health: $810.04 AWH Connected — Connected Utah: $614.68 BYU Athletics — Commercial: $686.15 BYU Risk Management — Workers Comp: $695.68 Campbell Scientific — Commercial: $686.15 Cigna — Open Access Flex: $600.38 Cigna — PPO/EPO: $810.04
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 15 insurance plan rates Aetna — Medicare Adv HMO: $125.21 Aetna — Medicare Adv PPO: $125.21 American Health — Medicare Adv UT HMO I-SNP: $125.21 Health Partners of Nevada — Medicare Advantage: $125.21 Humana — Medicare Choice PPO: $125.21 Molina — Medicare Advantage: $125.21 Molina — Medicare Choice Care HMO: $125.21 Molina — Medicare Complete Care HMO SNP: $125.21 Regence BCBS — MedAdvantage PPO: $125.21 SelectHealth — Med Individual ACA: $125.21
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps surg prst8ect rpbic rad	Not listed in the file	Not listed in the file	$2,867.76 – $12,516.33
Prostate removal by laparoscope (radical prostatectomy): 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $10,762.11 Aetna — Medicare Adv PPO: $11,838.32 American Health — Medicare Adv UT HMO I-SNP: $10,762.11 Health Partners of Nevada — Medicare Advantage: $10,762.11 Health Plan of Nevada — Medicaid: $10,762.11 Healthy U — Medicaid: $10,762.11 Humana — Medicare Choice PPO: $11,300.21 Intermountain Caregiver Plan — Med Network: $3,258.82 Intermountain Caregiver Plan — Share Network: $2,867.76 Molina — Medicaid: $10,762.11
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 15 insurance plan rates Aetna — Medicare Adv HMO: $958.41 Aetna — Medicare Adv PPO: $958.41 American Health — Medicare Adv UT HMO I-SNP: $958.41 Health Partners of Nevada — Medicare Advantage: $958.41 Humana — Medicare Choice PPO: $958.41 Molina — Medicare Advantage: $958.41 Molina — Medicare Choice Care HMO: $958.41 Molina — Medicare Complete Care HMO SNP: $958.41 Regence BCBS — MedAdvantage PPO: $958.41 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $184.75 Aetna — Medicare Adv PPO: $184.75 American Health — Medicare Adv UT HMO I-SNP: $184.75 Health Partners of Nevada — Medicare Advantage: $184.75 Humana — Medicare Choice PPO: $184.75 Molina — Medicare Advantage: $184.75 Molina — Medicare Choice Care HMO: $184.75 Molina — Medicare Complete Care HMO SNP: $184.75 Regence BCBS — MedAdvantage PPO: $184.75 SelectHealth — Med Individual ACA: $184.75
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$2,846.16 – $6,290
Hysteroscopy with biopsy of the uterus lining: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $3,276.92 Aetna — Medicare Adv PPO: $3,604.61 AG Administrators — USU Athletics: $6,290 American Health — Medicare Adv UT HMO I-SNP: $3,276.92 AWH Connected — Connected Utah: $6,290 BYU Athletics — Commercial: $6,290 Campbell Scientific — Commercial: $6,290 Deseret Mutual — All Other: $6,290 Deseret Mutual — Select: $5,824 EMI — Commercial: $6,290
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 62 In the file: Hysteroscopy biopsy	Not listed in the file	Not listed in the file	$139.65
Hysteroscopy with biopsy of the uterus lining: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $139.65 Aetna — Medicare Adv PPO: $139.65 American Health — Medicare Adv UT HMO I-SNP: $139.65 Health Partners of Nevada — Medicare Advantage: $139.65 Humana — Medicare Choice PPO: $139.65 Molina — Medicare Advantage: $139.65 Molina — Medicare Choice Care HMO: $139.65 Molina — Medicare Complete Care HMO SNP: $139.65 Regence BCBS — MedAdvantage PPO: $139.65 SelectHealth — Med Individual ACA: $139.65
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$2,785.15	$2,088.86	$36.21 – $2,506.64
Spinal injection, lower back (epidural), with imaging guidance: 10 of 61 insurance plan rates Aetna — Connected: $2,228.12 Aetna — Extended: $2,367.38 AG Administrators — USU Athletics: $2,005.31 Altius MHNet Behavioral Health — Behavioral Health: $2,367.38 AWH Connected — Connected Utah: $1,768.57 BYU Athletics — Commercial: $2,005.31 BYU Risk Management — Workers Comp: $1,949.60 Campbell Scientific — Commercial: $2,005.31 Cigna — Open Access Flex: $1,754.64 Cigna — PPO/EPO: $2,367.38
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ DX/THER INTRALAMINAR LUMBAR/SACRAL W/IMAGING	$2,785.15	$2,088.86	$721.35 – $2,506.64
Spinal injection, lower back (epidural), with imaging guidance: 10 of 61 insurance plan rates Aetna — Connected: $2,255.97 Aetna — Extended: $2,367.38 AG Administrators — USU Athletics: $2,005.31 Altius MHNet Behavioral Health — Behavioral Health: $2,367.38 AWH Connected — Connected Utah: $1,796.42 BYU Athletics — Commercial: $2,005.31 BYU Risk Management — Workers Comp: $2,033.16 Campbell Scientific — Commercial: $2,005.31 Cigna — Open Access Flex: $1,754.64 Cigna — PPO/EPO: $2,367.38
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx interlaminar lmbr/sac	Not listed in the file	Not listed in the file	$595.49 – $830.28
Spinal injection, lower back (epidural), with imaging guidance: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $713.91 Aetna — Medicare Adv PPO: $785.30 American Health — Medicare Adv UT HMO I-SNP: $713.91 Health Partners of Nevada — Medicare Advantage: $713.91 Health Plan of Nevada — Medicaid: $713.91 Healthy U — Medicaid: $713.91 Humana — Medicare Choice PPO: $749.61 Intermountain Caregiver Plan — Med Network: $676.69 Intermountain Caregiver Plan — Share Network: $595.49 Molina — Medicaid: $713.91
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC INJ ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$1,909.87	$1,432.40	$24.83 – $1,718.88
Nerve root injection, lower back, with imaging guidance: 10 of 61 insurance plan rates Aetna — Connected: $1,527.90 Aetna — Extended: $1,623.39 AG Administrators — USU Athletics: $1,375.11 Altius MHNet Behavioral Health — Behavioral Health: $1,623.39 AWH Connected — Connected Utah: $1,212.77 BYU Athletics — Commercial: $1,375.11 BYU Risk Management — Workers Comp: $1,336.91 Campbell Scientific — Commercial: $1,375.11 Cigna — Open Access Flex: $1,203.22 Cigna — PPO/EPO: $1,623.39
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC INJ ANES/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	$1,909.87	$1,432.40	$494.66 – $1,718.88
Nerve root injection, lower back, with imaging guidance: 10 of 61 insurance plan rates Aetna — Connected: $1,546.99 Aetna — Extended: $1,623.39 AG Administrators — USU Athletics: $1,375.11 Altius MHNet Behavioral Health — Behavioral Health: $1,623.39 AWH Connected — Connected Utah: $1,231.87 BYU Athletics — Commercial: $1,375.11 BYU Risk Management — Workers Comp: $1,394.21 Campbell Scientific — Commercial: $1,375.11 Cigna — Open Access Flex: $1,203.22 Cigna — PPO/EPO: $1,623.39
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Njx aa&/strd tfrm epi l/s 1	Not listed in the file	Not listed in the file	$570.72 – $1,041.01
Nerve root injection, lower back, with imaging guidance: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $895.11 Aetna — Medicare Adv PPO: $984.62 American Health — Medicare Adv UT HMO I-SNP: $895.11 Health Partners of Nevada — Medicare Advantage: $895.11 Health Plan of Nevada — Medicaid: $895.11 Healthy U — Medicaid: $895.11 Humana — Medicare Choice PPO: $939.86 Intermountain Caregiver Plan — Med Network: $648.54 Intermountain Caregiver Plan — Share Network: $570.72 Molina — Medicaid: $895.11
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Carpal tunnel surgery	Not listed in the file	Not listed in the file	$1,080.17 – $2,299.07
Carpal tunnel release: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $1,976.84 Aetna — Medicare Adv PPO: $2,174.53 American Health — Medicare Adv UT HMO I-SNP: $1,976.84 Health Partners of Nevada — Medicare Advantage: $1,976.84 Health Plan of Nevada — Medicaid: $1,976.84 Healthy U — Medicaid: $1,976.84 Humana — Medicare Choice PPO: $2,075.69 Intermountain Caregiver Plan — Med Network: $1,227.47 Intermountain Caregiver Plan — Share Network: $1,080.17 Molina — Medicaid: $1,976.84
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 15 insurance plan rates Aetna — Medicare Adv HMO: $637.01 Aetna — Medicare Adv PPO: $637.01 American Health — Medicare Adv UT HMO I-SNP: $637.01 Health Partners of Nevada — Medicare Advantage: $637.01 Humana — Medicare Choice PPO: $637.01 Molina — Medicare Advantage: $637.01 Molina — Medicare Choice Care HMO: $637.01 Molina — Medicare Complete Care HMO SNP: $637.01 Regence BCBS — MedAdvantage PPO: $637.01 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $322.75 Aetna — Medicare Adv PPO: $322.75 American Health — Medicare Adv UT HMO I-SNP: $322.75 Health Partners of Nevada — Medicare Advantage: $322.75 Humana — Medicare Choice PPO: $322.75 Molina — Medicare Advantage: $322.75 Molina — Medicare Choice Care HMO: $322.75 Molina — Medicare Complete Care HMO SNP: $322.75 Regence BCBS — MedAdvantage PPO: $322.75 SelectHealth — Med Individual ACA: $322.75
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,457.97	$1,093.48	$18.95 – $1,312.17
Laser treatment of clouding after cataract surgery: 10 of 61 insurance plan rates Aetna — Connected: $1,166.38 Aetna — Extended: $1,239.27 AG Administrators — USU Athletics: $1,049.74 Altius MHNet Behavioral Health — Behavioral Health: $1,239.27 AWH Connected — Connected Utah: $925.81 BYU Athletics — Commercial: $1,049.74 BYU Risk Management — Workers Comp: $1,020.58 Campbell Scientific — Commercial: $1,049.74 Cigna — Open Access Flex: $918.52 Cigna — PPO/EPO: $1,239.27
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: HC AFTER CATARACT LASER SURGERY	$1,457.97	$1,093.48	$377.61 – $1,312.17
Laser treatment of clouding after cataract surgery: 10 of 61 insurance plan rates Aetna — Connected: $1,180.96 Aetna — Extended: $1,239.27 AG Administrators — USU Athletics: $1,049.74 Altius MHNet Behavioral Health — Behavioral Health: $1,239.27 AWH Connected — Connected Utah: $940.39 BYU Athletics — Commercial: $1,049.74 BYU Risk Management — Workers Comp: $1,064.32 Campbell Scientific — Commercial: $1,049.74 Cigna — Open Access Flex: $918.52 Cigna — PPO/EPO: $1,239.27
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: After cataract laser surgery	Not listed in the file	Not listed in the file	$525.92 – $928.14
Laser treatment of clouding after cataract surgery: 10 of 28 insurance plan rates Aetna — Medicare Adv HMO: $556.27 Aetna — Medicare Adv PPO: $611.90 American Health — Medicare Adv UT HMO I-SNP: $556.27 Health Partners of Nevada — Medicare Advantage: $556.27 Health Plan of Nevada — Medicaid: $556.27 Healthy U — Medicaid: $556.27 Humana — Medicare Choice PPO: $584.08 Intermountain Caregiver Plan — Med Network: $883.94 Intermountain Caregiver Plan — Share Network: $777.87 Molina — Medicaid: $556.27
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	$2,121.50 – $4,182
Cataract removal with lens implant: 10 of 49 insurance plan rates Aetna — Medicare Adv HMO: $2,336.52 Aetna — Medicare Adv PPO: $2,570.17 AG Administrators — USU Athletics: $4,182 American Health — Medicare Adv UT HMO I-SNP: $2,336.52 AWH Connected — Connected Utah: $4,182 BYU Athletics — Commercial: $4,182 Campbell Scientific — Commercial: $4,182 Deseret Mutual — All Other: $4,182 Deseret Mutual — Select: $3,819 EMI — Commercial: $4,182
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Doctor (professional) fee · modifier 50 In the file: Xcapsl ctrc rmvl w/o ecp	Not listed in the file	Not listed in the file	$778.58
Cataract removal with lens implant: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $778.58 Aetna — Medicare Adv PPO: $778.58 American Health — Medicare Adv UT HMO I-SNP: $778.58 Health Partners of Nevada — Medicare Advantage: $778.58 Humana — Medicare Choice PPO: $778.58 Molina — Medicare Advantage: $778.58 Molina — Medicare Choice Care HMO: $778.58 Molina — Medicare Complete Care HMO SNP: $778.58 Regence BCBS — MedAdvantage PPO: $778.58 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $363.34 Aetna — Medicare Adv PPO: $363.34 American Health — Medicare Adv UT HMO I-SNP: $363.34 Health Partners of Nevada — Medicare Advantage: $363.34 Humana — Medicare Choice PPO: $363.34 Molina — Medicare Advantage: $363.34 Molina — Medicare Choice Care HMO: $363.34 Molina — Medicare Complete Care HMO SNP: $363.34 Regence BCBS — MedAdvantage PPO: $363.34 SelectHealth — Med Individual ACA: $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 15 insurance plan rates Aetna — Medicare Adv HMO: $2,326.99 Aetna — Medicare Adv PPO: $2,326.99 American Health — Medicare Adv UT HMO I-SNP: $2,326.99 Health Partners of Nevada — Medicare Advantage: $2,326.99 Humana — Medicare Choice PPO: $2,326.99 Molina — Medicare Advantage: $2,326.99 Molina — Medicare Choice Care HMO: $2,326.99 Molina — Medicare Complete Care HMO SNP: $2,326.99 Regence BCBS — MedAdvantage PPO: $2,326.99 SelectHealth — Med Individual ACA: $2,326.99
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetrical care	Not listed in the file	Not listed in the file	$5,790.53 – $6,909.16
Vaginal delivery, with care before and after: rates for 8 insurance plans Intermountain Caregiver Plan — Med Network: $6,580.15 Intermountain Caregiver Plan — Share Network: $5,790.53 SelectHealth — CHP: $6,580.15 SelectHealth — Commercial: $6,580.15 SelectHealth — FEHBP: $6,909.16 SelectHealth — SelectCare: $6,909.16 SelectHealth — SelectShare: $5,790.53 SelectHealth — SelectValue: $5,790.53
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$2,572.16
Cesarean delivery (C-section), with care before and after: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $2,572.16 Aetna — Medicare Adv PPO: $2,572.16 American Health — Medicare Adv UT HMO I-SNP: $2,572.16 Health Partners of Nevada — Medicare Advantage: $2,572.16 Humana — Medicare Choice PPO: $2,572.16 Molina — Medicare Advantage: $2,572.16 Molina — Medicare Choice Care HMO: $2,572.16 Molina — Medicare Complete Care HMO SNP: $2,572.16 Regence BCBS — MedAdvantage PPO: $2,572.16 SelectHealth — Med Individual ACA: $2,572.16
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cesarean delivery	Not listed in the file	Not listed in the file	$6,431.67 – $7,674.16
Cesarean delivery (C-section), with care before and after: rates for 8 insurance plans Intermountain Caregiver Plan — Med Network: $7,308.72 Intermountain Caregiver Plan — Share Network: $6,431.67 SelectHealth — CHP: $7,308.72 SelectHealth — Commercial: $7,308.72 SelectHealth — FEHBP: $7,674.16 SelectHealth — SelectCare: $7,674.16 SelectHealth — SelectShare: $6,431.67 SelectHealth — SelectValue: $6,431.67
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Doctor (professional) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$2,434.98
Vaginal delivery after a previous C-section, with care before and after: 10 of 15 insurance plan rates Aetna — Medicare Adv HMO: $2,434.98 Aetna — Medicare Adv PPO: $2,434.98 American Health — Medicare Adv UT HMO I-SNP: $2,434.98 Health Partners of Nevada — Medicare Advantage: $2,434.98 Humana — Medicare Choice PPO: $2,434.98 Molina — Medicare Advantage: $2,434.98 Molina — Medicare Choice Care HMO: $2,434.98 Molina — Medicare Complete Care HMO SNP: $2,434.98 Regence BCBS — MedAdvantage PPO: $2,434.98 SelectHealth — Med Individual ACA: $2,434.98
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Vbac delivery	Not listed in the file	Not listed in the file	$6,065.10 – $7,236.77
Vaginal delivery after a previous C-section, with care before and after: rates for 8 insurance plans Intermountain Caregiver Plan — Med Network: $6,892.16 Intermountain Caregiver Plan — Share Network: $6,065.10 SelectHealth — CHP: $6,892.16 SelectHealth — Commercial: $6,892.16 SelectHealth — FEHBP: $7,236.77 SelectHealth — SelectCare: $7,236.77 SelectHealth — SelectShare: $6,065.10 SelectHealth — SelectValue: $6,065.10

Source: LDS 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 5, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Acute Care Hospital
Address	8th Avenue and C Street, Salt Lake City, UT 84143
County	Salt Lake County
State	Utah
Phone	(801) 408‑1100
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	5 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	460006
Name in Medicare records	LDS HOSPITAL
Profile level	Medicare data + hospital website
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 2026-11-02.

Intermountain Health LDS Hospital — intermountainhealthcare.org
LDS Hospital Emergency Department — intermountainhealth.org
Medical Services - Intermountain Health — intermountainhealth.org
Intermountain Health LDS Hospital — intermountainhealth.org
Intermountain Health Cancer Center - LDS — intermountainhealth.org
About LDS Hospital | Salt Lake City, UT — intermountainhealth.org

LDS Hospital

Summary

Profile from official sources

At a glance