St Mary Medical Center
St Mary Medical Center in Langhorne, PA publishes cash prices for 56 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
1201 Langhorne-Newtown Rd, Langhorne, PA 19047 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $2,891.20 | $4,448.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $3,227.22 | — | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $2,891.20 | $4,448.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,682.85 | $2,589.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,682.85 | — | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,682.85 | $2,589.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,520.35 | $2,339.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,520.35 | $2,339.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $523.25 | $805.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $523.25 | $805.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $424.45 | $653.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $424.45 | $653.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $915.85 | — | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $424.45 | $653.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $424.45 | $653.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,214.90 | $4,946.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $2,143.05 | $3,297.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $2,143.05 | $3,297.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,214.90 | $4,946.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $2,143.05 | $3,297.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $2,143.05 | $3,297.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $4,152.85 | $6,389.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $2,768.35 | $4,259.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $2,768.35 | $4,259.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $4,152.85 | $6,389.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $2,768.35 | $4,259.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $2,768.35 | $4,259.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $2,143.05 | $3,297.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $2,143.05 | $3,297.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $2,768.35 | $4,259.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $2,768.35 | $4,259.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,143.05 | $3,297.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,143.05 | $3,297.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $328.54 | — | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $482.95 | $743.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $300.00 | $300.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $482.95 | $743.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $523.90 | $806.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $523.90 | $806.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $523.90 | $806.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $523.90 | $806.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $815.10 | $1,254.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $815.10 | $1,254.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $568.75 | $875.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $568.75 | — | — |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $568.75 | $875.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $390.65 | $601.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $390.65 | — | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $390.65 | $601.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $120.25 | $185.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $120.25 | $185.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest 92145 Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest 37849 Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest 37849 Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest 92145 Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest Lipid Panel | $139.75 | $215.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $139.75 | $215.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Labcorp Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC POCT Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $603.20 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Labcorp Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC POCT Cbc Automated/Differential Wbc Automated | $72.15 | $111.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated Intrauterine | $62.40 | $96.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $62.40 | $96.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $727.35 | — | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $62.40 | $96.00 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated Intrauterine | $62.40 | $96.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $168.35 | $259.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $707.85 | — | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $168.35 | $259.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $37.05 | $57.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $37.05 | $57.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $144.30 | $222.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $144.30 | $222.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Quest 31348 Prostate Specific Antigen Free | $68.25 | $105.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specific Antigen Free | $100.10 | $154.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Quest 31348 Prostate Specific Antigen Free | $68.25 | $105.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specific Antigen Free | $100.10 | $154.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Quest 31348 Prostate Specific Antigen Total | $68.25 | $105.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $110.50 | $170.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Quest Prostate Specific Antigen Total | $213.85 | $329.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Quest 31348 Prostate Specific Antigen Total | $68.25 | $105.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $110.50 | $170.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Quest Prostate Specific Antigen Total | $213.85 | $329.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 19872 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 90271 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 19790 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 7079 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 90271 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 19790 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 7079 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 19872 Thromboplastin Time Partial (Ptt) | $42.25 | $65.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $26.00 | $40.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $26.00 | $40.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $26.00 | $40.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $26.00 | $40.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $137.15 | $211.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest Thyroid Stimulating Hormone | $137.15 | $211.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest Thyroid Stimulating Hormone | $137.15 | $211.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $137.15 | $211.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $48.10 | $74.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Quest Urinalysis With Microscopy Automated | $48.10 | $74.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $256.10 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Quest Urinalysis With Microscopy Automated | $48.10 | $74.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $48.10 | $74.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $17.55 | $27.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $17.55 | $27.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $137.80 | — | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $17.55 | $27.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $17.55 | $27.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $9.75 | $15.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $9.75 | $15.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 PR Routine Obstetric Care Incl Antepartum Care/C-Section & Postpartum Care | $5,860.00 | $5,860.00 | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR Routine Obstetric Care Incl Antepartum Care/C-Section & Postpartum Care | $5,715.00 | $5,715.00 | — |
| Colonoscopy with polyp removal CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $551.00 | $551.00 | — |
| Colonoscopy with polyp removal CPT 45385 HC Colon Flex W/Rem Tumor(S)/Polyp(S)/Other Lesion(S) by Snare Tech (Restricted Method II CAH) | $4,153.01 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $660.00 | $660.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $560.00 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $4,180.57 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $560.00 | $560.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $475.00 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $2,810.37 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $475.00 | $475.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,451.00 | $1,451.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 HC Cholecystectomy W/Laparoscopy (Restricted Method II CAH) | $27,105.98 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,460.00 | $1,460.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,157.00 | $1,157.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC Repr Hernia Ing Init >=5yr Bl (Restricted Method II CAH) | $28,756.52 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,155.00 | $1,155.00 | — |
| Knee arthroscopy with meniscus trim CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $1,220.00 | $1,220.00 | — |
| Knee arthroscopy with meniscus trim one side CPT 29881 HC Arthro Knee W/Mnsc Med or Lat Incl/Chndrplsty Same/Sep Compart Lt (Rest Method II CAH) | $14,766.23 | — | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $1,215.00 | $1,215.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $6,454.50 | $9,930.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $6,454.50 | $9,930.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $213.00 | $213.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,634.75 | $2,515.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,335.03 | — | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $240.00 | $240.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,634.75 | $2,515.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $255.00 | — | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Bl | $3,131.70 | $4,818.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Rt | $2,087.80 | $3,212.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Lt | $2,087.80 | $3,212.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $255.00 | $255.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Bl | $3,131.70 | $4,818.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Rt | $2,087.80 | $3,212.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Lt | $2,087.80 | $3,212.00 | 35% |
| Prostate biopsy CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $325.00 | — | — |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $12,005.31 | — | — |
| Prostate biopsy inpatient CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $325.00 | $325.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $44,962.60 | $2,557.00 | -1658% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $3,965.00 | $3,965.00 | — |
| Removal of a breast lump, open surgery CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $930.00 | $930.00 | — |
| Removal of a breast lump, open surgery one side CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Lt | $12,209.53 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $920.00 | $920.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 PR Arthroscopy Shoulder Decompr Subacromial Space W/Part Acromioplasty | $370.00 | $370.00 | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 HC Arth Shld Srg Decompr Subacrml Sp W/Prt Acrmplsty W/Crccrml Sep Proc Lt(Rest Method II CAH) | $29,252.79 | — | — |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 PR Arthroscopy Shoulder Decompr Subacromial Space W/Part Acromioplasty | $890.00 | $890.00 | — |
| Total hip replacement CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $2,825.00 | $2,825.00 | — |
| Total hip replacement one side CPT 27130 HC Arthoplasty Acetabular & Proximal Femoral Prosthetic Repl Rt (Restricted Method II CAH) | $54,172.66 | — | — |
| Total hip replacement inpatient CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $3,030.00 | $3,030.00 | — |
| Total knee replacement CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $2,821.00 | $2,821.00 | — |
| Total knee replacement one side CPT 27447 HC Arthro Knee/Condyle/Plateau Med/Lat W/or W/O Patella Resurf (Tka) Lt(Rest Method II CAH) | $38,707.92 | — | — |
| Total knee replacement inpatient CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $3,030.00 | $3,030.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $4,619.80 | — | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $3,492.64 | $267.00 | -1208% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $285.00 | $285.00 | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 PR Routine OB Care Incl Antepartum Care Vag Del & Pp Care After Prev C/S | $5,936.96 | — | — |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 PR Routine OB Care Incl Antepartum Care Vag Del & Pp Care After Prev C/S | $5,400.00 | $5,400.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR Routine Obstetric Care Incl Antepartum Care Vaginal Delivery and Pp Care | $5,277.00 | $5,277.00 | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR Routine Obstetric Care Incl Antepartum Care Vaginal Delivery and Pp Care | $5,130.00 | $5,130.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $240.00 | $240.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $240.00 | $240.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $240.00 | $240.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $240.00 | $240.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $285.00 | $285.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $370.00 | $370.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $388.00 | $388.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $390.00 | $390.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $126.75 | $195.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $126.75 | $195.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $1,275.95 | — | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $126.75 | $195.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $126.75 | $195.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $199.00 | $199.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $199.00 | $199.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $241.00 | $241.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $241.00 | $241.00 | — |
Source file: https://hpt.trinity-health.org/231913910_st-mary-medical-center_standardcharges.zip