Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC CT THORAX DX W/O CONTRAST
City, UT
See all hospitals reporting CPT 71250 →Price type
IHC Health Services Inc., DBA Intermountain Primary Children's Hospital’s median price of $769 is 138% above the median hospital's median price ($323), higher than 70% of the 2,634 hospitals reporting CPT 71250. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 55 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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Filter by billing class
| # | ||||
|---|---|---|---|---|
| 1 | Molina medicaid facility · case rate · outpatient | $60.80 | $60.80 | $60.80 – $60.80 |
| 2 | Molina medicare advantage facility · case rate · outpatient | $65.67 | $65.67 | $65.67 – $65.67 |
| 3 | Molina medicare choice care hmo facility · case rate · outpatient | $65.67 | $65.67 | $65.67 – $65.67 |
| 4 | Molina medicare complete care hmo snp facility · case rate · outpatient | $65.67 | $65.67 | $65.67 – $65.67 |
| 5 | Molina medicaid professional · fee schedule · outpatient | $66.08 | $66.08 | $50.59 – $81.57 |
| 6 | Molina medicare advantage professional · fee schedule · outpatient | $66.08 | $66.08 | $50.59 – $81.57 |
| 7 | Molina medicare choice care hmo professional · fee schedule · outpatient | $66.08 | $66.08 | $50.59 – $81.57 |
| 8 | Molina medicare complete care hmo snp professional · fee schedule · outpatient | $66.08 | $66.08 | $50.59 – $81.57 |
| 9 | UnitedHealthcare medicare advantage professional · fee schedule · outpatient | $66.08 | $66.08 | $50.59 – $81.57 |
| 10 | Tricare tricare facility · case rate · outpatient | $101.95 | $101.95 | $101.95 – $101.95 |
| 11 | UnitedHealthcare medicare advantage facility · case rate · outpatient | $101.95 | $101.95 | $101.95 – $101.95 |
| 12 | UnitedHealthcare medicare advantage facility · percent of total billed charges · inpatientfrom % of charges | $444.31 | $444.31 | $444.31 – $444.31 |
| 13 | Molina medicare advantage facility · percent of total billed charges · inpatientfrom % of charges | $650.21 | $650.21 | $650.21 – $650.21 |
| 14 | Molina medicare choice care hmo facility · percent of total billed charges · inpatientfrom % of charges | $650.21 | $650.21 | $650.21 – $650.21 |
| 15 | Molina medicare complete care hmo snp facility · percent of total billed charges · inpatientfrom % of charges | $650.21 | $650.21 | $650.21 – $650.21 |
| 16 | Aetna connected facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 17 | Aetna extended facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 18 | Aetna standard facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 19 | Cigna hmo facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 20 | Cigna open access flex facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 21 | Cigna ppo/epo facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 22 | Cigna utah connect/local plus facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 23 | Humana commercial facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 24 | Molina chip facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
| 25 | Molina marketplace facility · percent of total billed charges · inpatientfrom % of charges | $769.42 | $769.42 | $769.42 – $769.42 |
Last updated: Aug 5, 2026
See CT scan of chest without contrast pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.