INTERMOUNTAIN HEALTH SANPETE VALLEY HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
2722109771	HC CATHETER HEMO/PERIT LONG-TERM IMPLANT LVL 10	$124,870	$93,652	—	—	35
2782649771	HC STENT COATED/COVERED IMPLANT LVL 44	$124,870	$93,652	—	—	35
2722109771	HC CATHETER HEMO/PERIT LONG-TERM IMPLANT LVL 10	$124,870	$93,652	—	—	44
2782649771	HC STENT COATED/COVERED IMPLANT LVL 44	$124,870	$93,652	—	—	44
2721649601	HC SPHENOPALATINE GANGLION BLOCK VIA SPHENOCATH THRU NOSE	$119,856	$89,892	—	—	35
2721649601	HC SPHENOPALATINE GANGLION BLOCK VIA SPHENOCATH THRU NOSE	$119,856	$89,892	—	—	44
2782649770	HC DRESSING QUIKCLOT CTL+ 3IN	$118,924	$89,193	—	—	35
278TRIG470	HC COM CON NEUTROPHIL CYTOPLASM AB SCREEN	$118,924	$89,193	—	—	35
2782649770	HC DRESSING QUIKCLOT CTL+ 3IN	$118,924	$89,193	—	—	44
278TRIG470	HC COM CON NEUTROPHIL CYTOPLASM AB SCREEN	$118,924	$89,193	—	—	44
2721040201	HC ORG ID AGGLUTINATIONS	$118,892	$89,169	—	—	35
2721649701	HC MORPH ISH SNGL PER SPEC/MAN	$118,892	$89,169	—	—	35
2721040201	HC ORG ID AGGLUTINATIONS	$118,892	$89,169	—	—	44
2721649701	HC MORPH ISH SNGL PER SPEC/MAN	$118,892	$89,169	—	—	44
275C188267	HC ONE DONOR FRESH FROZN PLASMA	$102,731	$77,048	—	—	35
275C188267	HC ONE DONOR FRESH FROZN PLASMA	$102,731	$77,048	—	—	44
278C188966	HC PLATELET AGGREGATION, EACH AGENT	$97,839	$73,379	—	—	35
278C182366	HC DRUG SCREENING TAPENTADOL	$97,839	$73,379	—	—	35
2782649766	HC DI ANKLE 2 VIEW UNILATERAL	$97,839	$73,379	—	—	35
278C188966	HC PLATELET AGGREGATION, EACH AGENT	$97,839	$73,379	—	—	44
278C182366	HC DRUG SCREENING TAPENTADOL	$97,839	$73,379	—	—	44
2782649766	HC DI ANKLE 2 VIEW UNILATERAL	$97,839	$73,379	—	—	44
2782649765	HC CLOSURE DEVICE-VASCULAR NON IMPLANT LVL 34	$93,180	$69,885	—	—	35
2782649765	HC CLOSURE DEVICE-VASCULAR NON IMPLANT LVL 34	$93,180	$69,885	—	—	44
2782669764	HC LACTATION EDUCATION; NON PHYSICIAN PROVIDER PER SESSION	$88,743	$66,557	—	—	35
2782649764	HC ANCHOR/SCREW BONE/SOFT TISSUE-TO-BONE IMPLANT LVL 25	$88,743	$66,557	—	—	35
2782669764	HC LACTATION EDUCATION; NON PHYSICIAN PROVIDER PER SESSION	$88,743	$66,557	—	—	44
2782649764	HC ANCHOR/SCREW BONE/SOFT TISSUE-TO-BONE IMPLANT LVL 25	$88,743	$66,557	—	—	44
278C188963	HC GI SUPPLY LVL 13	$84,517	$63,387	—	—	35
2782649763	HC TISSUE ISH SNGL PROBE PER SPEC	$84,517	$63,387	—	—	35
278C188963	HC GI SUPPLY LVL 13	$84,517	$63,387	—	—	44
2782649763	HC TISSUE ISH SNGL PROBE PER SPEC	$84,517	$63,387	—	—	44
278C188962	HC CONNECTIVE TISSUE NON-HUMAN LVL 15	$80,492	$60,369	—	—	35
278C187462	HC OCCULT BLD FECES 1-3 TESTS POC	$80,492	$60,369	—	—	35
2782669762	HC METANEPHRINES PLASMA	$80,492	$60,369	—	—	35
278C188962	HC CONNECTIVE TISSUE NON-HUMAN LVL 15	$80,492	$60,369	—	—	44
278C187462	HC OCCULT BLD FECES 1-3 TESTS POC	$80,492	$60,369	—	—	44
2782669762	HC METANEPHRINES PLASMA	$80,492	$60,369	—	—	44
278C182361	HC CTLSO INFANT IMMOBILIZER	$76,659	$57,494	—	—	35
2782649761	HC SOMATOMEDIN	$76,659	$57,494	—	—	35
2722109761	HC KIT CANNULA AORTIC/VENOUS BIO-MEDICUS	$76,659	$57,494	—	—	35
278C182361	HC CTLSO INFANT IMMOBILIZER	$76,659	$57,494	—	—	44
2782649761	HC SOMATOMEDIN	$76,659	$57,494	—	—	44
2722109761	HC KIT CANNULA AORTIC/VENOUS BIO-MEDICUS	$76,659	$57,494	—	—	44
2721649501	HC ANTIPSYCHOTICS NOS 1-3	$73,548	$55,161	—	—	35
2721649501	HC ANTIPSYCHOTICS NOS 1-3	$73,548	$55,161	—	—	44
2722109760	HC CULTURE, BACTERIAL, OTHER SOURCE	$73,009	$54,756	—	—	35
2722109760	HC CULTURE, BACTERIAL, OTHER SOURCE	$73,009	$54,756	—	—	44
2782649759	HC RADIATION ONCOLOGY NON IMPLANT SUPPLY LVL 36	$69,532	$52,149	—	—	35
278C182359	HC GENERAL BRONCHOSCOPY NON IMPLANT SUPPLY LVL 23	$69,532	$52,149	—	—	35

Showing top 50 of 23,212 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.