Mount Carmel Grove City
Mount Carmel Grove City in Grove City, OH publishes cash prices for 62 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.
5300 North Meadows Drive, Grove City, OH 43123 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 | $2,080.00 | $3,200.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $2,080.00 | $3,200.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $978.25 | — | — |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $978.25 | $1,505.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $978.25 | $1,505.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,119.30 | $1,722.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,195.35 | — | — |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,119.30 | $1,722.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $276.90 | $426.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $276.90 | $426.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $220.35 | $339.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $220.35 | $339.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $220.35 | $339.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $220.35 | $339.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $1,851.85 | $2,849.00 | 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 | $1,234.35 | $1,899.00 | 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 | $1,234.35 | $1,899.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $1,851.85 | $2,849.00 | 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 | $1,234.35 | $1,899.00 | 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 | $1,234.35 | $1,899.00 | 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 | $3,587.35 | $5,519.00 | 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 | $2,391.35 | $3,679.00 | 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 | $2,391.35 | $3,679.00 | 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 | $3,587.35 | $5,519.00 | 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 | $2,391.35 | $3,679.00 | 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 | $2,391.35 | $3,679.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $1,344.20 | $2,068.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $1,344.20 | $2,068.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $2,022.15 | $3,111.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $2,022.15 | $3,111.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $1,236.30 | $1,902.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $1,236.30 | $1,902.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $328.31 | — | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $474.50 | $730.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $296.00 | $296.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $474.50 | $730.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $79.30 | $122.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $135.85 | — | — |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $79.30 | $122.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $79.30 | $122.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $79.30 | $122.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $2,108.60 | $3,244.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $2,108.60 | $3,244.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $536.25 | $825.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $536.25 | $825.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $577.85 | $889.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $577.85 | $889.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $377.00 | $580.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $377.00 | $580.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $65.65 | $101.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC POCT Basic Metabolic Panel (Calcium Total) | $65.65 | $101.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $1,537.25 | — | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC POCT Basic Metabolic Panel (Calcium Total) | $65.65 | $101.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $65.65 | $101.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $53.95 | $83.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $53.95 | $83.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC POCT Cbc Automated/Differential Wbc Automated | $31.20 | $48.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $31.20 | $48.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $615.55 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $31.20 | $48.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC POCT Cbc Automated/Differential Wbc Automated | $31.20 | $48.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $48.10 | $74.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $2,545.17 | — | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $48.10 | $74.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $61.75 | $95.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $61.75 | $95.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $41.60 | $64.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $41.60 | $64.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $33.15 | $51.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $33.15 | $51.00 | 35% |
| Obstetric blood test panel CPT 80055 HC Obstetric Panel | $184.60 | $284.00 | 35% |
| Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel | $184.60 | $284.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specific Antigen Free | $80.60 | $124.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specific Antigen Free | $80.60 | $124.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde Prostate Specific Antigen Total | $76.70 | $118.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $76.70 | $118.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $76.70 | $118.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde Prostate Specific Antigen Total | $76.70 | $118.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $76.70 | $118.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $76.70 | $118.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3500044 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3514930 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3514930 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3500044 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $40.95 | $63.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Warde 3514930 Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Warde 3500044 Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Warde 3500044 Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Warde 3514930 Prothrombin Time | $31.20 | $48.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $31.20 | $48.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $66.95 | $103.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $66.95 | $103.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $444.60 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $13.00 | $20.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis With Microscopy Nonautomated | $15.60 | $24.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis With Microscopy Nonautomated | $15.60 | $24.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $13.65 | $21.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $13.65 | $21.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $317.20 | — | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC POCT Urinalysis Without Microscopy Automated | $13.65 | $21.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $13.65 | $21.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 PR Urinalysis Without Microscopy Non-Automated | $8.00 | $8.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $14.30 | $22.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PR Urinalysis Without Microscopy Non-Automated | $7.00 | $7.00 | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $14.30 | $22.00 | 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 | $6,187.06 | — | — |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 PR Routine Obstetric Care Incl Antepartum Care/C-Section & Postpartum Care | $6,017.00 | $6,017.00 | — |
| Colonoscopy with polyp removal CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $984.00 | — | — |
| 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) | $4,576.16 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $635.00 | $635.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $692.63 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $4,922.58 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $546.00 | $546.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $570.56 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $3,180.87 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $457.00 | $457.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,876.04 | — | — |
| Gallbladder removal, laparoscopic CPT 47562 HC Cholecystectomy W/Laparoscopy (Restricted Method II CAH) | $40,134.42 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,513.00 | $1,513.00 | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,383.42 | — | — |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 HC Repr Hernia Ing Init >=5yr Bl (Restricted Method II CAH) | $21,924.49 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,196.00 | $1,196.00 | — |
| 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) | $28,560.89 | — | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $4,328.35 | $6,659.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $4,328.35 | $6,659.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $1,322.00 | — | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,036.45 | $3,133.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,311.85 | — | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $218.00 | $218.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,036.45 | $3,133.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,106.95 | $1,703.00 | 35% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,106.95 | $1,703.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $1,082.00 | — | — |
| 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 | $3,191.50 | $4,910.00 | 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 | $2,127.45 | $3,273.00 | 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 | $2,127.45 | $3,273.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $314.00 | $314.00 | — |
| 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 | $3,191.50 | $4,910.00 | 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 | $2,127.45 | $3,273.00 | 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 | $2,127.45 | $3,273.00 | 35% |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $2,394.60 | $3,684.00 | 35% |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $22,299.39 | — | — |
| Prostate biopsy inpatient CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $2,394.60 | $3,684.00 | 35% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $88,763.04 | — | — |
| Removal of a breast lump, open surgery CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,470.27 | — | — |
| Removal of a breast lump, open surgery CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Bl | $4,152.85 | $6,389.00 | 35% |
| Removal of a breast lump, open surgery one side CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Rt | $2,768.35 | $4,259.00 | 35% |
| 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 | $2,768.35 | $4,259.00 | 35% |
| 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 | $16,490.36 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $944.00 | $944.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Bl | $4,152.85 | $6,389.00 | 35% |
| Removal of a breast lump, open surgery inpatient one side CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Lt | $2,768.35 | $4,259.00 | 35% |
| Removal of a breast lump, open surgery inpatient one side CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Rt | $2,768.35 | $4,259.00 | 35% |
| 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) | $39,342.66 | — | — |
| Total hip replacement one side CPT 27130 HC Arthoplasty Acetabular & Proximal Femoral Prosthetic Repl Rt (Restricted Method II CAH) | $49,903.91 | — | — |
| 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) | $48,323.00 | — | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $445.68 | — | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $3,778.71 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $360.00 | $360.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $2,517.84 | — | — |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $303.00 | $303.00 | — |
| 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 | $5,924.67 | — | — |
| 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 | $5,700.00 | $5,700.00 | — |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 PR Routine Obstetric Care Incl Antepartum Care Vaginal Delivery and Pp Care | $5,593.08 | — | — |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 PR Routine Obstetric Care Incl Antepartum Care Vaginal Delivery and Pp Care | $5,436.00 | $5,436.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR Ecg 12 Lead Interpretation & Report | $52.00 | $52.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR Ecg 12 Lead Interpretation & Report | $32.00 | $32.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $248.00 | $248.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $248.00 | $248.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $248.00 | $248.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $248.00 | $248.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $370.00 | $370.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $370.00 | $370.00 | — |
| 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 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 | $410.00 | $410.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $410.00 | $410.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $410.00 | $410.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $410.00 | $410.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $85.15 | $131.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $85.15 | $131.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $85.15 | $131.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $85.15 | $131.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $87.75 | $135.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $314.00 | $314.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $87.75 | $135.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $314.00 | $314.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $105.95 | $163.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $264.00 | $264.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $105.95 | $163.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $330.00 | $330.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $168.35 | $259.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $168.35 | $259.00 | 35% |
Source file: https://hpt.trinity-health.org/311439334-1710067376_mount-carmel-grove-city_standardcharges.zip