Saint Marys Hospital
Saint Marys Hospital in Waterbury, CT publishes cash prices for 61 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.
56 Franklin St, Waterbury, CT 06706 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 | $1,450.90 | $2,638.00 | 45% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $1,537.74 | — | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $1,450.90 | $2,638.00 | 45% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,025.20 | — | — |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,025.20 | $1,864.00 | 45% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,025.20 | $1,864.00 | 45% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,387.10 | $2,522.00 | 45% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,387.10 | $2,522.00 | 45% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $311.30 | $566.00 | 45% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $311.30 | $566.00 | 45% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $248.05 | $451.00 | 45% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $248.05 | $451.00 | 45% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $248.05 | $451.00 | 45% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $248.05 | $451.00 | 45% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $2,765.95 | $5,029.00 | 45% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $1,843.60 | — | — |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $1,843.60 | $3,352.00 | 45% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $1,843.60 | $3,352.00 | 45% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $2,765.95 | $5,029.00 | 45% |
| 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 | $1,843.60 | $3,352.00 | 45% |
| 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 | $1,843.60 | $3,352.00 | 45% |
| 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 | $3,843.95 | $6,989.00 | 45% |
| 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 | $2,562.45 | $4,659.00 | 45% |
| 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 | $2,562.45 | $4,659.00 | 45% |
| 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 | $3,843.95 | $6,989.00 | 45% |
| 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 | $2,562.45 | $4,659.00 | 45% |
| 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 | $2,562.45 | $4,659.00 | 45% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $1,884.30 | $3,426.00 | 45% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $1,884.30 | — | — |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $1,884.30 | $3,426.00 | 45% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $2,688.95 | $4,889.00 | 45% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $2,688.95 | $4,889.00 | 45% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,037.20 | $3,704.00 | 45% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,037.20 | $3,704.00 | 45% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $469.15 | $853.00 | 45% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $469.15 | $853.00 | 45% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $274.45 | $499.00 | 45% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $274.45 | $499.00 | 45% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $274.45 | $499.00 | 45% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $274.45 | $499.00 | 45% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $4,256.45 | $7,739.00 | 45% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $4,256.45 | $7,739.00 | 45% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $612.70 | $1,114.00 | 45% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $612.70 | $1,114.00 | 45% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $925.65 | — | — |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $925.65 | $1,683.00 | 45% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $925.65 | $1,683.00 | 45% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $376.20 | $684.00 | 45% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $376.20 | $684.00 | 45% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $46.75 | $85.00 | 45% |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $46.75 | $85.00 | 45% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest Lipid Panel | $49.50 | $90.00 | 45% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $50.60 | $92.00 | 45% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest Lipid Panel | $49.50 | $90.00 | 45% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $50.60 | $92.00 | 45% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $28.60 | $52.00 | 45% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $28.60 | $52.00 | 45% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $25.85 | $47.00 | 45% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $266.20 | — | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $25.85 | $47.00 | 45% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $47.30 | $86.00 | 45% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $47.30 | $86.00 | 45% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $106.70 | $194.00 | 45% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $106.70 | $194.00 | 45% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $32.45 | $59.00 | 45% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $32.45 | $59.00 | 45% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specific Antigen Free | $74.80 | $136.00 | 45% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Warde 1012090 Prostate Specific Antigen Free | $74.80 | $136.00 | 45% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specific Antigen Free | $74.80 | $136.00 | 45% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Warde 1012090 Prostate Specific Antigen Free | $74.80 | $136.00 | 45% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $85.80 | $156.00 | 45% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $85.80 | $156.00 | 45% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Warde 1012090 Prostate Specific Antigen Total | $85.80 | $156.00 | 45% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde 1012090 Prostate Specific Antigen Total | $85.80 | $156.00 | 45% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Warde Prostate Specific Antigen Total Ultrasensitive | $85.80 | $156.00 | 45% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $85.80 | $156.00 | 45% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 3502730 Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $22.00 | $40.00 | 45% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $18.70 | $34.00 | 45% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $18.70 | $34.00 | 45% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Mayo Thyroid Stimulating Hormone | $75.35 | $137.00 | 45% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $80.85 | $147.00 | 45% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Mayo Thyroid Stimulating Hormone | $75.35 | $137.00 | 45% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $80.85 | $147.00 | 45% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $7.70 | $14.00 | 45% |
| Urinalysis with microscope exam, automated CPT 81001 HC Quest Urinalysis With Microscopy Automated | $7.70 | $14.00 | 45% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $248.60 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $7.70 | $14.00 | 45% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Quest Urinalysis With Microscopy Automated | $7.70 | $14.00 | 45% |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis With Microscopy Nonautomated | $12.65 | $23.00 | 45% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis With Microscopy Nonautomated | $12.65 | $23.00 | 45% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $5.50 | $10.00 | 45% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $376.75 | — | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $5.50 | $10.00 | 45% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $3.85 | $7.00 | 45% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $3.85 | $7.00 | 45% |
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 | $7,554.83 | — | — |
| 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 | $5,709.00 | $5,709.00 | — |
| Colonoscopy with polyp removal CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $1,534.00 | $1,534.00 | — |
| 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) | $3,373.67 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $1,534.00 | $1,534.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $1,205.00 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $4,791.52 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $1,361.00 | $1,361.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $757.91 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $2,434.68 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $1,142.00 | $1,142.00 | — |
| 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) | $20,386.14 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $3,112.00 | $3,112.00 | — |
| 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) | $12,741.66 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $2,293.00 | $2,293.00 | — |
| 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) | $13,497.18 | — | — |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 PR Arthroscopy Knee Surg W/ Meniscectomy Incl Debr/Shvi Artc Cartilage | $1,220.00 | $1,220.00 | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $5,229.95 | $9,509.00 | 45% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $5,229.95 | $9,509.00 | 45% |
| 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 | $2,779.15 | $5,053.00 | 45% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $3,017.77 | — | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $700.00 | $700.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $2,779.15 | $5,053.00 | 45% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $435.00 | — | — |
| 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 | $3,444.10 | — | — |
| 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 | $5,386.15 | $9,793.00 | 45% |
| 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 | $3,590.40 | $6,528.00 | 45% |
| 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 | $3,590.40 | $6,528.00 | 45% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $862.00 | $862.00 | — |
| 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 | $5,386.15 | $9,793.00 | 45% |
| 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 | $3,590.40 | $6,528.00 | 45% |
| 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 | $3,590.40 | $6,528.00 | 45% |
| Prostate biopsy CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $430.00 | — | — |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $11,289.72 | — | — |
| Prostate biopsy inpatient CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $430.00 | $430.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $32,192.63 | $2,557.00 | -1159% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $5,579.00 | $5,579.00 | — |
| 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 | $11,335.42 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,224.00 | $1,224.00 | — |
| 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) | $19,444.19 | — | — |
| 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 | $1,658.00 | $1,658.00 | — |
| Tonsil and adenoid removal, child under 12 CPT 42820 PR Tonsillectomy & Adenoidectomy Younger Than Age 12 | $10,780.13 | — | — |
| 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) | $35,917.41 | — | — |
| Total hip replacement inpatient CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $3,642.00 | $3,642.00 | — |
| 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) | $34,352.81 | — | — |
| Total knee replacement inpatient CPT 27447 PR Arthroplasty Knee Condyle&Plateau Med/Lat Cpts W/WO Patella Resurfacing | $4,023.00 | $4,023.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $1,626.00 | $1,626.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $4,403.77 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $1,626.00 | $1,626.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $2,466.14 | $267.00 | -824% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $1,434.00 | $1,434.00 | — |
| 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 | $5,555.00 | $5,555.00 | — |
| 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 | $5,555.00 | $5,555.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $316.80 | $576.00 | 45% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $316.80 | $576.00 | 45% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy Msw | $176.55 | $321.00 | 45% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy | $185.90 | $338.00 | 45% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy Msw | $176.55 | $321.00 | 45% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy | $185.90 | $338.00 | 45% |
| 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 | $292.00 | $292.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $436.00 | $436.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $436.00 | $436.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $436.00 | $436.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $436.00 | $436.00 | — |
| 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 | $575.00 | $575.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $93.50 | $170.00 | 45% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $98.45 | $179.00 | 45% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $93.50 | $170.00 | 45% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $98.45 | $179.00 | 45% |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $156.75 | $285.00 | 45% |
| Psychotherapy session, 30 minutes CPT 90832 PR Psychotherapy Patient 30 Minutes | $181.48 | — | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $156.75 | $285.00 | 45% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR Psychotherapy Patient 30 Minutes | $200.00 | $200.00 | — |
Source file: https://hpt.trinity-health.org/060646844_saint-marys-hospital_standardcharges.zip