Supplies, drugs & other prices at Intermountain Health Primary Children's Hospital
Salt Lake City, UT · every code in this section with a posted price and a Medicare benchmark.
49 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Antibody treponema pallidum total & rpr ia qual (0064U) | $41.37 | $55.16 | 1.3× |
| Catheterize for urine spec (P9612) | $14.77 | $19.69 | 1.6× |
| Colon ca scrn not hi rsk ind (G0121) | $2,154.30 | $2,872.40 | 2.3× |
| Colorectal scrn; hi risk ind (G0105) | $1,714.01 | $2,285.35 | 1.8× |
| Covid-19 lab test non-cdc (U0002) | $127.94 | $170.58 | 2.5× |
| Diab manage trn per indiv (G0108) | $98.80 | $131.73 | 1.8× |
| Diab manage trn ind/group (G0109) | $34.40 | $45.86 | 2.1× |
| Direct refer hospital observ (G0379) | $728.01 | $970.68 | 1.2× |
| Drug test def 1-7 classes (G0480) | $80.36 | $107.15 | 0.7× |
| Drug test def 15-21 classes (G0482) | $153.35 | $204.47 | 0.8× |
| Drug test def 22+ classes (G0483) | $194.29 | $259.05 | 0.8× |
| Drug test def 8-14 classes (G0481) | $120.86 | $161.15 | 0.8× |
| Eia hiv-1/hiv-2 screen (G0432) | $99.08 | $132.10 | 5.1× |
| Elec stim other than wound (G0283) | $99.95 | $133.27 | 7.9× |
| Elec stim unattend for press (G0281) | $120.85 | $161.13 | 10.3× |
| Esophag muc integ w/eso egd (C9777) | $12,051.88 | $16,069.17 | 3.1× |
| Fecal microbiota prep instil (G0455) | $2,983.61 | $3,978.15 | 3.2× |
| Hbot, full body chamber, 30m (G0277) | $566.25 | $755 | 4.1× |
| Hospital outpt clinic visit (G0463) range across 3 matching MRF lines |
$255.73–$804.80 | $340.97–$1,073.07 | varies |
| Inj for sacroiliac jt anesth (G0260) | $885.55 | $1,180.73 | 1.2× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) | $31,075.45 | $41,433.93 | 1.0× |
| Neuro csf prion prtn qual (0035U) | $878.84 | $1,171.78 | 1.6× |
| Njx platelet plasma (0232T) | $240.58 | $320.77 | 0.5× |
| Oth resp proc, group (G0239) | $116.72 | $155.62 | 3.1× |
| Oth resp proc, indiv (G0238) | $55.22 | $73.63 | 1.9× |
| Pathogen test for platelets (P9100) | $426.50 | $568.67 | 7.1× |
| Perc d-e cor revasc chro sin (C9607) | $24,867.35 | $33,156.47 | 1.3× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$3,568.64 | $4,758.19 | 0.5× |
| Perq Sacral Augmt Unilat Inj (0200T) likely a partial charge, not the full procedure |
$1,444.04 | $1,925.39 | 0.2× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $12,824.14 | $17,098.86 | 1.1× |
| Place device/marker, non pro (C9728) | $1,070.70 | $1,427.60 | 0.8× |
| Prolonged iv inf, req pump (C8957) | $562.07 | $749.43 | 2.6× |
| Prostate biopsy, any mthd (G0416) | $1,769.18 | $2,358.90 | 4.9× |
| Psa screening (G0103) | $76.89 | $102.52 | 4.0× |
| Revasc intra lithotrip-ather (C9766) | $26,293.84 | $35,058.45 | 1.4× |
| Revasc intra lithotrip-stent (C9765) | $20,908.13 | $27,877.51 | 1.1× |
| Revasc intravasc lithotripsy (C9764) | $15,779.39 | $21,039.19 | 1.3× |
| Revasc lith-sten-ath tib/per (C9775) | $33,678.47 | $44,904.63 | 1.8× |
| Revasc lithotr-ather tib/per (C9774) | $23,521.64 | $31,362.19 | 1.3× |
| Revasc lithotr-stent tib/per (C9773) | $18,817.32 | $25,089.76 | 1.0× |
| Revasc lithotrip tibi/perone (C9772) | $14,201.47 | $18,935.29 | 1.2× |
| Revasc lithotrip-stent-ather (C9767) | $33,678.46 | $44,904.61 | 1.8× |
| Screen cerv/vag thin layer (G0123) | $207.50 | $276.66 | 10.2× |
| Sim ang w/prs cath rad emb (C8004) | $29,435.94 | $39,247.92 | 2.5× |
| Syphilis tst non-treponemal antibody ia qual rpr (0065U) | $23.89 | $31.85 | 1.3× |
| Tee w or w/o fol w/cont, mon (C8927) | $2,408.16 | $3,210.88 | 3.0× |
| Therapeutic ultrafiltration (0692T) | $1,547.18 | $2,062.90 | 1.0× |
| Trauma respons w/hosp criti (G0390) range across 2 matching MRF lines |
$8,050.06–$10,576.58 | $10,733.42–$14,102.11 | varies |
| Unsched dialysis esrd pt hos (G0257) | $2,571.90 | $3,429.20 | 3.7× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.