Plymouth Medical Center
Plymouth Medical Center in Plymouth, IN publishes cash prices for 49 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.
1915 Lake Ave, Plymouth, IN 46563 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 | $4,152.20 | $6,388.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $4,152.20 | $6,388.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,480.05 | — | — |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,480.05 | $2,277.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,480.05 | $2,277.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $2,299.05 | $3,537.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $2,299.05 | $3,537.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $492.05 | $757.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $492.05 | $757.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $425.10 | $654.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $425.10 | $654.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $425.10 | $654.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $425.10 | $654.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $4,455.10 | $6,854.00 | 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 | $2,970.50 | $4,570.00 | 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 | $2,970.50 | $4,570.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $4,455.10 | $6,854.00 | 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 | $2,970.50 | $4,570.00 | 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 | $2,970.50 | $4,570.00 | 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 | $5,489.90 | $8,446.00 | 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 | $3,659.50 | $5,630.00 | 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 | $3,659.50 | $5,630.00 | 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 | $5,489.90 | $8,446.00 | 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 | $3,659.50 | $5,630.00 | 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 | $3,659.50 | $5,630.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $2,678.00 | $4,120.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $2,678.00 | $4,120.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $3,762.85 | $5,789.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $3,762.85 | $5,789.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $3,025.75 | $4,655.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $3,025.75 | $4,655.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $744.25 | $1,145.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $744.25 | $1,145.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $299.00 | $460.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $257.40 | $396.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $299.00 | $460.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $257.40 | $396.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,339.70 | $5,138.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,339.70 | $5,138.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $729.30 | $1,122.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $729.30 | $1,122.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $1,015.95 | — | — |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $1,015.95 | $1,563.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $1,015.95 | $1,563.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $556.40 | $856.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $556.40 | $856.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Labcorp Basic Metabolic Panel (Calcium Total) | $148.85 | $229.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $148.85 | $229.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $313.30 | — | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Labcorp Basic Metabolic Panel (Calcium Total) | $148.85 | $229.00 | 35% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $148.85 | $229.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Labcorp Lipid Panel | $176.15 | $271.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $176.15 | $271.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Labcorp 884247 Lipid Panel | $176.15 | $271.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Labcorp Lipid Panel | $176.15 | $271.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Labcorp 884247 Lipid Panel | $176.15 | $271.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $176.15 | $271.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $79.30 | $122.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Labcorp Cbc Automated/Differential Wbc Automated | $79.30 | $122.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Labcorp Cbc Automated/Differential Wbc Automated | $79.30 | $122.00 | 35% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $79.30 | $122.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $76.05 | $117.00 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $76.05 | $117.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $198.90 | $306.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Labcorp Comprehensive Metabolic Panel | $198.90 | $306.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Labcorp Comprehensive Metabolic Panel | $198.90 | $306.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $198.90 | $306.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $133.90 | $206.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $133.90 | $206.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $183.30 | $282.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $183.30 | $282.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Labcorp 480947 Prostate Specific Antigen Free | $53.30 | $82.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Labcorp Prostate Specific Antigen Free | $53.30 | $82.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Labcorp 480947 Prostate Specific Antigen Free | $53.30 | $82.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Labcorp Prostate Specific Antigen Free | $53.30 | $82.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $160.55 | $247.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Labcorp Prostate Specific Antigen Total | $163.80 | $252.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Labcorp 480947 Prostate Specific Antigen Total | $163.80 | $252.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $160.55 | $247.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Labcorp 480947 Prostate Specific Antigen Total | $163.80 | $252.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Labcorp Prostate Specific Antigen Total | $163.80 | $252.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 501768 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 500070 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 117157 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 117199 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 501768 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 117199 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 500070 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 117157 Thromboplastin Time Partial (Ptt) | $78.00 | $120.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp 117028 Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp 117079 Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp 500070 Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp 117079 Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp 500070 Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $53.95 | $83.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp 117028 Prothrombin Time | $53.95 | $83.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp 237393 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp 620 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp 224576 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp 620 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp 237393 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp 224576 Thyroid Stimulating Hormone | $160.55 | $247.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Labcorp Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Labcorp 144053 Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $321.10 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Labcorp Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Labcorp 144053 Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $56.55 | $87.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Labcorp 306266 Urinalysis Without Microscopy Automated | $53.95 | $83.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $53.95 | $83.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $53.95 | $83.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Labcorp 306266 Urinalysis Without Microscopy Automated | $53.95 | $83.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 PR Rem Cataract Extracapsular Insert Intraocular Lens Prosth Man/Mech Tech | $7,893.18 | — | — |
| 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) | $6,288.36 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $614.00 | $614.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $517.00 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $6,998.16 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $517.00 | $517.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $430.00 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $5,067.17 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $430.00 | $430.00 | — |
| 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) | $18,973.23 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,396.00 | $1,396.00 | — |
| 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) | $15,211.20 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,221.00 | $1,221.00 | — |
| 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) | $18,199.32 | — | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $10,094.50 | $15,530.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $10,094.50 | $15,530.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,369.55 | $2,107.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,369.55 | $2,107.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,369.55 | $2,107.00 | 35% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,369.55 | $2,107.00 | 35% |
| 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 | $2,052.05 | $3,157.00 | 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 | $1,367.60 | $2,104.00 | 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 | $1,367.60 | $2,104.00 | 35% |
| 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 | $2,052.05 | $3,157.00 | 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 | $1,367.60 | $2,104.00 | 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 | $1,367.60 | $2,104.00 | 35% |
| Prostate biopsy CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $291.09 | — | — |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $13,866.22 | — | — |
| Prostate biopsy inpatient CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $307.00 | $307.00 | — |
| 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 | $12,507.04 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,062.00 | $1,062.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $301.00 | $301.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $6,547.84 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $389.00 | $389.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $4,978.74 | $267.00 | -1765% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $297.00 | $297.00 | — |
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 | $175.00 | $175.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $238.00 | $238.00 | — |
| 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 | $356.00 | $356.00 | — |
| 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 | $471.00 | $471.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $117.65 | $181.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $117.65 | $181.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $117.65 | $181.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $117.65 | $181.00 | 35% |
Source file: https://hpt.trinity-health.org/351142669_plymouth-medical-center_standardcharges.zip