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 |
|---|---|---|---|---|
| Laser treatment of retina CPT 67040 | not published | not published | $327.59 – $2,002.17 | 38 |
| Lateral canthopexy CPT 21282 | not published | not published | $85.79 – $1,291.25 | 38 |
| Lat retinacular release open CPT 27425 | not published | not published | $110.87 – $1,487.08 | 38 |
| Lavage cannulation maxillary sinus CPT 31000 | not published | not published | $23.62 – $126.34 | 38 |
| Lavh >250 gms 58553 CPT 58553 | not published | not published | $262.42 – $4,445.47 | 38 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | $120.83 – $1,132.89 | 38 |
| Lead capillary CPT 83655 | $184.80 | $308.00 | $4.85 – $27.61 | 24 |
| Lefort i-1 piece without graft CPT 21141 | not published | not published | $338.73 – $1,532.70 | 19 |
| Lefort i-2 piece without graft CPT 21142 | not published | not published | $333.35 – $1,627.40 | 19 |
| Lefort i-3/> piece with graft CPT 21147 | not published | not published | $422.15 – $1,747.50 | 19 |
| Lefort i-3/> piece without graft CPT 21143 | not published | not published | $350.47 – $1,610.10 | 19 |
| Lefort ii anterior intrusion CPT 21150 | not published | not published | $445.83 – $3,404.27 | 38 |
| Leg vein fusion 34530 CPT 34530 | not published | not published | $257.45 – $1,458.10 | 19 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,554.60 | $2,591.00 | $24.89 – $549.90 | 20 |
| Leishmania antibody CPT 86717 | not published | not published | $3.97 – $27.93 | 24 |
| Lengthening of hand tendon CPT 26478 | not published | not published | $162.56 – $1,487.08 | 38 |
| Lengthening of palate CPT 42227 | not published | not published | $216.84 – $2,702.95 | 38 |
| Lengthening of palate+pharyngeal flap 42226 CPT 42226 | not published | not published | $220.31 – $2,702.95 | 38 |
| Lengthening of thigh tendon CPT 27393 | not published | not published | $127.54 – $3,321.81 | 38 |
| Lengthening of thigh tendons CPT 27394 | not published | not published | $165.25 – $3,321.81 | 38 |
| Lengthening of thigh tendons CPT 27395 | not published | not published | $223.67 – $1,487.08 | 38 |
| Lengthening or shortening - tibia and fibula 27715 CPT 27715 | not published | not published | $272.81 – $1,369.90 | 19 |
| Lengthen metacarpal/finger CPT 26568 | not published | not published | $232.60 – $4,474.49 | 38 |
| Lengthen radius or ulna CPT 25391 | not published | not published | $284.58 – $8,594.98 | 38 |
| Lengthen radius & ulna CPT 25393 | not published | not published | $321.63 – $4,222.89 | 38 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $587.40 | $979.00 | $95.04 – $349.20 | 19 |
| Leukacyte transfusion CPT 86950 | not published | not published | $18.52 – $249.33 | 24 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $4.10 – $23.69 | 24 |
| Levalbuterol non-comp unit HCPCS J7614 | $20.15 | $33.58 | $0.06 – $1.02 | 17 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $40.91 | $68.19 | $0.03 – $0.29 | 21 |
| Levetiracetam therapeutic drug level CPT 80177 | $225.00 | $375.00 | $6.54 – $30.21 | 22 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $64.88 | $108.13 | $0.40 – $7.13 | 21 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $690.62 | $1,151.04 | $21.12 – $23.76 | 9 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | not published | not published | $260.39 – $633.00 | 11 |
| Lidocaine therapeutic drug level CPT 80176 | $214.20 | $357.00 | $6.61 – $33.49 | 24 |
| Ligate leg veins open CPT 37761 | not published | not published | $161.97 – $1,515.56 | 38 |
| Ligate leg veins radical 37760 CPT 37760 | not published | not published | $160.73 – $1,515.56 | 38 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | not published | not published | $18.32 – $107.69 | 19 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $122.86 – $1,515.56 | 38 |
| Ligate/strip short leg vein CPT 37718 | not published | not published | $104.35 – $1,515.56 | 38 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | not published | not published | $83.61 – $1,553.00 | 38 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $49.75 – $668.59 | 38 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $64.81 – $1,515.56 | 38 |
| Ligation external carotid artery 37600 CPT 37600 | not published | not published | $184.59 – $504.07 | 19 |
| Ligation internal/common carotid artery 37605 CPT 37605 | not published | not published | $210.93 – $565.85 | 19 |
| Ligation internal jugular vein 37565 CPT 37565 | not published | not published | $176.57 – $515.42 | 19 |
| Ligation/major artery/extremity 37618 CPT 37618 | not published | not published | $95.49 – $461.50 | 19 |
| Ligation major artery neck CPT 37615 | not published | not published | $118.34 – $528.10 | 19 |
| Ligation nasal sinus artery CPT 30915 | not published | not published | $130.56 – $1,515.56 | 38 |
| Ligation of abdomen artery 37617 CPT 37617 | not published | not published | $332.71 – $1,206.30 | 19 |
| Ligation of femoral vein CPT 37650 | not published | not published | $131.10 – $1,515.56 | 38 |
| Ligation of inf vena cava CPT 37619 | not published | not published | $496.19 – $2,245.90 | 19 |
| Ligation of neck artery CPT 37606 | not published | not published | $138.21 – $600.30 | 19 |
| Ligation of salivary duct CPT 42665 | not published | not published | $47.58 – $1,291.25 | 38 |
| Ligation upper jaw artery CPT 30920 | not published | not published | $187.16 – $1,515.56 | 38 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | not published | not published | $66.55 – $1,515.56 | 38 |
| Lig/band angioaccess av fistula CPT 37607 | not published | not published | $97.40 – $1,515.56 | 38 |
| Lig&div&compl strpg saph vn CPT 37735 | not published | not published | $164.04 – $1,515.56 | 38 |
| Limb exercise test CPT 95875 | not published | not published | $19.66 – $41.72 | 20 |
| Limited visual field xm CPT 92081 | not published | not published | $6.13 – $18.20 | 19 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $130.49 | $217.48 | $3.30 – $21.21 | 20 |
| Lipase CPT 83690 | $170.40 | $284.00 | $3.26 – $15.71 | 24 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | $81.24 – $1,291.25 | 38 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $12.45 – $77.20 | 24 |
| Lipoprotein blood quant CPT 83704 | $265.80 | $443.00 | $15.58 – $77.95 | 22 |
| Lipoprotein direct measurement hdl CPT 83718 | $90.60 | $151.00 | $3.87 – $18.67 | 24 |
| Lipoprotein direct measurement ldl CPT 83721 | $100.80 | $168.00 | $3.97 – $23.94 | 24 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $14.02 – $77.95 | 22 |
| Lip surgery procedure CPT 40799 | not published | not published | $0.01 – $87.15 | 17 |
| Listeria monocytogenes CPT 86723 | not published | not published | $5.29 – $30.07 | 24 |
| Lithium therapeutic drug level CPT 80178 | $127.80 | $213.00 | $3.13 – $15.07 | 24 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | not published | not published | $133.22 – $133.22 | 8 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | not published | not published | $265.13 – $840.00 | 19 |
| Liver elastography 91200 CPT 91200 | not published | not published | $7.73 – $495.69 | 20 |
| Liver Function Test CPT 80076 | $231.00 | $385.00 | $2.99 – $18.63 | 24 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $314.26 – $998.37 | 19 |
| Liver imaging CPT 78201 | not published | not published | $15.23 – $338.34 | 41 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $17.05 – $366.36 | 41 |
| Liver/spleen imag static only CPT 78215 | $1,250.40 | $2,084.00 | $17.33 – $348.41 | 41 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $18.55 – $249.61 | 41 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $8.36 – $51.12 | 19 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $123.51 – $1,487.08 | 38 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $2.57 | $4.29 | $0.84 – $3.51 | 21 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $38.73 | $64.55 | $0.69 – $3.29 | 22 |
| Loudness balance test CPT 92562 | not published | not published | $3.99 – $30.91 | 19 |
| Low back disk surgery CPT 63030 | not published | not published | $196.26 – $3,321.81 | 38 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,731.00 | $2,885.00 | $45.27 – $448.02 | 41 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $939.60 | $1,566.00 | $43.10 – $650.00 | 42 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,245.00 | $2,075.00 | $35.75 – $650.00 | 42 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,501.40 | $4,169.00 | $82.27 – $700.00 | 42 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,767.20 | $4,612.00 | $64.01 – $485.37 | 41 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,845.60 | $3,076.00 | $53.39 – $700.00 | 42 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $302.40 | $504.00 | $4.83 – $250.00 | 23 |
| Lower jaw bone graft CPT 21215 | not published | not published | $217.88 – $3,692.26 | 38 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $17.02 – $700.25 | 19 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $193.98 – $4,445.47 | 38 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $218.48 – $4,445.47 | 38 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $214.87 – $4,445.47 | 38 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $236.36 – $4,445.47 | 38 |
| L/s ratio fetal lung CPT 83661 | $76.80 | $128.00 | $3.97 – $50.14 | 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.