Covenant Medical Center — price list

← Hospital overviewVerified from Covenant Medical Center’s published price file

Includes cash prices, list prices. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

1,500 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM Outpatient	82306 HCPCS	$370	$155	—	—
HC 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED CDM Inpatient & outpatient	82306 HCPCS	$412	$173	—	—
HC ACC SYS BMX96 80 STR 105 BER BMX9680BER105 Inpatient & outpatient	C1887 HCPCS	$6,208	$2,607	—	—
HC ACC SYS BMX96 90 MP 125 BER BMX9690MBER125 Inpatient & outpatient	C1887 HCPCS	$6,208	$2,607	—	—
HC ACC SYS BMX96 90 STR 125 BER BMX9690BER125 Inpatient & outpatient	C1887 HCPCS	$6,208	$2,607	—	—
HC ACC SYS BMX96 90 STR 125 SIM BMX9690SIM125 Inpatient & outpatient	C1887 HCPCS	$6,208	$2,607	—	—
HC ACCUDRAIN W/O ANTI REFLUX VAL INS8400 Inpatient & outpatient	C1729 HCPCS	$2,711	$1,139	—	—
HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB Outpatient	82040 HCPCS	$62.00	$26.04	—	—
HC ALBUMIN SERUM PLASMA/WHOLE BLOOD LAB Inpatient & outpatient	82040 HCPCS	$319	$134	—	—
HC ALGRFT GRAFIX PRIME 1.5X2CM PS11015 3SQCM Inpatient & outpatient	Q4133 HCPCS	$1,729	$726	—	—
HC ALGRFT GRAFIX PRIME PLS 16MM 2SQCM PS13016 Inpatient & outpatient	Q4133 HCPCS	$1,729	$726	—	—
HC ALGRFT GRAFIX PRIME PLS 2X3CM PS13023 6SQCM Inpatient & outpatient	Q4133 HCPCS	$1,078	$453	—	—
HC ALGRFT GRAFIX PRIME PLS 3X4CM PS13034 12SQCM Inpatient & outpatient	Q4133 HCPCS	$624	$262	—	—
HC ALGRFT TISS EPIFIX 18MM DISK GS5180 Inpatient & outpatient	Q4186 HCPCS	$1,624	$682	—	—
HC ALGRFT TISS EPIFIX 2X2CM GS5220 Inpatient & outpatient	Q4186 HCPCS	$1,639	$688	—	—
HC ALGRFT TISS EPIFIX 2X4CM GS5240 Inpatient & outpatient	Q4186 HCPCS	$1,088	$457	—	—
HC ALGRFT TISS EPIFIX 4X4CM GS5440 Inpatient & outpatient	Q4186 HCPCS	$931	$391	—	—
HC ALGRFT TISS EPIFIX 5X6CM GS5560 Inpatient & outpatient	Q4186 HCPCS	$875	$368	—	—
HC ALKALINE PHOS Outpatient	84075 HCPCS	$65.00	$27.30	—	—
HC ALKALINE PHOS Inpatient & outpatient	84075 HCPCS	$246	$103	—	—
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH Outpatient	86003 HCPCS	$59.00	$24.78	—	—
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH Inpatient & outpatient	86003 HCPCS	$122	$51.24	—	—
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB Outpatient	86003 HCPCS	$59.00	$24.78	—	—
HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH LAB Inpatient & outpatient	86003 HCPCS	$122	$51.24	—	—
HC ALLERGEN SPECIFIC IGE Outpatient	86003 HCPCS	$59.00	$24.78	—	—
HC ALLERGEN SPECIFIC IGE Inpatient & outpatient	86003 HCPCS	$122	$51.24	—	—
HC ALLERGEN SPECIFIC IGE - IGE QUANT Outpatient	86003 HCPCS	$59.00	$24.78	—	—
HC ALLERGEN SPECIFIC IGE - IGE QUANT Inpatient & outpatient	86003 HCPCS	$122	$51.24	—	—
HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN Outpatient	86003 HCPCS	$59.00	$24.78	—	—
HC ALLERGEN SPECIFIC IGE PANEL EACH ALLERGEN Inpatient & outpatient	86003 HCPCS	$122	$51.24	—	—