Chest X-ray, 2 views at Intermountain Health Good Samaritan Medical Center. CPT 71046.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$563list price
$80.32–$505range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $104 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $130 |
| Kaiser Perm HMO | Kaiser Out Of State | $130 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $130 |
| Allegiance | Cigna Sclhs Employees | $141 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $141 |
| Cigna | Cigna Co Public Option | $143 |
| Cigna | Cigna Connect Exchange | $143 |
| Cigna | Cigna Surefit | $143 |
| Aetna | Aetna Colorado Preferred | $145 |
| Aetna | Aetna HMO/EPO | $156 |
| Aetna | Aetna Indemnity | $156 |
| Aetna | Aetna Other | $156 |
| Aetna | Aetna POS/Qpos | $156 |
| Aetna | Aetna PPO | $156 |
| Aetna | Aetna Src | $156 |
| Geha | Geha-Asa | $156 |
| Preferred One | Preferred One | $156 |
| BCBS/Anthem | BCBS Co Federal | $224 |
| BCBS/Anthem | BCBS Co HMO | $224 |
| BCBS/Anthem | BCBS Co PPO | $224 |
| Choicecare Humana | Choicecare Humana HMO EPO | $236 |
| Choicecare Humana | Choicecare Humana PPO | $236 |
| Cigna | Cigna HMO | $322 |
| Cigna | Cigna Indemnity | $322 |
| Cigna | Cigna Local Plus | $322 |
| Cigna | Cigna Other | $322 |
| Cigna | Cigna POS/Qpos | $322 |
| Cigna | Cigna PPO | $322 |
| Cigna | Eighth Dist Elect Ben Pln | $322 |
Inpatient
—cash price (self-pay)
$563list price
$166–$563range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $166 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $237 |
| Kaiser Perm HMO | Kaiser Out Of State | $237 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $237 |
| Kaiser Self Funded | Kaiser Self Funded | $237 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $244 |
| Private Hlthcare Sys | Phcs Other | $422 |
| Private Hlthcare Sys | Phcs PPO | $422 |
| BCBS/Anthem | BCBS Co Indemnity | $474 |
| Multiplan Inc | Multiplan Inc Other | $479 |
| Multiplan Inc | Multiplan Inc PPO | $479 |
| Aetna | Aetna Nap | $505 |
| Cigna | Cigna HMO | $563 |
| Cigna | Cigna Indemnity | $563 |
| Cigna | Cigna Local Plus | $563 |
| Cigna | Cigna Other | $563 |
| Cigna | Cigna POS/Qpos | $563 |
| Cigna | Cigna PPO | $563 |
| Cigna | Eighth Dist Elect Ben Pln | $563 |
| Cigna | Health-Partners | $563 |
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All common services at Intermountain Health Good Samaritan Medical Center