Covenant Medical Center Inc
Covenant Medical Center Inc in Waterloo, IA publishes cash prices for 66 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.
3421 W. 9th St, Waterloo, IA 50702 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 | $3,553.55 | $5,467.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $6,512.50 | — | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $3,553.55 | $5,467.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,609.40 | $2,476.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $2,476.00 | — | — |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,609.40 | $2,476.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,914.25 | $2,945.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,914.25 | $2,945.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $490.10 | $754.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $490.10 | $754.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $204.10 | $314.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $204.10 | $314.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $204.10 | $314.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $204.10 | $314.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $4,687.80 | $7,212.00 | 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 | $3,125.20 | $4,808.00 | 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 | $3,125.20 | $4,808.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $4,687.80 | $7,212.00 | 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 | $3,125.20 | $4,808.00 | 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 | $3,125.20 | $4,808.00 | 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 | $9,209.20 | $14,168.00 | 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 | $6,139.25 | $9,445.00 | 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 | $6,139.25 | $9,445.00 | 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 | $9,209.20 | $14,168.00 | 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 | $6,139.25 | $9,445.00 | 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 | $6,139.25 | $9,445.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $2,068.30 | $3,182.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $2,068.30 | $3,182.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $3,315.00 | $5,100.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $3,315.00 | $5,100.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $3,125.20 | $4,808.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $3,125.20 | $4,808.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $874.90 | $1,346.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $874.90 | $1,346.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $394.55 | $607.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $212.55 | $327.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $394.55 | $607.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $212.55 | $327.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 PR Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $1,785.00 | $1,785.00 | — |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,866.20 | $5,948.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PR Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $1,785.00 | $1,785.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,866.20 | $5,948.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $874.90 | $1,346.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $1,504.00 | — | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $874.90 | $1,346.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $688.35 | $1,059.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $688.35 | $1,059.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $442.65 | $681.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $919.00 | — | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $442.65 | $681.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $77.35 | $119.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $607.00 | — | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Mayo Lmpp Lipid Panel | $94.25 | $145.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $111.15 | $171.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $1,035.00 | — | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Mayo Lmpp Lipid Panel | $94.25 | $145.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $111.15 | $171.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 PR Cbc Automated/Differential Wbc Automated | $16.00 | $16.00 | — |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $68.90 | $106.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $911.00 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 PR Cbc Automated/Differential Wbc Automated | $30.19 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $68.90 | $106.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $37.05 | $57.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $941.00 | — | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $37.05 | $57.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $123.50 | $190.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $925.00 | — | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $123.50 | $190.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $79.95 | $123.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $630.00 | — | — |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $79.95 | $123.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $71.50 | $110.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $71.50 | $110.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Mayo Psaft Prostate Specific Antigen Free | $152.75 | $235.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Mayo Psaft Prostate Specific Antigen Free | $152.75 | $235.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Mayo Prostate Specific Antigen Total Ultrasensitive | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde 1012090 Prostate Specific Antigen Total | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Mayo Psaft Prostate Specific Antigen Total | $137.80 | $212.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $936.00 | — | — |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Mayo Prostate Specific Antigen Total Ultrasensitive | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde 1012090 Prostate Specific Antigen Total | $87.75 | $135.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Mayo Psaft Prostate Specific Antigen Total | $137.80 | $212.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Mayo Albld Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Mayo Aathr Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $19,256.81 | — | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Mayo Aathr Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Mayo Albld Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $37.70 | $58.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Mayo Albld Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Mayo Aathr Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $636.00 | — | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Mayo Aathr Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Mayo Albld Prothrombin Time | $41.60 | $64.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $41.60 | $64.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Mayo Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Mayo Fcuip Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $1,087.00 | — | — |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Mayo Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Mayo Fcuip Thyroid Stimulating Hormone | $139.10 | $214.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Automated | $7.00 | $7.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $118.30 | $182.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $841.00 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Automated | $21.25 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $118.30 | $182.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Nonautomated | $9.00 | $9.00 | — |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis With Microscopy Nonautomated | $104.00 | $160.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Nonautomated | $9.00 | — | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis With Microscopy Nonautomated | $104.00 | $160.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 PR Urinalysis Without Microscopy Automated | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 PR Urinalysis Without Microscopy Automated | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $45.50 | $70.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $596.00 | — | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PR Urinalysis Without Microscopy Automated | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PR Urinalysis Without Microscopy Automated | $10.00 | $10.00 | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $45.50 | $70.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 PR Urinalysis Without Microscopy Non-Automated | $7.00 | $7.00 | — |
| Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $97.50 | $150.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PR Urinalysis Without Microscopy Non-Automated | $9.12 | — | — |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $97.50 | $150.00 | 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 | $12,099.00 | — | — |
| 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 | $8,236.00 | $8,236.00 | — |
| 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) | $14,326.95 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $924.00 | $924.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $730.00 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $13,647.75 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $730.00 | $730.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $671.00 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $5,675.20 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $671.00 | $671.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $2,363.00 | $2,363.00 | — |
| Gallbladder removal, laparoscopic CPT 47562 HC Cholecystectomy W/Laparoscopy (Restricted Method II CAH) | $49,677.94 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $2,363.00 | $2,363.00 | — |
| 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) | $33,459.65 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,878.00 | $1,878.00 | — |
| 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) | $31,778.88 | — | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $1,870.00 | $1,870.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $3,529.50 | $5,430.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 PR Lt Heart Catheterization Incl Intraproc Inj for Lt Ventriculography Img | $2,697.00 | $2,697.00 | — |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $3,529.50 | $5,430.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $310.00 | $310.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,325.70 | $3,578.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $3,725.90 | — | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $310.00 | $310.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,325.70 | $3,578.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $321.21 | — | — |
| 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 | $4,316.00 | $6,640.00 | 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 | $6,172.95 | — | — |
| 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 | $2,877.55 | $4,427.00 | 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 | $2,877.55 | $4,427.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $347.00 | $347.00 | — |
| 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 | $4,316.00 | $6,640.00 | 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 | $2,877.55 | $4,427.00 | 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 | $2,877.55 | $4,427.00 | 35% |
| Prostate biopsy CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $466.00 | — | — |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $3,589.30 | $5,522.00 | 35% |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $14,602.00 | — | — |
| Prostate biopsy inpatient CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $466.00 | $466.00 | — |
| Prostate biopsy inpatient CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $3,589.30 | $5,522.00 | 35% |
| Removal of a breast lump, open surgery CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,352.00 | $1,352.00 | — |
| Removal of a breast lump, open surgery CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Bl | $8,661.25 | $13,325.00 | 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 | $5,773.95 | $8,883.00 | 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 | $5,773.95 | $8,883.00 | 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 | $33,225.23 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,352.00 | $1,352.00 | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 HC Excision Cyst/Fibroadenoma/Other Benign/Malignant Tumor Open Male/Female >= 1 Lesion Bl | $8,661.25 | $13,325.00 | 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 | $5,773.95 | $8,883.00 | 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 | $5,773.95 | $8,883.00 | 35% |
| 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) | $39,950.70 | — | — |
| 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 | $2,280.00 | $2,280.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR Tonsillectomy & Adenoidectomy Younger Than Age 12 | $27,622.17 | — | — |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 PR Tonsillectomy & Adenoidectomy Younger Than Age 12 | $1,077.00 | $1,077.00 | — |
| 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) | $66,548.91 | — | — |
| Total hip replacement inpatient CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $4,387.00 | $4,387.00 | — |
| 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) | $62,973.50 | — | — |
| Total knee replacement inpatient CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $4,383.00 | $4,383.00 | — |
| 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) | $15,222.85 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $503.00 | $503.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $8,323.75 | $267.00 | -3018% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $446.00 | $446.00 | — |
| 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 | $7,792.00 | — | — |
| 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 | $7,792.00 | $7,792.00 | — |
| 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 | $7,499.00 | $7,499.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR Ecg 12 Lead Interpretation & Report | $63.00 | $63.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC Ecg 12 Lead Interpretation & Report | $213.85 | $329.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR Ecg 12 Lead Interpretation & Report | $60.00 | — | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC Ecg 12 Lead Interpretation & Report | $213.85 | $329.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $254.15 | $391.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 PR Psychotherapy Family W/Patient 50 Minutes | $315.00 | $315.00 | — |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $254.15 | $391.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 PR Psychotherapy Family W/Patient 50 Minutes | $315.00 | $315.00 | — |
| Family therapy without the patient, 50 minutes CPT 90846 HC Psychotherapy Family W/O Patient 50 Minutes | $282.75 | $435.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 PR Psychotherapy Family W/O Patient 50 Minutes | $303.00 | $303.00 | — |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Psychotherapy Family W/O Patient 50 Minutes | $282.75 | $435.00 | 35% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 PR Psychotherapy Family W/O Patient 50 Minutes | $303.00 | $303.00 | — |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy | $74.10 | $114.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Drug Rehabilitation | $547.95 | $843.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy | $74.10 | $114.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Drug Rehabilitation | $547.95 | $843.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $402.00 | $402.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $402.00 | $402.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $145.60 | $224.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $145.60 | $224.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $1,932.00 | — | — |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $145.60 | $224.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $145.60 | $224.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $148.20 | $228.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $237.00 | $237.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $1,069.00 | — | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $148.20 | $228.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $237.00 | $237.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $175.50 | $270.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $288.00 | $288.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $288.00 | $288.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $175.50 | $270.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $288.00 | $288.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $288.00 | $288.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $132.60 | $204.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 PR Psychotherapy Patient 30 Minutes | $189.00 | $189.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $204.00 | — | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $132.60 | $204.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR Psychotherapy Patient 30 Minutes | $189.00 | $189.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $182.00 | $280.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 PR Psychotherapy Patient 45 Minutes | $251.00 | $251.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 PR Psychotherapy Patient 45 Minutes | $251.00 | $251.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $182.00 | $280.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR Psychotherapy Patient 45 Minutes | $251.00 | $251.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR Psychotherapy Patient 45 Minutes | $251.00 | $251.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $266.50 | $410.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 PR Psychotherapy Patient 60 Minutes | $376.00 | $376.00 | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $266.50 | $410.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR Psychotherapy Patient 60 Minutes | $376.00 | $376.00 | — |
Source file: https://hpt.trinity-health.org/421264647_covenant-medical-center-inc_standardcharges.zip