Hospital Lima, OH

Mercy Health St Ritas Medical Center

Mercy Health St Ritas Medical Center in Lima, OH publishes cash prices for 347 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Ohio median for 265 of 347 procedures and below it for 80. By typical cash price it ranks #122 of 139 Ohio hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

730 W. Market St.,Lima,OH 45801 Collected Sep 23, 2026 Source price file Check a bill from this hospital (419) 227-3361

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 360066 · CMS hospital register NPI 1811939887

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Mercy Health St Ritas Medical Center is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

State law

This state limits hospital bills for lower-income patients

Ohio's Hospital Care Assurance Program (HCAP): Ohio residents who are not on Medicaid and whose income is at or below 100% of the federal poverty level get basic, medically necessary hospital services free at hospitals in the program; physician bills are not included. Ask the hospital's billing office for an HCAP application. Other states' laws.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT Abd W&W/O Cont	$1,857.60	$3,096.00	—	40% above	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W&W/O Cont	$2,158.20	$3,597.00	—	—	40%
Abdominal X-ray, 2 views CPT 74019 HC X-Ray Exam Abdomen 2 Views	$417.00	$695.00	—	23% above	40%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-Ray Exam Abdomen 2 Views	$417.00	$695.00	—	—	40%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-Ray Ankle Rout 3 Views	$417.60	$696.00	—	31% above	40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-Ray Ankle Rout 3 Views	$417.60	$696.00	—	—	40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity W/O Contrast	$1,408.20	$2,347.00	—	49% above	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT Upper Extremity W/O Contrast	$1,636.80	$2,728.00	—	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Fluro Esophagram	$471.00	$785.00	—	6% above	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Fluro Esophagram	$471.00	$785.00	—	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM Bone Scan Whole Body	$2,445.60	$4,076.00	—	59% above	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM Bone Scan Whole Body	$2,445.60	$4,076.00	—	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$1,300.20	$2,167.00	—	39% below	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$1,510.80	$2,518.00	—	—	40%
CT angiography (CTA) of the head CPT 70496 HC Cta Head W & W/O Cont	$1,330.80	$2,218.00	—	at median	40%
CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head W & W/O Cont	$1,330.80	$2,218.00	—	—	40%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,168.20	$1,947.00	—	10% below	40%
CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,168.20	$1,947.00	—	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Angio Chest W & W/O Cont	$1,143.00	$1,905.00	—	19% below	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Angio Chest W & W/O Cont	$1,327.80	$2,213.00	—	—	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC Cta Heart W/WO Calcium	$1,865.40	$3,109.00	—	16% above	40%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 HC Cta Heart W/WO Calcium	$2,168.40	$3,614.00	—	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$192.00	$192.00	—	31% below	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$192.00	$192.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abd/Pelvis W/O Contrast	$1,828.20	$3,047.00	—	15% above	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,290.20	$3,817.00	—	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pel W Cont	$3,134.40	$5,224.00	—	58% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pel W Cont	$4,555.20	$7,592.00	—	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$3,955.80	$6,593.00	—	69% above	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$4,599.00	$7,665.00	—	—	40%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/ Cont	$1,306.80	$2,178.00	—	12% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/ Cont	$1,897.80	$3,163.00	—	—	40%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen W/O Cont	$1,306.80	$2,178.00	—	25% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abdomen W/O Cont	$1,636.80	$2,728.00	—	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Facial Bones W/O Contrast	$1,007.40	$1,679.00	—	15% above	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Facial Bones W/O Contrast	$1,007.40	$1,679.00	—	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Brain W/O Contrast	$1,009.20	$1,682.00	—	21% above	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Brain W/O Contrast	$1,009.20	$1,682.00	—	—	40%
CT scan of the head with contrast CPT 70460 HC CT Brain W/ Contrast	$1,668.60	$2,781.00	—	66% above	40%
CT scan of the head with contrast inpatient CPT 70460 HC CT Brain W/ Contrast	$1,668.60	$2,781.00	—	—	40%
CT scan of the head without and with contrast CPT 70470 HC CT Brain W/WO Contrast	$1,900.80	$3,168.00	—	60% above	40%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT Brain W/WO Contrast	$1,900.80	$3,168.00	—	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-Spine W/O Contrast	$985.80	$1,643.00	—	10% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-Spine W/O Contrast	$1,146.00	$1,910.00	—	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-Spine W/O Contrast	$886.80	$1,478.00	—	17% below	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-Spine W/O Contrast	$1,031.40	$1,719.00	—	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast	$1,633.20	$2,722.00	—	33% above	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast	$1,897.80	$3,163.00	—	—	40%
Chest CT scan without and with contrast CPT 71270 HC CT Chest W/WO Contrast	$1,857.60	$3,096.00	—	23% above	40%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT Chest W/WO Contrast	$2,158.20	$3,597.00	—	—	40%
Chest X-ray, 2 views CPT 71046 HC X-Ray Exam Chest 2 Views	$324.00	$540.00	—	23% above	40%
Chest X-ray, 2 views inpatient CPT 71046 HC X-Ray Exam Chest 2 Views	$426.60	$711.00	—	—	40%
Chest X-ray, single view CPT 71045 HC X-Ray Exam Chest 1 View	$213.60	$356.00	—	4% below	40%
Chest X-ray, single view inpatient CPT 71045 HC X-Ray Exam Chest 1 View	$213.60	$356.00	—	—	40%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-Ray Clavicle	$468.60	$781.00	—	73% above	40%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-Ray Clavicle	$468.60	$781.00	—	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa Axial Skeleton	$349.80	$583.00	—	23% below	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Dexa Axial Skeleton	$69.00	$115.00	—	—	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC Dexa Appendicular Skeleton	$303.00	$505.00	—	18% above	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC Dexa Appendicular Skeleton	$58.20	$97.00	—	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast	$915.00	$1,525.00	—	3% below	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast	$1,146.00	$1,910.00	—	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest W/ Contrast	$979.20	$1,632.00	—	19% below	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Chest W/ Contrast	$1,327.80	$2,213.00	—	—	40%
Elbow X-ray, 2 views CPT 73070 HC Elbow 2 Views	$303.60	$506.00	—	16% above	40%
Elbow X-ray, 2 views inpatient CPT 73070 HC Elbow 2 Views	$303.60	$506.00	—	—	40%
Elbow X-ray, complete, 3 or more views CPT 73080 HC Elbow Min 3 Views	$464.40	$774.00	—	47% above	40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC Elbow Min 3 Views	$464.40	$774.00	—	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$1,441.20	$2,402.00	—	67% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$1,441.20	$2,402.00	—	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Facial Bones Min 3 Views	$656.40	$1,094.00	—	74% above	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Facial Bones Min 3 Views	$656.40	$1,094.00	—	—	40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Forearm 2 Views	$472.80	$788.00	—	74% above	40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Forearm 2 Views	$472.80	$788.00	—	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$2,232.60	$3,721.00	—	41% above	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$2,232.60	$3,721.00	—	—	40%
Hand X-ray, 2 views CPT 73120 HC Hand 2 Views	$424.80	$708.00	—	59% above	40%
Hand X-ray, 2 views inpatient CPT 73120 HC Hand 2 Views	$424.80	$708.00	—	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-Ray Os Calcis Min 2 Views	$394.20	$657.00	—	45% above	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-Ray Os Calcis Min 2 Views	$394.20	$657.00	—	—	40%
Knee X-ray, 3 views CPT 73562 HC X-Ray Knee 3 Views	$463.20	$772.00	—	31% above	40%
Knee X-ray, 3 views inpatient CPT 73562 HC X-Ray Knee 3 Views	$463.20	$772.00	—	—	40%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$448.20	$747.00	—	14% above	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$448.20	$747.00	—	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Ext W/O Cont	$1,408.20	$2,347.00	—	49% above	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT Lower Ext W/O Cont	$1,636.80	$2,728.00	—	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$192.00	$320.00	—	35% below	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$192.00	$320.00	—	—	40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$492.00	$820.00	—	80% above	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$492.00	$820.00	—	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-Spine Min 4 Views	$834.00	$1,390.00	—	86% above	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-Spine Min 4 Views	$834.00	$1,390.00	—	—	40%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$1,168.20	$1,947.00	—	1% below	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$1,168.20	$1,947.00	—	—	40%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$1,441.20	$2,402.00	—	56% above	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$1,441.20	$2,402.00	—	—	40%
Neck soft tissue X-ray CPT 70360 HC Soft Tissue Lat Neck	$309.00	$515.00	—	19% above	40%
Neck soft tissue X-ray inpatient CPT 70360 HC Soft Tissue Lat Neck	$309.00	$515.00	—	—	40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM Sest. Rest Stress Mult	$6,753.60	$11,256.00	—	68% above	40%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM Sest. Rest Stress Mult	$6,753.60	$11,256.00	—	—	40%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast	$1,408.20	$2,347.00	—	40% above	40%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast	$1,636.80	$2,728.00	—	—	40%
Rib X-ray, one side, 2 views one side CPT 71100 HC Ribs Unilateral 2 Views	$402.60	$671.00	—	32% above	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Ribs Unilateral 2 Views	$402.60	$671.00	—	—	40%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$514.80	$858.00	—	35% above	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$514.80	$858.00	—	—	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Shoulder Complete Min 2 Views	$427.20	$712.00	—	27% above	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Shoulder Complete Min 2 Views	$427.20	$712.00	—	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Sinuses Min 3 Views	$57.00	$95.00	—	84% below	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Sinuses Min 3 Views	$57.00	$95.00	—	—	40%
Skull X-ray, fewer than 4 views CPT 70250 HC Skull Less Than 4 Views	$554.40	$924.00	—	92% above	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Skull Less Than 4 Views	$554.40	$924.00	—	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Dysphagia/Swallowing Study	$564.60	$941.00	—	12% above	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Dysphagia/Swallowing Study	$564.60	$941.00	—	—	40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$512.40	$854.00	—	89% above	40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$512.40	$854.00	—	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-Spine W/O Contrast	$1,408.20	$2,347.00	—	55% above	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-Spine W/O Contrast	$1,636.80	$2,728.00	—	—	40%
Toe X-ray, 2 or more views CPT 73660 HC X-Ray Toes Min 2 Views	$367.20	$612.00	—	47% above	40%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-Ray Toes Min 2 Views	$367.20	$612.00	—	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$772.80	$1,288.00	—	30% above	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$772.80	$1,288.00	—	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Humerus Min 2 View	$375.60	$626.00	—	37% above	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC Humerus Min 2 View	$375.60	$626.00	—	—	40%
Wrist X-ray, 2 views CPT 73100 HC Xr Wrist 2 Views	$414.60	$691.00	—	59% above	40%
Wrist X-ray, 2 views inpatient CPT 73100 HC Xr Wrist 2 Views	$414.60	$691.00	—	—	40%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Wrist Min 3 Views	$499.20	$832.00	—	49% above	40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Wrist Min 3 Views	$499.20	$832.00	—	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$379.80	$633.00	—	23% above	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$379.80	$633.00	—	—	40%
X-ray of the abdomen, 1 view CPT 74018 HC X-Ray Exam Abdomen 1 View	$216.00	$360.00	—	16% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-Ray Exam Abdomen 1 View	$216.00	$360.00	—	—	40%
X-ray of the ankle, 2 views CPT 73600 HC X-Ray Ankle 2 Views	$357.60	$596.00	—	44% above	40%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-Ray Ankle 2 Views	$357.60	$596.00	—	—	40%
X-ray of the finger(s), 2 or more views CPT 73140 HC Fingers Min 2 Views	$385.80	$643.00	—	50% above	40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC Fingers Min 2 Views	$385.80	$643.00	—	—	40%
X-ray of the foot, 2 views CPT 73620 HC X-Ray Foot 2 Views	$319.80	$533.00	—	38% above	40%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-Ray Foot 2 Views	$319.80	$533.00	—	—	40%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-Ray Foot Min 3 Views Complete	$360.00	$600.00	—	18% above	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 HC X-Ray Foot Min 3 Views Complete\|LEFT SIDE	$495.60	$826.00	$86.28–$88.01	62% above	40%
X-ray of the foot, complete, 3 or more views one side CPT 73630 HC X-Ray Foot Min 3 Views Complete\|RIGHT SIDE	$720.00	$1,200.00	$86.28–$88.01	135% above	40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-Ray Foot Min 3 Views Complete	$360.00	$600.00	—	—	40%
X-ray of the hand, 3 or more views CPT 73130 HC Hand Routine Min 3 Views	$368.40	$614.00	—	13% above	40%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Hand Routine Min 3 Views	$368.40	$614.00	—	—	40%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-Ray Knee 1-2 Views	$418.20	$697.00	—	53% above	40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-Ray Knee 1-2 Views	$418.20	$697.00	—	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L-Spine 2-3 Views	$339.60	$566.00	—	5% above	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L-Spine 2-3 Views	$339.60	$566.00	—	—	40%
X-ray of the lower back, 4 or more views CPT 72110 HC L-Spine Min 4 Views	$738.00	$1,230.00	—	57% above	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-Spine 2 Views	$246.00	$410.00	—	19% below	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-Spine 2 Views	$246.00	$410.00	—	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Nasal Bones Min 3 Views	$472.80	$788.00	—	62% above	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C-Spine 2-3 Views	$485.40	$809.00	—	45% above	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C-Spine 2-3 Views	$485.40	$809.00	—	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Pelvis Ap Only	$339.00	$565.00	—	35% above	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Pelvis Ap Only	$339.00	$565.00	—	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Sacrum and Coccyx Min 2 Views	$464.40	$774.00	—	56% above	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Sacrum and Coccyx Min 2 Views	$464.40	$774.00	—	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 HC So Acth	$161.40	$269.00	—	22% above	40%
ACTH blood test CPT 82024 HC Acth	$187.80	$313.00	—	42% above	40%
ACTH blood test inpatient CPT 82024 HC So Acth	$161.40	$269.00	—	—	40%
ACTH blood test inpatient CPT 82024 HC Acth	$187.80	$313.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Sgpt (Alt)	$24.00	$40.00	—	14% below	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC So Sgpt (Alt)	$24.00	$40.00	—	14% below	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC So Sgpt (Alt)	$24.00	$40.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Sgpt (Alt)	$27.60	$46.00	—	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$24.00	$40.00	—	5% below	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC So Sgot (Ast)	$24.00	$40.00	—	5% below	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC So Sgot (Ast)	$24.00	$40.00	—	—	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$27.60	$46.00	—	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$315.00	$525.00	—	45% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$732.00	$1,220.00	—	—	40%
Albumin blood test CPT 82040 HC So Albumin	$24.00	$40.00	—	9% above	40%
Albumin blood test CPT 82040 HC Albumin	$24.00	$40.00	—	9% above	40%
Albumin blood test inpatient CPT 82040 HC So Albumin	$24.00	$40.00	—	—	40%
Albumin blood test inpatient CPT 82040 HC Albumin	$27.60	$46.00	—	—	40%
Aldosterone blood test CPT 82088 HC So Aldosterone, Serum	$163.20	$272.00	—	17% above	40%
Aldosterone blood test CPT 82088 HC Aldosterone, Serum	$189.60	$316.00	—	36% above	40%
Aldosterone blood test inpatient CPT 82088 HC So Aldosterone, Serum	$163.20	$272.00	—	—	40%
Aldosterone blood test inpatient CPT 82088 HC Aldosterone, Serum	$189.60	$316.00	—	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC So Alkaline Phosphatase	$24.00	$40.00	—	at median	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Alkaline Phosphatase	$24.00	$40.00	—	at median	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC So Alkaline Phosphatase	$24.00	$40.00	—	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Alkaline Phosphatase	$27.60	$46.00	—	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So Allergen Specific	$30.60	$51.00	—	31% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So1 Allergen Specific	$30.60	$51.00	—	31% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each	$37.20	$62.00	—	59% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So1 Allergen Specific	$30.60	$51.00	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So Allergen Specific	$30.60	$51.00	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each	$37.20	$62.00	—	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC So Alpha Fetoprotein	$60.60	$101.00	—	at median	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC Alpha-Fetoprotein Serum	$70.20	$117.00	—	16% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC So Alpha Fetoprotein	$60.60	$101.00	—	—	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC Alpha-Fetoprotein Serum	$70.20	$117.00	—	—	40%
Ammonia blood test CPT 82140 HC Ammonia	$84.60	$141.00	—	55% above	40%
Ammonia blood test CPT 82140 HC So Ammonia	$84.60	$141.00	—	55% above	40%
Ammonia blood test inpatient CPT 82140 HC So Ammonia	$84.60	$141.00	—	—	40%
Ammonia blood test inpatient CPT 82140 HC Ammonia	$98.40	$164.00	—	—	40%
Amylase blood test CPT 82150 HC So Amylase	$110.40	$184.00	—	130% above	40%
Amylase blood test CPT 82150 HC Amylase	$111.00	$185.00	—	132% above	40%
Amylase blood test inpatient CPT 82150 HC So Amylase	$110.40	$184.00	—	—	40%
Amylase blood test inpatient CPT 82150 HC Amylase	$128.40	$214.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$142.20	$237.00	—	146% above	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$164.40	$274.00	—	184% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$142.20	$237.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$164.40	$274.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC So Anti Nuclear Antibody	$42.00	$70.00	—	24% below	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Antinuclear Antibodies Ana	$42.60	$71.00	—	23% below	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC So Anti Nuclear Antibody	$42.00	$70.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Antinuclear Antibodies Ana	$49.80	$83.00	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$112.20	$187.00	—	25% below	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC So Natriuretic Peptide	$160.80	$268.00	—	8% above	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Natriuretic Peptide	$130.20	$217.00	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC So Natriuretic Peptide	$160.80	$268.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC So Body Fluid Culture	$74.40	$124.00	—	13% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture, Aerobic	$86.40	$144.00	—	31% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC So Body Fluid Culture	$74.40	$124.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Culture, Aerobic	$86.40	$144.00	—	—	40%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Calcium Total	$175.80	$293.00	—	168% above	40%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Calcium Total	$175.80	$293.00	—	—	40%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$42.00	$70.00	—	75% above	40%
Bilirubin blood test, total CPT 82247 HC So Bilirubin Total	$61.20	$102.00	—	155% above	40%
Bilirubin blood test, total inpatient CPT 82247 HC So Bilirubin Total	$61.20	$102.00	—	—	40%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Total	$70.80	$118.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Tissue Level IV	$155.40	$259.00	—	24% below	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC So Tissue Level IV	$360.00	$600.00	—	77% above	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC So1 Tissue Level IV	$360.00	$600.00	—	77% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Tissue Level IV	$292.20	$487.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC So Tissue Level IV	$360.00	$600.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC So1 Tissue Level IV	$360.00	$600.00	—	—	40%
Blood culture for bacteria CPT 87040 HC Culture Blood	$70.20	$117.00	—	25% below	40%
Blood culture for bacteria inpatient CPT 87040 HC Culture Blood	$70.20	$117.00	—	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Collection Venous Blood Venipuncture	$12.60	$21.00	—	21% below	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Collection Venous Blood Venipuncture	$12.60	$21.00	—	—	40%
Blood glucose (sugar) test CPT 82947 HC Glucose, Fasting	$25.80	$43.00	—	9% above	40%
Blood glucose (sugar) test CPT 82947 HC Glucose Quant, for Cmpk/Bmpk	$28.20	$47.00	—	20% above	40%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose Quant, for Cmpk/Bmpk	$28.20	$47.00	—	—	40%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose, Fasting	$31.80	$53.00	—	—	40%
Blood lead test CPT 83655 HC So Lead	$45.00	$75.00	—	7% below	40%
Blood lead test CPT 83655 HC Assay of Lead	$52.80	$88.00	—	9% above	40%
Blood lead test inpatient CPT 83655 HC So Lead	$45.00	$75.00	—	—	40%
Blood lead test inpatient CPT 83655 HC Assay of Lead	$52.80	$88.00	—	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$69.60	$116.00	—	28% above	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$69.60	$116.00	—	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Blood Typing, Abo	$82.20	$137.00	—	38% above	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC So Blood Typing, Abo	$100.80	$168.00	—	70% above	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Blood Typing, Abo	$82.20	$137.00	—	—	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC So Blood Typing, Abo	$100.80	$168.00	—	—	40%
Blood urea nitrogen (BUN) test CPT 84520 HC Assay of Urea Nitrogen Quantitative	$24.00	$40.00	—	3% above	40%
Blood urea nitrogen (BUN) test CPT 84520 HC So Bun	$24.00	$40.00	—	3% above	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC So Bun	$24.00	$40.00	—	—	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Assay of Urea Nitrogen Quantitative	$27.60	$46.00	—	—	40%
C-peptide blood test CPT 84681 HC So Peptide,C	$81.00	$135.00	—	2% above	40%
C-peptide blood test CPT 84681 HC Assay of C-Peptide	$95.40	$159.00	—	20% above	40%
C-peptide blood test inpatient CPT 84681 HC So Peptide,C	$81.00	$135.00	—	—	40%
C-peptide blood test inpatient CPT 84681 HC Assay of C-Peptide	$95.40	$159.00	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein	$93.60	$156.00	—	86% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC So Crp	$93.60	$156.00	—	86% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC So Crp	$93.60	$156.00	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-Reactive Protein	$109.80	$183.00	—	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$184.20	$307.00	—	41% above	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$213.00	$355.00	—	63% above	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$184.20	$307.00	—	—	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$213.00	$355.00	—	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 HC So Carbohydrate Antigen 19-9	$68.40	$114.00	—	6% below	40%
CA 19-9 blood test (tumor marker) CPT 86301 HC Immunoassay Tumor Antigen Quantitative Ca 19-9	$80.40	$134.00	—	10% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC So Carbohydrate Antigen 19-9	$68.40	$114.00	—	—	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Immunoassay Tumor Antigen Quantitative Ca 19-9	$80.40	$134.00	—	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC So Ca 125	$82.20	$137.00	—	12% below	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$96.00	$160.00	—	3% above	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC So Ca 125	$82.20	$137.00	—	—	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$96.00	$160.00	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$33.60	$56.00	—	76% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$105.60	$176.00	—	25% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$105.60	$176.00	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$122.40	$204.00	—	—	40%
Calcium blood test, total CPT 82310 HC Calcium Total	$24.00	$40.00	—	24% below	40%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total	$27.60	$46.00	—	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC So Cea	$143.40	$239.00	—	65% above	40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Carcinoembryonic Antigen Cea	$143.40	$239.00	—	65% above	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC So Cea	$143.40	$239.00	—	—	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Carcinoembryonic Antigen Cea	$166.20	$277.00	—	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 HC So Varicella Igg Igm	$75.00	$125.00	—	30% above	40%
Chickenpox (varicella) immunity blood test CPT 86787 HC Antibody Varicella-Zoster	$87.00	$145.00	—	50% above	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC So Varicella Igg Igm	$75.00	$125.00	—	—	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Antibody Varicella-Zoster	$87.00	$145.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC So Chylmd Trach Dna Amp Probe	$97.80	$163.00	—	6% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Chlamydia Amp Probe Tech, 1	$114.00	$190.00	—	23% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC So Chylmd Trach Dna Amp Probe	$97.80	$163.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Chlamydia Amp Probe Tech, 1	$114.00	$190.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel	$100.20	$167.00	—	89% above	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC So Lipid Panel	$153.60	$256.00	—	190% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel	$124.20	$207.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC So Lipid Panel	$153.60	$256.00	—	—	40%
Complete blood count (CBC) with differential CPT 85025 HC Cbc	$756.00	$1,260.00	$7.77–$7.93	1977% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc	$72.00	$120.00	—	—	40%
Complete blood count (CBC), no differential CPT 85027 HC Cbc (Hemogram)	$46.80	$78.00	—	38% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc (Hemogram)	$53.40	$89.00	—	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$420.60	$701.00	—	562% above	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$526.20	$877.00	—	—	40%
Cortisol blood test, total CPT 82533 HC So Cortisol,Serum	$143.40	$239.00	—	98% above	40%
Cortisol blood test, total CPT 82533 HC Cortisol Total	$144.00	$240.00	—	99% above	40%
Cortisol blood test, total inpatient CPT 82533 HC So Cortisol,Serum	$143.40	$239.00	—	—	40%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total	$166.20	$277.00	—	—	40%
Creatine kinase (CK) blood test, total CPT 82550 HC Creatine Kinase Total	$50.40	$84.00	—	42% above	40%
Creatine kinase (CK) blood test, total CPT 82550 HC So Cpk (CK)	$51.00	$85.00	—	44% above	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC So Cpk (CK)	$51.00	$85.00	—	—	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Creatine Kinase Total	$58.80	$98.00	—	—	40%
Creatinine blood test CPT 82565 HC Creatinine,Serum	$24.00	$40.00	—	3% below	40%
Creatinine blood test inpatient CPT 82565 HC Creatinine,Serum	$27.60	$46.00	—	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC So Cytomegalovirus, Igg Antibody	$77.40	$129.00	—	13% above	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Antibody Cytomegalovirus Cmv	$89.40	$149.00	—	30% above	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC So Cytomegalovirus, Igg Antibody	$77.40	$129.00	—	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Antibody Cytomegalovirus Cmv	$89.40	$149.00	—	—	40%
D-dimer blood test (blood clot marker) CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$148.20	$247.00	—	113% above	40%
D-dimer blood test (blood clot marker) CPT 85379 HC So D-Dimer, Quantitative	$148.80	$248.00	—	114% above	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC So D-Dimer, Quantitative	$148.80	$248.00	—	—	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$172.80	$288.00	—	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC So Dhea Sulfate	$97.20	$162.00	—	2% below	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC Dehydroepiandrosterone-Sulfate	$113.40	$189.00	—	14% above	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC So Dhea Sulfate	$97.20	$162.00	—	—	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC Dehydroepiandrosterone-Sulfate	$113.40	$189.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So Drg Scrn Class List A	$67.20	$112.00	—	30% below	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$70.80	$118.00	—	26% below	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$78.60	$131.00	—	18% below	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So Drg Scrn Class List A	$67.20	$112.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$70.80	$118.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$78.60	$131.00	—	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolyte Panel	$111.60	$186.00	—	134% above	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolyte Panel	$111.60	$186.00	—	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC So Epstein-Barr Virus Vca	$82.80	$138.00	—	27% above	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$96.60	$161.00	—	49% above	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC So Epstein-Barr Virus Vca	$82.80	$138.00	—	—	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$96.60	$161.00	—	—	40%
Estradiol blood test CPT 82670 HC Assay of Total Estradiol	$228.00	$380.00	—	104% above	40%
Estradiol blood test CPT 82670 HC So Estradiol	$229.80	$383.00	—	105% above	40%
Estradiol blood test inpatient CPT 82670 HC So Estradiol	$229.80	$383.00	—	—	40%
Estradiol blood test inpatient CPT 82670 HC Assay of Total Estradiol	$266.40	$444.00	—	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$226.20	$377.00	—	164% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$263.40	$439.00	—	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC So Calprotectin Fecal	$406.80	$678.00	—	172% above	40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC Assay of Calprotectin Fecal	$471.00	$785.00	—	215% above	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC So Calprotectin Fecal	$406.80	$678.00	—	—	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC Assay of Calprotectin Fecal	$471.00	$785.00	—	—	40%
Ferritin blood test (iron stores) CPT 82728 HC Assay of Ferritin	$121.80	$203.00	—	60% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Assay of Ferritin	$142.20	$237.00	—	—	40%
Fibrinogen blood test CPT 85384 HC So Fibrinogen	$48.00	$80.00	—	7% above	40%
Fibrinogen blood test CPT 85384 HC Fibrinogen Activity	$50.40	$84.00	—	12% above	40%
Fibrinogen blood test inpatient CPT 85384 HC So Fibrinogen	$48.00	$80.00	—	—	40%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen Activity	$50.40	$84.00	—	—	40%
Folate (folic acid) blood test CPT 82746 HC Assay of Folic Acid Serum	$91.80	$153.00	—	36% above	40%
Folate (folic acid) blood test inpatient CPT 82746 HC Assay of Folic Acid Serum	$107.40	$179.00	—	—	40%
Free T3 thyroid hormone test CPT 84481 HC So Triiodothyronine T-3, Free	$73.20	$122.00	—	4% below	40%
Free T3 thyroid hormone test CPT 84481 HC Assay of Triiodothyronine T3 Free	$84.60	$141.00	—	11% above	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC So Triiodothyronine T-3, Free	$73.20	$122.00	—	—	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC Assay of Triiodothyronine T3 Free	$84.60	$141.00	—	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Assay of Free Thyroxine	$114.60	$191.00	—	170% above	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC So T4 Free	$142.20	$237.00	—	235% above	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Assay of Free Thyroxine	$115.20	$192.00	—	—	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC So T4 Free	$142.20	$237.00	—	—	40%
Free testosterone test CPT 84402 HC So Testosterone Free	$66.00	$110.00	—	32% below	40%
Free testosterone test CPT 84402 HC Assay of Testosterone Free	$69.60	$116.00	—	28% below	40%
Free testosterone test inpatient CPT 84402 HC So Testosterone Free	$66.00	$110.00	—	—	40%
Free testosterone test inpatient CPT 84402 HC Assay of Testosterone Free	$69.60	$116.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Assay of Glutamyltrase Gamma	$67.80	$113.00	—	59% above	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC So Ggtp	$67.80	$113.00	—	59% above	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC So Ggtp	$67.80	$113.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Assay of Glutamyltrase Gamma	$79.20	$132.00	—	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC General Health Panel	$677.40	$1,129.00	—	206% above	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC General Health Panel	$54.60	$91.00	—	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Glucose Post Glucose Dose	$75.60	$126.00	—	97% above	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Glucose Post Glucose Dose	$88.80	$148.00	—	—	40%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Tolerance Test	$155.40	$259.00	—	131% above	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Tolerance Test	$179.40	$299.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$111.60	$186.00	—	20% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$111.60	$186.00	—	—	40%
H. pylori antibody blood test CPT 86677 HC Antibody Helicobacter Pylori	$146.40	$244.00	—	94% above	40%
H. pylori antibody blood test CPT 86677 HC So H.Pylori. Serum	$149.40	$249.00	—	98% above	40%
H. pylori antibody blood test inpatient CPT 86677 HC So H.Pylori. Serum	$149.40	$249.00	—	—	40%
H. pylori antibody blood test inpatient CPT 86677 HC Antibody Helicobacter Pylori	$174.00	$290.00	—	—	40%
H. pylori stool antigen test CPT 87338 HC So H.Pylori Stool Antigen	$135.60	$226.00	—	94% above	40%
H. pylori stool antigen test CPT 87338 HC Iaad Ia Hpylori Stool	$157.80	$263.00	—	126% above	40%
H. pylori stool antigen test inpatient CPT 87338 HC So H.Pylori Stool Antigen	$135.60	$226.00	—	—	40%
H. pylori stool antigen test inpatient CPT 87338 HC Iaad Ia Hpylori Stool	$157.80	$263.00	—	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC So Hiv-1, Quantification	$267.60	$446.00	—	25% below	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC Iadna Hiv-1 Quant & Reverse Transcription	$310.20	$517.00	—	13% below	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC So Hiv-1, Quantification	$267.60	$446.00	—	—	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC Iadna Hiv-1 Quant & Reverse Transcription	$310.20	$517.00	—	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 HC Antibody Hiv-1&Hiv-2 Single Result	$118.80	$198.00	—	92% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Antibody Hiv-1&Hiv-2 Single Result	$118.80	$198.00	—	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC So Hiv-1 & Hiv-2 Ab	$55.20	$92.00	—	26% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$64.80	$108.00	—	13% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC So Hiv-1 & Hiv-2 Ab	$55.20	$92.00	—	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$64.80	$108.00	—	—	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC So Hpv Dna Amp Probe	$81.00	$135.00	—	32% below	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$153.60	$256.00	—	29% above	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC So Hpv Dna Amp Probe	$81.00	$135.00	—	—	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$153.60	$256.00	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycosylated A1c	$88.20	$147.00	—	93% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC So Glycohemoglobin	$124.20	$207.00	—	172% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycosylated A1c	$115.20	$192.00	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC So Glycohemoglobin	$124.20	$207.00	—	—	40%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin	$31.80	$53.00	—	96% above	40%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin	$37.80	$63.00	—	—	40%
Hepatitis B core antibody test (total) CPT 86704 HC So Hepatitis B Core Antibody	$61.20	$102.00	—	13% above	40%
Hepatitis B core antibody test (total) CPT 86704 HC Hepatitis B Core Antibody Hbcab Total	$70.80	$118.00	—	31% above	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC So Hepatitis B Core Antibody	$61.20	$102.00	—	—	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC Hepatitis B Core Antibody Hbcab Total	$70.80	$118.00	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$181.20	$302.00	—	275% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$211.80	$353.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$126.60	$211.00	—	167% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$126.60	$211.00	—	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis C Antibody	$150.60	$251.00	—	135% above	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC So Hepatitis C Virus Antibody	$152.40	$254.00	—	138% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC So Hepatitis C Virus Antibody	$152.40	$254.00	—	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Hepatitis C Antibody	$176.40	$294.00	—	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So Hcv Ultraquant	$343.80	$573.00	—	79% above	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So1 Hcv Ultraquant	$343.80	$573.00	—	79% above	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Iadna Hepatitis C Quant & Reverse Transcription	$398.40	$664.00	—	107% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So Hcv Ultraquant	$343.80	$573.00	—	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So1 Hcv Ultraquant	$343.80	$573.00	—	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Iadna Hepatitis C Quant & Reverse Transcription	$398.40	$664.00	—	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HC So Herpes Simplex, Type 1	$39.00	$65.00	—	34% below	40%
Herpes blood test, HSV-1 antibody CPT 86695 HC Antibody Herpes Smplx Type 1	$45.00	$75.00	—	24% below	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC So Herpes Simplex, Type 1	$39.00	$65.00	—	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Antibody Herpes Smplx Type 1	$45.00	$75.00	—	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HC So Herpes Simplex, Type 2	$39.00	$65.00	—	41% below	40%
Herpes blood test, HSV-2 antibody CPT 86696 HC Antibody Herpes Smplx Type 2	$45.00	$75.00	—	32% below	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC So Herpes Simplex, Type 2	$39.00	$65.00	—	—	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Antibody Herpes Smplx Type 2	$45.00	$75.00	—	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC So Crp High Sensitivity	$120.60	$201.00	—	79% above	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-Reactive Protein High Sensitivity	$140.40	$234.00	—	108% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC So Crp High Sensitivity	$120.60	$201.00	—	—	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-Reactive Protein High Sensitivity	$140.40	$234.00	—	—	40%
Homocysteine blood test CPT 83090 HC So Homocystine	$175.20	$292.00	—	117% above	40%
Homocysteine blood test CPT 83090 HC Assay of Homocysteine	$203.40	$339.00	—	152% above	40%
Homocysteine blood test inpatient CPT 83090 HC So Homocystine	$175.20	$292.00	—	—	40%
Homocysteine blood test inpatient CPT 83090 HC Assay of Homocysteine	$203.40	$339.00	—	—	40%
Insulin blood test CPT 83525 HC So Insulin	$51.00	$85.00	—	1% below	40%
Insulin blood test CPT 83525 HC Assay of Insulin Total	$58.80	$98.00	—	15% above	40%
Insulin blood test inpatient CPT 83525 HC So Insulin	$51.00	$85.00	—	—	40%
Insulin blood test inpatient CPT 83525 HC Assay of Insulin Total	$58.80	$98.00	—	—	40%
Iron blood test (serum iron) CPT 83540 HC So Iron	$46.80	$78.00	—	23% above	40%
Iron blood test (serum iron) CPT 83540 HC Assay of Iron	$47.40	$79.00	—	25% above	40%
Iron blood test (serum iron) inpatient CPT 83540 HC So Iron	$46.80	$78.00	—	—	40%
Iron blood test (serum iron) inpatient CPT 83540 HC Assay of Iron	$54.00	$90.00	—	—	40%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity	$54.00	$90.00	—	38% above	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity	$63.60	$106.00	—	—	40%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$315.00	$525.00	—	338% above	40%
Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel	$315.00	$525.00	—	—	40%
LH (luteinizing hormone) test CPT 83002 HC Gonadotropin Luteinizing Hormone	$174.60	$291.00	—	83% above	40%
LH (luteinizing hormone) test inpatient CPT 83002 HC Gonadotropin Luteinizing Hormone	$203.40	$339.00	—	—	40%
Lactate (lactic acid) blood test CPT 83605 HC Assay of Lactate	$58.20	$97.00	—	12% above	40%
Lactate (lactic acid) blood test CPT 83605 HC So Lactic Acid	$83.40	$139.00	—	60% above	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Assay of Lactate	$67.80	$113.00	—	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC So Lactic Acid	$83.40	$139.00	—	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC So Ldh	$34.20	$57.00	—	25% above	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lactate Dehydrogenase Ldh	$35.40	$59.00	—	30% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC So Ldh	$34.20	$57.00	—	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lactate Dehydrogenase Ldh	$39.60	$66.00	—	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 HC Assay of Lipase	$53.40	$89.00	—	8% below	40%
Lipase blood test (pancreas enzyme) CPT 83690 HC So Lipase	$77.40	$129.00	—	33% above	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Assay of Lipase	$62.40	$104.00	—	—	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC So Lipase	$77.40	$129.00	—	—	40%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$136.80	$228.00	—	126% above	40%
Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel	$136.80	$228.00	—	—	40%
Lyme disease antibody test CPT 86618 HC So Lyme Disease Total Anitbodies	$52.20	$87.00	—	32% below	40%
Lyme disease antibody test CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$60.60	$101.00	—	21% below	40%
Lyme disease antibody test inpatient CPT 86618 HC So Lyme Disease Total Anitbodies	$52.20	$87.00	—	—	40%
Lyme disease antibody test inpatient CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$60.60	$101.00	—	—	40%
Magnesium blood test CPT 83735 HC Assay of Magnesium	$36.60	$61.00	—	8% above	40%
Magnesium blood test CPT 83735 HC So Magnesium	$52.20	$87.00	—	55% above	40%
Magnesium blood test inpatient CPT 83735 HC Assay of Magnesium	$42.00	$70.00	—	—	40%
Magnesium blood test inpatient CPT 83735 HC So Magnesium	$52.20	$87.00	—	—	40%
Measles (rubeola) antibody test CPT 86765 HC So Rubeola Igg / Igm	$55.20	$92.00	—	3% below	40%
Measles (rubeola) antibody test CPT 86765 HC Antibody Rubeola	$64.80	$108.00	—	13% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC So Rubeola Igg / Igm	$55.20	$92.00	—	—	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC Antibody Rubeola	$64.80	$108.00	—	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC So Mono Antibody	$73.20	$122.00	—	37% above	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Spot Test,Agglutination	$84.60	$141.00	—	59% above	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC So Mono Antibody	$73.20	$122.00	—	—	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Mono Spot Test,Agglutination	$84.60	$141.00	—	—	40%
Mumps immunity blood test CPT 86735 HC So Antibody; Mumps	$63.60	$106.00	—	9% above	40%
Mumps immunity blood test CPT 86735 HC Antibody Mumps	$73.80	$123.00	—	26% above	40%
Mumps immunity blood test inpatient CPT 86735 HC So Antibody; Mumps	$63.60	$106.00	—	—	40%
Mumps immunity blood test inpatient CPT 86735 HC Antibody Mumps	$73.80	$123.00	—	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC So Prostate Specific Antigen/Free	$69.60	$116.00	—	16% below	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC Assay of Prostate Specific Antigen Free	$81.00	$135.00	—	2% below	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC So Prostate Specific Antigen/Free	$69.60	$116.00	—	—	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Assay of Prostate Specific Antigen Free	$81.00	$135.00	—	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Assay of Prostate Specific Antigen Total	$73.80	$123.00	—	7% below	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC So Assay of Psa Total	$91.20	$152.00	—	15% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC So Assay of Psa Total	$91.20	$152.00	—	—	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Assay of Prostate Specific Antigen Total	$105.60	$176.00	—	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$82.20	$137.00	—	16% below	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$82.20	$137.00	—	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$75.00	$125.00	—	18% below	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$75.00	$125.00	—	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 HC Assay of Parathormone	$253.80	$423.00	—	79% above	40%
Parathyroid hormone (PTH) blood test CPT 83970 HC So Parathyroid Hormone	$254.40	$424.00	—	80% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC So Parathyroid Hormone	$254.40	$424.00	—	—	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Assay of Parathormone	$294.60	$491.00	—	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC So Ptt	$48.00	$80.00	—	28% above	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt	$49.20	$82.00	—	31% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC So Ptt	$48.00	$80.00	—	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt	$55.20	$92.00	—	—	40%
Phosphorus (phosphate) blood test CPT 84100 HC Assay of Phosphorus Inorganic	$24.00	$40.00	—	33% below	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Assay of Phosphorus Inorganic	$27.60	$46.00	—	—	40%
Potassium blood test CPT 84132 HC Potassium Serum Plasma/Whole Blood	$24.00	$40.00	—	3% above	40%
Potassium blood test CPT 84132 HC So Potassium	$24.00	$40.00	—	3% above	40%
Potassium blood test inpatient CPT 84132 HC So Potassium	$24.00	$40.00	—	—	40%
Potassium blood test inpatient CPT 84132 HC Potassium Serum Plasma/Whole Blood	$27.60	$46.00	—	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC So Fetal Chrmoml Aneuploidy	$643.80	$1,073.00	—	56% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC So1 Fetal Chrmoml Aneuploidy	$643.80	$1,073.00	—	56% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC Fetal Chromosomal Aneuploidy Genomic Seq Analys	$745.20	$1,242.00	—	49% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC So Fetal Chrmoml Aneuploidy	$643.80	$1,073.00	—	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC So1 Fetal Chrmoml Aneuploidy	$643.80	$1,073.00	—	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC Fetal Chromosomal Aneuploidy Genomic Seq Analys	$745.20	$1,242.00	—	—	40%
Progesterone blood test CPT 84144 HC So Progesterone	$70.80	$118.00	—	13% below	40%
Progesterone blood test CPT 84144 HC Assay of Progesterone	$118.80	$198.00	—	47% above	40%
Progesterone blood test inpatient CPT 84144 HC So Progesterone	$70.80	$118.00	—	—	40%
Progesterone blood test inpatient CPT 84144 HC Assay of Progesterone	$82.80	$138.00	—	—	40%
Prolactin blood test CPT 84146 HC Assay of Prolactin	$226.20	$377.00	—	160% above	40%
Prolactin blood test CPT 84146 HC So Prolactin	$226.80	$378.00	—	160% above	40%
Prolactin blood test inpatient CPT 84146 HC So Prolactin	$226.80	$378.00	—	—	40%
Prolactin blood test inpatient CPT 84146 HC Assay of Prolactin	$263.40	$439.00	—	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$28.20	$47.00	—	17% above	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC So Prothrombin Time	$29.40	$49.00	—	22% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC So Prothrombin Time	$29.40	$49.00	—	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time	$35.40	$59.00	—	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Drug Test Prsmv Read Direct Optical Obs PR Date	$10.80	$18.00	—	81% below	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Drug Test Prsmv Read Direct Optical Obs PR Date	$681.60	$1,136.00	—	—	40%
Rapid flu test (influenza antigen) CPT 87804 HC Iaadiadoo Influenza	$29.40	$49.00	—	55% below	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC Iaadiadoo Influenza	$68.40	$114.00	—	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Iaadiadoo Streptococcus Group A	$74.40	$124.00	—	30% above	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Iaadiadoo Streptococcus Group A	$74.40	$124.00	—	—	40%
Renin blood test CPT 84244 HC So Renin	$91.80	$153.00	—	7% above	40%
Renin blood test CPT 84244 HC Assay of Renin	$106.20	$177.00	—	24% above	40%
Renin blood test inpatient CPT 84244 HC So Renin	$91.80	$153.00	—	—	40%
Renin blood test inpatient CPT 84244 HC Assay of Renin	$106.20	$177.00	—	—	40%
Rh blood typing CPT 86901 HC So Blood Typing, Rh(D)	$44.40	$74.00	—	19% above	40%
Rh blood typing CPT 86901 HC Blood Typing, Rh(D)	$52.20	$87.00	—	40% above	40%
Rh blood typing inpatient CPT 86901 HC So Blood Typing, Rh(D)	$44.40	$74.00	—	—	40%
Rh blood typing inpatient CPT 86901 HC Blood Typing, Rh(D)	$52.20	$87.00	—	—	40%
Rheumatoid factor (RF) test CPT 86431 HC So Ra Titer, Quantitative	$139.80	$233.00	—	322% above	40%
Rheumatoid factor (RF) test CPT 86431 HC Rheumatoid Factor Quantitative	$162.00	$270.00	—	389% above	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC So Ra Titer, Quantitative	$139.80	$233.00	—	—	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC Rheumatoid Factor Quantitative	$162.00	$270.00	—	—	40%
Rubella antibody test (immunity check) CPT 86762 HC So Rubella Latex Test	$94.80	$158.00	—	93% above	40%
Rubella antibody test (immunity check) CPT 86762 HC Antibody Rubella	$117.00	$195.00	—	138% above	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC So Rubella Latex Test	$94.80	$158.00	—	—	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC Antibody Rubella	$110.40	$184.00	—	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sed Rate	$39.00	$65.00	—	3% above	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Sed Rate	$39.00	$65.00	—	—	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC Semen Analysis Complete	$286.80	$478.00	—	115% above	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC Semen Analysis Complete	$286.80	$478.00	—	—	40%
Sodium blood test CPT 84295 HC Sodium Serum Plasma or Whole Blood	$22.80	$38.00	—	16% below	40%
Sodium blood test inpatient CPT 84295 HC Sodium Serum Plasma or Whole Blood	$28.20	$47.00	—	—	40%
Stool ova and parasites exam CPT 87177 HC So Ova and Parasites	$76.80	$128.00	—	94% above	40%
Stool ova and parasites exam CPT 87177 HC Ova and Parasites	$88.80	$148.00	—	124% above	40%
Stool ova and parasites exam inpatient CPT 87177 HC So Ova and Parasites	$76.80	$128.00	—	—	40%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasites	$88.80	$148.00	—	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$81.00	$135.00	—	181% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$81.00	$135.00	—	—	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$49.80	$83.00	—	7% below	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$55.20	$92.00	—	—	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC So Fta-Abs	$60.60	$101.00	—	5% above	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Antibody Treponema Pallidum	$70.20	$117.00	—	21% above	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC So Fta-Abs	$60.60	$101.00	—	—	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Antibody Treponema Pallidum	$70.20	$117.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC So Vdrl / Rpr	$68.40	$114.00	—	187% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$68.40	$114.00	—	187% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC So Vdrl / Rpr	$68.40	$114.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$72.00	$120.00	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC So TB Test, Cell Immun Measure	$193.20	$322.00	—	65% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB Cell Mediated Antign Respnse Gamma Interferon	$223.80	$373.00	—	91% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC So TB Test, Cell Immun Measure	$193.20	$322.00	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB Cell Mediated Antign Respnse Gamma Interferon	$223.80	$373.00	—	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC So Testosterone Total	$106.20	$177.00	—	15% above	40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC Assay of Testosterone Total	$124.20	$207.00	—	35% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC So Testosterone Total	$106.20	$177.00	—	—	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC Assay of Testosterone Total	$124.20	$207.00	—	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC So Microsomal Antibody	$44.40	$74.00	—	32% below	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Microsomal Antibodies Each	$52.20	$87.00	—	20% below	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC So Microsomal Antibody	$44.40	$74.00	—	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Microsomal Antibodies Each	$52.20	$87.00	—	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone	$102.00	$170.00	—	36% above	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC So Tsh 3rd Generation	$164.40	$274.00	—	119% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone	$133.80	$223.00	—	—	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC So Tsh 3rd Generation	$164.40	$274.00	—	—	40%
Total IgE blood test CPT 82785 HC So Immunoglobulin,Ige	$65.40	$109.00	—	5% above	40%
Total IgE blood test CPT 82785 HC Assay of Gammaglobulin Ige	$75.60	$126.00	—	22% above	40%
Total IgE blood test inpatient CPT 82785 HC So Immunoglobulin,Ige	$65.40	$109.00	—	—	40%
Total IgE blood test inpatient CPT 82785 HC Assay of Gammaglobulin Ige	$75.60	$126.00	—	—	40%
Total cholesterol blood test CPT 82465 HC So Cholesterol	$27.60	$46.00	—	25% below	40%
Total cholesterol blood test CPT 82465 HC Cholesterol Serum/Whole Blood Total	$27.60	$46.00	—	25% below	40%
Total cholesterol blood test inpatient CPT 82465 HC So Cholesterol	$27.60	$46.00	—	—	40%
Total cholesterol blood test inpatient CPT 82465 HC Cholesterol Serum/Whole Blood Total	$32.40	$54.00	—	—	40%
Total thyroxine (T4) blood test CPT 84436 HC So Thyroxine Total	$32.40	$54.00	—	23% below	40%
Total thyroxine (T4) blood test CPT 84436 HC Assay of Thyroxine Total	$38.40	$64.00	—	8% below	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC So Thyroxine Total	$32.40	$54.00	—	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC Assay of Thyroxine Total	$38.40	$64.00	—	—	40%
Total triiodothyronine (T3) blood test CPT 84480 HC So T-3 by Ria,Total	$156.60	$261.00	—	160% above	40%
Total triiodothyronine (T3) blood test CPT 84480 HC Assay of Triiodothyronine T3 Total Tt3	$157.80	$263.00	—	162% above	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC So T-3 by Ria,Total	$156.60	$261.00	—	—	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC Assay of Triiodothyronine T3 Total Tt3	$181.20	$302.00	—	—	40%
Transferrin blood test CPT 84466 HC So Transferrin	$50.40	$84.00	—	32% below	40%
Transferrin blood test CPT 84466 HC Assay of L7383transferrin	$58.20	$97.00	—	21% below	40%
Transferrin blood test inpatient CPT 84466 HC So Transferrin	$50.40	$84.00	—	—	40%
Transferrin blood test inpatient CPT 84466 HC Assay of L7383transferrin	$58.20	$97.00	—	—	40%
Trichomonas test (NAAT) CPT 87661 HC So Trichomonas Vaginalis Amplif	$79.20	$132.00	—	8% below	40%
Trichomonas test (NAAT) CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$91.80	$153.00	—	6% above	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC So Trichomonas Vaginalis Amplif	$79.20	$132.00	—	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$91.80	$153.00	—	—	40%
Triglycerides blood test CPT 84478 HC So Triglycerides	$27.60	$46.00	—	20% below	40%
Triglycerides blood test CPT 84478 HC Assay of Triglycerides	$27.60	$46.00	—	20% below	40%
Triglycerides blood test inpatient CPT 84478 HC So Triglycerides	$27.60	$46.00	—	—	40%
Triglycerides blood test inpatient CPT 84478 HC Assay of Triglycerides	$32.40	$54.00	—	—	40%
Troponin test, quantitative CPT 84484 HC Assay of Troponin Quantitative	$61.20	$102.00	—	27% below	40%
Troponin test, quantitative inpatient CPT 84484 HC Assay of Troponin Quantitative	$61.20	$102.00	—	—	40%
Uric acid blood test CPT 84550 HC Assay of Blood/Uric Acid	$24.00	$40.00	—	32% below	40%
Uric acid blood test inpatient CPT 84550 HC Assay of Blood/Uric Acid	$27.60	$46.00	—	—	40%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/ Microscopy	$37.20	$62.00	—	38% above	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/ Microscopy	$42.60	$71.00	—	—	40%
Urinalysis with microscope exam, manual CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$47.40	$79.00	—	160% above	40%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$58.80	$98.00	—	—	40%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis, Auto, W/O Scope	$67.80	$113.00	—	190% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis, Auto, W/O Scope	$79.20	$132.00	—	—	40%
Urinalysis without microscope exam, manual CPT 81002 HC Non-Auto,Urine W/O Microscopy	$39.00	$65.00	—	141% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Non-Auto,Urine W/O Microscopy	$4.20	$7.00	—	—	40%
Urine culture for bacteria, with colony count CPT 87086 HC Urine Cult./Colony Count	$81.00	$135.00	—	42% above	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Urine Cult./Colony Count	$81.00	$135.00	—	—	40%
Urine microalbumin (albumin) test CPT 82043 HC Urine,Microalbumin,Quantitativ	$58.20	$97.00	—	15% above	40%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Urine,Microalbumin,Quantitativ	$67.80	$113.00	—	—	40%
Urine pregnancy test, read by color change CPT 81025 HC Hcg (Urine) Pregnancy Test	$70.80	$118.00	—	46% above	40%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Hcg (Urine) Pregnancy Test	$83.40	$139.00	—	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Cyanocobalamin Vitamin B-12	$90.60	$151.00	—	22% above	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Cyanocobalamin Vitamin B-12	$105.60	$176.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$208.20	$347.00	—	121% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC So Vitamin D Hydroxyvitamin D	$208.80	$348.00	—	121% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC So Vitamin D Hydroxyvitamin D	$208.80	$348.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$241.20	$402.00	—	—	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC So Dihydroxyvitamin D, 1 25	$161.40	$269.00	—	5% above	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC 1 25 Dihydroxy Includes Fractions if Performed	$187.80	$313.00	—	22% above	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC So Dihydroxyvitamin D, 1 25	$161.40	$269.00	—	—	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC 1 25 Dihydroxy Includes Fractions if Performed	$187.80	$313.00	—	—	40%
Zinc blood test CPT 84630 HC So Zinc, Serum	$40.20	$67.00	—	22% below	40%
Zinc blood test CPT 84630 HC Assay of Zinc	$47.40	$79.00	—	8% below	40%
Zinc blood test inpatient CPT 84630 HC So Zinc, Serum	$40.20	$67.00	—	—	40%
Zinc blood test inpatient CPT 84630 HC Assay of Zinc	$47.40	$79.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Hcg Quantitative	$222.60	$371.00	—	229% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC So Hcg Quantitative	$223.20	$372.00	—	230% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC So Hcg Quantitative	$223.20	$372.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Hcg Quantitative	$259.20	$432.00	—	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy Primary <Age 12	$18,030.00	$30,050.00	$3,287.07–$3,352.82	152% above	40%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrd Ant Interbody Decompress Cervical Belw C2	$68,904.20	$114,840.33	$12,728.77–$12,983.34	26% above	40%
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|RIGHT SIDE	$28,535.67	$47,559.45	$7,194.09–$7,337.97	2% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Bx Breast 1st Lesion Strtctc	$4,222.80	$7,038.00	—	5% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC Bx Breast 1st Lesion Strtctc	$4,222.80	$7,038.00	—	—	40%
Bunion correction with a bone cut near the head of the first metatarsal one side CPT 28296 Corrj Hallux Valgus W/Sesmdc W/Dist Metar Osteot\|RIGHT SIDE	$28,228.99	$47,048.32	$7,194.09	17% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|LEFT SIDE	$12,843.30	$21,405.50	$1,936.01–$1,974.73	55% above	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|RIGHT SIDE	$13,279.56	$22,132.60	$1,936.01–$1,974.73	61% above	40%
Cataract surgery with lens implant CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp	$15,759.42	$26,265.70	$2,288.07–$2,333.83	111% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|RIGHT SIDE	$17,488.40	$29,147.33	$2,288.07–$2,333.83	134% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|LEFT SIDE	$18,512.71	$30,854.52	$2,288.07–$2,333.83	148% above	40%
Cervical biopsy CPT 57500 Biopsy Cervix Single/Mult/Excision of Lesion Spx	$16,878.71	$28,131.18	$3,209.41–$3,273.60	868% above	40%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 HC Circumcision Age>28 Days	$14,647.78	$24,412.97	$2,072.49–$2,113.94	139% above	40%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 HC Circumcision W/Clamp/Oth Dev W/Block	$10,149.84	$16,916.40	$2,072.49–$2,113.94	474% above	40%
Colonoscopy with endoscopic ultrasound CPT 45391 Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux	$3,134.70	$5,224.50	$1,186.40–$1,210.12	at median	40%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$7,489.86	$12,483.10	$1,186.40–$1,210.12	124% above	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$5,571.72	$9,286.20	$1,186.40–$1,210.12	67% above	40%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$6,070.68	$10,117.80	$922.00–$940.44	123% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|LEFT SIDE	$26,761.23	$44,602.05	$4,098.04–$4,180.00	274% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|RIGHT SIDE	$26,863.29	$44,772.15	$4,098.04–$4,180.00	276% above	40%
Cystoscopy with ureteral stent placement CPT 52332 Cysto W/Insert Ureteral Stent	$15,835.21	$26,392.02	$3,494.80	59% above	40%
Cystoscopy with ureteral stent placement one side CPT 52332 Cysto W/Insert Ureteral Stent\|RIGHT SIDE	$20,825.00	$34,708.33	$3,494.80	110% above	40%
Cystoscopy with ureteral stent placement one side CPT 52332 Cysto W/Insert Ureteral Stent\|LEFT SIDE	$21,860.87	$36,434.78	$3,494.80–$3,564.70	120% above	40%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC Cystourethroscopy	$2,381.40	$3,969.00	$691.33–$705.15	19% above	40%
D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation & Curettage Dx&/Ther Nonobstetric	$13,422.24	$22,370.40	$3,209.41–$3,273.60	93% above	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tympanostomy General Anesthesia	$15,587.10	$25,978.50	$1,538.30–$1,569.07	264% above	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear one side CPT 69436 Tympanostomy General Anesthesia\|RIGHT SIDE	$13,620.85	$22,701.42	$1,538.30–$1,569.07	218% above	40%
Ear tube placement (tympanostomy) under general anesthesia, one ear one side CPT 69436 Tympanostomy General Anesthesia\|LEFT SIDE	$14,314.06	$23,856.77	$1,538.30	234% above	40%
Earwax removal with instruments, one ear one side CPT 69210 HC Removal Impacted Cerumen Unilateral	$14,575.08	$24,291.80	$1,538.30–$1,569.07	9322% above	40%
Earwax removal with instruments, one ear one side CPT 69210 HC Removal Impacted Cerumen Unilateral\|RIGHT SIDE	$19,597.66	$32,662.77	$3,287.07–$3,352.82	12568% above	40%
Endoscopic sinus surgery: full ethmoid sinus opening one side CPT 31255 Nasal/Sinus Ndsc W/Total Ethoidectomy\|LEFT SIDE	$44,687.50	$74,479.17	$6,997.04	242% above	40%
Endoscopic sinus surgery: opening the frontal sinus one side CPT 31276 Nasal/Sinus Ndsc W/Rmvl Tiss From Frontal Sinus\|RIGHT SIDE	$48,010.22	$80,017.03	$6,997.04–$7,136.98	111% above	40%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Nasal/Sinus Endoscopy W/Maxillary Antrostomy	$45,011.52	$75,019.20	$6,997.04	328% above	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus	$48,646.48	$81,077.47	$6,997.04–$7,136.98	124% above	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus\|RIGHT SIDE	$42,752.39	$71,253.98	$6,997.04	97% above	40%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue one side CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus\|LEFT SIDE	$44,632.07	$74,386.78	$6,997.04	105% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$7,792.98	$12,988.30	$699.84–$713.83	249% above	40%
Epidural steroid injection, neck or mid back, with imaging guidance one side CPT 62321 HC Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn\|LEFT SIDE	$8,209.50	$13,682.50	$699.84–$713.83	268% above	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC N Block Paravert Lumbar 1st	$2,185.20	$3,642.00	—	at median	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC Facet Jnt, L/S, Single\|LEFT SIDE	$7,810.44	$13,017.40	$876.90–$894.44	258% above	40%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 HC Facet Jnt, L/S, Single\|RIGHT SIDE	$8,165.88	$13,609.80	$876.90–$894.44	274% above	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC N Block Paravert Lumbar 1st	$2,185.20	$3,642.00	—	—	40%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr Aa Hernia 1st 3-10 Cm Reducible	$57,070.82	$95,118.03	$6,418.40–$6,546.76	126% above	40%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 Rpr Aa Hernia 1st > 10 Cm Reducible	$19,364.90	$32,274.83	$6,418.40–$6,546.76	28% below	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible	$23,566.63	$39,277.72	$3,549.75–$3,620.74	44% above	40%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Flx Dx W/Collj Spec Br/Wa if Pfrmd	$4,472.94	$7,454.90	$922.00	74% above	40%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy	$49,347.44	$82,245.73	$5,993.77	183% above	40%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laps Surg Cholecystectomy W/Cholangiography	$24,996.10	$41,660.17	$5,993.77–$6,113.65	43% above	40%
Hammertoe correction surgery CPT 28285 Correction Hammertoe	$70,515.91	$117,526.52	$3,243.99–$3,308.87	627% above	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Ntrnl & Xtrnl 1 Column/Group	$22,387.91	$37,313.18	$2,751.90–$2,806.94	139% above	40%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Endometrial Ablation	$23,726.06	$39,543.43	$4,959.62–$5,058.81	106% above	40%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$17,499.84	$29,166.40	$3,209.41	84% above	40%
IUD insertion (the device itself billed separately) CPT 58300 HC Insert Intrauterine Device	$28,694.47	$47,824.12	$3,209.41–$3,273.60	5597% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Incision & Drainage-Simple	$602.40	$1,004.00	—	55% above	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Simple	$862.20	$1,437.00	$198.92–$202.90	123% above	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Incision & Drainage-Simple	$602.40	$1,004.00	—	—	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|RIGHT SIDE	$16,065.20	$26,775.33	$3,549.75–$3,620.74	52% above	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|LEFT SIDE	$17,808.84	$29,681.40	$3,549.75–$3,620.74	69% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$729.60	$1,216.00	—	5% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$2,334.00	$3,890.00	$304.32–$310.41	235% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Arthrocent/Aspiration Maj Jnt\|LEFT SIDE	$7,967.76	$13,279.60	$304.32	1045% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 HC Arthrocent/Aspiration Maj Jnt\|RIGHT SIDE	$7,970.64	$13,284.40	$304.32	1045% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Arthrocent/Aspiration Maj Jnt	$729.60	$1,216.00	—	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Asp Inj Intermediate Joint	$660.60	$1,101.00	—	7% above	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Asp Inj Intermediate Joint	$660.60	$1,101.00	—	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Injection Small Joint/Bursa	$520.80	$868.00	—	6% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Injection Small Joint/Bursa	$520.80	$868.00	—	—	40%
Laparoscopic Roux-en-Y gastric bypass, standard limb length CPT 43644 Laps Gstr Rstcv Px W/Byp Roux-en-Y Limb <150 Cm	$97,555.52	$162,592.53	$217.10	310% above	40%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopic Appendectomy	$56,759.79	$94,599.65	$5,993.77	225% above	40%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy W Total Hysterectomy Uterus 250 Gm/<	$63,522.31	$105,870.52	$10,538.83	62% above	40%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laps Total Hysterect 250 Gm/< W/Rmvl Tube/Ovary	$63,081.31	$105,135.52	$10,538.83–$10,749.61	66% above	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|LEFT SIDE	$54,738.85	$91,231.42	$5,993.77–$6,113.65	129% above	40%
Laparoscopic inguinal (groin) hernia repair, first repair on that side one side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia\|RIGHT SIDE	$57,527.05	$95,878.42	$5,993.77–$6,113.65	141% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|RIGHT SIDE	$55,135.24	$91,892.07	$5,993.77–$6,113.65	105% above	40%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia one side CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia\|LEFT SIDE	$59,856.74	$99,761.23	$10,538.83–$10,749.61	122% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy W/Rmvl Adnexal Structures	$36,718.33	$61,197.22	$5,993.77–$6,113.65	122% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|RIGHT SIDE	$24,131.74	$40,219.57	$5,993.77–$6,113.65	46% above	40%
Laparoscopic removal of fallopian tubes and/or ovaries one side CPT 58661 Laparoscopy W/Rmvl Adnexal Structures\|LEFT SIDE	$33,019.78	$55,032.97	$5,993.77–$6,113.65	100% above	40%
Laparoscopic sleeve gastrectomy for weight loss CPT 43775 Laps Gstrc Rstrictiv Px Longitudinal Gastrectomy	$100,515.77	$167,526.28	$210.88	176% above	40%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$8,182.08	$13,636.80	$699.84–$713.83	302% above	40%
Lower-back epidural injection, with imaging guidance one side CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn\|RIGHT SIDE	$7,786.86	$12,978.10	$699.84–$713.83	282% above	40%
Lower-back epidural injection, with imaging guidance one side CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn\|LEFT SIDE	$9,037.92	$15,063.20	$699.84–$713.83	344% above	40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj a/S Transforam Lumbar	$3,011.40	$5,019.00	$876.90–$894.44	45% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inj a/S Transforam Lumbar\|LEFT SIDE	$7,915.44	$13,192.40	$876.90–$894.44	282% above	40%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Inj a/S Transforam Lumbar\|RIGHT SIDE	$8,184.78	$13,641.30	$876.90–$894.44	295% above	40%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Lamnotmy Incl W/Dcmprsn Nrv Root 1 Intrspc Lumbr	$33,482.30	$55,803.83	$7,194.09–$7,337.97	33% above	40%
Lumbar discectomy or laminotomy to free a nerve root, one level one side CPT 63030 Lamnotmy Incl W/Dcmprsn Nrv Root 1 Intrspc Lumbr\|LEFT SIDE	$36,825.19	$61,375.32	$7,194.09–$7,337.97	46% above	40%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level CPT 22633 Arthrodesis Combined Tq 1ntrspc Lumbar	$121,876.63	$203,127.72	$26,901.72	20% above	40%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Laminec/Facetect/Foramin,Lumbar	$84,543.83	$140,906.38	$17,383.71	155% above	40%
Lumbar spinal fusion (posterior), one level CPT 22612 Arthrodesis Posterior/Pstlat Tq 1ntrspc Lumbar	$99,584.61	$165,974.35	—	232% above	40%
Lumpectomy (partial mastectomy) CPT 19301 Mastectomy Partial	$29,958.21	$49,930.35	$6,583.32	70% above	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|RIGHT SIDE	$23,155.42	$38,592.37	$6,583.32–$6,714.99	31% above	40%
Lumpectomy (partial mastectomy) one side CPT 19301 Mastectomy Partial\|LEFT SIDE	$25,500.46	$42,500.77	—	45% above	40%
Mastectomy (total removal of the breast) CPT 19303 Mastectomy Simple Complete	$68,866.58	$114,777.63	$6,583.32	152% above	40%
Mastectomy (total removal of the breast) one side CPT 19303 Mastectomy Simple Complete\|RIGHT SIDE	$22,159.02	$36,931.70	$6,583.32	19% below	40%
Mastectomy (total removal of the breast) one side CPT 19303 Mastectomy Simple Complete\|LEFT SIDE	$25,809.24	$43,015.40	$6,583.32	6% below	40%
Miscarriage treatment with D&C, first trimester CPT 59820 Tx Missed Abortion First Trimester Surgical	$14,509.62	$24,182.70	$3,209.41–$3,273.60	105% above	40%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Exc Skin Benig <5mm Face Facial	$14,551.86	$24,253.10	$702.07	961% above	40%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion of Nail Plate	$493.20	$822.00	—	55% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC Avulsion of Nail Plate	$493.20	$822.00	—	—	40%
Pacemaker implant (dual chamber) CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$12,317.40	$20,529.00	—	21% below	40%
Pacemaker implant (dual chamber) inpatient CPT 33208 HC Ins/Repl of Dual Cham Ppm Lead	$12,317.40	$20,529.00	—	—	40%
Paracentesis with imaging guidance CPT 49083 HC Abd Paracentesis W Guide	$2,116.80	$3,528.00	—	22% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abd Paracentesis W Guide	$2,116.80	$3,528.00	—	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Removal of Nail Bed	$16,396.50	$27,327.50	$1,637.46–$1,670.21	2010% above	40%
Prostate biopsy CPT 55700 HC Biopsy Prostate Needle or Punc	$12,948.24	$21,580.40	$122.09–$124.53	543% above	40%
Prostate removal (prostatectomy), laparoscopic CPT 55866 Laps Surg Prst8ect Rpbic Rad W/Nrv Sparing Robot	$93,704.15	$156,173.58	$10,538.83–$10,749.61	76% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HC Rf Destruct Lum Single\|RIGHT SIDE	$8,184.36	$13,640.60	$1,936.01–$1,974.73	145% above	40%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 HC Rf Destruct Lum Single\|LEFT SIDE	$10,043.94	$16,739.90	$1,936.01–$1,974.73	201% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|RIGHT SIDE	$13,234.68	$22,057.80	$3,881.91	197% above	40%
Removal of a breast lump, open surgery one side CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion\|LEFT SIDE	$15,210.48	$25,350.80	$3,881.91	242% above	40%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy	$45,354.39	$75,590.65	$5,993.77–$6,113.65	107% above	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|LEFT SIDE	$33,337.83	$55,563.05	$5,993.77–$6,113.65	52% above	40%
Removal of one lobe of the thyroid (lobectomy) one side CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy\|RIGHT SIDE	$54,392.84	$90,654.73	$5,993.77–$6,113.65	148% above	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$4,166.28	$6,943.80	$922.00–$940.44	60% above	40%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Scrn; Hi Risk Ind	$4,202.70	$7,004.50	$922.00	61% above	40%
Septoplasty to straighten the nasal septum CPT 30520 Septoplasty/Submucous Resecj W/WO Cartilage Grf	$42,497.06	$70,828.43	$6,997.04–$7,136.98	106% above	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 HC Lithotripsy	$23,630.31	$39,383.85	$3,494.80–$3,564.70	137% above	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 HC Lithotripsy\|LEFT SIDE	$16,168.86	$26,948.10	$3,494.80–$3,564.70	62% above	40%
Shock-wave lithotripsy to break up kidney stones (from outside the body) one side CPT 50590 HC Lithotripsy\|RIGHT SIDE	$16,794.30	$27,990.50	$3,494.80–$3,564.70	68% above	40%
Short arm splint (forearm and hand) CPT 29125 HC Splint - Short Arm	$441.00	$735.00	—	52% above	40%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Splint - Short Arm	$441.00	$735.00	—	—	40%
Short leg cast (below the knee) CPT 29405 HC Application Short Leg Cast	$606.60	$1,011.00	—	59% above	40%
Short leg cast (below the knee) inpatient CPT 29405 HC Application Short Leg Cast	$606.60	$1,011.00	—	—	40%
Short leg splint (calf to foot) CPT 29515 HC Splint App/Short Leg	$511.80	$853.00	—	74% above	40%
Short leg splint (calf to foot) inpatient CPT 29515 HC Splint App/Short Leg	$511.80	$853.00	—	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|RIGHT SIDE	$67,897.70	$113,162.83	$7,194.09	155% above	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|RIGHT SIDE	$28,535.67	$47,559.45	$7,194.09–$7,337.97	26% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$941.40	$1,569.00	—	185% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$941.40	$1,569.00	—	—	40%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Biopsy Skin Single Lesion	$465.60	$776.00	$403.03	5% above	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Biopsy Skin Single Lesion	$465.60	$776.00	—	—	40%
Skin tag removal, up to 15 tags CPT 11200 HC Excision Up to 15 Skin Tags	$28,224.48	$47,040.80	$2,879.85	9549% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$941.40	$1,569.00	—	167% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs one side CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5\|LEFT SIDE	$941.40	$1,569.00	—	167% above	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5	$941.40	$1,569.00	—	—	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient one side CPT 12002 HC Rpr Lac Smp Scalp 2.6-7.5\|LEFT SIDE	$941.40	$1,569.00	—	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$22,792.56	$37,987.60	$198.92	7084% above	40%
TURP (transurethral resection of the prostate) CPT 52601 Trurl Electrosurg Rescj Prostate Bleed Complete	$26,224.78	$43,707.97	$5,315.89–$5,422.21	48% above	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Single Lesion	$465.60	$776.00	—	54% above	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Single Lesion	$15,778.02	$26,296.70	$1,594.23	5127% above	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC Tangential Biopsy Skin Single Lesion	$465.60	$776.00	—	—	40%
Thoracentesis with imaging guidance CPT 32555 HC Aspirate Pleura W/ Imaging	$2,767.20	$4,612.00	—	59% above	40%
Thoracentesis with imaging guidance CPT 32555 HC Sp Thora for Aspiration	$3,255.00	$5,425.00	—	87% above	40%
Thoracentesis with imaging guidance CPT 32555 HC Aspirate Pleura W/ Imaging	$3,906.00	$6,510.00	$621.93	125% above	40%
Thoracentesis with imaging guidance one side CPT 32555 HC Aspirate Pleura W/ Imaging\|RIGHT SIDE	$4,140.00	$6,900.00	$621.93–$634.37	138% above	40%
Thoracentesis with imaging guidance one side CPT 32555 HC Aspirate Pleura W/ Imaging\|LEFT SIDE	$11,522.31	$19,203.85	$621.93–$634.37	563% above	40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Aspirate Pleura W/ Imaging	$2,767.20	$4,612.00	—	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Aspirate Pleura W/ Imaging	$3,255.00	$5,425.00	—	—	40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Sp Thora for Aspiration	$3,255.00	$5,425.00	—	—	40%
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & Adenoidectomy Age 12/>	$20,075.76	$33,459.60	$3,287.07	288% above	40%
Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12	$18,331.48	$30,552.47	$5,869.15–$5,986.53	118% above	40%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy Primary/Secondary Age 12/>	$21,756.36	$36,260.60	$3,287.07	91% above	40%
Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Tonsillectomy Primary/Secondary <Age 12	$17,520.07	$29,200.12	$5,869.15	174% above	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|LEFT SIDE	$50,962.28	$84,937.13	$12,728.77	15% above	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|RIGHT SIDE	$51,657.04	$86,095.07	$12,728.77	17% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT SIDE	$58,366.35	$97,277.25	$12,728.77	36% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|LEFT SIDE	$61,454.56	$102,424.27	$12,728.77	43% above	40%
Total shoulder replacement one side CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder\|RIGHT SIDE	$61,689.12	$102,815.20	—	13% above	40%
Total shoulder replacement one side CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder\|LEFT SIDE	$63,871.62	$106,452.70	$17,383.71	17% above	40%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy Total/Complete	$54,018.21	$90,030.35	$5,993.77–$6,113.65	86% above	40%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inject Trigger Point 1/2 Muscle	$741.60	$1,236.00	—	6% above	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Inject Trigger Point 1/2 Muscle	$741.60	$1,236.00	—	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Bx Breast 1st Lesion US Img	$5,634.00	$9,390.00	—	70% above	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC Bx Breast 1st Lesion US Img	$5,634.00	$9,390.00	—	—	40%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd Balloon Dilation Esophagus <30 Mm Diam	$8,920.32	$14,867.20	$1,902.48–$1,940.53	155% above	40%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple	$7,631.58	$12,719.30	$899.22–$917.20	172% above	40%
Upper endoscopy (EGD) with injection into the lining CPT 43236 Esophagogastroduodenoscopy Submucosal Injection	$5,790.42	$9,650.70	$899.22	107% above	40%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Removal Tumor Polyp/Other Lesion Snare Tech	$10,450.46	$17,417.43	$1,902.48–$1,940.53	223% above	40%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Insert Guide Wire Dilator Passage Esophagus	$8,426.28	$14,043.80	$899.22–$917.20	201% above	40%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash	$2,807.28	$4,678.80	$899.22–$917.20	8% above	40%
Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cysto W/Ureteroscopy W/Lithotripsy\|RIGHT SIDE	$16,642.76	$27,737.93	$5,315.89–$5,422.21	41% above	40%
Ureteroscopy with laser stone breaking (lithotripsy) one side CPT 52353 Cysto W/Ureteroscopy W/Lithotripsy\|LEFT SIDE	$26,425.18	$44,041.97	$5,315.89	124% above	40%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt	$26,876.48	$44,794.13	$5,315.89–$5,422.21	77% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|RIGHT SIDE	$27,847.03	$46,411.72	$5,315.89–$5,422.21	83% above	40%
Ureteroscopy with laser stone breaking and stent placement one side CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt\|LEFT SIDE	$28,201.75	$47,002.92	$5,315.89–$5,422.21	86% above	40%
Vein ablation, radiofrequency, first vein CPT 36475 HC Endovenous Rf 1st Vein	$5,330.40	$8,884.00	—	18% below	40%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 HC Endovenous Rf 1st Vein	$5,330.40	$8,884.00	—	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,108.20	$1,847.00	—	42% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,544.22	$2,573.70	$403.03	98% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Subq First 20 Sq Cm	$1,108.20	$1,847.00	—	—	40%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Optx Dstl Radl X-Artic Fx/Epiphysl Sep\|RIGHT SIDE	$42,730.23	$71,217.05	$7,194.09	156% above	40%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Optx Dstl Radl X-Artic Fx/Epiphysl Sep\|LEFT SIDE	$45,901.15	$76,501.92	$7,194.09–$7,337.97	175% above	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chemotherapy IV infusion, first hour CPT 96413 HC Chemo Infusion 1st Hour Chemo	$419.40	$699.00	—	45% below	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemo Infusion 1st Hour Chemo	$419.40	$699.00	—	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 Lead Ekg	$504.60	$841.00	$132.00–$134.64	172% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Inf 1st Hour Hyd	$499.20	$832.00	—	19% above	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Inf 1st Hour Hyd	$499.20	$832.00	—	—	40%
IV infusion of a medicine, first hour CPT 96365 HC IV 1st Hour Init Drug	$384.60	$641.00	—	11% below	40%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV 1st Hour Init Drug	$384.60	$641.00	—	—	40%
IV push of a medicine, first drug CPT 96374 HC IV Push Initial Drug	$136.20	$227.00	—	47% below	40%
IV push of a medicine, first drug inpatient CPT 96374 HC IV Push Initial Drug	$136.20	$227.00	—	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Injection Im Sub Q	$84.00	$140.00	—	41% below	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Injection Im Sub Q	$84.00	$140.00	—	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$115.32	$192.20	—	69% below	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$115.32	$192.20	—	—	40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$17.76	$29.60	—	73% below	40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$17.76	$29.60	—	—	40%
Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY	$79.50	$132.50	—	74% below	40%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY	$79.50	$132.50	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSY	$17.58	$29.30	—	71% below	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$438.78	$731.30	—	631% above	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSY	$17.58	$29.30	—	—	40%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY	$438.78	$731.30	—	—	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$8.10	$13.50	—	73% below	40%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR	$8.10	$13.50	—	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$58.80	$98.00	—	72% below	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$58.80	$98.00	—	—	40%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$100.08	$166.80	—	68% below	40%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR	$100.08	$166.80	—	—	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$164.82	$274.70	—	75% below	40%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$164.82	$274.70	—	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$25.38	$42.30	—	72% below	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$25.38	$42.30	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$29.28	$48.80	—	74% below	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	$29.52	$49.20	—	73% below	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$29.28	$48.80	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP	$29.52	$49.20	—	—	40%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.mercy.com/-/media/mercy/patient-resources/hospital-pricing-transparency/341105619_mercy-health-st-ritas-medical-center-llc_standardcharges.ashx