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In order to enable you to have more information for educated health care decisions, Central Utah Clinic has provided the following cost information. It does not represent our billed charges which are set based on insurance contract models and rates but actual “off the street” rates.

While insurance company contracts determine the actual rate of payment for services for their enrollees, and those rates vary by plan and company, the rates below reflect what an individual without insurance would pay with our 30% prompt pay discount. Without treating you it’s difficult to know which level of service may apply to an office visit. Also, the average patient experience results in some additional testing or services that could also be a part of your overall fees. We’re happy to discuss with you the specifics of your services to better enable you to decide the best option for services. In doing so we’re confident you won’t find a higher quality or more cost effective service.

Prices reflected are as they are today, and are updated periodically.

Click on a category to view pricing.

Cardiovascular

Cardiography
Cardiovascular stress test $35.70
Cardiovascular stress test $23.80
Cardiovascular stress test $133.70
ECG monitor/report 24 hrs $153.30
ECG monitor/review 24 hrs $39.90
Electrocardiogram complete $28.70
Icd device interrogate $100.80
Pm device eval in person $58.80
Pm device progr eval dual $92.40
Echocardiography
Tte w/doppler complete $341.60
Injection
Inject for coronary x-rays $32.90
Injection for aortography $20.30
Injection for heart x-rays $23.10
Stent
Insert intracoronary stent $1215.20

Chemotherapy

Chemotherapy Admin
Chemo iv infusion 1 hr $244.30
Chemo iv infusion addl hr $53.20
Chemo iv push addl drug $105.00
Chemo hormon antineopl sq/im $61.60
Chemo iv infus each addl seq $120.40
Chemo prolong infuse w/pump $266.70
Irrig drug delivery device $42.70
Infusion
Ther/diag concurrent inf $33.60
Ther/proph/diag inj iv push $91.70
Ther/proph/diag inj sc/im $38.50
Ther/proph/diag iv inf init $116.20
Ther/proph/diag iv inf addon $36.40
Tx/pro/dx inj new drug addon $38.50
Tx/proph/dg addl seq iv inf $56.70
Photodynamic Therapy
Photodynamic tx skin $203.00

Consultations

Inpatient
Inpatient consultation $181.30
Office
Office consultation $133.70
Office consultation $242.90
Office consultation $198.80
Office consultation $98.00

Dialysis

Dialysis
Hemodialysis one evaluation $85.40

Durable Medical Equipment (DME)

Orthotics
Afo ankle gauntlet $60.90
Cast sup shrt leg fiberglass $130.90
Cast sup sht arm adult fbrgl $63.70
Ko elas w/ condyle pads & jo $105.00
LO sag stays/panels pre-fab $57.40
Non-pneum walk boot prefab $149.10
Wrist cock-up non-molded $58.10

Hospital

Critical Care
Critical care first hour $281.40
Hospital Observation
Observation care $164.50
Observation care discharge $75.60
Inpatient Care
Hospital discharge day $75.60
Hospital discharge day $111.30
Initial hospital care $146.30
Initial hospital care $214.90
Subsequent hospital care $110.60
Subsequent hospital care $77.00
Subsequent hospital care $42.00

Imaging

Bone/Joint Studies
Dxa bone density axial $107.80
Breast,Mammography
Comp screen mammogram add-on $20.30
Computer dx mammogram add-on $20.30
Computed Tomography (CT)
Ct abdomen w/dye $564.90
Ct abdomen w/o & w/dye $741.30
Ct abdomen w/o dye $424.20
Ct angiography chest $866.60
Ct angiography head $1096.20
Ct angiography neck $1097.60
Ct maxillofacial w/o dye $441.70
Ct pelvis w/dye $500.50
Ct pelvis w/o & w/dye $637.70
Ct pelvis w/o dye $417.90
Ct thorax w/dye $529.20
Ct upper extremity w/o dye $422.80
Magnetic Resonance Imaging (MRI)
Card mri vel flw map add-on $159.60
Card mri w/stress img & dye $1294.30
Cardiac mri for morph w/dye $1052.80
Mri angio chest w or w/o dye $1013.60
Mri brain w/o & w/dye $1262.10
Mri jnt of lwr extre w/o dye $838.60
Mri joint upr extrem w/dye $907.20
Mri joint upr extrem w/o dye $823.20
Mri lumbar spine w/o & w/dye $1245.30
Mri lumbar spine w/o dye $800.10
Mri neck spine w/o dye $796.60
Nuclear Medicine
Ht muscle image spect mult $663.60
Radiologic Guidance
Fluoroguide for spine inject $106.40
Needle localization by xray $123.20
Tc99m medronate $21.70
Tc99m sestamibi $116.20
TL201 thallium $32.90
Radiological Guidance
Gad-base MR contrast NOS 1ml $7.00
Ultrasound
Echo exam of abdomen $176.40
Echo guide for biopsy $317.10
Ob us detailed sngl fetus $334.60
Ob us follow-up per fetus $193.90
Ob us limited fetus(s) $153.30
Ob us < 14 wks single fetus $221.20
Transvaginal us non-ob $205.10
Us exam abdom complete $233.10
Us exam pelvic complete $206.50
Us exam pelvic limited $168.70
Us exam abdo back wall comp $221.90
Us exam of head and neck $191.10
X-Ray
Chest x-ray $53.20
X-ray exam knee 4 or more $70.00
X-ray exam of abdomen $43.40
X-ray exam of ankle $53.20
X-ray exam of collar bone $48.30
X-ray exam of elbow $46.20
X-ray exam of finger(s) $52.50
X-ray exam of foot $52.50
X-ray exam of foot $44.80
X-ray exam of forearm $46.20
X-ray exam of hand $45.50
X-ray exam of hand $53.20
X-ray exam of hip $44.10
X-ray exam of hip $63.00
X-ray exam of humerus $49.70
X-ray exam of knee 1 or 2 $50.40
X-ray exam of knee 3 $59.50
X-ray exam of knees $57.40
X-ray exam of lower leg $46.20
X-ray exam of lower spine $66.50
X-ray exam of neck spine $63.70
X-ray exam of pelvis $45.50
X-ray exam of shoulder $51.10
X-ray exam of thigh $48.30
X-ray exam of toe(s) $49.00
X-ray exam of wrist $51.10
X-ray exam of wrist $59.50

Immunizations

Administration for Vaccines/Toxoids
Immune admin 1 inj < 8 yrs $23.80
Immune admin addl inj < 8 y $14.00
Immune admin H1N1 im/nasal $16.10
Immunization admin $15.40
Influenza A H1N1 admin w cou $16.10
Vaccines, Toxoids
Dtap-hep b-ipv vaccine im $85.40
Flu vaccine 3 yrs & > im $9.80
Hib vaccine hboc im $34.30
Influenza A H1N1 vaccine $10.50
Pneumococcal vacc 7 val im $89.60

Lab

Blood Draw
Draw blood off venous device $34.30
Routine venipuncture $4.20
Chemistry
Alanine amino (ALT) (SGPT) $8.40
Assay bld/serum cholesterol $7.70
Assay glucose blood quant $7.00
Assay triiodothyronine (t3) $9.10
Assay of amylase $11.20
Assay of blood lipoprotein $16.10
Assay of blood/uric acid $7.70
Assay of calcium $9.10
Assay of ck (cpk) $11.20
Assay of creatinine $8.40
Assay of ferritin $23.10
Assay of free thyroxine $14.70
Assay of insulin $19.60
Assay of iron $11.20
Assay of lipase $11.90
Assay of lipoprotein $14.00
Assay of magnesium $11.20
Assay of parathormone $70.00
Assay of phosphorus $8.40
Assay of prolactin $32.90
Assay of protein urine $6.30
Assay of psa total $31.50
Assay of serum potassium $7.70
Assay of triglycerides $9.80
Assay of urine creatinine $7.00
Assay test for blood fecal $20.30
Assay thyroid stim hormone $28.70
Blood folic acid serum $25.20
Carcinoembryonic antigen $32.20
Chorionic gonadotropin test $9.10
Glucose tolerance test (GTT) $14.70
Glycosylated hemoglobin test $16.80
Gonadotropin (FSH) $31.50
Gonadotropin (LH) $30.10
Iron binding test $14.70
Lactate (LD) (LDH) enzyme $9.80
Microalbumin quantitative $9.80
Natriuretic peptide $58.10
Transferase (AST) (SGOT) $9.10
Vitamin B-12 $25.90
Hematology and Coagulation Testing
Automated reticulocyte count $5.60
Complete cbc w/auto diff wbc $9.10
Hematocrit $4.20
Hemoglobin $4.20
Prothrombin time $7.00
Rbc sed rate nonautomated $6.30
Thromboplastin time partial $9.80
Immunology
C-reactive protein $9.10
Immunoassay tumor ca 125 $35.70
Immunoassay tumor qual $33.60
Microbiology
Strep a assay w/optic $20.30
Organ or Disease Oriented Panels
Comprehen metabolic panel $18.20
General health panel $56.70
Hepatic function panel $14.00
Lipid panel $23.10
Metabolic panel total ca $14.70
Renal function panel $14.70
Special Services/Reports
Specimen handling $12.60
Surgical Pathology
Path consult intraop 1 bloc $133.70
Tissue exam by pathologist $113.40
Urinalysis
Urinalysis auto w/o scope $4.20
Urinalysis auto w/scope $5.60
Urinalysis volume measure $4.90
Urinalysis nonauto w/o scope $4.20
Urine pregnancy test $10.50

Maternity Care and Delivery

Antepartem Services
Fetal non-stress test $59.50
Obstetric Care
Obstetrical care $2352.00

Neurology/Neuromuscular

Electromyography
Motor nerve conduction test $100.10
Motor nerve conduction test $85.40
Muscle test 2 limbs $197.40
Muscle test nonparaspinal $89.60
Muscle test one limb $133.00
Sense nerve conduction test $74.90
Reflex Test
H-reflex test $86.10

Nursing Facility

Nursing Care
Nursing fac care subseq $95.20
Nursing fac care subseq $71.40

Office Visit

Established Patient Visit
Office/outpatient visit Level 1 $20.30
Office/outpatient visit Level 2 $42.70
Office/outpatient visit Level 3 $72.80
Office/outpatient visit Level 4 $108.50
Office/outpatient visit Level 5 $147.00
New Patient Visit
Office/outpatient visit Level 4 $169.40
Office/outpatient visit Level 5 $211.40
Office/outpatient visit Level 1 $42.70
Office/outpatient visit Level 2 $74.90
Office/outpatient visit Level 3 $108.50
Preventive Medicine
Prev visit est age 18-39 $100.10
Prev visit est age 40-64 $109.20
Prev visit new age 18-39 $114.80

Ophthalmology

Ophthalmology
Eye exam established pat $116.90
Ophth dx imaging post seg $67.20

Otorhinolaryngologic Service

Hearing Test
Comprehensive hearing test $59.50

Physical Therapy

Physical Medicine and Rehabilitation
Aquatic therapy/exercises $41.30
Electrical stimulation $18.90
Manual therapy $30.10
Massage therapy $25.90
Physical therapy treatment $15.40
Pt evaluation $77.70
Therapeutic exercises $32.20
Ultrasound therapy $13.30

Preventive Medicine

Preventive Medicine
Per pm reeval est pat inf $81.20
Prev visit est age 1-4 $90.30

Pulmonary

Pulmonary
Measure blood oxygen level $31.50

Radiation Oncology

Radiation
Radiation physics consult $106.40
Radiation treatment aid(s) $268.10
Radiation treatment delivery $389.20
Radiation treatment delivery $437.50
Radiation tx delivery imrt $864.50
Radiation tx management x5 $370.30
Radiology port film(s) $25.90
Set radiation therapy field $881.30
Set radiation therapy field $313.60
Stereoscopic x-ray guidance $187.60

Sleep

Sleep Study
Polysomnography w/cpap $1184.40

Surgery - Auditory

Remove Ear Wax
Remove impacted ear wax $72.80

Surgery - Digestive

Colonoscopy
Colonoscopy and biopsy $569.80
Diagnostic colonoscopy $476.00
Lesion removal colonoscopy $644.00
Endoscopy
Esoph endoscopy dilation $224.70
Upper GI endoscopy biopsy $413.70
Uppr gi endoscopy diagnosis $355.60

Surgery - Eye

Cataracts
Cataract surg w/iol 1 stage $1108.10

Surgery - Female

IUD
Insert intrauterine device $93.10
Remove intrauterine device $120.40

Surgery - Integumentary(skin)

Destruction Skin Lesions
Destroy premlg lesions 15+ $177.10
Destruct b9 lesion 1-14 $108.50
Destruct premalg les 2-14 $9.10
Destruct premalg lesion $81.20
Epidermal Shaving
Shave skin lesion 0.6 to 1.0 cm $94.50
Shave skin lesion <0.5 cm $69.30
Mohs Micrographic Surgery
Mohs 1 stage h/n/hf/g $687.40
Mohs addl stage $408.80
Skin Biopsy
Biopsy skin add-on $34.30
Biopsy skin lesion $103.60
Tissue rearrangement
Skin tissue rearrangement $988.40
Skin tissue rearrangement $1060.50
Skin tissue rearrangement $1130.50

Surgery - Musculoskeletal

Arthroscopy
Arthroscop rotator cuff repr $1359.40
Knee arthroscopy/surgery $806.40
Knee arthroscopy/surgery $1250.20
Knee arthroscopy/surgery $774.90
Knee arthroscopy/surgery $862.40
Shoulder arthroscopy/surgery $834.40
Shoulder arthroscopy/surgery $843.50
Casts
Application of forearm cast $105.70
Incision
Incise finger tendon sheath $651.70
Introduction or Removal
Drain/inject joint/bursa $74.20
Drain/inject joint/bursa $98.70
Drain/inject joint/bursa $67.90
Inj tendon origin/insertion $75.60
Inj tendon sheath/ligament $72.80
Inj trigger point 1/2 muscl $67.20
Injection for shoulder x-ray $178.50
Removal of support implant $760.90
Repair, Revision, and/or Reconstruction
Total knee arthroplasty $2019.50
Splints
Apply forearm splint $82.60

Surgery - Nevous System

Carpal Tunnel
Carpal tunnel surgery $595.70
Injection
Inj foramen epidural l/s $366.10
Inject spine l/s (cd) $244.30

Surgery - Respiratory

Endoscopy
Nasal endoscopy dx $257.60

Surgery - Urinary

Cytoscopy
Cystoscopy $272.30
Urodynamics
Electro-uroflowmetry first $110.60
Us urine capacity measure $23.80

Vascular Study

Study
Extracranial study $333.20
Extremity study $341.60
Extremity study $225.40