Hospital Toledo, OH

Fulton County Health Center

Fulton County Health Center in Wauseon, OH publishes cash prices for 271 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 below the Ohio median for 162 of 271 procedures and above it for 107. By typical cash price it ranks #50 of 139 Ohio hospitals and #2 of 7 hospitals in the Toledo, OH area, cheapest first. Select a procedure to compare it with other hospitals nearby.

725 South Shoop Avenue, Wauseon, OH 43567 Collected Sep 22, 2026 Source price file Check a bill from this hospital (419) 335-2015

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 3 of 5 CCN 361333 · CMS hospital register NPI 1548279714

Financial assistance

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

Fulton County Health 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 CT ABDOMEN W/WO CONTRAST	$1,529.04	$2,184.34	—	15% above	30%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/WO CONTRAST	$1,529.04	$2,184.34	—	—	30%
Abdominal X-ray, 2 views CPT 74019 XR ABDOMEN 2 VIEW	$165.55	$236.50	—	51% below	30%
Abdominal X-ray, 2 views inpatient CPT 74019 XR ABDOMEN 2 VIEW	$165.55	$236.50	—	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ARTERIAL-ABI	$381.69	$545.27	—	21% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTERIAL-ABI	$381.69	$545.27	—	—	30%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE W/O CONTRAST RT	$1,272.92	$1,818.46	—	35% above	30%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT UE W/O CONTRAST LT	$1,272.92	$1,818.46	—	35% above	30%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE W/O CONTRAST RT	$1,272.92	$1,818.46	—	—	30%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT UE W/O CONTRAST LT	$1,272.92	$1,818.46	—	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 XR ESOPHAGUS CONTRAST	$281.05	$401.50	—	36% below	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 XR ESOPHAGUS CONTRAST	$281.05	$401.50	—	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 NM BONE SCAN - A	$1,121.39	$1,601.99	—	27% below	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 NM BONE SCAN - A	$1,121.39	$1,601.99	—	—	30%
Breast ultrasound, complete, one breast CPT 76641 BREAST SONOGRAPHY	$282.07	$402.96	—	41% below	30%
Breast ultrasound, complete, one breast CPT 76641 US BRST B-SCAN&/REL TM W/IMAG	$282.07	$402.96	—	41% below	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BRST B-SCAN&/REL TM W/IMAG	$282.07	$402.96	—	—	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 BREAST SONOGRAPHY	$282.07	$402.96	—	—	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BRST LMTD LT	$320.24	$457.48	—	22% below	30%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BRST LMTD RT	$320.24	$457.48	—	22% below	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BRST LMTD RT	$320.24	$457.48	—	—	30%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US BRST LMTD LT	$320.24	$457.48	—	—	30%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA ABD/PELVIS W/O & W/CONTRAS	$2,442.41	$3,489.16	—	14% above	30%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA ABD/PELVIS W/O & W/CONTRAS	$2,442.41	$3,489.16	—	—	30%
CT angiography (CTA) of the head CPT 70496 CTA HEAD WITH CONTRAST	$1,652.70	$2,361.00	—	24% above	30%
CT angiography (CTA) of the head inpatient CPT 70496 CTA HEAD WITH CONTRAST	$1,652.70	$2,361.00	—	—	30%
CT angiography (CTA) of the neck CPT 70498 CTA NECK W&W/O CONTRAST	$1,702.32	$2,431.88	—	31% above	30%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA NECK W&W/O CONTRAST	$1,702.32	$2,431.88	—	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA CHEST W & W/O CONTRAST	$1,702.32	$2,431.88	—	20% above	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA CHEST W & W/O CONTRAST	$1,702.32	$2,431.88	—	—	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA ANGIO HEART W/CONTRAST	$1,702.32	$2,431.88	—	6% above	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA ANGIO HEART W/CONTRAST	$1,702.32	$2,431.88	—	—	30%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 3D HEART SCREEN/W CALCIUM SCOR	$76.34	$109.05	—	73% below	30%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 3D HEART SCREEN/W CALCIUM SCOR	$76.34	$109.05	—	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT abdomen/pelvis w/o contrast	$1,506.13	$2,151.62	—	5% below	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT abdomen/pelvis w/o contrast	$1,506.13	$2,151.62	—	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELVIS WITH CONTRAST	$1,488.58	$2,126.54	—	25% below	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD/PELVIS WITH CONTRAST	$1,488.58	$2,126.54	—	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD/PELVIS W/O & W/CONTRAST	$2,137.44	$3,053.49	—	8% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABD/PELVIS W/O & W/CONTRAST	$2,137.44	$3,053.49	—	—	30%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN WITH CONTRAST	$1,388.95	$1,984.22	—	19% above	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN WITH CONTRAST	$1,388.95	$1,984.22	—	—	30%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST	$1,204.99	$1,721.41	—	15% above	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST	$1,204.99	$1,721.41	—	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,274.46	$1,820.65	—	46% above	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST	$1,274.46	$1,820.65	—	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD W/O CONTRAST	$875.97	$1,251.38	—	5% above	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD W/O CONTRAST	$875.97	$1,251.38	—	—	30%
CT scan of the head with contrast CPT 70460 CT Head/brain w/contrast	$984.93	$1,407.04	—	2% below	30%
CT scan of the head with contrast inpatient CPT 70460 CT Head/brain w/contrast	$984.93	$1,407.04	—	—	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD W/WO CONTRAST	$1,489.33	$2,127.62	—	25% above	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD W/WO CONTRAST	$1,489.33	$2,127.62	—	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT SPINE/LUMBAR W/O CONTRAST	$1,279.80	$1,828.28	—	16% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT SPINE/LUMBAR W/O CONTRAST	$1,279.80	$1,828.28	—	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT SPINE/CERVICAL W/O CONTRAST	$1,279.80	$1,828.28	—	19% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT SPINE/CERVICAL W/O CONTRAST	$1,279.80	$1,828.28	—	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS WITH CONTRAST	$1,389.72	$1,985.31	—	14% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS WITH CONTRAST	$1,389.72	$1,985.31	—	—	30%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX - VASCULAR	$695.43	$993.47	—	4% below	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 CAROTID DUPLEX - VASCULAR	$695.43	$993.47	—	—	30%
Chest CT scan without and with contrast CPT 71270 CT THORAX W/WO CONTRAST	$916.05	$1,308.64	—	39% below	30%
Chest CT scan without and with contrast inpatient CPT 71270 CT THORAX W/WO CONTRAST	$916.05	$1,308.64	—	—	30%
Chest X-ray, 2 views CPT 71046 XR Chest 2 views	$172.20	$246.00	—	35% below	30%
Chest X-ray, 2 views inpatient CPT 71046 XR Chest 2 views	$172.20	$246.00	—	—	30%
Chest X-ray, single view CPT 71045 XR Chest single front view	$154.00	$220.00	—	31% below	30%
Chest X-ray, single view inpatient CPT 71045 XR Chest single front view	$154.00	$220.00	—	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL, COMP	$601.54	$859.34	—	15% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL, COMP	$601.54	$859.34	—	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY AXIAL	$348.48	$497.83	—	23% below	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DEXA BONE DENSITY AXIAL	$348.48	$497.83	—	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX W/O CONTRAST	$687.04	$981.48	—	27% below	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT THORAX W/O CONTRAST	$687.04	$981.48	—	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX WITH CONTRAST	$1,119.10	$1,598.72	—	8% below	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT THORAX WITH CONTRAST	$1,119.10	$1,598.72	—	—	30%
Diagnostic mammogram, both breasts CPT 77066 MAMMOGRAM DIAG BIL W/ CAD	$235.12	$335.89	—	34% below	30%
Diagnostic mammogram, both breasts inpatient CPT 77066 MAMMOGRAM DIAG BIL W/ CAD	$235.12	$335.89	—	—	30%
Duplex ultrasound of the leg arteries, both legs CPT 93925 DPLX SCAN LWR EXT ART;BILATERL	$832.84	$1,189.77	—	7% below	30%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 DPLX SCAN LWR EXT ART;BILATERL	$832.84	$1,189.77	—	—	30%
Duplex ultrasound of the leg veins, both legs CPT 93970 DUPLEX VENUS EXTR COMPL BIL	$844.28	$1,206.12	—	6% below	30%
Duplex ultrasound of the leg veins, both legs inpatient CPT 93970 DUPLEX VENUS EXTR COMPL BIL	$844.28	$1,206.12	—	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 CA Echo Comp w/spect&color	$1,285.14	$1,835.91	—	24% below	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 CA Echo Comp w/spect&color	$1,285.14	$1,835.91	—	—	30%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT/EAR/FOSSA W/O CONT	$1,279.80	$1,828.28	—	48% above	30%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT/EAR/FOSSA W/O CONT	$1,279.80	$1,828.28	—	—	30%
Facial bones X-ray, complete, 3 or more views CPT 70150 XR FACIAL BONES MIN 3 VWS	$226.10	$323.00	—	40% below	30%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 XR FACIAL BONES MIN 3 VWS	$226.10	$323.00	—	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP 4 CHAN TYPE III MON HOME	$396.95	$567.07	—	43% below	30%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 SLEEP TESTING 7 CHANNEL HOME	$801.16	$1,144.51	—	14% above	30%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP 4 CHAN TYPE III MON HOME	$396.95	$567.07	—	—	30%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP TESTING 7 CHANNEL HOME	$801.16	$1,144.51	—	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM. >=6YRS W/CPAP 4+PARAM	$3,337.84	$4,768.34	—	19% below	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM. >=6YRS W/CPAP 4+PARAM	$3,337.84	$4,768.34	—	—	30%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LWR EXT W/O CONTR LT	$1,279.80	$1,828.28	—	36% above	30%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT LWR EXT W/O CONTR RT	$1,279.80	$1,828.28	—	36% above	30%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LWR EXT W/O CONTR RT	$1,279.80	$1,828.28	—	—	30%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT LWR EXT W/O CONTR LT	$1,279.80	$1,828.28	—	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABD. LIMITED REAL TIME	$469.48	$670.68	—	15% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 MINI US-ER ECHOEXAM OF ABDOMEN	$482.22	$688.89	—	13% below	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABD. LIMITED REAL TIME	$469.48	$670.68	—	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 MINI US-ER ECHOEXAM OF ABDOMEN	$482.22	$688.89	—	—	30%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US JNT OR NON-VAS EXT LMTD	$509.94	$728.48	—	7% above	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT JNT LMTD LT	$412.60	$589.43	—	14% below	30%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US EXT JNT LMTD RT	$412.60	$589.43	—	14% below	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US JNT OR NON-VAS EXT LMTD	$509.94	$728.48	—	—	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT JNT LMTD LT	$412.60	$589.43	—	—	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US EXT JNT LMTD RT	$412.60	$589.43	—	—	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Lung Cancer Screening	$1,279.80	$1,828.28	—	335% above	30%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Lung Cancer Screening	$1,279.80	$1,828.28	—	—	30%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD WITHOUT CONTRAST	$1,464.15	$2,091.64	—	1% above	30%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD WITHOUT CONTRAST	$1,464.15	$2,091.64	—	—	30%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI Bil breast w/wo contrast	$1,494.30	$2,134.72	—	62% below	30%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Bil breast w/wo contrast	$1,494.30	$2,134.72	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LWR EXT JT W/O CNTST LT	$1,842.78	$2,632.54	—	5% above	30%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI LWR EXT JT W/O CNTRST RT	$1,842.78	$2,632.54	—	5% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LWR EXT JT W/O CNTRST RT	$1,842.78	$2,632.54	—	—	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MRI LWR EXT JT W/O CNTST LT	$1,842.78	$2,632.54	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LWR EXT JT W/WO CNTRST LT	$2,167.21	$3,096.01	—	9% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI LWR EXT JT W/WO CNTRST RT	$2,167.21	$3,096.01	—	9% below	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LWR EXT JT W/WO CNTRST LT	$2,167.21	$3,096.01	—	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MRI LWR EXT JT W/WO CNTRST RT	$2,167.21	$3,096.01	—	—	30%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,842.78	$2,632.54	—	at median	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST	$1,842.78	$2,632.54	—	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/ & W/O CONTRAST	$1,972.17	$2,817.39	—	14% below	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/ & W/O CONTRAST	$1,972.17	$2,817.39	—	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WITHOUT CONTRAST	$1,842.78	$2,632.54	—	14% above	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAINW/O CONT INCLD MRA BR	$2,497.75	$3,568.22	—	55% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WITHOUT CONTRAST	$1,842.78	$2,632.54	—	—	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAINW/O CONT INCLD MRA BR	$2,497.75	$3,568.22	—	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O - W/CONTR.	$2,276.38	$3,251.97	—	4% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/O - W/CONTR.	$2,276.38	$3,251.97	—	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	11% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMB SPINE W/O & W/CONTRST	$2,276.38	$3,251.97	—	3% below	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI LUMB SPINE W/O & W/CONTRST	$2,276.38	$3,251.97	—	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THRC SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	10% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI THRC SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERVCL SPINE W/& W/O CONTR	$2,276.38	$3,251.97	—	1% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI CERVCL SPINE W/& W/O CONTR	$2,276.38	$3,251.97	—	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERV SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	12% above	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI CERV SPINE W/O CONTRAST	$1,842.78	$2,632.54	—	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W & W/O CONTRAST	$1,972.17	$2,817.39	—	1% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W & W/O CONTRAST	$1,972.17	$2,817.39	—	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST	$1,755.38	$2,507.68	—	16% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST	$1,755.38	$2,507.68	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JT W/O CONT LT	$1,842.78	$2,632.54	—	22% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI UE JT W/O CONT RT	$1,842.78	$2,632.54	—	22% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE JT W/O CONT RT	$1,842.78	$2,632.54	—	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MRI UE JT W/O CONT LT	$1,842.78	$2,632.54	—	—	30%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 XR SPINE CERV MIN 4 VIEWS	$294.70	$421.00	—	34% below	30%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 XR SPINE CERV MIN 4 VIEWS	$294.70	$421.00	—	—	30%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK W/ CONTRAST	$1,382.46	$1,974.95	—	17% above	30%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT NECK W/ CONTRAST	$1,382.46	$1,974.95	—	—	30%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK W/O CONTRAST	$1,279.80	$1,828.28	—	39% above	30%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT NECK W/O CONTRAST	$1,279.80	$1,828.28	—	—	30%
Neck soft tissue X-ray CPT 70360 XR NECK SOFT TISSUE	$185.50	$265.00	—	28% below	30%
Neck soft tissue X-ray inpatient CPT 70360 XR NECK SOFT TISSUE	$185.50	$265.00	—	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 NM HT MUSCLE IMAGE SPECT,MULTI	$2,819.90	$4,028.43	—	30% below	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 NM HT MUSCLE IMAGE SPECT,MULTI	$2,819.90	$4,028.43	—	—	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET/CT TORSO SCAN	$2,757.30	$3,939.00	—	43% below	30%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET/CT TORSO SCAN	$2,757.30	$3,939.00	—	—	30%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST	$1,199.64	$1,713.77	—	19% above	30%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST	$1,199.64	$1,713.77	—	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC NON-OB LMTD/F/U	$319.09	$455.84	—	27% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC NON-OB LMTD/F/U	$319.09	$455.84	—	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC	$526.72	$752.46	—	5% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NON-OB COMPLETE	$526.72	$752.46	—	5% above	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC	$526.72	$752.46	—	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NON-OB COMPLETE	$526.72	$752.46	—	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US TA >/=14WEEK	$678.25	$968.93	—	13% above	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US TA >/=14 WKS 1ST FETUS	$678.25	$968.93	—	13% above	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US TA >/=14WEEK	$678.25	$968.93	—	—	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 OB US TA >/=14 WKS 1ST FETUS	$678.25	$968.93	—	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US <14WKS, 1ST/SINGLE FETUS	$396.19	$565.99	—	28% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 OB US <14WKS, 1ST/SINGLE FETUS	$396.19	$565.99	—	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S)	$406.95	$581.36	—	15% below	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 OB US LIMITED FETUS(S)	$406.95	$581.36	—	—	30%
Screening mammogram, both breasts CPT 77067 Mammogram screen bil w/CAD	$233.59	$333.70	—	22% above	30%
Screening mammogram, both breasts inpatient CPT 77067 Mammogram screen bil w/CAD	$233.59	$333.70	—	—	30%
Sinus X-ray, complete, 3 or more views CPT 70220 XR SINUS SERIES MIN 3 VW	$226.10	$323.00	—	37% below	30%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 XR SINUS SERIES MIN 3 VW	$226.10	$323.00	—	—	30%
Skull X-ray, fewer than 4 views CPT 70250 XR SKULL AP/LAT < 4 VIEWS	$107.80	$154.00	—	63% below	30%
Skull X-ray, fewer than 4 views inpatient CPT 70250 XR SKULL AP/LAT < 4 VIEWS	$107.80	$154.00	—	—	30%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY >=6YRS 4+PARAM	$3,080.58	$4,400.83	—	14% below	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY >=6YRS 4+PARAM	$3,080.58	$4,400.83	—	—	30%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS ECHO/TTE	$921.01	$1,315.73	—	55% below	30%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS ECHO/TTE	$921.01	$1,315.73	—	—	30%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT SPINE/THORACIC W/O CONTRAST	$1,279.80	$1,828.28	—	41% above	30%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT SPINE/THORACIC W/O CONTRAST	$1,279.80	$1,828.28	—	—	30%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL ECHOGRAPHY	$485.12	$693.03	—	14% below	30%
Transvaginal pelvic ultrasound CPT 76830 US PELVIC TRANSVAGINAL NONOB	$485.12	$693.03	—	14% below	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US PELVIC TRANSVAGINAL NONOB	$485.12	$693.03	—	—	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL ECHOGRAPHY	$485.12	$693.03	—	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 US PREGNANCY TRANSVAGINAL	$508.41	$726.30	—	1% above	30%
Transvaginal ultrasound during pregnancy CPT 76817 OB ULTRASOUND TRANSVAGINAL	$508.41	$726.30	—	1% above	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 OB ULTRASOUND TRANSVAGINAL	$508.41	$726.30	—	—	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREGNANCY TRANSVAGINAL	$508.41	$726.30	—	—	30%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN -COMPLETE	$627.11	$895.87	—	at median	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN -COMPLETE	$627.11	$895.87	—	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM AND CONTENTS	$564.52	$806.45	—	5% above	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM AND CONTENTS	$564.52	$806.45	—	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD/NECK	$419.86	$599.80	—	27% below	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD/NECK	$419.86	$599.80	—	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER GI W/O KUB	$346.57	$495.10	—	42% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 UPPER GI W/O KUB	$346.57	$495.10	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 DUPLEX SCAN EXTRMTY,LMTED/UNIL	$659.55	$942.21	—	10% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP SCAN VENUS EXT LMTD LT	$659.55	$942.21	—	10% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP SCAN VENUS EXT LMTD RT	$659.55	$942.21	—	10% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 DUPLEX SCAN EXTRMTY,LMTED/UNIL	$659.55	$942.21	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUP SCAN VENUS EXT LMTD RT	$659.55	$942.21	—	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUP SCAN VENUS EXT LMTD LT	$659.55	$942.21	—	—	30%
X-ray of the abdomen, 1 view CPT 74018 XR ABD SINGLE A/P VIEW	$166.95	$238.50	—	35% below	30%
X-ray of the abdomen, 1 view CPT 74018 XR ABDOMEN 1 VIEW	$166.95	$238.50	—	35% below	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABD SINGLE A/P VIEW	$166.95	$238.50	—	—	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 XR ABDOMEN 1 VIEW	$166.95	$238.50	—	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 XR SPINE LUMBOSACRAL 2-3 VW	$180.25	$257.50	—	44% below	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 XR SPINE LUMBOSACRAL 2-3 VW	$180.25	$257.50	—	—	30%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE LUMBOSACRAL 4+ VW	$285.60	$408.00	—	39% below	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE LUMBOSACRAL 4+ VW	$285.60	$408.00	—	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 XR SPINE THORACIC 2 VIEWS	$200.55	$286.50	—	34% below	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 XR SPINE THORACIC 2 VIEWS	$200.55	$286.50	—	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 XR NOSE MIN 3 VIEW	$164.50	$235.00	—	44% below	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 XR NOSE MIN 3 VIEW	$164.50	$235.00	—	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 XR SPINE CERVICAL 2 OR 3 VWS	$219.10	$313.00	—	34% below	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 XR SPINE CERVICAL 2 OR 3 VWS	$219.10	$313.00	—	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 XR PELVIS 1-2 VIEWS	$180.25	$257.50	—	28% below	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 XR PELVIS 1-2 VIEWS	$180.25	$257.50	—	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 XR SACRUM/COCYX MIN 2 VW	$184.45	$263.50	—	38% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 XR SACRUM/COCYX MIN 2 VW	$184.45	$263.50	—	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT Alanine Aminotransfer	$47.37	$67.67	—	70% above	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT Alanine Aminotransfer	$47.37	$67.67	—	—	30%
AST (aspartate aminotransferase) enzyme test CPT 84450 AST/SGOT Aspartate Amino Trans	$45.88	$65.54	—	82% above	30%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 AST/SGOT Aspartate Amino Trans	$45.88	$65.54	—	—	30%
Albumin blood test CPT 82040 ALBUMIN ASSAY SERUM	$6.12	$8.74	—	72% below	30%
Albumin blood test CPT 82040 Albumin Level serum	$47.37	$67.67	—	114% above	30%
Albumin blood test inpatient CPT 82040 ALBUMIN ASSAY SERUM	$6.12	$8.74	—	—	30%
Albumin blood test inpatient CPT 82040 Albumin Level serum	$47.37	$67.67	—	—	30%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$47.37	$67.67	—	97% above	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$47.37	$67.67	—	—	30%
Alpha-fetoprotein (AFP) blood test CPT 82105 Maternal serum AFP	$23.87	$34.10	—	61% below	30%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Maternal serum AFP	$23.87	$34.10	—	—	30%
Ammonia blood test CPT 82140 Ammonia	$51.85	$74.07	—	5% below	30%
Ammonia blood test inpatient CPT 82140 Ammonia	$51.85	$74.07	—	—	30%
Amylase blood test CPT 82150 Amylase peritoneal fluid	$52.22	$74.60	—	9% above	30%
Amylase blood test CPT 82150 Amylase	$67.52	$96.45	—	41% above	30%
Amylase blood test inpatient CPT 82150 Amylase peritoneal fluid	$52.22	$74.60	—	—	30%
Amylase blood test inpatient CPT 82150 Amylase	$67.52	$96.45	—	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ARTHRITIS PROFILE - D	$51.10	$73.00	—	8% below	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ARTHRITIS PROFILE - D	$51.10	$73.00	—	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP B-type Natriuretic Peptid	$79.07	$112.96	—	47% below	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP B-type Natriuretic Peptid	$79.07	$112.96	—	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture Bacteria other aerobic	$58.18	$83.12	—	12% below	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Culture and Gram stain	$85.41	$122.02	—	29% above	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture Bacteria other aerobic	$58.18	$83.12	—	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Culture and Gram stain	$85.41	$122.02	—	—	30%
Basic metabolic panel (blood test) CPT 80048 BMP-Basic Metabolic Panel	$71.62	$102.31	—	9% above	30%
Basic metabolic panel (blood test) CPT 80048 BM Panel (HCH)	$115.63	$165.18	—	76% above	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BMP-Basic Metabolic Panel	$71.62	$102.31	—	—	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BM Panel (HCH)	$115.63	$165.18	—	—	30%
Bilirubin blood test, total CPT 82247 Bilirubin Total	$45.88	$65.54	—	91% above	30%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total	$45.88	$65.54	—	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV	$146.57	$209.38	—	28% below	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - F	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 4 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 4 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 4 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 4 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 3 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 3 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 3 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 2 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 2 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Micro-pathology level IV	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 5 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 5 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 5 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 5 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 6 - F	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - F	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 7 - G	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - G	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 8 - H	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - F	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - G	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - H	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 9 - I	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - B	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - C	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - D	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - E	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - F	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - G	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - H	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - I	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 10 - J	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 MICRO III X 5 - A	$239.70	$342.43	—	18% above	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 LEVEL IV	$146.57	$209.38	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - H	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - G	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 5 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 5 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 5 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 3 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - F	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 3 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Micro-pathology level IV	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 2 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 2 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - F	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 7 - F	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - G	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 3 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - F	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 4 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - G	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - I	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 8 - H	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 4 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 4 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - J	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 4 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - F	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - G	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - H	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 9 - I	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - A	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - B	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 10 - C	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 6 - D	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 5 - E	$239.70	$342.43	—	—	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 MICRO III X 5 - D	$239.70	$342.43	—	—	30%
Blood culture for bacteria CPT 87040 Blood Culture	$108.54	$155.06	—	16% above	30%
Blood culture for bacteria inpatient CPT 87040 Blood Culture	$108.54	$155.06	—	—	30%
Blood glucose (sugar) test CPT 82947 GLUCOSE BLOOD QUANT ASSAY	$5.59	$7.99	—	76% below	30%
Blood glucose (sugar) test CPT 82947 Glucose	$45.88	$65.54	—	95% above	30%
Blood glucose (sugar) test inpatient CPT 82947 GLUCOSE BLOOD QUANT ASSAY	$5.59	$7.99	—	—	30%
Blood glucose (sugar) test inpatient CPT 82947 Glucose	$45.88	$65.54	—	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 TRAUMA PROFILE FEMALE - J	$45.88	$65.54	—	16% below	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG Qualitative (Pregnancy)	$79.07	$112.96	—	45% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 TRAUMA PROFILE FEMALE - J	$45.88	$65.54	—	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG Qualitative (Pregnancy)	$79.07	$112.96	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO Type	$44.76	$63.94	—	25% below	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Ex-Type & Screen Anti - B	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPE (ABO & RH) POST - A	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 CORD BLOOD WORK-UP - A	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Ex-Blood Type ABO & RH - A	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING - ABO	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ANTEPARTUM RHOGAM - B	$91.76	$131.08	—	54% above	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO Type	$44.76	$63.94	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ANTEPARTUM RHOGAM - B	$91.76	$131.08	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPING - ABO	$91.76	$131.08	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 BLOOD TYPE (ABO & RH) POST - A	$91.76	$131.08	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Ex-Blood Type ABO & RH - A	$91.76	$131.08	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Ex-Type & Screen Anti - B	$91.76	$131.08	—	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 CORD BLOOD WORK-UP - A	$91.76	$131.08	—	—	30%
Blood urea nitrogen (BUN) test CPT 84520 BUN - Blood Urea Nitrogen	$45.88	$65.54	—	96% above	30%
Blood urea nitrogen (BUN) test CPT 84520 BUN (HCH)	$51.47	$73.53	—	120% above	30%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN - Blood Urea Nitrogen	$45.88	$65.54	—	—	30%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN (HCH)	$51.47	$73.53	—	—	30%
C-peptide blood test CPT 84681 C-Peptide serum	$76.46	$109.23	—	3% below	30%
C-peptide blood test inpatient CPT 84681 C-Peptide serum	$76.46	$109.23	—	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 CRP (C REACTIVE PROTEIN)	$49.98	$71.40	—	1% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 CRP (C REACTIVE PROTEIN)	$49.98	$71.40	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS COV2 RNA NAAT	$106.68	$152.40	—	24% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Covid-19-Abbott ID now	$130.55	$186.50	—	7% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV-19 AMP PRB HGH THRUPUT	$130.55	$186.50	—	7% below	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 SARS COV2 RNA NAAT	$106.68	$152.40	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 COV-19 AMP PRB HGH THRUPUT	$130.55	$186.50	—	—	30%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Covid-19-Abbott ID now	$130.55	$186.50	—	—	30%
Calcium blood test, total CPT 82310 Calcium	$47.37	$67.67	—	50% above	30%
Calcium blood test, total inpatient CPT 82310 Calcium	$47.37	$67.67	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$12.68	$18.12	—	76% below	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$63.00	$90.00	—	19% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$12.68	$18.12	—	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$63.00	$90.00	—	—	30%
Complete blood count (CBC) with differential CPT 85025 CBC with Differential	$69.75	$99.64	—	92% above	30%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC with Differential	$69.75	$99.64	—	—	30%
Complete blood count (CBC), no differential CPT 85027 CBC w/o diff (Hemogram)	$54.46	$77.80	—	61% above	30%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC w/o diff (Hemogram)	$54.46	$77.80	—	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 CMP-Comp Metabolic Panel	$96.24	$137.48	—	51% above	30%
Comprehensive metabolic panel (blood test) CPT 80053 CM Panel (HCH)	$164.12	$234.45	—	158% above	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CMP-Comp Metabolic Panel	$96.24	$137.48	—	—	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 CM Panel (HCH)	$164.12	$234.45	—	—	30%
Creatine kinase (CK) blood test, total CPT 82550 Cardiac Profile 1	$41.03	$58.61	—	16% above	30%
Creatine kinase (CK) blood test, total CPT 82550 Ex-Creatinine Kinase total	$41.03	$58.61	—	16% above	30%
Creatine kinase (CK) blood test, total CPT 82550 Creatinine Kinase (CK) CPK;tot	$86.53	$123.62	—	144% above	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Ex-Creatinine Kinase total	$41.03	$58.61	—	—	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Cardiac Profile 1	$41.03	$58.61	—	—	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatinine Kinase (CK) CPK;tot	$86.53	$123.62	—	—	30%
Creatinine blood test CPT 82565 Creatinine	$45.88	$65.54	—	86% above	30%
Creatinine blood test CPT 82565 Creatinine Assay (HCH)	$53.71	$76.73	—	117% above	30%
Creatinine blood test inpatient CPT 82565 Creatinine	$45.88	$65.54	—	—	30%
Creatinine blood test inpatient CPT 82565 Creatinine Assay (HCH)	$53.71	$76.73	—	—	30%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer	$84.29	$120.42	—	21% above	30%
D-dimer blood test (blood clot marker) CPT 85379 D-Dimer (HCH)	$146.30	$209.00	—	110% above	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer	$84.29	$120.42	—	—	30%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D-Dimer (HCH)	$146.30	$209.00	—	—	30%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolytes	$101.83	$145.47	—	113% above	30%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolytes	$101.83	$145.47	—	—	30%
Ferritin blood test (iron stores) CPT 82728 Ferritin - serum or plasma	$79.07	$112.96	—	4% above	30%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin - serum or plasma	$79.07	$112.96	—	—	30%
Fibrinogen blood test CPT 85384 Fibrinogen	$82.06	$117.23	—	82% above	30%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen	$82.06	$117.23	—	—	30%
Folate (folic acid) blood test CPT 82746 FOLATE	$63.41	$90.58	—	6% below	30%
Folate (folic acid) blood test inpatient CPT 82746 FOLATE	$63.41	$90.58	—	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 free	$67.52	$96.45	—	59% above	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 free	$67.52	$96.45	—	—	30%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT Gamma Glutamyl Transpeptid	$47.37	$67.67	—	11% above	30%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT Gamma Glutamyl Transpeptid	$47.37	$67.67	—	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hour	$50.73	$72.47	—	32% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hour	$50.73	$72.47	—	—	30%
Glucose tolerance test, 3 samples CPT 82951 Glucose 3 hour tolerance test	$99.96	$142.80	—	49% above	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose 3 hour tolerance test	$99.96	$142.80	—	—	30%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1 and 2 antibody	$87.28	$124.69	—	41% above	30%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1 and 2 antibody	$87.28	$124.69	—	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HBA1C DELTA	$14.92	$21.31	—	67% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C	$82.06	$117.23	—	80% above	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HBA1C DELTA	$14.92	$21.31	—	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C	$82.06	$117.23	—	—	30%
Hemoglobin blood test CPT 85018 HGB Hemoglobin	$32.82	$46.89	—	103% above	30%
Hemoglobin blood test inpatient CPT 85018 HGB Hemoglobin	$32.82	$46.89	—	—	30%
Iron blood test (serum iron) CPT 83540 Iron	$49.24	$70.34	—	29% above	30%
Iron blood test (serum iron) inpatient CPT 83540 Iron	$49.24	$70.34	—	—	30%
Iron-binding capacity (TIBC) test CPT 83550 Ex-Iron binding capacity	$33.57	$47.96	—	14% below	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Ex-Iron binding capacity	$33.57	$47.96	—	—	30%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$166.36	$237.65	—	131% above	30%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL	$166.36	$237.65	—	—	30%
Lactate (lactic acid) blood test CPT 83605 Lactic Acid	$45.88	$65.54	—	12% below	30%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactic Acid	$45.88	$65.54	—	—	30%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH Lactate Dehydrogenase	$45.88	$65.54	—	68% above	30%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LDH Lactate Dehydrogenase	$45.88	$65.54	—	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase serum	$70.87	$101.24	—	22% above	30%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Assay (HCH)	$149.20	$213.14	—	156% above	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase serum	$70.87	$101.24	—	—	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Assay (HCH)	$149.20	$213.14	—	—	30%
Liver function blood test panel CPT 80076 Liver Panel	$177.92	$254.17	—	194% above	30%
Liver function blood test panel inpatient CPT 80076 Liver Panel	$177.92	$254.17	—	—	30%
Magnesium blood test CPT 83735 Magnesium level	$56.32	$80.46	—	67% above	30%
Magnesium blood test inpatient CPT 83735 Magnesium level	$56.32	$80.46	—	—	30%
Measles (rubeola) antibody test CPT 86765 Rubeola (measles) IgM	$44.02	$62.88	—	23% below	30%
Measles (rubeola) antibody test inpatient CPT 86765 Rubeola (measles) IgM	$44.02	$62.88	—	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 MONOTEST SCREENING	$51.85	$74.07	—	3% below	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 MONOTEST SCREENING	$51.85	$74.07	—	—	30%
Obstetric blood test panel CPT 80055 PRE-NATAL PROFILE	$215.59	$307.99	—	1% above	30%
Obstetric blood test panel inpatient CPT 80055 PRE-NATAL PROFILE	$215.59	$307.99	—	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Prostate Specific Antigen	$99.96	$142.80	—	26% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE HEALTH INDEX-QUEST	$147.71	$211.01	—	87% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Prostate Specific Antigen	$99.96	$142.80	—	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE HEALTH INDEX-QUEST	$147.71	$211.01	—	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT Partial Thromboplastin Tim	$54.46	$77.80	—	45% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT Partial Thromboplastin Tim	$54.46	$77.80	—	—	30%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus	$47.37	$67.67	—	33% above	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus	$47.37	$67.67	—	—	30%
Potassium blood test CPT 84132 Potassium	$47.37	$67.67	—	103% above	30%
Potassium blood test inpatient CPT 84132 Potassium	$47.37	$67.67	—	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PT Protime INR	$36.55	$52.22	—	52% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT Protime INR	$36.55	$52.22	—	—	30%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Triage Drug Screen HCH	$224.70	$321.00	—	288% above	30%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Triage Drug Screen HCH	$224.70	$321.00	—	—	30%
Rh blood typing CPT 86901 BLOOD TYPE (ABO & RH) POST - B	$29.09	$41.56	—	22% below	30%
Rh blood typing CPT 86901 ANTEPARTUM RHOGAM - C	$29.09	$41.56	—	22% below	30%
Rh blood typing CPT 86901 BLOOD TYPING RH	$32.08	$45.83	—	14% below	30%
Rh blood typing CPT 86901 Ex-Type & Screen Anti - C	$33.94	$48.49	—	9% below	30%
Rh blood typing CPT 86901 Ex-Blood Type ABO & RH - B	$33.94	$48.49	—	9% below	30%
Rh blood typing CPT 86901 CORD BLOOD WORK-UP - B	$33.94	$48.49	—	9% below	30%
Rh blood typing inpatient CPT 86901 ANTEPARTUM RHOGAM - C	$29.09	$41.56	—	—	30%
Rh blood typing inpatient CPT 86901 BLOOD TYPE (ABO & RH) POST - B	$29.09	$41.56	—	—	30%
Rh blood typing inpatient CPT 86901 BLOOD TYPING RH	$32.08	$45.83	—	—	30%
Rh blood typing inpatient CPT 86901 Ex-Blood Type ABO & RH - B	$33.94	$48.49	—	—	30%
Rh blood typing inpatient CPT 86901 Ex-Type & Screen Anti - C	$33.94	$48.49	—	—	30%
Rh blood typing inpatient CPT 86901 CORD BLOOD WORK-UP - B	$33.94	$48.49	—	—	30%
Rheumatoid factor (RF) test CPT 86431 ARTHRITIS PROFILE - B	$39.91	$57.01	—	20% above	30%
Rheumatoid factor (RF) test inpatient CPT 86431 ARTHRITIS PROFILE - B	$39.91	$57.01	—	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 ARTHRITIS PROFILE - C	$42.90	$61.28	—	13% above	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Sed Rate	$49.24	$70.34	—	30% above	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 ARTHRITIS PROFILE - C	$42.90	$61.28	—	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Sed Rate	$49.24	$70.34	—	—	30%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 SPERM ANALYSIS	$99.96	$142.80	—	25% below	30%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 SPERM ANALYSIS	$99.96	$142.80	—	—	30%
Sodium blood test CPT 84295 Sodium	$47.37	$67.67	—	74% above	30%
Sodium blood test inpatient CPT 84295 Sodium	$47.37	$67.67	—	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD 1 SPECIMEN	$19.40	$27.71	—	64% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD 2 SPECIMENS	$38.42	$54.88	—	28% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCLT BLD STOOL 1-3 DET SCREEN	$41.03	$58.61	—	23% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 OCCULT BLD STOOL 1-3 DET.DIAG	$41.03	$58.61	—	23% below	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 FECAL OCCULT BLOOD 3 SPECIMENS	$57.81	$82.59	—	8% above	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD 1 SPECIMEN	$19.40	$27.71	—	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD 2 SPECIMENS	$38.42	$54.88	—	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCLT BLD STOOL 1-3 DET SCREEN	$41.03	$58.61	—	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 OCCULT BLD STOOL 1-3 DET.DIAG	$41.03	$58.61	—	—	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 FECAL OCCULT BLOOD 3 SPECIMENS	$57.81	$82.59	—	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH Thyroid Stimulating Hormon	$105.18	$150.26	—	40% above	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH Thyroid Stimulating Hormon	$105.18	$150.26	—	—	30%
Total cholesterol blood test CPT 82465 Cholesterol	$38.79	$55.42	—	6% above	30%
Total cholesterol blood test inpatient CPT 82465 Cholesterol	$38.79	$55.42	—	—	30%
Total thyroxine (T4) blood test CPT 84436 T4 Thyroxine	$63.04	$90.05	—	51% above	30%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 Thyroxine	$63.04	$90.05	—	—	30%
Trichomonas test (NAAT) CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$81.31	$116.16	—	6% below	30%
Trichomonas test (NAAT) inpatient CPT 87661 TRICHOMONAS VAGINALIS AMPLIF	$81.31	$116.16	—	—	30%
Triglycerides blood test CPT 84478 Triglycerides	$47.37	$67.67	—	38% above	30%
Triglycerides blood test inpatient CPT 84478 Triglycerides	$47.37	$67.67	—	—	30%
Troponin test, quantitative CPT 84484 Cardiac Profile 1	$66.40	$94.85	—	21% below	30%
Troponin test, quantitative CPT 84484 Ex-Troponin Quantitative	$66.40	$94.85	—	21% below	30%
Troponin test, quantitative CPT 84484 TNI (HCH)	$123.09	$175.84	—	47% above	30%
Troponin test, quantitative inpatient CPT 84484 Cardiac Profile 1	$66.40	$94.85	—	—	30%
Troponin test, quantitative inpatient CPT 84484 Ex-Troponin Quantitative	$66.40	$94.85	—	—	30%
Troponin test, quantitative inpatient CPT 84484 TNI (HCH)	$123.09	$175.84	—	—	30%
Uric acid blood test CPT 84550 ARTHRITIS PROFILE-A	$38.79	$55.42	—	10% above	30%
Uric acid blood test CPT 84550 Uric Acid	$47.37	$67.67	—	35% above	30%
Uric acid blood test inpatient CPT 84550 ARTHRITIS PROFILE-A	$38.79	$55.42	—	—	30%
Uric acid blood test inpatient CPT 84550 Uric Acid	$47.37	$67.67	—	—	30%
Urinalysis with microscope exam, automated CPT 81001 UA Urinalysis	$45.88	$65.54	—	70% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 UA Urinalysis	$45.88	$65.54	—	—	30%
Urinalysis without microscope exam, automated CPT 81003 URINE CHEMISTRY(DIPSTICK ONLY)	$18.65	$26.64	—	20% below	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE CHEMISTRY(DIPSTICK ONLY)	$18.65	$26.64	—	—	30%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture quantitative	$75.35	$107.64	—	32% above	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture quantitative	$75.35	$107.64	—	—	30%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN RANDOM URINE	$67.52	$96.45	—	33% above	30%
Urine microalbumin (albumin) test inpatient CPT 82043 MICROALBUMIN RANDOM URINE	$67.52	$96.45	—	—	30%
Urine pregnancy test, read by color change CPT 81025 Pregnancy test Urine	$79.07	$112.96	—	63% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 Pregnancy test Urine	$79.07	$112.96	—	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12/FOLATE PROFILE-A	$47.37	$67.67	—	36% below	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$58.56	$83.66	—	21% below	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B-12/FOLATE PROFILE-A	$47.37	$67.67	—	—	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VITAMIN B12	$58.56	$83.66	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 hydroxy	$55.95	$79.93	—	41% below	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25-OH, Vit D2 D3	$145.47	$207.81	—	54% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D; 25 hydroxy	$55.95	$79.93	—	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25-OH, Vit D2 D3	$145.47	$207.81	—	—	30%
Zinc blood test CPT 84630 ZINC RBC QUEST	$42.52	$60.74	—	17% below	30%
Zinc blood test inpatient CPT 84630 ZINC RBC QUEST	$42.52	$60.74	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Tumor Marker	$71.62	$102.31	—	6% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG Quantitative	$104.44	$149.20	—	54% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Tumor Marker	$71.62	$102.31	—	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG Quantitative	$104.44	$149.20	—	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Cardiac catheterization with coronary angiogram one side CPT 93458 HVC HVC Angio Left heart cath	$8,595.72	$12,279.60	—	28% below	30%
Cardiac catheterization with coronary angiogram inpatient one side CPT 93458 HVC HVC Angio Left heart cath	$8,595.72	$12,279.60	—	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HVC Cardioversion Elective Ext	$1,159.63	$1,656.62	—	44% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Ext M/S	$1,159.63	$1,656.62	—	44% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 NonED Cardioversion Ext. elect	$1,159.63	$1,656.62	—	44% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION - EXTERNAL	$1,159.63	$1,656.62	—	44% below	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION - CCU	$1,159.63	$1,656.62	—	44% below	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION - EXTERNAL	$1,159.63	$1,656.62	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HVC Cardioversion Elective Ext	$1,159.63	$1,656.62	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Elective Ext M/S	$1,159.63	$1,656.62	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 NonED Cardioversion Ext. elect	$1,159.63	$1,656.62	—	—	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION - CCU	$1,159.63	$1,656.62	—	—	30%
Catheter ablation for atrial fibrillation CPT 93656 Atrial fibrillation ablation	$28,652.40	$40,932.00	—	16% below	30%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Atrial fibrillation ablation	$28,652.40	$40,932.00	—	—	30%
Cervical biopsy CPT 57500 EXC/BIOPSY CERVICAL LESION	$825.24	$1,178.91	—	53% below	30%
Cervical biopsy inpatient CPT 57500 EXC/BIOPSY CERVICAL LESION	$825.24	$1,178.91	—	—	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION CLMP/OTH DEV BLCK	$2,046.42	$2,923.45	—	16% above	30%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION CLMP/OTH DEV BLCK	$2,046.42	$2,923.45	—	—	30%
Coronary stent placement, one artery CPT 92928 DE Stent single major cor/bran	$12,893.58	$18,419.40	—	at median	30%
Coronary stent placement, one artery CPT 92928 NDE Stent single major cor/bra	$12,893.58	$18,419.40	—	at median	30%
Coronary stent placement, one artery inpatient CPT 92928 DE Stent single major cor/bran	$12,893.58	$18,419.40	—	—	30%
Coronary stent placement, one artery inpatient CPT 92928 NDE Stent single major cor/bra	$12,893.58	$18,419.40	—	—	30%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EARWAX UNILATE	$127.83	$182.61	—	17% below	30%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EARWAX UNILATE	$127.83	$182.61	—	—	30%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPCTD EAR WAX INSTR EA	$129.40	$184.85	—	16% below	30%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPCTD EAR WAX INSTR EA	$129.40	$184.85	—	—	30%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INJ DIAG SBST CER/THOR W/GUID	$619.82	$885.46	—	72% below	30%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 INJ DIAG SBST CER/THOR W/GUID	$619.82	$885.46	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET JT INJ L/S 1ST LEVEL RT	$668.41	$954.87	—	69% below	30%
Facet joint injection, lower back, one level, with imaging guidance one side CPT 64493 FACET JT INJ L/S 1ST LEVEL LT	$668.41	$954.87	—	69% below	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET JT INJ L/S 1ST LEVEL LT	$668.41	$954.87	—	—	30%
Facet joint injection, lower back, one level, with imaging guidance inpatient one side CPT 64493 FACET JT INJ L/S 1ST LEVEL RT	$668.41	$954.87	—	—	30%
Hemorrhoid banding (rubber band ligation) CPT 46221 HEMORRHOIDECTOMY BY SIMPLE LIG	$654.71	$935.30	—	66% below	30%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY BY SIMPLE LIG	$654.71	$935.30	—	—	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 CATHETER FOR HYSTEROGRAPHY	$51.14	$73.06	—	87% below	30%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETER FOR HYSTEROGRAPHY	$51.14	$73.06	—	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSC SMPL OR SGL	$353.25	$504.64	—	9% below	30%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D Absc Simple or Single	$353.25	$504.64	—	9% below	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D ABSC SMPL OR SGL	$353.25	$504.64	—	—	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I&D Absc Simple or Single	$353.25	$504.64	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection 1 tendon/ ligament	$227.50	$325.00	—	33% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJ 1 TENDON/LIGMNT APONEUROSI	$252.48	$360.69	—	26% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection 1 tendon/ ligament	$227.50	$325.00	—	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJ 1 TENDON/LIGMNT APONEUROSI	$252.48	$360.69	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ MJR BURSA W/O US	$419.86	$599.80	—	40% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 INJ/ASPIRATION MAJOR JOINT	$419.86	$599.80	—	40% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASPIR&INJ	$419.86	$599.80	—	40% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 INJ/ASPIRATION MAJOR JOINT	$419.86	$599.80	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS ASPIR&INJ	$419.86	$599.80	—	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 DRAIN/INJ MJR BURSA W/O US	$419.86	$599.80	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS INTERMEDIATE JT	$327.87	$468.38	—	47% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Inj/Aspiration INT Jnt w/o US	$336.76	$481.08	—	45% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Inj Aspiration Int Joint w/o U	$336.76	$481.08	—	45% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS INTERMEDIATE JT	$327.87	$468.38	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Inj Aspiration Int Joint w/o U	$336.76	$481.08	—	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Inj/Aspiration INT Jnt w/o US	$336.76	$481.08	—	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS SMALL JOINT	$287.41	$410.59	—	42% below	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 INJ/ASPIRATION SMALL JOINT	$295.20	$421.71	—	40% below	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS SMALL JOINT	$287.41	$410.59	—	—	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 INJ/ASPIRATION SMALL JOINT	$295.20	$421.71	—	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTMD WND S/A/T/EXT<2.5	$352.84	$504.05	—	34% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTMD WND S/A/T/EXT<2.5	$352.84	$504.05	—	—	30%
Left heart catheterization, diagnostic one side CPT 93452 HVC cath left heart	$6,804.94	$9,721.35	—	27% below	30%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HVC cath left heart	$6,804.94	$9,721.35	—	—	30%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ DIAG/THER SBST/LUM/SAC W/G	$619.82	$885.46	—	70% below	30%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DIAG/THER SBST/LUM/SAC W/G	$619.82	$885.46	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ FORAMEN EPDRL L/S W/GUIDAN	$900.13	$1,285.90	—	57% below	30%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 INJ FORAMEN EPDRL L/S LVL 1 LT	$900.13	$1,285.90	—	57% below	30%
Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 INJ FORAMEN EPDRL L/S LVL 1 RT	$900.13	$1,285.90	—	57% below	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ FORAMEN EPDRL L/S W/GUIDAN	$900.13	$1,285.90	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 INJ FORAMEN EPDRL L/S LVL 1 LT	$900.13	$1,285.90	—	—	30%
Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 INJ FORAMEN EPDRL L/S LVL 1 RT	$900.13	$1,285.90	—	—	30%
Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE SINGLE	$246.99	$352.84	—	23% below	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 REMOVAL OF NAIL PLATE SINGLE	$246.99	$352.84	—	—	30%
Occipital nerve block (injection for headaches) CPT 64405 N BLOCK INJ OCCIPITAL	$461.84	$659.77	—	41% below	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 N BLOCK INJ OCCIPITAL	$461.84	$659.77	—	—	30%
Pacemaker implant (dual chamber) CPT 33208 HVC Pacer insert 2 leads AV Pa	$10,317.46	$14,739.23	—	34% below	30%
Pacemaker implant (dual chamber) inpatient CPT 33208 HVC Pacer insert 2 leads AV Pa	$10,317.46	$14,739.23	—	—	30%
Paracentesis with imaging guidance CPT 49083 Paracentesis w/ CT Guidance	$1,156.13	$1,651.61	—	33% below	30%
Paracentesis with imaging guidance CPT 49083 Paracentesis w/ US Guidance	$1,156.13	$1,651.61	—	33% below	30%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS ABD W/GUIDANCE	$1,187.47	$1,696.38	—	32% below	30%
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis w/ CT Guidance	$1,156.13	$1,651.61	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 Paracentesis w/ US Guidance	$1,156.13	$1,651.61	—	—	30%
Paracentesis with imaging guidance inpatient CPT 49083 PARACENTESIS ABD W/GUIDANCE	$1,187.47	$1,696.38	—	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL & NAIL MATRIX	$305.35	$436.21	—	61% below	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL & NAIL MATRIX	$305.35	$436.21	—	—	30%
Prostate biopsy CPT 55700 PROSTATE BIOPSY	$1,681.32	$2,401.89	—	17% below	30%
Prostate biopsy CPT 55700 BIOPSY OF PROSTATE	$1,726.90	$2,467.00	—	14% below	30%
Prostate biopsy inpatient CPT 55700 PROSTATE BIOPSY	$1,681.32	$2,401.89	—	—	30%
Prostate biopsy inpatient CPT 55700 BIOPSY OF PROSTATE	$1,726.90	$2,467.00	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 PVT JT DESTN L/S SING BIL	$3,293.07	$4,704.39	—	1% below	30%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 PVT JT DESTN L/S SING RT	$1,646.55	$2,352.22	—	51% below	30%
Radiofrequency ablation of facet joint nerves, lower back, one level one side CPT 64635 PVT JT DESTN L/S SING LT	$1,646.55	$2,352.22	—	51% below	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 PVT JT DESTN L/S SING BIL	$3,293.07	$4,704.39	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 PVT JT DESTN L/S SING RT	$1,646.55	$2,352.22	—	—	30%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient one side CPT 64635 PVT JT DESTN L/S SING LT	$1,646.55	$2,352.22	—	—	30%
Removal of a foreign object under the skin, simple CPT 10120 INC/RMVL FOREIGN BODY SQ SMPL	$368.90	$527.00	—	45% below	30%
Removal of a foreign object under the skin, simple CPT 10120 FOREIGN BODY REMVAL SUBQ SIMPL	$368.90	$527.00	—	45% below	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INC/RMVL FOREIGN BODY SQ SMPL	$368.90	$527.00	—	—	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 FOREIGN BODY REMVAL SUBQ SIMPL	$368.90	$527.00	—	—	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 LITHOTRIPSY	$8,040.94	$11,487.05	—	19% below	30%
Shock-wave lithotripsy to break up kidney stones (from outside the body) inpatient CPT 50590 LITHOTRIPSY	$8,040.94	$11,487.05	—	—	30%
Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT	$213.74	$305.35	—	26% below	30%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLY FOREARM SPLINT	$213.74	$305.35	—	—	30%
Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT	$190.85	$272.64	—	35% below	30%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION LOWER LEG SPLINT	$190.85	$272.64	—	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR/S/N/AX/GEN/TRUNK 2.5CM/<	$278.63	$398.04	—	16% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 RPR/S/N/AX/GEN/TRUNK 2.5CM/<	$278.63	$398.04	—	—	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION	$394.39	$563.42	—	11% below	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX SKIN SINGLE LESION	$394.39	$563.42	—	—	30%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL OF SKIN TAGS </15	$151.15	$215.93	—	48% below	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL OF SKIN TAGS </15	$151.15	$215.93	—	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$605.35	$864.79	—	43% below	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL FLUID TAP DIAGNOSTIC	$605.35	$864.79	—	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR/S/N/AX/GEN/TRUNK2.6-7.5CM	$295.43	$422.04	—	16% below	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 RPR/S/N/AX/GEN/TRUNK2.6-7.5CM	$295.43	$422.04	—	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR/F/E/E/N/L/M 2.5CM/<	$291.61	$416.59	—	8% below	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 RPR/F/E/E/N/L/M 2.5CM/<	$291.61	$416.59	—	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SINGLE LESION	$276.00	$394.28	—	9% below	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGNTL BX SKIN SINGLE LESION	$276.00	$394.28	—	—	30%
Thoracentesis with imaging guidance CPT 32555 Thoracentesis w/ Guidance	$838.94	$1,198.49	—	52% below	30%
Thoracentesis with imaging guidance inpatient CPT 32555 Thoracentesis w/ Guidance	$838.94	$1,198.49	—	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION TRIGGER PNT 1-2MUSCL	$305.35	$436.21	—	56% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER POINT INJECTION	$305.35	$436.21	—	56% below	30%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECT TRIGGER POINT 1/2 MUSCL	$305.35	$436.21	—	56% below	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECT TRIGGER POINT 1/2 MUSCL	$305.35	$436.21	—	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION TRIGGER PNT 1-2MUSCL	$305.35	$436.21	—	—	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 TRIGGER POINT INJECTION	$305.35	$436.21	—	—	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCT B9 LESION 1-14	$169.77	$242.53	—	46% below	30%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCT B9 LESION 1-14	$169.77	$242.53	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRID SUBQ TIS<=20SQCM	$615.50	$879.29	—	21% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDE SUBQ TISS 20SQ OR LESS	$615.50	$879.29	—	21% below	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE SUBQ TISS 20SQ OR LESS	$615.50	$879.29	—	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRID SUBQ TIS<=20SQCM	$615.50	$879.29	—	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-ONC	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-OR	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-ED	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-OB	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-PACU	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-ENDO	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-MS4TH	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-ISOLATION	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION-CCU	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Administration-MS4TH	$641.38	$916.26	—	42% below	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-PACU	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-ED	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-ONC	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-OR	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-ENDO	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-CCU	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-ISOLATION	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-OB	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Administration-MS4TH	$641.38	$916.26	—	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMINISTRATION-MS4TH	$641.38	$916.26	—	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhal TX int AER/IPPB/HELIOX/M	$304.58	$435.12	—	74% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Inhal TX int AER/IPPB/HELIOX/M	$304.58	$435.12	—	—	30%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION-INITAL HR	$513.98	$734.26	—	33% below	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO INFUSION-INITAL HR	$513.98	$734.26	—	—	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST 30-74 MIN	$879.75	$1,256.79	—	70% below	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE, FIRST 30-74MIN	$879.75	$1,256.79	—	70% below	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE FIRST 30-74 MIN	$879.75	$1,256.79	—	—	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE, FIRST 30-74MIN	$879.75	$1,256.79	—	—	30%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG, Awake and Drowsy	$406.50	$580.71	—	57% below	30%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 EEG, Awake and Drowsy	$406.50	$580.71	—	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG Electrocardiogram (EKG)	$136.26	$194.66	—	26% below	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG Electrocardiogram (EKG)	$136.26	$194.66	—	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY RM LEVEL I	$190.85	$272.64	—	39% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY RM LEVEL I	$190.85	$272.64	—	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY RM LEVEL II	$312.87	$446.96	—	39% below	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY RM LEVEL II	$312.87	$446.96	—	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Room Level III visit	$517.49	$739.27	—	39% below	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Room Level III visit	$517.49	$739.27	—	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Room Level IV visit	$782.50	$1,117.85	—	41% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Room Level IV visit	$782.50	$1,117.85	—	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency room Level V visit	$980.09	$1,400.13	—	44% below	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency room Level V visit	$980.09	$1,400.13	—	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST, CV, TRACING ONLY	$582.36	$831.94	—	35% below	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 STRESS TEST, CV, TRACING ONLY	$582.36	$831.94	—	—	30%
Family therapy with the patient, 50 minutes CPT 90847 PAR/IOP-FAMILY CONJ W/PT 50MIN	$251.30	$359.00	—	15% below	30%
Family therapy with the patient, 50 minutes CPT 90847 OBS FAMILY CONJOINT W/ PT	$251.30	$359.00	—	15% below	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 PAR/IOP-FAMILY CONJ W/PT 50MIN	$251.30	$359.00	—	—	30%
Family therapy with the patient, 50 minutes inpatient CPT 90847 OBS FAMILY CONJOINT W/ PT	$251.30	$359.00	—	—	30%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTX W/O PT 50 MIN	$191.72	$273.89	—	38% below	30%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTX W/O PT 50MIN	$191.72	$273.89	—	38% below	30%
Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$191.72	$273.89	—	38% below	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYTX W/O PT 50 MIN	$191.72	$273.89	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTX W/O PT 50 MIN	$191.72	$273.89	—	—	30%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTX W/O PT 50MIN	$191.72	$273.89	—	—	30%
Group psychotherapy session CPT 90853 IOP GROUP TX 31-90 MIN	$66.26	$94.66	—	61% below	30%
Group psychotherapy session CPT 90853 IOP GROUP TX <=30MIN	$66.26	$94.66	—	61% below	30%
Group psychotherapy session CPT 90853 IOP GROUP TX 126-150 MIN	$197.98	$282.83	—	16% above	30%
Group psychotherapy session CPT 90853 IOP GROUP TX 151-175 MIN	$197.98	$282.83	—	16% above	30%
Group psychotherapy session inpatient CPT 90853 IOP GROUP TX 31-90 MIN	$66.26	$94.66	—	—	30%
Group psychotherapy session inpatient CPT 90853 IOP GROUP TX <=30MIN	$66.26	$94.66	—	—	30%
Group psychotherapy session inpatient CPT 90853 IOP GROUP TX 126-150 MIN	$197.98	$282.83	—	—	30%
Group psychotherapy session inpatient CPT 90853 IOP GROUP TX 151-175 MIN	$197.98	$282.83	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr CCU	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr M/S	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr OB	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr ISOL	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr PICU	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr PSYCH	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr SDC	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr HVC	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr ONC	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Hydration initial hr ED	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 NonED IV hydration Intl Hr	$212.90	$304.15	—	49% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr PSYCH	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr ONC	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr SDC	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr OB	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 NonED IV hydration Intl Hr	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr ISOL	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr HVC	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr PICU	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr M/S	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr CCU	$212.90	$304.15	—	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Hydration initial hr ED	$212.90	$304.15	—	—	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr M/S2	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 NonED Therapy IV initial hr	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr ED	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr ONC	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr HVC	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr SDC	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr PSYC	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr CCU	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr PICU	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr ISOL	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr OB	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour CPT 96365 IV Therapeutic initial hr M/S4	$341.07	$487.24	—	21% below	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr HVC	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr ONC	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr PSYC	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr SDC	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 NonED Therapy IV initial hr	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr M/S2	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr ED	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr M/S4	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr OB	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr ISOL	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr PICU	$341.07	$487.24	—	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Therapeutic initial hr CCU	$341.07	$487.24	—	—	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug RAD	$170.23	$243.19	—	34% below	30%
IV push of a medicine, first drug CPT 96374 IV Push initial/single SDC	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug PSYCH	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Initial drug MS	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Initial drug OB	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug ONC	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Initial drug ED	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug ISOL	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug PICU	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug CCU	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 NonED IV PUSH,SINGLE/INITL DRG	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug CPT 96374 IV Push Single/Intl drug HVC	$174.85	$249.79	—	32% below	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug RAD	$170.23	$243.19	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Initial drug MS	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push initial/single SDC	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug PSYCH	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Initial drug ED	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug ONC	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 NonED IV PUSH,SINGLE/INITL DRG	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Initial drug OB	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug ISOL	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug HVC	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug PICU	$174.85	$249.79	—	—	30%
IV push of a medicine, first drug inpatient CPT 96374 IV Push Single/Intl drug CCU	$174.85	$249.79	—	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection ED	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection ISOL	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection PAIN	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection OB	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 NonED-IM/SQ MEDICATION INJ	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection M/S	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection ENDO	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection Occ Med	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection CCU	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection ONC	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection PSYCH	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SQ injection PICU	$53.32	$76.17	—	62% below	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection CCU	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection PSYCH	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection ENDO	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection PAIN	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection ONC	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection ED	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 NonED-IM/SQ MEDICATION INJ	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection Occ Med	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection PICU	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection ISOL	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection OB	$53.32	$76.17	—	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SQ injection M/S	$53.32	$76.17	—	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSC RE-ED EA 15 MIN PT	$65.88	$94.11	—	40% below	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEUROMUSC RE-ED EA 15 MIN PT	$65.88	$94.11	—	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTR ED/TRAIN-INITIAL (15 MIN)	$38.35	$54.78	—	41% below	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTR ED/TRAIN-INITIAL (15 MIN)	$38.35	$54.78	—	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL TX EA 15 MIN PT	$94.09	$134.41	—	15% below	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL TX EA 15 MIN PT	$94.09	$134.41	—	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic exercise 15 min PT	$91.76	$131.08	—	23% below	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic exercise 15 min PT	$91.76	$131.08	—	—	30%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITIAL 30-74MIN	$257.56	$367.95	—	18% below	30%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYTX CRISIS INITIAL 30-74MIN	$257.56	$367.95	—	—	30%
Psychotherapy session, 30 minutes CPT 90832 PSYCHOTX 30 MIN	$133.32	$190.46	—	30% below	30%
Psychotherapy session, 30 minutes CPT 90832 PAR/IOP-PSYTX W PT 30 MIN	$133.32	$190.46	—	30% below	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTX 30 MIN	$133.32	$190.46	—	—	30%
Psychotherapy session, 30 minutes inpatient CPT 90832 PAR/IOP-PSYTX W PT 30 MIN	$133.32	$190.46	—	—	30%
Psychotherapy session, 45 minutes CPT 90834 PAR/IOP-PSYTX W PT 45 MIN	$199.16	$284.52	—	25% below	30%
Psychotherapy session, 45 minutes CPT 90834 PSYCHOTX 45 MIN	$199.16	$284.52	—	25% below	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 PAR/IOP-PSYTX W PT 45 MIN	$199.16	$284.52	—	—	30%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTX 45 MIN	$199.16	$284.52	—	—	30%
Psychotherapy session, 60 minutes CPT 90837 PAR/IOP PSYTX W PT 60 MIN	$240.35	$343.36	—	23% below	30%
Psychotherapy session, 60 minutes CPT 90837 PSYCHOTX 60 MIN	$240.35	$343.36	—	23% below	30%
Psychotherapy session, 60 minutes inpatient CPT 90837 PAR/IOP PSYTX W PT 60 MIN	$240.35	$343.36	—	—	30%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTX 60 MIN	$240.35	$343.36	—	—	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M Level 5 Occ Med	$152.68	$218.11	—	9% below	30%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 E&M LEVEL 5 WOUND CARE	$198.48	$283.54	—	18% above	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M Level 5 Occ Med	$152.68	$218.11	—	—	30%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 E&M LEVEL 5 WOUND CARE	$198.48	$283.54	—	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M Level 3 Occ Med	$114.51	$163.58	—	1% below	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 E&M LEVEL 3 WOUND CARE	$137.41	$196.30	—	18% above	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M Level 3 Occ Med	$114.51	$163.58	—	—	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 E&M LEVEL 3 WOUND CARE	$137.41	$196.30	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M Level 4 Occ Med	$133.60	$190.85	—	2% below	30%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 E&M LEVEL 4 WOUND CARE	$167.94	$239.91	—	23% above	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M Level 4 Occ Med	$133.60	$190.85	—	—	30%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 E&M LEVEL 4 WOUND CARE	$167.94	$239.91	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M LEVEL 2 OB	$86.65	$123.78	—	14% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M Level 2 Occ Med	$95.42	$136.31	—	5% below	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 E&M LEVEL 2 WOUND CARE	$106.88	$152.68	—	6% above	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M LEVEL 2 OB	$86.65	$123.78	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M Level 2 Occ Med	$95.42	$136.31	—	—	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 E&M LEVEL 2 WOUND CARE	$106.88	$152.68	—	—	30%
Spirometry (breathing test) CPT 94010 PFT 1 Spirometry	$248.86	$355.51	—	20% below	30%
Spirometry (breathing test) inpatient CPT 94010 PFT 1 Spirometry	$248.86	$355.51	—	—	30%
Spirometry before and after a bronchodilator CPT 94060 PFT3 PRE/POST BRONCHODILA MEAS	$565.66	$808.08	—	1% below	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 PFT3 PRE/POST BRONCHODILA MEAS	$565.66	$808.08	—	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAP ACT EA 15MIN PT	$63.13	$90.18	—	48% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAP ACT 1:1 EA 15 MIN PSYCH	$63.13	$90.18	—	48% below	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic act Psy; 1:1 15min	$63.13	$90.18	—	48% below	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAP ACT 1:1 EA 15 MIN PSYCH	$63.13	$90.18	—	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic act Psy; 1:1 15min	$63.13	$90.18	—	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAP ACT EA 15MIN PT	$63.13	$90.18	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY, THERAPEUTIC	$256.42	$366.31	—	8% above	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC	$256.42	$366.31	—	8% above	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY, THERAPEUTIC	$256.42	$366.31	—	—	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC	$256.42	$366.31	—	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARIVAS(VAR)VAC 1350U/0.5ML	$463.72	$662.45	—	25% above	30%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARIVAS(VAR)VAC 1350U/0.5ML	$463.72	$662.45	—	—	30%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 KINRIX(DPT/POLIO)VAC 0.5ML	$168.42	$240.60	—	31% above	30%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 KINRIX(DPT/POLIO)VAC 0.5ML	$168.42	$240.60	—	—	30%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,TET,PERT PED 0.5ML SYR	$77.98	$111.40	—	20% above	30%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,TET,PERT PED 0.5ML SYR	$77.98	$111.40	—	—	30%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 PEDIARIX(HEP B/DPT/POLIO)VAC 0	$170.62	$243.75	—	13% below	30%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 PEDIARIX(HEP B/DPT/POLIO)VAC 0	$170.62	$243.75	—	—	30%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 GARDASIL 9-VALENT VACCINE 0.5M	$755.68	$1,079.55	—	46% above	30%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL 9-VALENT VACCINE 0.5M	$755.68	$1,079.55	—	—	30%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HAVRIX(HEP A)VAC 720U/0.5ML	$102.90	$147.00	—	15% above	30%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HAVRIX(HEP A)VAC 720U/0.5ML	$102.90	$147.00	—	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B ADULT VACC 20MCG/M	$175.77	$251.10	—	13% above	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B ADULT VACC 20MCG/M	$175.77	$251.10	—	—	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B VAC PED 10MCG/0.5ML/3DOS	$60.76	$86.80	—	1% above	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B VAC PED 10MCG/0.5ML/3DOS	$60.76	$86.80	—	—	30%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 PEDVAXHIB(HAEMPH B CONJ-MEN)VA	$104.82	$149.75	—	49% above	30%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) inpatient CPT 90647 PEDVAXHIB(HAEMPH B CONJ-MEN)VA	$104.82	$149.75	—	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza hi dose Quad Vaccine	$161.42	$230.60	—	56% above	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Influenza hi dose Quad Vaccine	$161.42	$230.60	—	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA 0.5ML VL	$243.14	$347.35	—	16% above	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA 0.5ML VL	$243.14	$347.35	—	—	30%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MEASLES,MUMP,RUB,VARI VAC 0.5M	$718.58	$1,026.55	—	40% above	30%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES,MUMP,RUB,VARI VAC 0.5M	$718.58	$1,026.55	—	—	30%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 PREVNAR(PNEUM 13 CONJ)VAC 0.5M	$589.19	$841.70	—	34% above	30%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PREVNAR(PNEUM 13 CONJ)VAC 0.5M	$589.19	$841.70	—	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Prevnar 20 0.5ml syringe	$660.62	$943.75	—	at median	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20 0.5ml syringe	$660.62	$943.75	—	—	30%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE	$851.55	$1,216.50	—	10% below	30%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE	$851.55	$1,216.50	—	—	30%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTARIX(ROTAVIRUS)VAC 1ML	$282.59	$403.70	—	109% above	30%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTARIX(ROTAVIRUS)VAC 1ML	$282.59	$403.70	—	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TET/DIPH/PERT 0.5 ML VIAL	$145.64	$208.05	—	32% above	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TET/DIPH/PERT 0.5 ML VIAL	$145.64	$208.05	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN, INITIAL	$49.62	$70.88	—	22% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin-Initial	$49.62	$70.88	—	22% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Influenza administration	$49.62	$70.88	—	22% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN INITIAL	$49.62	$70.88	—	22% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin-Initial	$49.62	$70.88	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN, INITIAL	$49.62	$70.88	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Influenza administration	$49.62	$70.88	—	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUNIZATION ADMIN INITIAL	$49.62	$70.88	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN SUBSEQUENT	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD'L	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN, EACH ADD'L	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin-each addl	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADM EA ADD'L	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN;EACH ADD'L	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EA ADDL	$43.93	$62.76	—	26% above	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN;EACH ADD'L	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN, EACH ADD'L	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin-each addl	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADM EA ADD'L	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EACH ADD'L	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN SUBSEQUENT	$43.93	$62.76	—	—	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUNIZATION ADMIN EA ADDL	$43.93	$62.76	—	—	30%

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://fultoncountyhealthcenter.org/?force_download=24959