Hospital Salt Lake City-Murray, UT

Mountain West Medical Center

Listed in its price file as “Tooele Hospital Corporation”.

Mountain West Medical Center in Tooele, UT publishes cash prices for 263 common procedures listed here, from its own machine-readable price file updated Sep 17, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Utah median for 186 of 261 procedures and above it for 67. By typical cash price it ranks #6 of 16 Utah hospitals and #2 of 5 hospitals in the Salt Lake City, UT area, cheapest first. Select a procedure to compare it with other hospitals nearby.

2055 N Main St Tooele UT 84074 Collected Sep 30, 2026 Source price file Check a bill from this hospital (435) 843-3700

Acute care hospital For-profit hospital Emergency department CMS star rating 4 of 5 CCN 460014 · CMS hospital register NPI 1124090659

Scans and imaging

ProcedureCash priceList priceInsurers payvs UtahOff list
Abdominal CT scan without and with contrast CPT 74170 CT scan of abdomen before and after contrast $1,633.66 $2,722.76 $177.60–$2,504.94 60% below 40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ultrasound study of arm and leg arteries $259.23 $432.05 $106.48–$397.49 60% below 40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT scan of arm without contrast $1,848.91 $3,081.51 $105.86–$2,834.99 37% below 40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Single contrast X-ray of esophagus $502.57 $837.61 $177.60–$817.05 24% below 40%
Bone scan, whole body (nuclear medicine) CPT 78306 Nuclear medicine study of bone and/or joint whole body $1,661.89 $2,769.82 $404.78–$2,548.23 41% below 40%
Breast ultrasound, complete, one breast CPT 76641 Complete ultrasound scan of 1 breast $982.43 $1,637.38 $105.86–$1,506.39 42% above 40%
Breast ultrasound, limited (one breast or one area) CPT 76642 Limited ultrasound scan of 1 breast $982.43 $1,637.38 $88.12–$1,506.39 61% above 40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT scan of blood vessels of abdomen and pelvis with contrast $1,568.27 $2,613.79 $353.24–$2,404.69 70% below 40%
CT angiography (CTA) of the head CPT 70496 CT scan of blood vessels of head with contrast $784.45 $1,307.42 $177.60–$1,202.83 79% below 40%
CT angiography (CTA) of the neck CPT 70498 CT scan of blood vessels of neck with contrast $863.99 $1,439.99 $177.60–$1,324.79 79% below 40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT scan of blood vessels of chest with contrast $2,203.66 $3,672.76 $177.60–$3,378.94 41% below 40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT scan of blood vessels and grafts of heart with contrast $1,530.00 $2,550.00 $353.24–$2,346.00 21% above 40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT scan of heart with evaluation of blood vessel calcium $150.00 $250.00 $88.12–$1,131.00 117% above 40%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT scan of abdomen and pelvis without contrast $2,917.96 $4,863.27 $241.59–$4,474.21 53% below 40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast $3,027.25 $5,045.41 $353.24–$4,641.78 57% below 40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT scan of abdomen and pelvis before and after contrast $3,235.65 $5,392.75 $353.24–$4,961.33 59% below 40%
CT scan of the abdomen with contrast CPT 74160 CT scan of abdomen with contrast $1,528.49 $2,547.49 $177.60–$2,343.69 63% below 40%
CT scan of the abdomen without contrast CPT 74150 CT scan of abdomen without contrast $1,423.19 $2,371.98 $105.86–$2,182.22 54% below 40%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT scan of face without contrast $1,827.26 $3,045.43 $105.86–$2,801.80 11% below 40%
CT scan of the head or brain, no contrast dye CPT 70450 CT scan head or brain without contrast $1,782.72 $2,971.20 $105.86–$2,733.50 46% below 40%
CT scan of the head with contrast CPT 70460 CT scan head or brain with contrast $1,868.46 $3,114.10 $177.60–$2,864.97 46% below 40%
CT scan of the head without and with contrast CPT 70470 CT scan of head or brain before and after contrast $2,064.77 $3,441.29 $177.60–$3,165.99 50% below 40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT scan of lower spine without contrast $2,246.77 $3,744.61 $105.86–$3,445.04 31% below 40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT scan of upper spine without contrast $1,980.45 $3,300.75 $105.86–$3,036.69 40% below 40%
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast $1,498.74 $2,497.90 $177.60–$2,298.07 59% below 40%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Ultrasound of both sides of head and neck blood flow $1,482.73 $2,471.22 $230.56–$2,273.52 1% above 40%
Chest CT scan without and with contrast CPT 71270 CT scan of chest before and after contrast $1,899.48 $3,165.80 $177.60–$2,912.54 46% below 40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Complete ultrasound scan behind abdominal cavity $1,331.34 $2,218.90 $105.86–$2,041.39 9% above 40%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Ultrasound scan of pregnant uterus with detailed fetal anatomic examination, single or first fetus $676.28 $1,127.13 $241.59–$1,071.00 18% below 40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT scan of chest without contrast $1,899.48 $3,165.80 $105.86–$2,912.54 42% below 40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT scan of chest with contrast $1,784.78 $2,974.64 $177.60–$2,736.67 55% below 40%
Diagnostic mammogram, both breasts CPT 77066 Diagnostic mammography of both breasts $390.50 $650.83 $120.37–$598.76 — 40%
Diagnostic mammogram, one breast CPT 77065 Diagnostic mammography of 1 breast $339.69 $566.15 $94.06–$520.86 43% below 40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Ultrasound of leg arteries or artery grafts $617.54 $1,029.23 $230.56–$946.89 59% below 40%
Duplex ultrasound of the leg veins, both legs CPT 93970 Ultrasound study of arm or leg veins with compression and maneuvers $1,134.53 $1,890.89 $230.56–$1,739.62 19% below 40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function $3,296.53 $5,494.22 $497.49–$5,054.68 23% below 40%
Eye socket (orbit) CT scan without contrast CPT 70480 CT scan of cranial cavity without contrast $1,846.19 $3,076.98 $105.86–$2,830.82 44% below 40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nuclear medicine study of liver and bile duct system $1,259.26 $2,098.76 $404.78–$1,930.86 51% below 40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT scan of leg without contrast $2,035.66 $3,392.77 $105.86–$3,121.35 35% below 40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Limited ultrasound scan of abdomen $1,053.71 $1,756.19 $105.86–$1,615.69 2% below 40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Limited ultrasound scan of joint or other extremity structure except blood vessels $538.06 $896.76 $105.86–$1,071.00 2% below 40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Low dose CT scan of chest for lung cancer screening $137.42 $229.04 $105.86–$1,131.00 71% below 40%
MR angiography (MRA) of the head without contrast CPT 70544 MRI scan of blood vessels of head without contrast $2,629.98 $4,383.30 $241.59–$4,032.64 42% below 40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint without contrast $2,277.02 $3,795.04 $241.59–$3,491.44 51% below 40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI scan of leg joint before and after contrast $2,277.02 $3,795.04 $353.24–$3,491.44 60% below 40%
MRI of the abdomen without contrast CPT 74181 MRI scan of abdomen without contrast $2,508.31 $4,180.52 $241.59–$3,846.08 42% below 40%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI scan of abdomen before and after contrast $2,508.31 $4,180.52 $353.24–$3,846.08 56% below 40%
MRI of the brain, no contrast dye CPT 70551 MRI scan of brain without contrast $2,498.69 $4,164.49 $241.59–$3,831.33 44% below 40%
MRI of the brain, with and without contrast dye CPT 70553 MRI scan of brain before and after contrast $2,704.10 $4,506.84 $353.24–$4,146.29 54% below 40%
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal without contrast $2,897.46 $4,829.10 $241.59–$4,442.77 32% below 40%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI scan of lower spinal canal before and after contrast $3,207.24 $5,345.40 $353.24–$4,917.77 41% below 40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI scan of middle spinal canal without contrast $2,223.00 $3,705.00 $241.59–$3,408.60 48% below 40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI scan of upper spinal canal before and after contrast $3,262.83 $5,438.05 $353.24–$5,003.01 44% below 40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI scan of upper spinal canal without contrast $2,913.02 $4,855.04 $241.59–$4,466.64 37% below 40%
MRI of the pelvis without and with contrast CPT 72197 MRI scan of pelvis before and after contrast $2,498.69 $4,164.49 $353.24–$3,831.33 57% below 40%
MRI of the pelvis, no contrast dye CPT 72195 MRI scan of pelvis without contrast $1,764.11 $2,940.18 $241.59–$2,704.97 58% below 40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI scan of arm joint without contrast $2,277.02 $3,795.04 $241.59–$3,491.44 54% below 40%
Neck soft tissue CT scan with contrast CPT 70491 CT scan of soft tissue of neck with contrast $2,111.23 $3,518.71 $177.60–$3,237.21 40% below 40%
Neck soft tissue CT scan without contrast CPT 70490 CT scan of soft tissue of neck without contrast $1,716.69 $2,861.15 $105.86–$2,632.26 47% below 40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear medicine studies of heart muscle at rest and with stress and SPECT $2,637.94 $4,396.56 $799.00–$4,978.99 59% below 40%
Pelvic CT scan without contrast CPT 72192 CT scan of pelvis without contrast $1,494.77 $2,491.29 $105.86–$2,291.99 51% below 40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Limited ultrasound scan of pelvis $528.16 $880.27 $105.86–$1,071.00 18% below 40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Complete ultrasound scan of pelvis $556.40 $927.34 $105.86–$1,071.00 53% below 40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus $1,369.48 $2,282.46 $105.86–$2,099.86 18% above 40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus $707.13 $1,178.55 $105.86–$1,084.27 10% above 40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Limited ultrasound of pregnant uterus $556.40 $927.34 $105.86–$1,071.00 38% below 40%
Screening mammogram, both breasts CPT 77067 Screening mammography $365.15 $608.58 $99.47–$559.89 at median 40%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Ultrasound of heart with continuous electrocardiogram (ECG) during rest, exercise and/or drug induced stress with review and report $1,166.46 $1,944.10 $497.49–$1,788.57 77% below 40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Imaging for evaluation of swallowing function $212.09 $353.48 $177.60–$455.67 80% below 40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT scan of middle spine without contrast $1,598.65 $2,664.42 $105.86–$2,451.27 54% below 40%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina $719.38 $1,198.96 $105.86–$1,103.04 28% below 40%
Transvaginal ultrasound during pregnancy CPT 76817 Vaginal ultrasound of pregnant uterus $650.10 $1,083.50 $105.86–$1,071.00 3% above 40%
Ultrasound of the abdomen, complete CPT 76700 Complete ultrasound scan of abdomen $1,471.91 $2,453.18 $105.86–$2,256.93 at median 40%
Ultrasound of the scrotum and testicles CPT 76870 Ultrasound scan of scrotum $1,191.95 $1,986.59 $105.86–$1,827.66 5% above 40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound scan of head and neck soft tissue $1,081.96 $1,803.26 $105.86–$1,659.00 1% above 40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Single contrast X-ray of upper digestive tract $657.17 $1,095.28 $177.60–$1,007.66 34% below 40%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Ultrasound study of one arm or leg veins with compression and maneuvers $1,060.72 $1,767.87 $105.86–$1,626.44 4% below 40%

Lab tests

ProcedureCash priceList priceInsurers payvs UtahOff list
ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) level $142.14 $236.90 $38.62–$217.95 29% below 40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Liver enzyme (SGPT), level $113.18 $188.64 $5.30–$173.55 6% below 40%
AST (aspartate aminotransferase) enzyme test CPT 84450 Liver enzyme (SGOT), level $113.18 $188.64 $5.18–$173.55 6% below 40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel $254.36 $423.94 $47.63–$390.02 56% below 40%
Albumin blood test CPT 82040 Albumin (protein) level $113.18 $188.64 $4.95–$173.55 5% above 40%
Aldosterone blood test CPT 82088 Aldosterone hormone level $101.75 $169.58 $40.75–$156.01 74% below 40%
Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase (enzyme) level, alkaline $113.18 $188.64 $5.18–$173.55 14% below 40%
Allergy blood test, specific IgE, per allergen CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each $24.00 $40.00 $2.09–$36.80 58% below 40%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP) level, serum $60.02 $100.03 $16.77–$92.03 59% below 40%
Ammonia blood test CPT 82140 Ammonia level $231.31 $385.51 $14.57–$354.67 23% below 40%
Amylase blood test CPT 82150 Amylase (enzyme) level $113.18 $188.64 $6.48–$173.55 1% above 40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Measurement of antibody for rheumatoid arthritis assessment $213.78 $356.30 $12.95–$327.80 41% above 40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Screening test for autoimmune disorder $144.61 $241.02 $12.09–$221.74 13% above 40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide (heart and blood vessel protein) level $280.85 $468.08 $39.26–$430.63 4% above 40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial culture, any other source except urine, blood or stool, aerobic $161.76 $269.60 $8.62–$248.03 57% above 40%
Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) $146.90 $244.84 $8.46–$225.25 30% below 40%
Bilirubin blood test, total CPT 82247 Bilirubin level, total $113.18 $188.64 $5.02–$173.55 14% below 40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity $120.04 $200.07 $50.98–$184.06 75% below 40%
Blood culture for bacteria CPT 87040 Bacterial blood culture $211.49 $352.49 $10.32–$324.29 25% below 40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample $28.97 $48.28 $3.00–$44.42 27% below 40%
Blood glucose (sugar) test CPT 82947 Blood glucose (sugar) level $90.12 $150.20 $3.93–$138.18 14% below 40%
Blood lead test CPT 83655 Lead level $173.58 $289.30 $12.11–$266.16 69% above 40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin (reproductive hormone) analysis $142.14 $236.90 $7.52–$217.95 53% above 40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood group typing (ABO) $60.02 $100.03 $2.99–$92.03 70% below 40%
Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen level to assess kidney function, quantitative $113.18 $188.64 $3.95–$173.55 42% above 40%
C-peptide blood test CPT 84681 C-peptide (protein) level $299.32 $498.87 $20.81–$458.96 76% above 40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Measurement C-reactive protein for detection of infection or inflammation $113.18 $188.64 $5.18–$173.55 35% below 40%
C. difficile toxin gene test (stool PCR) CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique $90.70 $151.16 $37.27–$139.07 43% below 40%
CA 19-9 blood test (tumor marker) CPT 86301 Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9 $157.19 $261.98 $20.81–$241.02 8% below 40%
CA-125 blood test (ovarian cancer marker) CPT 86304 Immunologic analysis for detection of tumor antigen, quantitative; CA 125 $102.88 $171.47 $20.81–$157.75 68% below 40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen $132.00 $220.00 $51.25–$202.40 73% above 40%
Calcium blood test, total CPT 82310 Calcium level, total $113.18 $188.64 $5.16–$173.55 11% below 40%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) protein level $268.26 $447.10 $18.96–$411.33 12% below 40%
Chickenpox (varicella) immunity blood test CPT 86787 Analysis for antibody to varicella-zoster virus (chicken pox) $103.27 $172.11 $12.88–$158.34 13% below 40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique $131.66 $219.43 $35.09–$201.88 37% below 40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) $151.47 $252.45 $13.39–$232.25 10% below 40%
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count $115.21 $192.02 $7.77–$176.66 71% above 40%
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test $87.83 $146.38 $6.47–$134.67 49% below 40%
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals $151.47 $252.45 $10.56–$232.25 14% below 40%
Cortisol blood test, total CPT 82533 Cortisol (hormone) measurement, total $66.00 $110.00 $16.30–$101.20 67% below 40%
Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (cardiac enzyme) level, total $113.18 $188.64 $6.51–$173.55 1% above 40%
Creatinine blood test CPT 82565 Blood creatinine level $96.41 $160.68 $5.12–$147.83 at median 40%
Cytomegalovirus (CMV) antibody test CPT 86644 Analysis for antibody to Cytomegalovirus (CMV) $219.68 $366.13 $14.39–$336.84 3% below 40%
D-dimer blood test (blood clot marker) CPT 85379 Coagulation function measurement, D-dimer; quantitative $241.59 $402.65 $10.18–$370.44 31% above 40%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (DHEA-S) hormone level $401.26 $668.76 $22.23–$615.26 65% above 40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Testing for presence of drug, by chemistry analyzers $33.61 $56.02 $34.81–$77.68 86% below 40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) $86.69 $144.48 $7.01–$132.92 62% below 40%
Epstein-Barr virus (EBV) antibody test CPT 86665 Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid $90.12 $150.20 $18.14–$138.18 25% below 40%
Estradiol blood test CPT 82670 Measurement of total estradiol (hormone) $93.74 $156.24 $27.94–$143.74 76% below 40%
FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level $336.29 $560.48 $18.58–$515.64 70% above 40%
Fecal calprotectin (stool inflammation test) CPT 83993 Stool calprotectin (protein) level $76.40 $127.33 $19.63–$117.14 86% below 40%
Ferritin blood test (iron stores) CPT 82728 Ferritin (blood protein) level $233.60 $389.33 $13.63–$358.18 65% above 40%
Fibrinogen blood test CPT 85384 Fibrinogen (factor 1) activity measurement $196.44 $327.40 $9.72–$301.21 3% below 40%
Folate (folic acid) blood test CPT 82746 Folic acid level, serum $306.18 $510.30 $14.70–$469.48 76% above 40%
Free T3 thyroid hormone test CPT 84481 Thyroid hormone, T3 measurement, free $164.05 $273.41 $16.94–$251.54 3% below 40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (thyroid chemical), free $149.19 $248.65 $9.02–$228.76 2% below 40%
Free testosterone test CPT 84402 Testosterone (hormone) level, free $135.28 $225.47 $25.47–$207.43 7% below 40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase (liver enzyme) level $113.18 $188.64 $7.20–$173.55 26% below 40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel $459.94 $766.57 $47.21–$705.24 15% below 40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Blood glucose (sugar) level after receiving dose of glucose $113.18 $188.64 $4.75–$173.55 14% below 40%
Glucose tolerance test, 3 samples CPT 82951 Blood glucose (sugar) tolerance test, 3 specimens $173.58 $289.30 $12.87–$266.16 13% below 40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique $131.66 $219.43 $35.09–$201.88 37% below 40%
H. pylori antibody blood test CPT 86677 Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria) $180.43 $300.72 $16.85–$276.66 5% above 40%
H. pylori stool antigen test CPT 87338 Detection test by immunoassay technique for Helicobacter pylori (GI tract bacteria) in stool $77.55 $129.25 $14.38–$118.91 80% below 40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification $321.43 $535.71 $85.10–$492.85 8% below 40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 antibodies $36.00 $60.00 $14.45–$55.20 51% below 40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Detection test by nucleic acid for Human Papillomavirus (HPV), high-risk types $81.55 $135.91 $35.09–$125.04 59% below 40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C level $71.64 $119.40 $9.71–$109.85 38% below 40%
Hemoglobin blood test CPT 85018 Blood count, hemoglobin $69.36 $115.60 $2.37–$106.35 22% below 40%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody measurement $198.72 $331.20 $12.05–$304.70 1% above 40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody measurement $186.14 $310.24 $10.74–$285.42 2% above 40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen $105.18 $175.30 $10.33–$161.28 19% above 40%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody measurement $241.59 $402.65 $14.27–$370.44 6% above 40%
Hepatitis C viral load (HCV RNA) test CPT 87522 Detection test by nucleic acid for Hepatitis C virus, quantification $104.98 $174.96 $42.84–$160.96 68% below 40%
Herpes blood test, HSV-1 antibody CPT 86695 Analysis for antibody to Herpes simplex virus, type 1 $271.51 $452.51 $13.19–$416.31 56% above 40%
Herpes blood test, HSV-2 antibody CPT 86696 Analysis for antibody to Herpes simplex virus, type 2 $284.47 $474.11 $19.35–$436.18 106% above 40%
High-sensitivity CRP (hs-CRP) test CPT 86141 Measurement C-reactive protein for detection of infection or inflammation, high sensitivity $119.08 $198.46 $12.95–$182.58 46% below 40%
Homocysteine blood test CPT 83090 Homocysteine (amino acid) level $151.47 $252.45 $17.92–$232.25 36% below 40%
Insulin blood test CPT 83525 Insulin measurement, total $71.64 $119.40 $11.43–$109.85 47% below 40%
Iron blood test (serum iron) CPT 83540 Iron level $113.18 $188.64 $6.47–$173.55 7% above 40%
Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity $113.18 $188.64 $8.74–$173.55 at median 40%
Kidney function blood test panel CPT 80069 Kidney function blood test panel $146.90 $244.84 $8.68–$225.25 1% below 40%
LH (luteinizing hormone) test CPT 83002 Gonadotropin, luteinizing (reproductive hormone) level $323.71 $539.52 $18.52–$496.36 2% above 40%
Lactate (lactic acid) blood test CPT 83605 Lactic acid level $233.60 $389.33 $11.57–$358.18 13% above 40%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate dehydrogenase (enzyme) level $113.18 $188.64 $6.04–$173.55 4% above 40%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase (fat enzyme) level $52.01 $86.68 $5.97–$79.75 67% below 40%
Liver function blood test panel CPT 80076 Liver function blood test panel $121.37 $202.28 $8.17–$186.10 7% below 40%
Lyme disease antibody test CPT 86618 Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria) $283.13 $471.88 $17.03–$434.13 47% above 40%
Magnesium blood test CPT 83735 Magnesium level $113.18 $188.64 $6.70–$173.55 8% above 40%
Measles (rubeola) antibody test CPT 86765 Analysis for antibody to Rubeola (measles virus) $183.86 $306.44 $12.88–$281.92 14% above 40%
Mono test (heterophile antibody, Monospot) CPT 86308 Screening test for mononucleosis (mono) $115.46 $192.44 $5.18–$177.04 31% below 40%
Mumps immunity blood test CPT 86735 Analysis for antibody to mumps virus $202.35 $337.25 $13.05–$310.27 11% below 40%
Obstetric blood test panel CPT 80055 Obstetric blood test panel $105.34 $175.56 $47.81–$161.52 75% below 40%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free $122.51 $204.18 $18.39–$187.85 34% below 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total $122.51 $204.18 $18.39–$187.85 46% below 40%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap test, automated thin layer preparation; automated system and manual rescreening $59.07 $98.45 $26.20–$90.57 55% below 40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap test, manual screening $91.08 $151.80 $20.26–$139.66 32% below 40%
Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) level $187.29 $312.15 $41.28–$287.18 27% below 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood $157.19 $261.98 $6.01–$241.02 6% above 40%
Phosphorus (phosphate) blood test CPT 84100 Phosphate level $113.18 $188.64 $4.74–$173.55 14% below 40%
Potassium blood test CPT 84132 Blood potassium level $113.18 $188.64 $4.76–$173.55 1% above 40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Test for detecting genes associated with fetal disease, aneuploidy genomic sequence analysis panel $628.20 $1,047.00 $680.55–$7,947.25 59% below 40%
Progesterone blood test CPT 84144 Progesterone (reproductive hormone) level $59.26 $98.76 $20.60–$90.86 57% below 40%
Prolactin blood test CPT 84146 Prolactin (milk producing hormone) level $81.00 $135.00 $19.38–$124.20 60% below 40%
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time $39.25 $65.42 $2.81–$60.19 55% below 40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Testing for presence of drug, read by direct observation $292.84 $488.07 $12.60–$449.02 324% above 40%
Rapid flu test (influenza antigen) CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus $28.58 $47.64 $7.88–$43.83 32% below 40%
Renin blood test CPT 84244 Renin (kidney enzyme) level $345.44 $575.73 $21.99–$529.67 11% below 40%
Rh blood typing CPT 86901 Blood typing for Rh (D) antigen $60.02 $100.03 $2.99–$92.03 20% below 40%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor level $124.81 $208.01 $5.67–$191.37 at median 40%
Rubella antibody test (immunity check) CPT 86762 Analysis for antibody to Rubella (German measles virus) $217.39 $362.32 $14.39–$333.33 105% above 40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Red blood cell sedimentation rate, to detect inflammation, automated $24.01 $40.01 $1.08–$36.81 57% below 40%
Sodium blood test CPT 84295 Blood sodium level $113.18 $188.64 $4.81–$173.55 19% above 40%
Stool ova and parasites exam CPT 87177 Smear for parasites $73.93 $123.21 $8.90–$113.35 53% below 40%
Syphilis antibody test (Treponema pallidum) CPT 86780 Analysis for antibody, Treponema pallidum $63.00 $105.00 $13.24–$96.60 20% below 40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis detection test $107.45 $179.09 $4.27–$164.76 58% above 40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, gamma interferon $284.47 $474.11 $61.98–$436.18 17% above 40%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone (hormone) level, total $135.28 $225.47 $25.81–$207.43 30% below 40%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (autoantibody) measurement $94.69 $157.82 $14.55–$145.19 9% below 40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) $193.01 $321.68 $16.80–$295.95 3% below 40%
Total IgE blood test CPT 82785 IgE (immune system protein) level $113.18 $188.64 $16.46–$173.55 54% below 40%
Total cholesterol blood test CPT 82465 Cholesterol level $113.18 $188.64 $4.35–$173.55 8% above 40%
Total thyroxine (T4) blood test CPT 84436 Thyroxine (thyroid chemical), total $113.18 $188.64 $6.87–$173.55 8% below 40%
Total triiodothyronine (T3) blood test CPT 84480 Thyroid hormone, T3 measurement, total $164.05 $273.41 $14.18–$251.54 3% above 40%
Transferrin blood test CPT 84466 Transferrin (iron binding protein) level $233.60 $389.33 $12.76–$358.18 29% above 40%
Trichomonas test (NAAT) CPT 87661 Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique $64.39 $107.32 $35.09–$98.73 at median 40%
Triglycerides blood test CPT 84478 Triglycerides level $113.18 $188.64 $5.74–$173.55 14% below 40%
Troponin test, quantitative CPT 84484 Troponin (protein) analysis, quantitative $476.14 $793.56 $12.47–$730.08 111% above 40%
Uric acid blood test CPT 84550 Uric acid level, blood $113.18 $188.64 $4.52–$173.55 8% above 40%
Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated $63.64 $106.06 $3.17–$97.58 36% below 40%
Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test $56.78 $94.64 $2.13–$87.07 43% below 40%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test $61.36 $102.26 $3.48–$94.08 at median 40%
Urine culture for bacteria, with colony count CPT 87086 Bacterial colony count, urine $90.12 $150.20 $8.07–$138.18 12% below 40%
Urine microalbumin (albumin) test CPT 82043 Urine microalbumin (protein) level $114.51 $190.85 $5.78–$175.58 4% above 40%
Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test $115.46 $192.44 $8.61–$177.04 5% above 40%
Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (vitamin B-12) level $260.08 $433.46 $15.08–$398.78 79% above 40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D-3 level $107.45 $179.09 $29.60–$164.76 50% below 40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Dihydroxyvitamin D, 1, 25 level $119.08 $198.46 $38.50–$182.58 58% below 40%
Zinc blood test CPT 84630 Zinc level $233.60 $389.33 $11.39–$358.18 106% above 40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (reproductive hormone) level $145.75 $242.92 $15.05–$223.49 7% above 40%

Surgery and procedures

ProcedureCash priceList priceInsurers payvs UtahOff list
Cardiac catheterization with coronary angiogram one side CPT 93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist $17,445.33 $29,075.55 $2,810.41–$26,749.51 53% above 40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat $932.20 $1,553.66 $526.49–$1,429.37 52% below 40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat $2,087.17 $3,478.62 $526.49–$3,200.33 8% above 40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 External shock to heart to regulate heart beat $932.20 $1,553.66 $526.49–$1,429.37 — 40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance $1,274.65 $2,124.42 $598.81–$1,954.47 6% below 40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Insertion of tube and introduction of contrast for X-ray of uterus and fallopian tubes $781.36 $1,302.27 $50.51–$1,198.09 18% above 40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint $172.35 $287.25 $186.71–$388.50 56% below 40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint $193.93 $323.22 $210.09–$388.50 44% below 40%
Left heart catheterization, diagnostic one side CPT 93452 Insertion of tube in left heart chambers for diagnosis with review by radiologist $14,136.70 $23,561.16 $2,810.41–$21,676.27 — 40%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance $1,093.78 $1,822.96 $598.81–$1,677.12 13% below 40%
Paracentesis with imaging guidance CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance $3,439.95 $5,733.25 $761.55–$5,274.59 177% above 40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 Shock wave crushing of kidney stones $14,011.22 $23,352.04 $2,926.86–$21,483.88 at median 40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test $893.06 $1,488.43 $598.81–$1,369.36 17% above 40%
Thoracentesis with imaging guidance CPT 32555 Aspiration of fluid from chest cavity using imaging guidance $1,252.26 $2,087.10 $620.01–$1,920.13 23% above 40%

Doctor visits and therapy

ProcedureCash priceList priceInsurers payvs UtahOff list
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion of blood or blood products $540.00 $900.00 $382.90–$828.00 59% below 40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment for airway obstruction or sputum production $217.42 $362.37 $191.60–$333.38 22% below 40%
Chemotherapy IV infusion, first hour CPT 96413 Administration of chemotherapy into vein, 1 hour or less $488.67 $814.45 $288.38–$749.29 23% below 40%
Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes $4,358.17 $7,263.61 $740.02–$6,682.52 46% below 40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care, first 30-74 minutes $4,358.17 $7,263.61 $740.02–$6,682.52 — 40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing $368.97 $614.95 $55.90–$565.75 16% above 40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional $316.15 $526.92 $69.73–$872.00 at median 40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency department visit for problem that may not require health care professional $316.15 $526.92 $69.73–$872.00 — 40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making $554.00 $923.34 $127.96–$998.00 56% below 40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency department visit with straightforward medical decision making $554.00 $923.34 $127.96–$998.00 — 40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making $879.02 $1,465.04 $222.99–$1,531.00 61% below 40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency department visit with low level of medical decision making $879.02 $1,465.04 $222.99–$1,531.00 — 40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making $1,314.83 $2,191.39 $360.37–$4,459.00 65% below 40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency department visit with moderate level of medical decision making $1,314.83 $2,191.39 $360.37–$4,459.00 — 40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making $1,839.28 $3,065.46 $525.30–$2,820.22 64% below 40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency department visit with high level of medical decision making $1,839.28 $3,065.46 $525.30–$2,820.22 — 40%
Exercise stress test, tracing only, the hospital charge CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG) $1,658.32 $2,763.86 $218.63–$2,542.75 3% below 40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes $519.70 $866.16 $187.18–$796.87 21% below 40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes $831.75 $1,386.25 $187.18–$1,275.35 26% above 40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Infusion into a vein for hydration, 31-60 minutes $831.75 $1,386.25 $187.18–$1,275.35 — 40%
IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less $519.70 $866.16 $187.18–$796.87 21% below 40%
IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less $831.75 $1,386.25 $187.18–$1,275.35 26% above 40%
IV infusion of a medicine, first hour inpatient CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less $831.75 $1,386.25 $187.18–$1,275.35 — 40%
IV push of a medicine, first drug CPT 96374 Injection of drug or substance into vein $212.31 $353.85 $187.18–$325.54 61% below 40%
IV push of a medicine, first drug CPT 96374 Injection of drug or substance into vein $401.81 $669.69 $187.18–$616.11 26% below 40%
IV push of a medicine, first drug inpatient CPT 96374 Injection of drug or substance into vein $401.81 $669.69 $187.18–$616.11 — 40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle $75.13 $125.22 $59.75–$115.20 72% below 40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle $125.57 $209.29 $59.75–$192.55 53% below 40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection of drug or substance under skin or into muscle $125.57 $209.29 $59.75–$192.55 — 40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Therapy procedure for nutrition management, each 15 minutes $58.80 $98.00 $25.85–$90.16 37% below 40%
Spirometry before and after a bronchodilator CPT 94060 Test to measure expiratory airflow and volume changes before and after medication administration $1,052.58 $1,754.30 $252.31–$1,613.96 at median 40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Drawing of blood for a medical problem $119.08 $198.46 $106.48–$182.58 64% below 40%

Vaccines

ProcedureCash priceList priceInsurers payvs UtahOff list
Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza vaccine, inactivated $77.05 $128.42 $54.78–$118.15 at median 40%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella vaccine $247.43 $412.39 $268.05–$379.40 18% below 40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diphtheria, tetanus, and acellular pertussis vaccine (younger than 7 years) $49.98 $83.30 $54.15–$76.64 46% below 40%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza vaccine, trivalent, split virus, preservative-free, 0.5 mL dosage $18.00 $30.00 $19.50–$27.60 71% below 40%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine, adult dosage (3 dose schedule) $72.20 $120.33 $67.03–$110.70 57% below 40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B vaccine, pediatric or adolescent dosage (3 dose schedule) $31.73 $52.88 $27.03–$48.65 71% below 40%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza vaccine split virus, preservative free $21.83 $36.38 $23.65–$53.34 78% below 40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps, and rubella vaccine $134.29 $223.82 $145.48–$205.91 68% below 40%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal vaccine, 13-valent $215.51 $359.18 $215.15–$330.45 70% below 40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use $262.94 $438.24 $284.86–$403.18 41% below 40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal vaccine, 23-valent $235.22 $392.04 $114.24–$360.68 36% below 40%
Rabies vaccine, one dose CPT 90675 Rabies vaccine for injection into muscle $432.07 $720.12 $294.53–$662.51 62% below 40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Diphtheria and tetanus vaccine (7 years or older) $67.81 $113.02 $73.46–$103.98 63% below 40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older) $121.61 $202.68 $131.74–$186.47 65% below 40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of vaccine $42.33 $70.55 $45.86–$91.13 84% below 40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration of vaccine, each additional vaccine $34.79 $57.98 $15.36–$53.34 75% below 40%
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbMWMCTOOELEUT&type=CDMWithoutLabel&fileType=CSV