Ascension St. Vincent Salem (St. Vincent Salem Hospital, Inc.)
911 N Shelby St, Salem, IN · Ascension · · NPI 1427388982
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 |
|---|---|---|---|---|
| Glaucoma surgery CPT 66155 | not published | not published | $195.47 – $2,757.77 | 38 |
| Glaucoma surgery CPT 66160 | not published | not published | $222.42 – $1,158.89 | 38 |
| Glaucoma surgery CPT 66170 | not published | not published | $269.09 – $1,227.61 | 38 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $351.53 | $585.88 | $174.77 – $522.52 | 41 |
| Glucagon plasma - sendout CPT 82943 | $172.80 | $288.00 | $4.87 – $32.58 | 24 |
| Glucose 1 hr post dose CPT 82950 | $70.20 | $117.00 | $2.25 – $10.83 | 24 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $2.65 – $13.79 | 24 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $47.40 | $79.00 | $1.32 – $7.48 | 24 |
| Glucose blood quantitative CPT 82947 | $71.40 | $119.00 | $1.94 – $8.96 | 24 |
| Glucose body fluid CPT 82945 | $88.20 | $147.00 | $1.94 – $9.07 | 24 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $11.38 – $218.24 | 20 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $223.20 | $372.00 | $4.63 – $29.34 | 24 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $13.80 | $23.00 | $1.80 – $8.94 | 24 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $120.40 | $200.66 | $0.62 – $1.15 | 12 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $277.20 | $462.00 | $7.93 – $42.36 | 24 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $334.80 | $558.00 | $7.93 – $42.23 | 24 |
| Gonioscopy CPT 92020 | not published | not published | $2.44 – $19.25 | 19 |
| Goniotomy CPT 65820 | not published | not published | $172.85 – $2,002.17 | 38 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $217.31 – $1,487.08 | 38 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $222.43 – $1,241.90 | 19 |
| Great toe with reduction 28495 CPT 28495 | not published | not published | $37.30 – $125.66 | 38 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $99.49 – $926.15 | 32 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $98.37 – $1,822.02 | 32 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $29.59 – $130.32 | 13 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $98.99 – $1,822.02 | 32 |
| Growth hormone antibody CPT 86277 | not published | not published | $7.77 – $35.89 | 24 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $11.97 – $172.37 | 22 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $415.72 – $1,564.10 | 19 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $152.91 – $631.30 | 19 |
| G-tube reposition CPT 43761 | not published | not published | $25.48 – $125.52 | 38 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $16.48 – $939.74 | 22 |
| Guided cath fluid drainage 10030 CPT 10030 | not published | not published | $32.81 – $1,563.42 | 39 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $12,765.00 | $21,275.00 | $334.73 – $406.45 | 15 |
| Guid loc target vol rad tx CPT 77387 | not published | not published | $60.11 – $154.80 | 13 |
| Gum graft CPT 41870 | not published | not published | $70.20 – $652.86 | 32 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $63.92 – $1,438.67 | 38 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $13.10 – $318.97 | 32 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $38.55 – $247.61 | 32 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $58.62 – $353.36 | 32 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $51.04 | $85.07 | $8.78 – $33.98 | 21 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $38.87 | $64.78 | $1.42 – $6.26 | 21 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | not published | not published | $2.85 – $11.58 | 20 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $205.47 – $1,487.08 | 38 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $162.10 – $3,321.81 | 38 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $181.62 – $1,487.08 | 38 |
| Hand X-ray CPT 73130 | $609.60 | $1,016.00 | $3.88 – $250.00 | 23 |
| Haptoglobin quantitative CPT 83010 | $171.60 | $286.00 | $5.29 – $28.68 | 24 |
| Harvest allogeneic stem cell CPT 38205 | not published | not published | $23.04 – $133.20 | 19 |
| Harvest auto stem cells CPT 38206 | not published | not published | $23.15 – $779.23 | 38 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $22.38 – $926.15 | 38 |
| Harvest eye tissue alograft CPT 68371 | not published | not published | $97.15 – $958.01 | 38 |
| Harvest femoropopliteal vein 35572 CPT 35572 | not published | not published | $93.23 – $488.00 | 19 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $8.40 – $14.72 | 13 |
| Harvest vein for bypass 35500 CPT 35500 | not published | not published | $86.60 – $410.00 | 19 |
| Hast w/i&r phys/qhp CPT 94452 | not published | not published | $10.40 – $42.47 | 19 |
| Hast w/oxygen titrate CPT 94453 | not published | not published | $13.46 – $63.03 | 19 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $240.00 – $1,368.00 | 22 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | not published | not published | $80.96 – $461.47 | 22 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $150.10 – $855.57 | 22 |
| Hbb full gene sequence CPT 81364 | not published | not published | $129.83 – $740.04 | 20 |
| Hbb gene com variants CPT 81361 | not published | not published | $69.92 – $398.57 | 20 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $80.96 – $461.47 | 15 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $150.10 – $855.57 | 15 |
| Hc ea ha check monaural CPT 92594 | not published | not published | $4.85 – $30.00 | 19 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | not published | not published | $24.63 – $779.20 | 41 |
| Hcg free betachain test CPT 84704 | not published | not published | $7.36 – $34.86 | 22 |
| Hcg qualitative CPT 84703 | $138.60 | $231.00 | $3.55 – $17.15 | 24 |
| Hcg quantitative CPT 84702 | $275.40 | $459.00 | $7.01 – $34.31 | 24 |
| Hc hearing aid chck binaurl CPT 92593 | not published | not published | $30.00 – $45.42 | 19 |
| Hc hearing aid chck monarl CPT 92592 | not published | not published | $20.00 – $34.27 | 19 |
| Hc hearing aid exam both ears CPT 92591 | not published | not published | $44.19 – $110.00 | 19 |
| Hc hearing aid exam one ear CPT 92590 | not published | not published | $37.72 – $70.00 | 19 |
| Hc metata joint dislocation anes CPT 28635 | not published | not published | $35.62 – $801.87 | 38 |
| Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks CPT 17311 | not published | not published | $64.26 – $446.16 | 38 |
| Hc mohs micrographic h/n/h/f/g each addl stage CPT 17312 | not published | not published | $34.22 – $261.33 | 19 |
| Hc mohs trunk/arm/leg 1st stage 5 blocks CPT 17313 | not published | not published | $57.72 – $416.91 | 38 |
| Hc mohs trunk/arm/leg ea addl block any stage CPT 17315 | not published | not published | $9.04 – $59.65 | 19 |
| Hc mohs trunk/arm/leg ea stage after 1st stage CPT 17314 | not published | not published | $31.65 – $250.51 | 19 |
| Hc nm cardiac blood pool planar 1 stdy wal motn eject fract CPT 78481 | not published | not published | $30.49 – $327.11 | 41 |
| Hc nm fusion spect CT unlisted CPT 78999 | not published | not published | $0.01 – $249.61 | 32 |
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $17.33 – $387.93 | 41 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | not published | not published | $32.63 – $368.53 | 41 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | not published | not published | $51.75 – $2,255.47 | 41 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | not published | not published | $31.15 – $31.15 | 11 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | not published | not published | $45.39 – $445.15 | 39 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | not published | not published | $84.60 – $810.81 | 39 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | not published | not published | $128.94 – $1,279.42 | 39 |
| Hdr rdncl skn surf brachytx CPT 77767 | not published | not published | $31.56 – $344.11 | 39 |
| Hdr rdncl skn surf brachytx CPT 77768 | not published | not published | $49.26 – $565.59 | 39 |
| Head CT scan (with and without contrast) CPT 70470 | $1,749.60 | $2,916.00 | $43.36 – $650.00 | 42 |
| Head CT scan (with contrast) CPT 70460 | $1,279.80 | $2,133.00 | $35.79 – $650.00 | 42 |
| Head CT scan (without contrast) CPT 70450 | $1,252.80 | $2,088.00 | $28.11 – $650.00 | 42 |
| Heart first pass add-on CPT 78496 | not published | not published | $13.85 – $81.60 | 20 |
| Heart first pass multiple CPT 78483 | not published | not published | $44.08 – $346.26 | 41 |
| Heart image spect CPT 78494 | not published | not published | $38.74 – $346.26 | 41 |
| Heart infarct image CPT 78466 | not published | not published | $21.15 – $303.17 | 41 |
| Heart infarct image (ef) CPT 78468 | not published | not published | $27.28 – $327.11 | 41 |
| Heart tmr w/other procedure 33141 CPT 33141 | not published | not published | $41.23 – $347.50 | 19 |
| Heinz bodies direct CPT 85441 | not published | not published | $1.32 – $9.58 | 24 |
| Helicobacter pylori antibody igm CPT 86677 | $231.60 | $386.00 | $5.29 – $38.42 | 24 |
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.