Samaritan Hospital
Samaritan Hospital in Troy, NY publishes cash prices for 64 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.
2215 Burdett Ave, Troy, NY 12180 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 | $2,809.30 | $4,322.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $2,809.30 | $4,322.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,419.60 | $2,184.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,419.60 | $2,184.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $2,376.40 | $3,656.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $2,376.40 | $3,656.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 PR Diagnostic Mammography Incl Cad Bilateral | $423.95 | — | — |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $707.20 | $1,088.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 PR Diagnostic Mammography Incl Cad Bilateral | $404.00 | $404.00 | — |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $707.20 | $1,088.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 PR Mammography Diagnostic Unilat Including Cad | $336.18 | — | — |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $471.25 | $725.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $471.25 | $725.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 PR Mammography Diagnostic Unilat Including Cad | $321.00 | $321.00 | — |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $471.25 | $725.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $471.25 | $725.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,377.40 | $5,196.00 | 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 | $2,252.25 | $3,465.00 | 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 | $2,252.25 | $3,465.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,377.40 | $5,196.00 | 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 | $2,252.25 | $3,465.00 | 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 | $2,252.25 | $3,465.00 | 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 | $5,047.25 | $7,765.00 | 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 | $3,364.40 | $5,176.00 | 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 | $3,364.40 | $5,176.00 | 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 | $5,047.25 | $7,765.00 | 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 | $3,364.40 | $5,176.00 | 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 | $3,364.40 | $5,176.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $2,374.45 | $3,653.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $2,374.45 | $3,653.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $3,597.10 | $5,534.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $3,597.10 | $5,534.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,379.65 | $3,661.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,379.65 | $3,661.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $349.00 | $349.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $500.50 | $770.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 PR US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $349.00 | $349.00 | — |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $500.50 | $770.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 PR Screening Mammography Bilateral Incl Cad When Performed | $364.54 | — | — |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $429.65 | $661.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $339.30 | $522.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 PR Screening Mammography Bilateral Incl Cad When Performed | $329.00 | $329.00 | — |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $429.65 | $661.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $339.30 | $522.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 PR Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $2,543.00 | — | — |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $4,882.15 | $7,511.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 PR Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $1,544.00 | $1,544.00 | — |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $4,882.15 | $7,511.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 PR US Transvaginal Non Obstetric | $308.00 | $308.00 | — |
| Transvaginal pelvic ultrasound CPT 76830 PR US Transvaginal Non Obstetric | $308.00 | $216.85 | -42% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $990.60 | $1,524.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PR US Transvaginal Non Obstetric | $275.82 | — | — |
| Transvaginal pelvic ultrasound inpatient CPT 76830 PR US Transvaginal Non Obstetric | $308.00 | $216.85 | -42% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $990.60 | $1,524.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $1,237.60 | $1,904.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $1,237.60 | $1,904.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 PR Xr Lumbosacral Spine >= 4 Views | $156.24 | — | — |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $624.65 | $961.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 PR Xr Lumbosacral Spine >= 4 Views | $131.00 | $131.00 | — |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $624.65 | $961.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $81.90 | $126.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $228.15 | — | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $81.90 | $126.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Quest 92145 Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Labcorp Lipid Panel | $206.70 | $318.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Labcorp 884247 Lipid Panel | $206.70 | $318.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $560.95 | — | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Quest 92145 Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $77.35 | $119.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Labcorp 884247 Lipid Panel | $206.70 | $318.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Labcorp Lipid Panel | $206.70 | $318.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $54.60 | $84.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $563.55 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $54.60 | $84.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $63.05 | $97.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $632.45 | — | — |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $63.05 | $97.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Quest Comprehensive Metabolic Panel | $120.25 | $185.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $120.25 | $185.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $540.80 | — | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $120.25 | $185.00 | 35% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Quest Comprehensive Metabolic Panel | $120.25 | $185.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $84.50 | $130.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $84.50 | $130.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $74.10 | $114.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $74.10 | $114.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Labcorp Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Quest 31348 Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Quest Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Quest 31348 Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Labcorp Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Quest Prostate Specific Antigen Free | $59.15 | $91.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Quest 31348 Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Quest Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Labcorp Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Labcorp Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Quest Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Quest 31348 Prostate Specific Antigen Total | $66.30 | $102.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $8.45 | $13.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 501768 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 7079 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 19790 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Quest 90271 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Warde 2500780 Thromboplastin Time Partial (Ptt) | $8.45 | $13.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 91242 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 19790 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 90271 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Quest 7079 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 117079 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Labcorp 501768 Thromboplastin Time Partial (Ptt) | $81.25 | $125.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PR Prothrombin Time | $15.00 | $15.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC POCT Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Labcorp 117079 Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PR Prothrombin Time | $13.53 | — | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC POCT Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp Prothrombin Time | $58.50 | $90.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Labcorp 117079 Prothrombin Time | $58.50 | $90.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $94.25 | $145.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp 620 Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Labcorp 224576 Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Quest Thyroid Stimulating Hormone (Tsh) | $127.40 | $196.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $94.25 | $145.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp 224576 Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Labcorp 620 Thyroid Stimulating Hormone | $107.25 | $165.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Quest Thyroid Stimulating Hormone (Tsh) | $127.40 | $196.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Automated | $11.00 | $11.00 | — |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $70.20 | $108.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $622.70 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Automated | $21.21 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $70.20 | $108.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 HC Urinalysis With Microscopy Nonautomated | $9.75 | $15.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Nonautomated | $11.00 | $11.00 | — |
| Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinalysis With Microscopy Nonautomated | $9.75 | $15.00 | 35% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 PR Urinalysis by Dipstick or Tablet Reagent With Microscopy Nonautomated | $11.05 | — | — |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $5.85 | $9.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 PR Urinalysis Without Microscopy Automated | $7.00 | $7.00 | — |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $546.65 | — | — |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $5.85 | $9.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 PR Urinalysis Without Microscopy Automated | $7.48 | — | — |
| 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 | $8.45 | $13.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urinalysis Without Microscopy Nonautomated | $8.45 | $13.00 | 35% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 PR Urinalysis Without Microscopy Non-Automated | $9.12 | — | — |
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 | $3,655.53 | — | — |
| 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 | $6,684.00 | $6,684.00 | — |
| 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) | $5,914.35 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $641.00 | $641.00 | — |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $602.37 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $5,903.30 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $506.00 | $506.00 | — |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $537.55 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $4,014.24 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $465.00 | $465.00 | — |
| 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) | $10,080.56 | — | — |
| Gallbladder removal, laparoscopic inpatient CPT 47562 PR Laparoscopy Surgical Cholecystectomy | $1,671.00 | $1,671.00 | — |
| 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) | $5,650.45 | — | — |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 PR Repr Init Ing Hernia 5y or Older Reducible | $1,327.00 | $1,327.00 | — |
| 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) | $5,765.01 | — | — |
| Left heart catheterization, diagnostic one side CPT 93452 HC Cath Lt Heart/Lv Gram | $5,759.65 | $8,861.00 | 35% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Cath Lt Heart/Lv Gram | $5,759.65 | $8,861.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,491.75 | $2,295.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,491.75 | $2,295.00 | 35% |
| Prostate biopsy CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $475.61 | — | — |
| Prostate biopsy CPT 55700 HC Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $8,411.49 | — | — |
| Prostate biopsy inpatient CPT 55700 PR Biopsy Prostate Needle/Punch Single/Multiple Any Approach | $328.00 | $328.00 | — |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $25,391.20 | $2,557.00 | -893% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 PR Lap Surg Prostatectomy Retropubic Radical Incl Nrv Sparing/Robotic Asst | $3,601.00 | $3,601.00 | — |
| 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 | $4,145.80 | — | — |
| Removal of a breast lump, open surgery inpatient CPT 19120 PR Exc Cyst/Aberrant Breast Tissue Open Male/Female 1/> Lesion | $1,061.00 | $1,061.00 | — |
| 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) | $10,221.15 | — | — |
| 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) | $21,790.34 | — | — |
| Total hip replacement inpatient CPT 27130 PR Arthroplasty Acetabular and Proximal Femoral Prosthetic Replacement | $3,261.00 | $3,261.00 | — |
| 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) | $8,516.56 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $349.00 | $349.00 | — |
| Upper endoscopy (EGD), diagnostic CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $7,884.50 | $267.00 | -2853% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 PR Egd Flexible Transoral Dx Incl Coll Spec by Brushing/Washing | $309.00 | $309.00 | — |
| 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 | $6,060.00 | $6,060.00 | — |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR Ecg 12 Lead Interpretation & Report | $37.00 | $37.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC Ecg 12 Lead Interpretation & Report | $49.40 | $76.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC Ecg 12 Lead Interpretation & Report | $49.40 | $76.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR Ecg 12 Lead Interpretation & Report | $50.92 | — | — |
| Family therapy with the patient, 50 minutes CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $471.25 | $725.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $471.25 | $725.00 | 35% |
| Group psychotherapy session CPT 90853 PR Psychotherapy Group | $61.00 | $61.00 | — |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy | $148.20 | $228.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Alcohol Rehabilitation Telehealth (Sparc) | $148.20 | $228.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Drug Rehabilitation Telehealth (Sparc) | $148.20 | $228.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy Msw | $148.20 | $228.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 PR Psychotherapy Group | $61.00 | $61.00 | — |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Drug Rehabilitation Telehealth (Sparc) | $148.20 | $228.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Alcohol Rehabilitation Telehealth (Sparc) | $148.20 | $228.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy Msw | $148.20 | $228.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy | $148.20 | $228.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 HC Visit New Low Pro 30-44 Mins (Restricted Method II CAH) | $221.71 | — | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $286.00 | $286.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $286.00 | $286.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $425.00 | $425.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $425.00 | $425.00 | — |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $562.00 | $562.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $462.00 | $462.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $82.55 | $127.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $82.55 | $127.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $82.55 | $127.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $82.55 | $127.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $130.00 | $200.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $331.00 | $331.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $331.00 | $331.00 | — |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $609.05 | — | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $130.00 | $200.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $331.00 | $331.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $331.00 | $331.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $130.00 | $200.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $381.00 | $381.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $381.00 | $381.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $130.00 | $200.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $381.00 | $381.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $381.00 | $381.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 PR Psychotherapy Patient 30 Minutes | $172.00 | $172.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient 30 Minutes Alcohol Rehabilitation (Sparc) | $183.95 | $283.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $256.10 | $394.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PR Psychotherapy Patient 30 Minutes | $172.00 | $172.00 | — |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient 30 Minutes Alcohol Rehabilitation (Sparc) | $183.95 | $283.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $256.10 | $394.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Patient 45 Minutes Alcohol Rehabilitation (Sparc) | $183.95 | $283.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 PR Psychotherapy Patient 45 Minutes | $229.00 | $229.00 | — |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $355.55 | $547.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Patient 45 Minutes Alcohol Rehabilitation (Sparc) | $183.95 | $283.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PR Psychotherapy Patient 45 Minutes | $229.00 | $229.00 | — |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $355.55 | $547.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 PR Psychotherapy Patient 60 Minutes | $336.00 | $336.00 | — |
| Psychotherapy session, 60 minutes CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $355.55 | $547.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PR Psychotherapy Patient 60 Minutes | $315.36 | — | — |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $355.55 | $547.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 HC Consultation Office/Outpatient New/Estab Patient 30-39 Mins Sane | $346.45 | $533.00 | 35% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 HC Consultation Office/Outpatient New/Estab Patient 30-39 Mins Sane | $346.45 | $533.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 HC Consultation Office/Outpatient New/Estab Patient 40-54 Mins Sane | $377.65 | $581.00 | 35% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 HC Consultation Office/Outpatient New/Estab Patient 40-54 Mins Sane | $377.65 | $581.00 | 35% |
Source file: https://hpt.trinity-health.org/141338544_samaritan-hospital_standardcharges.zip