Summit Test/Procedure Costs

The following test / procedure costs apply to:

  • St. Anthony Summit Medical Center
Location Service Description Test/Procedure Billing Code Self-Pay Rate Payment Method
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCCDRG 807$6,778 PER CASE
SUMMIT COUNTYINPATIENTMAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCCDRG 470$39,470 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W STERILIZATION W/O CC/MCCDRG 785$11,438 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W/O STERILIZATION W/O CC/MCCDRG 788$11,438 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W STERILIZATION W MCCDRG 783$13,366 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W STERILIZATION W CCDRG 784$13,366 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W/O STERILIZATION W MCCDRG 786$13,366 PER CASE
SUMMIT COUNTYINPATIENTCESAREAN SECTION W/O STERILIZATION W CCDRG 787$13,366 PER CASE
SUMMIT COUNTYINPATIENTSPINAL FUSION EXCEPT CERVICAL W/O MCCDRG 460N/APER CASE
SUMMIT COUNTYINPATIENTSEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCCDRG 871$20,990 PER CASE
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W/O STERILIZATION/D&C W MCCDRG 805$8,213 PER CASE
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W/O STERILIZATION/D&C W CCDRG 806$8,213 PER CASE
SUMMIT COUNTYINPATIENTPERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCCDRG 247N/APER CASE
SUMMIT COUNTYINPATIENTESOPHAGITIS GASTROENT MISC DIGEST DISORDERS W/O MCCDRG 392$15,961 PER CASE
SUMMIT COUNTYINPATIENTSEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCCDRG 872$13,100 PER CASE
SUMMIT COUNTYINPATIENTCERVICAL SPINAL FUSION W/O CC/MCCDRG 473N/APER CASE
SUMMIT COUNTYINPATIENTO.R. PROCEDURES FOR OBESITY W/O CC/MCCDRG 621N/APER CASE
SUMMIT COUNTYINPATIENTMAJOR SMALL LARGE BOWEL PROCEDURES W CCDRG 330$53,004 PER CASE
SUMMIT COUNTYINPATIENTMAJOR SMALL LARGE BOWEL PROCEDURES W/O CC/MCCDRG 331$28,967 PER CASE
SUMMIT COUNTYINPATIENTLOWER EXTREM HUMER PROC EXCEPT HIPFOOTFEMUR W/O CC/MCCDRG 494$32,335 PER CASE
SUMMIT COUNTYINPATIENTCELLULITIS W/O MCCDRG 603$13,688 PER CASE
SUMMIT COUNTYINPATIENTUTERINE ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCCDRG 743$18,692 PER CASE
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W STERILIZATION/D&C W MCCDRG 796$8,746 PER CASE
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W STERILIZATION/D&C W CCDRG 797$8,746 PER CASE
SUMMIT COUNTYINPATIENTVAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCCDRG 798$8,746 PER CASE
SUMMIT COUNTYINPATIENTMAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIESDRG 483$52,011 PER CASE
SUMMIT COUNTYINPATIENTDISORDERS OF PANCREAS EXCEPT MALIGNANCY W CCDRG 439N/APER CASE
SUMMIT COUNTYINPATIENTPULMONARY EDEMA RESPIRATORY FAILUREDRG 189$27,379 PER CASE
SUMMIT COUNTYINPATIENTMAJOR MALE PELVIC PROCEDURES W/O CC/MCCDRG 708N/APER CASE
SUMMIT COUNTYINPATIENTNEUROSES EXCEPT DEPRESSIVEDRG 882N/APER CASE
SUMMIT COUNTYINPATIENTINFECTIOUS PARASITIC DISEASES W O.R. PROCEDURE W MCCDRG 853$47,032 PER CASE
SUMMIT COUNTYINPATIENTDIABETES W CCDRG 638N/APER CASE
SUMMIT COUNTYINPATIENTG.I. OBSTRUCTION W/O CC/MCCDRG 390$15,454 PER CASE
SUMMIT COUNTYINPATIENTNORMAL NEWBORNDRG 795$2,171 PER CASE
SUMMIT COUNTYINPATIENTALCOHOL/DRUG ABUSE/DEPEND W/O REHAB W/O MCCDRG 897$15,248 PER CASE
SUMMIT COUNTYINPATIENTREVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCCDRG 468N/APER CASE
SUMMIT COUNTYINPATIENTSHOULDER, ELBOW, OR FOREARM PROC, EXC MAJOR JOINT W/O CC/MCCDRG 512$24,776 PER CASE
SUMMIT COUNTYINPATIENTNEONATE W OTHER SIGNIFICANT PROBLEMSDRG 794$3,000 PER CASE
SUMMIT COUNTYINPATIENTPSYCHOSESDRG 885N/APER CASE
SUMMIT COUNTYINPATIENTFULL TERM NEONATE W MAJOR PROBLEMSDRG 793$4,452 PER CASE
SUMMIT COUNTYINPATIENTPREMATURITY W/O MAJOR PROBLEMSDRG 792$11,391 PER CASE
SUMMIT COUNTYINPATIENTPOISONING TOXIC EFFECTS OF DRUGS W MCCDRG 917$21,459 PER CASE
SUMMIT COUNTYINPATIENTEXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME NEONATEDRG 790$69,975 PER CASE
SUMMIT COUNTYINPATIENTPREMATURITY W MAJOR PROBLEMSDRG 791$34,966 PER CASE
SUMMIT COUNTYINPATIENTPOISONING TOXIC EFFECTS OF DRUGS W/O MCCDRG 918N/APER CASE
SUMMIT COUNTYINPATIENTINTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRSDRG 065N/APER CASE
SUMMIT COUNTYINPATIENTPERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTSDRG 246N/APER CASE
SUMMIT COUNTYINPATIENTMISC DISORDERS OF NUTRITIONMETABOLISMFLUIDS/ELECTROLYTES W/O MCCDRG 641$25,657 PER CASE
SUMMIT COUNTYINPATIENTOTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCCDRG 817$3,806 PER CASE
SUMMIT COUNTYINPATIENTOTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CCDRG 818$3,806 PER CASE
SUMMIT COUNTYINPATIENTOTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCCDRG 831$3,806 PER CASE
SUMMIT COUNTYINPATIENTOTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CCDRG 832$3,806 PER CASE
SUMMIT COUNTYINPATIENTLAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCCDRG 419$24,801 PER CASE
SUMMIT COUNTYINPATIENTPULMONARY EMBOLISM W/O MCCDRG 176$15,746 PER CASE
SUMMIT COUNTYINPATIENTBRONCHITIS ASTHMA W/O CC/MCCDRG 203$5,961 PER CASE
SUMMIT COUNTYINPATIENTBILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCCDRG 462N/APER CASE
SUMMIT COUNTYINPATIENTSIMPLE PNEUMONIA PLEURISY W MCCDRG 193$19,376 PER CASE
SUMMIT COUNTYINPATIENTSIMPLE PNEUMONIA PLEURISY W CCDRG 194$15,027 PER CASE
SUMMIT COUNTYINPATIENTG.I. HEMORRHAGE W CCDRG 378N/APER CASE
SUMMIT COUNTYINPATIENTHIP FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCCDRG 482$31,020 PER CASE
SUMMIT COUNTYINPATIENTRENAL FAILURE W CCDRG 683$12,743 PER CASE
SUMMIT COUNTYINPATIENTCERVICAL SPINAL FUSION W CCDRG 472N/APER CASE
SUMMIT COUNTYINPATIENTCIRCULATORY DISORDERS EXCEPT AMI W CARD CATH W/O MCCDRG 287N/APER CASE
SUMMIT COUNTYINPATIENTDISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCCDRG 440$14,466 PER CASE
SUMMIT COUNTYINPATIENTPULMONARY EMBOLISM W MCCDRG 175N/APER CASE
SUMMIT COUNTYINPATIENTBRONCHITIS ASTHMA W CC/MCCDRG 202N/APER CASE
SUMMIT COUNTYINPATIENTMAJOR SMALL LARGE BOWEL PROCEDURES W MCCDRG 329$32,499 PER CASE
SUMMIT COUNTYINPATIENTKIDNEY URINARY TRACT INFECTIONS W/O MCCDRG 690N/APER CASE
SUMMIT COUNTYINPATIENTDEPRESSIVE NEUROSESDRG 881N/APER CASE
SUMMIT COUNTYINPATIENTINFECTIOUS PARASITIC DISEASES W O.R. PROCEDURE W CCDRG 854N/APER CASE
SUMMIT COUNTYINPATIENTLAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CCDRG 418N/APER CASE
SUMMIT COUNTYINPATIENTINTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCCDRG 064N/APER CASE
SUMMIT COUNTYINPATIENTMEDICAL BACK PROBLEMS W/O MCCDRG 552$21,198 PER CASE
SUMMIT COUNTYINPATIENTCOMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CCDRG 454N/APER CASE
SUMMIT COUNTYINPATIENTG.I. OBSTRUCTION W CCDRG 389$11,909 PER CASE
SUMMIT COUNTYINPATIENTCOMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCCDRG 455N/APER CASE
SUMMIT COUNTYINPATIENTDEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCCDRG 057N/APER CASE
SUMMIT COUNTYINPATIENTLOWER EXTREM HUMER PROC EXCEPT HIPFOOTFEMUR W CCDRG 493$38,042 PER CASE
SUMMIT COUNTYINPATIENTSIMPLE PNEUMONIA PLEURISY W/O CC/MCCDRG 195$9,072 PER CASE
SUMMIT COUNTYOUTPATIENTCARDIAC DIAGNOSTIC - ELECTROCARDIOGRAM TRACINGCPT 93005$335 PER PROCEDURE
SUMMIT COUNTYOUTPATIENTCARDIAC DIAGNOSTIC - CARDIOVASCULAR STRESS TESTCPT 93017$622 PER PROCEDURE
SUMMIT COUNTYOUTPATIENTCARDIAC DIAGNOSTIC - ECHOCARDIOGRAM, TTE W/DOPPLER COMPLETECPT 93306$991 PER PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - COLONOSCOPY AND BIOPSYCPT 45380N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - DIAGNOSTIC COLONOSCOPYCPT 45378N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - EGD BIOPSY SINGLE/MULTIPLECPT 43239N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - LAPAROSCOPIC CHOLECYSTECTOMYCPT 47562$11,447 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - COLONOSCOPY W/LESION REMOVALCPT 45385N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - HYSTEROSCOPY BIOPSYCPT 58558$7,608 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - LAP ING HERNIA REPAIR INITCPT 49650N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - LOW BACK DISK SURGERYCPT 63030N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - PRP I/HERN INIT REDUC >5 YRCPT 49505N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - KNEE ARTHROSCOPY/SURGERYCPT 29881$8,623 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - LAP CHOLECYSTECTOMY/GRAPHCPT 47563$14,622 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - CARE OF MISCARRIAGECPT 59820$4,533 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - TLH W/T/O 250 G OR LESSCPT 58571$19,252 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - CYSTO/URETERO W/LITHOTRIPSYCPT 52356$10,832 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - EGD DIAGNOSTIC BRUSH WASHCPT 43235N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTSURGERY - INSERT TUNNELED CV CATHCPT 36561N/APER CASE, SINGLE PROCEDURE
SUMMIT COUNTYOUTPATIENTIMAGING - COMPUTED TOMOGRAPHY SCAN - CALCIUM SCORINGCPT 75571$99 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - COMPUTED TOMOGRAPHY SCAN - LUNG SCREENINGCPT G0297$385 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - COMPUTED TOMOGRAPHY SCAN - ALL OTHERCPT 70010-76499$600 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - MAGNETIC RESONANCE IMAGING - MRICPT 70010-76499$655 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - DIAGNOSTIC X-RAYCPT 70010-76499$156 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - MAMMOGRAPHYCPT 77053-77067$281 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - BREAST TOMOSYNTHESISCPT 77061-77063, G0279, 0159T$40 PER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - POSITRON EMMISSION TOMOGRAHY - PETCPT 78491-78815N/APER SCAN
SUMMIT COUNTYOUTPATIENTIMAGING - ULTRASOUNDCPT 76506-76999$412 PER SCAN
SUMMIT COUNTYOUTPATIENTLAB - ASSAY THYROID STIM HORMONECPT 84443N/APER PROCEDURE
SUMMIT COUNTYOUTPATIENTLAB - COMPREHEN METABOLIC PANELCPT 80053N/APER PROCEDURE
SUMMIT COUNTYOUTPATIENTLAB - URINALYSIS AUTO W/O SCOPECPT 81003N/APER PROCEDURE
SUMMIT COUNTYOUTPATIENTLAB - COMPLETE CBC W/AUTO DIFF WBCCPT 85025$49 PER PROCEDURE
SUMMIT COUNTYOUTPATIENTLAB - METABOLIC PANEL TOTAL CACPT 80048N/APER PROCEDURE
SUMMIT COUNTYOUTPATIENTLAB - VENIPUNCTURECPT 36415$3 PER PROCEDURE
SUMMIT COUNTYOUTPATIENTANCILLARY - SLEEP STUDY FACILITYCPT 95805, 95807-95811$3,616 PER VISIT
SUMMIT COUNTYOUTPATIENTANCILLARY - PHYSICAL THERAPYREV 420-429N/APER VISIT
SUMMIT COUNTYOUTPATIENTANCILLARY - OCCUPATIONAL THERAPYREV 430-439N/APER VISIT
SUMMIT COUNTYOUTPATIENTANCILLARY - SPEECH THERAPYREV 440-449N/APER VISIT

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The pricing information provided on this website is intended to give self-pay patients, who have scheduled services, an estimate of the prices and expected payment amounts for commonly provided health care services at Centura Health hospitals. The pricing only covers the specific service listed and provided through the hospital, and does not include complicating factors or professional fees for services such as those provided by a physician, surgeon, pathologist, anesthesiologist, radiologist, nurse practitioner or other independent practitioners. Please contact those offices directly for price information associated with their care and service. The pricing does not include fees associated with implants, high-cost drugs, or second procedures. The pricing is for patients who have pre-scheduled the service and not applicable to patients who receive services in the emergency department.

This pricing does not apply to patients who have health insurance coverage through Medicare, Medicaid, other government insurance programs, or an insurance company. If a patient has health insurance, the patient’s health insurance policy (including deductibles, co-pay, co-insurance and out-of-pocket maximums) will apply and the amount the patient owes for health care services will depend on the patient’s insurance coverage.

The pricing information provided is region specific, and is not transferrable across regions.

The pricing information is not a guarantee of insurance coverage or availability of services.

There are certain chronic conditions or long-term care that Centura Health may not be able to provide customized pricing  for without additional clinical information from your physician.

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