Ascension St. Vincent Carmel Ambulatory Surgery Center
13421 Old Meridian St., Carmel, IN · Ascension · · NPI 1497782833
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $413.40 | $689.00 | $7.93 – $42.36 | 25 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $430.20 | $717.00 | $7.93 – $42.23 | 25 |
| Gonioscopy CPT 92020 | not published | not published | $2.44 – $19.25 | 20 |
| Goniotomy CPT 65820 | not published | not published | $139.99 – $2,002.17 | 39 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $1,577.10 | $2,628.50 | $184.15 – $1,934.33 | 43 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $3,642.00 | $6,070.00 | $30.40 – $108.92 | 21 |
| Graft axiofill 1000mg HCPCS J3590 | $2,890.20 | $4,817.00 | $0.01 – $0.01 | 11 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $10,096.80 | $16,828.00 | $0.01 – $337.67 | 21 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $139.53 – $1,487.08 | 39 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $23,233.80 | $38,723.00 | $31.05 – $108.92 | 21 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $4,177.80 | $6,963.00 | $33.35 – $108.92 | 21 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $10,983.60 | $18,306.00 | $37.56 – $187.92 | 21 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $222.43 – $1,241.90 | 20 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $5,781.00 | $9,635.00 | $37.56 – $239.03 | 21 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $5,176.20 | $8,627.00 | $20.63 – $108.92 | 21 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $19,062.00 | $31,770.00 | $37.56 – $108.92 | 18 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $9,120.60 | $15,201.00 | $37.56 – $394.70 | 21 |
| Granisetron 1 mg tab HCPCS Q0166 | $10.04 | $16.74 | $1.46 – $6.75 | 22 |
| Granisetron hcl injection HCPCS J1626 | $41.81 | $69.69 | $0.53 – $4.36 | 23 |
| Great toe with reduction 28495 CPT 28495 | not published | not published | $29.42 – $125.66 | 39 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $75.95 – $926.15 | 33 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $75.10 – $1,822.02 | 33 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $22.29 – $130.32 | 14 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $75.63 – $1,822.02 | 33 |
| Growth hormone antibody CPT 86277 | not published | not published | $7.77 – $35.89 | 25 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $11.97 – $172.37 | 23 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $415.72 – $1,564.10 | 20 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $152.91 – $631.30 | 20 |
| G-tube reposition CPT 43761 | $1,395.00 | $2,325.00 | $25.48 – $1,416.85 | 40 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $16.48 – $939.74 | 23 |
| Guided cath fluid drainage 10030 CPT 10030 | $3,337.20 | $5,562.00 | $26.34 – $3,559.68 | 41 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $5,511.60 | $9,186.00 | $318.77 – $406.45 | 16 |
| Guid loc target vol rad tx CPT 77387 | $526.20 | $877.00 | $60.11 – $154.80 | 14 |
| Gum graft CPT 41870 | not published | not published | $70.20 – $652.86 | 33 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $63.92 – $1,438.67 | 39 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $11.67 – $318.97 | 33 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $35.40 – $247.61 | 33 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $56.12 – $353.36 | 33 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $130.49 | $217.48 | $8.78 – $33.98 | 22 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $38.87 | $64.78 | $1.42 – $6.26 | 22 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | not published | not published | $2.85 – $11.58 | 21 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $151.21 – $1,487.08 | 39 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $118.89 – $3,321.81 | 39 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $133.45 – $1,487.08 | 39 |
| Hand X-ray CPT 73130 | $403.20 | $672.00 | $3.88 – $250.00 | 24 |
| Haptoglobin quantitative CPT 83010 | $243.00 | $405.00 | $5.29 – $28.68 | 25 |
| Harvest allogeneic stem cell CPT 38205 | not published | not published | $15.93 – $133.20 | 20 |
| Harvest auto stem cells CPT 38206 | not published | not published | $16.00 – $779.23 | 39 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $20.08 – $926.15 | 39 |
| Harvest eye tissue alograft CPT 68371 | not published | not published | $77.33 – $958.01 | 39 |
| Harvest femoropopliteal vein 35572 CPT 35572 | not published | not published | $85.91 – $488.00 | 20 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $8.40 – $14.72 | 14 |
| Harvest vein for bypass 35500 CPT 35500 | not published | not published | $79.35 – $410.00 | 20 |
| Hast w/i&r phys/qhp CPT 94452 | not published | not published | $9.51 – $42.47 | 20 |
| Hast w/oxygen titrate CPT 94453 | not published | not published | $13.17 – $63.03 | 20 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $240.00 – $1,368.00 | 23 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | not published | not published | $80.96 – $461.47 | 23 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $150.10 – $855.57 | 23 |
| Hbb full gene sequence CPT 81364 | not published | not published | $129.83 – $740.04 | 21 |
| Hbb gene com variants CPT 81361 | not published | not published | $69.92 – $398.57 | 21 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $80.96 – $461.47 | 16 |
| Hbb gene known fam variant CPT 81362 | $1,033.20 | $1,722.00 | $150.10 – $855.57 | 16 |
| Hbot, full body chamber, 30m HCPCS G0277 | $490.80 | $818.00 | $7.24 – $52.77 | 14 |
| Hc ea ha check monaural CPT 92594 | $90.00 | $150.00 | $4.85 – $30.00 | 20 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | $258.00 | $430.00 | $24.63 – $779.20 | 42 |
| Hcg free betachain test CPT 84704 | not published | not published | $7.36 – $34.86 | 23 |
| Hcg qualitative CPT 84703 | $189.00 | $315.00 | $3.55 – $17.15 | 25 |
| Hcg quantitative CPT 84702 | $315.60 | $526.00 | $7.01 – $34.31 | 25 |
| Hc hearing aid chck binaurl CPT 92593 | $98.40 | $164.00 | $30.00 – $45.42 | 20 |
| Hc hearing aid chck monarl CPT 92592 | $73.20 | $122.00 | $20.00 – $34.27 | 20 |
| Hc hearing aid exam both ears CPT 92591 | $214.80 | $358.00 | $44.19 – $110.00 | 20 |
| Hc hearing aid exam one ear CPT 92590 | $131.40 | $219.00 | $37.72 – $70.00 | 20 |
| Hc i-131 sodium iodide cap dx per mci HCPCS A9528 | $22.20 | $37.00 | $0.70 – $24.66 | 12 |
| Hc metata joint dislocation anes CPT 28635 | not published | not published | $26.04 – $801.87 | 39 |
| Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks CPT 17311 | not published | not published | $59.89 – $446.16 | 39 |
| Hc mohs micrographic h/n/h/f/g each addl stage CPT 17312 | not published | not published | $31.84 – $261.33 | 20 |
| Hc mohs trunk/arm/leg 1st stage 5 blocks CPT 17313 | not published | not published | $53.69 – $416.91 | 39 |
| Hc mohs trunk/arm/leg ea addl block any stage CPT 17315 | not published | not published | $8.40 – $59.65 | 20 |
| Hc mohs trunk/arm/leg ea stage after 1st stage CPT 17314 | not published | not published | $29.54 – $250.51 | 20 |
| Hc nm cardiac blood pool planar 1 stdy wal motn eject fract CPT 78481 | not published | not published | $25.40 – $327.11 | 42 |
| Hc nm fusion spect CT unlisted CPT 78999 | $6,829.80 | $11,383.00 | $0.01 – $6,659.05 | 38 |
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $17.33 – $387.93 | 42 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | not published | not published | $32.63 – $368.53 | 42 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | not published | not published | $51.75 – $2,255.47 | 42 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | $18,754.80 | $31,258.00 | $31.15 – $4,631.00 | 19 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | $7,490.40 | $12,484.00 | $45.39 – $445.15 | 40 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | $9,365.40 | $15,609.00 | $84.60 – $810.81 | 40 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | $9,830.40 | $16,384.00 | $128.94 – $1,279.42 | 40 |
| Hdr rdncl skn surf brachytx CPT 77767 | not published | not published | $31.56 – $344.11 | 40 |
| Hdr rdncl skn surf brachytx CPT 77768 | not published | not published | $49.26 – $565.59 | 40 |
| Head CT scan (with and without contrast) CPT 70470 | $542.40 | $904.00 | $39.50 – $650.00 | 43 |
| Head CT scan (with contrast) CPT 70460 | $542.40 | $904.00 | $33.31 – $650.00 | 43 |
| Head CT scan (without contrast) CPT 70450 | $542.40 | $904.00 | $23.94 – $650.00 | 43 |
| Heart first pass add-on CPT 78496 | not published | not published | $6.50 – $81.60 | 21 |
| Heart first pass multiple CPT 78483 | not published | not published | $35.21 – $346.26 | 42 |
| Heart image spect CPT 78494 | not published | not published | $32.73 – $346.26 | 42 |
| Heart infarct image CPT 78466 | not published | not published | $21.15 – $303.17 | 42 |
| Heart infarct image (ef) CPT 78468 | not published | not published | $27.28 – $327.11 | 42 |
| Heart tmr w/other procedure 33141 CPT 33141 | not published | not published | $32.32 – $347.50 | 20 |
| Heinz bodies direct CPT 85441 | not published | not published | $1.32 – $9.58 | 25 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.