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 COUNTY INPATIENT VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES DRG 775 $6,499 PER CASE
SUMMIT COUNTY INPATIENT MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC DRG 470 $37,843 PER CASE
SUMMIT COUNTY INPATIENT CESAREAN SECTION W/O CC/MCC DRG 766 $10,966 PER CASE
SUMMIT COUNTY INPATIENT CESAREAN SECTION W CC/MCC DRG 765 $12,815 PER CASE
SUMMIT COUNTY INPATIENT SPINAL FUSION EXCEPT CERVICAL W/O MCC DRG 460 N/A PER CASE
SUMMIT COUNTY INPATIENT SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC DRG 871 $20,124 PER CASE
SUMMIT COUNTY INPATIENT VAGINAL DELIVERY W COMPLICATING DIAGNOSES DRG 774 $7,874 PER CASE
SUMMIT COUNTY INPATIENT PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC DRG 247 N/A PER CASE
SUMMIT COUNTY INPATIENT ESOPHAGITIS GASTROENT  MISC DIGEST DISORDERS W/O MCC DRG 392 $15,303 PER CASE
SUMMIT COUNTY INPATIENT SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC DRG 872 $12,560 PER CASE
SUMMIT COUNTY INPATIENT CERVICAL SPINAL FUSION W/O CC/MCC DRG 473 N/A PER CASE
SUMMIT COUNTY INPATIENT O.R. PROCEDURES FOR OBESITY W/O CC/MCC DRG 621 N/A PER CASE
SUMMIT COUNTY INPATIENT MAJOR SMALL  LARGE BOWEL PROCEDURES W CC DRG 330 $50,819 PER CASE
SUMMIT COUNTY INPATIENT MAJOR SMALL  LARGE BOWEL PROCEDURES W/O CC/MCC DEG 331 $27,773 PER CASE
SUMMIT COUNTY INPATIENT LOWER EXTREM  HUMER PROC EXCEPT HIPFOOTFEMUR W/O CC/MCC DEG 494 $31,002 PER CASE
SUMMIT COUNTY INPATIENT CELLULITIS W/O MCC DRG 603 $13,124 PER CASE
SUMMIT COUNTY INPATIENT UTERINE  ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC DRG 743 $17,922 PER CASE
SUMMIT COUNTY INPATIENT VAGINAL DELIVERY W STERILIZATION /OR DC DRG 767 $8,385 PER CASE
SUMMIT COUNTY INPATIENT MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES DRG 483 $49,867 PER CASE
SUMMIT COUNTY INPATIENT DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC DRG 439 N/A PER CASE
SUMMIT COUNTY INPATIENT PULMONARY EDEMA  RESPIRATORY FAILURE DRG 189 $26,250 PER CASE
SUMMIT COUNTY INPATIENT MAJOR MALE PELVIC PROCEDURES W/O CC/MCC DRG 708 N/A PER CASE
SUMMIT COUNTY INPATIENT NEUROSES EXCEPT DEPRESSIVE DRG 882 N/A PER CASE
SUMMIT COUNTY INPATIENT INFECTIOUS  PARASITIC DISEASES W O.R. PROCEDURE W MCC DRG 853 $45,093 PER CASE
SUMMIT COUNTY INPATIENT DIABETES W CC DRG 638 N/A PER CASE
SUMMIT COUNTY INPATIENT G.I. OBSTRUCTION W/O CC/MCC DRG 390 $14,817 PER CASE
SUMMIT COUNTY INPATIENT NORMAL NEWBORN DRG 795 $2,081 PER CASE
SUMMIT COUNTY INPATIENT ALCOHOL/DRGU ABUSE/DEPEND W/O REHAB W/O MCC DRG 897 $14,620 PER CASE
SUMMIT COUNTY INPATIENT REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC DRG 468 N/A PER CASE
SUMMIT COUNTY INPATIENT SHOULDER, ELBOW, OR FOREARM PROC, EXC MAJOR JOINT W/O CC/MCC DRG 512 $23,754 PER CASE
SUMMIT COUNTY INPATIENT NEONATE W OTHER SIGNIFICANT PROBLEMS DRG 794 $2,876 PER CASE
SUMMIT COUNTY INPATIENT PSYCHOSES DRG 885 N/A PER CASE
SUMMIT COUNTY INPATIENT FULL TERM NEONATE W MAJOR PROBLEMS DRG 793 $4,268 PER CASE
SUMMIT COUNTY INPATIENT PREMATURITY W/O MAJOR PROBLEMS DRG 792 $10,921 PER CASE
SUMMIT COUNTY INPATIENT POISONING  TOXIC EFFECTS OF DRUGS W MCC DRG 917 $20,575 PER CASE
SUMMIT COUNTY INPATIENT EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME NEONATE DRG 790 $67,090 PER CASE
SUMMIT COUNTY INPATIENT PREMATURITY W MAJOR PROBLEMS DRG 791 $33,524 PER CASE
SUMMIT COUNTY INPATIENT POISONING  TOXIC EFFECTS OF DRUGS W/O MCC DRG 918 N/A PER CASE
SUMMIT COUNTY INPATIENT INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS DRG 065 N/A PER CASE
SUMMIT COUNTY INPATIENT PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS DRG 246 N/A PER CASE
SUMMIT COUNTY INPATIENT MISC DISORDERS OF NUTRITIONMETABOLISMFLUIDS/ELECTROLYTES W/O MCC DRG 641 $24,599 PER CASE
SUMMIT COUNTY INPATIENT OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS DRG 781 $3,649 PER CASE
SUMMIT COUNTY INPATIENT LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC DRG 419 $23,778 PER CASE
SUMMIT COUNTY INPATIENT PULMONARY EMBOLISM W/O MCC DRG 176 $15,097 PER CASE
SUMMIT COUNTY INPATIENT BRONCHITIS  ASTHMA W/O CC/MCC DRG 203 $5,715 PER CASE
SUMMIT COUNTY INPATIENT BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC DRG 462 N/A PER CASE
SUMMIT COUNTY INPATIENT SIMPLE PNEUMONIA  PLEURISY W MCC DRG 193 $18,577 PER CASE
SUMMIT COUNTY INPATIENT SIMPLE PNEUMONIA  PLEURISY W CC DRG 194 $14,408 PER CASE
SUMMIT COUNTY INPATIENT G.I. HEMORRHAGE W CC DRG 378 N/A PER CASE
SUMMIT COUNTY INPATIENT HIP  FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC DRG 482 $29,741 PER CASE
SUMMIT COUNTY INPATIENT RENAL FAILURE W CC DRG 683 $12,218 PER CASE
SUMMIT COUNTY INPATIENT CERVICAL SPINAL FUSION W CC DRG 472 N/A PER CASE
SUMMIT COUNTY INPATIENT CIRCULATORY DISORDERS EXCEPT AMI W CARD CATH W/O MCC DRG 287 N/A PER CASE
SUMMIT COUNTY INPATIENT DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC DRG 440 $13,870 PER CASE
SUMMIT COUNTY INPATIENT PULMONARY EMBOLISM W MCC DRG 175 N/A PER CASE
SUMMIT COUNTY INPATIENT BRONCHITIS  ASTHMA W CC/MCC DRG 202 N/A PER CASE
SUMMIT COUNTY INPATIENT MAJOR SMALL  LARGE BOWEL PROCEDURES W MCC DRG 329 $31,159 PER CASE
SUMMIT COUNTY INPATIENT KIDNEY  URINARY TRACT INFECTIONS W/O MCC DRG 690 N/A PER CASE
SUMMIT COUNTY INPATIENT DEPRESSIVE NEUROSES DRG 881 N/A PER CASE
SUMMIT COUNTY INPATIENT INFECTIOUS  PARASITIC DISEASES W O.R. PROCEDURE W CC DRG 854 N/A PER CASE
SUMMIT COUNTY INPATIENT LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC DRG 418 N/A PER CASE
SUMMIT COUNTY INPATIENT INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC DRG 064 N/A PER CASE
SUMMIT COUNTY INPATIENT MEDICAL BACK PROBLEMS W/O MCC DRG 552 $20,324 PER CASE
SUMMIT COUNTY INPATIENT COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC DRG 454 N/A PER CASE
SUMMIT COUNTY INPATIENT G.I. OBSTRUCTION W CC DRG 389 $11,418 PER CASE
SUMMIT COUNTY INPATIENT COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC DRG 455 N/A PER CASE
SUMMIT COUNTY INPATIENT DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC DRG 057 N/A PER CASE
SUMMIT COUNTY INPATIENT LOWER EXTREM  HUMER PROC EXCEPT HIPFOOTFEMUR W CC DRG 493 $36,474 PER CASE
SUMMIT COUNTY INPATIENT SIMPLE PNEUMONIA  PLEURISY W/O CC/MCC DRG 195 $8,698 PER CASE
SUMMIT COUNTY OUTPATIENT CARDIAC DIAGNOSTIC - ELECTROCARDIOGRAM TRACING CPT 93005 $322 PER PROCEDURE
SUMMIT COUNTY OUTPATIENT CARDIAC DIAGNOSTIC - CARDIOVASCULAR STRESS TEST CPT 93017 $596 PER PROCEDURE
SUMMIT COUNTY OUTPATIENT CARDIAC DIAGNOSTIC - ECHOCARDIOGRAM, TTE W/DOPPLER COMPLETE CPT 93306 $950 PER PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - COLONOSCOPY AND BIOPSY CPT 45380 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - DIAGNOSTIC COLONOSCOPY CPT 45378 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - EGD BIOPSY SINGLE/MULTIPLE CPT 43239 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - LAPAROSCOPIC CHOLECYSTECTOMY CPT 47562 $10,975 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - COLONOSCOPY W/LESION REMOVAL CPT 45385 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - HYSTEROSCOPY BIOPSY CPT 58558 $7,294 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - LAP ING HERNIA REPAIR INIT CPT 49650 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - LOW BACK DISK SURGERY CPT 63030 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - PRP I/HERN INIT REDUC >5 YR CPT 49505 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - KNEE ARTHROSCOPY/SURGERY CPT 29881 $8,268 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - LAPARO CHOLECYSTECTOMY/GRAPH CPT 47563 $14,020 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - CARE OF MISCARRIAGE CPT 59820 $4,346 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - TLH W/T/O 250 G OR LESS CPT 58571 $18,458 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - CYSTO/URETERO W/LITHOTRIPSY CPT 52356 $10,386 PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - EGD DIAGNOSTIC BRUSH WASH CPT 43235 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT SURGERY - INSERT TUNNELED CV CATH CPT 36561 N/A PER CASE, SINGLE PROCEDURE
SUMMIT COUNTY OUTPATIENT IMAGING - COMPUTED TOMOGRAPHY SCAN - CALCIUM SCORING CPT 75571 $99 PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - COMPUTED TOMOGRAPHY SCAN - LUNG SCREENING CPT G0297 $385 PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - COMPUTED TOMOGRAPHY SCAN - ALL OTHER CPT 70010-76499 $575 PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - MAGNETIC RESONANCE IMAGING - MRI CPT 70010-76499 $628 PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - DIAGNOSTIC X-RAY CPT 70010-76499 N/A PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - MAMMOGRAPHY CPT 77053-77067 $309 PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - POSITRON EMMISSION TOMOGRAHY - PET CPT 78491-78815 N/A PER SCAN
SUMMIT COUNTY OUTPATIENT IMAGING - ULTRASOUND CPT 76506-76999 $395 PER SCAN
SUMMIT COUNTY OUTPATIENT LAB - ASSAY THYROID STIM HORMONE CPT 84443 N/A PER PROCEDURE
SUMMIT COUNTY OUTPATIENT LAB - COMPREHEN METABOLIC PANEL CPT 80053 N/A PER PROCEDURE
SUMMIT COUNTY OUTPATIENT LAB - URINALYSIS AUTO W/O SCOPE CPT 81003 N/A PER PROCEDURE
SUMMIT COUNTY OUTPATIENT LAB - COMPLETE CBC W/AUTO DIFF WBC CPT 85025 $47 PER PROCEDURE
SUMMIT COUNTY OUTPATIENT LAB - METABOLIC PANEL TOTAL CA CPT 80048 N/A PER PROCEDURE
SUMMIT COUNTY OUTPATIENT LAB - VENIPUNCTURE CPT 36415 $3 PER PROCEDURE
SUMMIT COUNTY OUTPATIENT ANCILLARY - SLEEP STUDY FACILITY CPT 95805-95811 $3,467 PER VISIT
SUMMIT COUNTY OUTPATIENT ANCILLARY - PHYSICAL THERAPY REV 420-429 N/A PER VISIT
SUMMIT COUNTY OUTPATIENT ANCILLARY - OCCUPATIONAL THERAPY REV 430-439 N/A PER VISIT
SUMMIT COUNTY OUTPATIENT ANCILLARY - SPEECH THERAPY REV 440-449 N/A PER VISIT

Select Another Location

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.

Centura Health reserves the right to update or change any price at any time.

If you do not see the procedure or service you are looking for, or wish to receive a customized quote on a specific procedure, please request a custom estimate.