Hospital Cleveland, OH

Southwest General Health Center

Southwest General Health Center in Middleburg Heights, OH publishes cash prices for 495 common procedures listed here, from its own machine-readable price file updated Jul 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Ohio median for 240 of 343 procedures and below it for 99. By typical cash price it ranks #102 of 139 Ohio hospitals and #15 of 26 hospitals in the Cleveland, OH area, cheapest first. Select a procedure to compare it with other hospitals nearby.

18697 Bagley Rd, Middleburg Heights, OH Collected Sep 22, 2026 Source price file Check a bill from this hospital (440) 816-8000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 360155 · CMS hospital register NPI 1154353993

Financial assistance

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

Southwest General 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.

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 4 actions for a hospital named Southwest General Health Center in Middleburg Heights, OH:

Jun 8, 2023 Warning notice
Sep 21, 2023 Case closed
Apr 9, 2025 Warning notice
Apr 16, 2025 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

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 IV CONT	$2,781.75	$3,709.00	$70.96–$458.94	110% above	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS	$320.25	$427.00	$42.39–$167.59	5% below	25%
Abdominal X-ray, 2 views CPT 74019 ABDOMEN 2 VIEWS OPC	$320.25	$427.00	$42.39–$167.59	5% below	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RT/COMPLETE	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RT COMP STUDY	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LT COMP STUDY	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LT/COMPLETE	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE RIGHT COMPLETE	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 ANKLE LEFT COMPLETE	$360.75	$481.00	$153.92–$481.00	13% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ABI LIMITED STUDY	$583.50	$778.00	$51.38–$203.14	21% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ART EXT STDY UPR 1-2LVLS	$583.50	$778.00	$51.38–$203.14	21% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 ARTERIAL STUDY UPP EXT 1-2 LEVELS	$112.50	$150.00	$720.00	—	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXT WO CONT	$1,394.25	$1,859.00	$42.39–$285.11	48% above	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 BA SWALLOW / ESOPHAGUS	$605.25	$807.00	$70.96–$280.55	37% above	25%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE SCAN - ROUTINE	$1,563.00	$2,084.00	$160.18–$633.27	2% above	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST (L) COMPLETE	$273.75	$365.00	$42.39–$178.98	43% below	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST (R) COMPLETE	$273.75	$365.00	$42.39–$178.98	43% below	25%
Breast ultrasound, complete, one breast CPT 76641 US BREAST (R)COMPLETE	$479.25	$639.00	$42.39–$178.98	at median	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST (L) LIMITED	$249.00	$332.00	$106.24–$332.00	39% below	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US BREAST (R) LIMITED	$249.00	$332.00	$106.24–$332.00	39% below	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD AND PELVIS	$5,033.25	$6,711.00	$142.36–$674.06	135% above	25%
CT angiography (CTA) of the head CPT 70496 CT ANGIO HEAD	$2,136.75	$2,849.00	$70.96–$491.11	60% above	25%
CT angiography (CTA) of the neck CPT 70498 CT ANGIO NECK	$1,919.25	$2,559.00	$70.96–$490.53	47% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIO CHEST	$2,196.00	$2,928.00	$70.96–$501.32	55% above	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CCTA QUANT EVAL HEART	$931.50	$1,242.00	$142.36–$575.77	42% below	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD PELVIS WO IV CONT	$1,917.00	$2,556.00	$96.36–$380.94	21% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ENTEROGRAPHY	$2,204.25	$2,939.00	$142.36–$562.83	11% above	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD/PELV WITH CONT	$2,204.25	$2,939.00	$142.36–$562.83	11% above	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD PELV W&WO IV CONT	$2,886.75	$3,849.00	$142.36–$599.57	24% above	25%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W IV CONTRAST	$1,914.75	$2,553.00	$70.96–$408.51	64% above	25%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN WO IV CONT	$1,578.75	$2,105.00	$42.39–$243.58	50% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT FACIAL BONES W/O CONT	$1,287.75	$1,717.00	$42.39–$227.64	47% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SIN NASO W/O CONT	$1,287.75	$1,717.00	$42.39–$227.64	47% above	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT SINUS/NASO W/O CONTR	$1,287.75	$1,717.00	$42.39–$227.64	47% above	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT BRAIN HEAD WO CONT	$1,287.75	$1,717.00	$42.39–$190.41	54% above	25%
CT scan of the head with contrast CPT 70460 CT BRAIN HEAD W CONT	$1,416.00	$1,888.00	$70.96–$280.55	41% above	25%
CT scan of the head without and with contrast CPT 70470 CT BRAIN HEAD W&WO CONT	$1,571.25	$2,095.00	$70.96–$308.82	32% above	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR W/O CONTRAT	$1,895.25	$2,527.00	$42.39–$230.62	72% above	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR W/O CONT.	$1,895.25	$2,527.00	$42.39–$230.62	72% above	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SP W/O CONT.	$1,783.50	$2,378.00	$42.39–$231.76	66% above	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE WO CON	$1,783.50	$2,378.00	$42.39–$231.76	66% above	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W IV CONTRAST	$1,569.00	$2,092.00	$70.96–$401.05	28% above	25%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 CAROTID DUPLEX	$1,199.25	$1,599.00	$96.36–$380.94	65% above	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX CAROTID BILAT COMPLETE	$120.00	$160.00	$720.00	—	25%
Chest CT scan without and with contrast CPT 71270 CT CHEST W & WO CONT	$1,942.50	$2,590.00	$70.96–$348.27	28% above	25%
Chest X-ray, 2 views CPT 71046 CHEST EMPLOYEE (2V)	$273.00	$364.00	$35.10–$138.76	4% above	25%
Chest X-ray, 2 views CPT 71046 CHEST 2 VIEWS	$273.00	$364.00	$35.10–$138.76	4% above	25%
Chest X-ray, 2 views CPT 71046 CHEST 4V (2V W/ DIG SUB)	$273.00	$364.00	$35.10–$138.76	4% above	25%
Chest X-ray, single view CPT 71045 CHEST DECUBITUS 1 VW OPC	$223.50	$298.00	$35.10–$138.76	at median	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW	$223.50	$298.00	$35.10–$138.76	at median	25%
Chest X-ray, single view CPT 71045 CHEST 1 VIEW PORTABLE	$223.50	$298.00	$35.10–$138.76	at median	25%
Chest X-ray, single view CPT 71045 CHEST DECUBITUS 1 VIEW	$223.50	$298.00	$35.10–$138.76	at median	25%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE RIGHT	$262.50	$350.00	$112.00–$350.00	3% below	25%
Collarbone (clavicle) X-ray, complete one side CPT 73000 CLAVICLE LEFT	$262.50	$350.00	$112.00–$350.00	3% below	25%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RADIOLOGIC EXAM; CLAVICLE, COMPLETE	$78.75	$105.00	$720.00	—	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPRTNL (COMPL) ECHO	$873.00	$1,164.00	$42.39–$188.84	23% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 RETROPERITONEAL COMPLETE	$873.00	$1,164.00	$42.39–$188.84	23% above	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSTY SCRN	$276.75	$369.00	$42.39–$167.59	39% below	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DEXA BONE DENSITY SCREEN	$276.75	$369.00	$42.39–$167.59	39% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA LIMITED STUDY	$186.00	$248.00	$35.10–$138.76	28% below	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA, BONE STUDY, 1+ SITES, APPEN SKELE	$45.00	$60.00	$720.00	—	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 MFM GRAVID + DET ANATOMY	$528.75	$705.00	$96.36–$380.94	38% below	25%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 ULTRASOUND, PREG UTER, REAL TIME; FETAL&	$246.00	$328.00	$720.00	—	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT CHEST WO CONT	$1,683.00	$2,244.00	$42.39–$237.36	79% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT CHEST W CONT	$1,964.25	$2,619.00	$70.96–$296.79	62% above	25%
Diagnostic mammogram, both breasts both sides CPT 77066 DIGITAL MAMM DIAG BILAT	$593.25	$791.00	$61.29–$281.15	—	25%
Diagnostic mammogram, one breast one side CPT 77065 DIGITAL MAMM DIAG UNILAT	$465.75	$621.00	$48.68–$221.99	29% above	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ARTERIAL GRAFT SCAN BI	$1,192.50	$1,590.00	$96.36–$409.97	—	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 ART DUPLX LOWR BILAT	$1,192.50	$1,590.00	$96.36–$409.97	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUPLEX ART LEG BILAT / COMP	$315.00	$420.00	$720.00	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS REFLUX BILATERAL	$1,304.25	$1,739.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEN DUPLX LOWER BILAT	$1,304.25	$1,739.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 REFLUX BILATERAL	$1,304.25	$1,739.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DUPLEX UPPR BILAT	$1,304.25	$1,739.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VENOUS DUPLEX BILATERAL	$1,304.25	$1,739.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEIN MAP LOWER BILAT	$1,629.75	$2,173.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 VEN DUPLX UPPER BILAT	$1,629.75	$2,173.00	$96.36–$380.94	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUPLEX VENOUS EXT BILAT / COMP	$105.00	$140.00	$720.00	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHOCARDIGRAM	$2,190.00	$2,920.00	$218.57–$864.10	30% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 M-MODE/2D ECHO	$2,190.00	$2,920.00	$218.57–$864.10	30% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 M-MODE/2D ECHO DEPT ONLY	$2,190.00	$2,920.00	$218.57–$864.10	30% above	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 MMODE/2D ECHO	$2,226.75	$2,969.00	$218.57–$864.10	32% above	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHOCARDIOGRAPHY,TRANSTHORACIC COMPLETE	$300.00	$400.00	$720.00	—	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW RIGHT 2 VIEWS	$261.00	$348.00	$35.10–$138.76	at median	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW RIGHT 2 VIEWS	$273.00	$364.00	$116.48–$364.00	5% above	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW LEFT 2 VIEWS	$273.00	$364.00	$116.48–$364.00	5% above	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW LEFT 2 VIEW	$273.00	$364.00	$116.48–$364.00	5% above	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW LT-2 VIEWS	$273.00	$364.00	$116.48–$364.00	5% above	25%
Elbow X-ray, 2 views one side CPT 73070 ELBOW RT-2 VIEWS	$273.00	$364.00	$116.48–$364.00	5% above	25%
Elbow X-ray, 2 views inpatient CPT 73070 RADIOLOGIC EXAM, ELBOW; ANTEROPOSTERIOR	$68.25	$91.00	$720.00	—	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW LEFT COMPLETE	$345.00	$460.00	$147.20–$460.00	10% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW RIGHT COMPLETE	$345.00	$460.00	$147.20–$460.00	10% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW RT COM MIN 3VW	$517.50	$690.00	$220.80–$690.00	64% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW LT-COMPLETE/MIN 3V	$517.50	$690.00	$220.80–$690.00	64% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW LEFT COM MIN 3	$517.50	$690.00	$220.80–$690.00	64% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 ELBOW RT-COMPLETE/MIN 3V	$517.50	$690.00	$220.80–$690.00	64% above	25%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RADIOLOGIC EXAM, ELBOW; COMPLETE, 3+ VIE	$87.75	$117.00	$720.00	—	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBT SELL IAC WO CONT	$1,287.75	$1,717.00	$42.39–$283.67	49% above	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT TEMPORAL BNE INNER	$1,287.75	$1,717.00	$42.39–$283.67	49% above	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT TEMP BONE-INN EAR	$1,287.75	$1,717.00	$42.39–$283.67	49% above	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMPLETE	$448.50	$598.00	$42.39–$167.59	19% above	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 FACIAL BONES COMP	$448.50	$598.00	$42.39–$167.59	19% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RADIOLOGIC EXAM, FACIAL BONES; COMPLETE,	$120.00	$160.00	$720.00	—	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RT INC 1 JNT	$284.25	$379.00	$121.28–$379.00	4% above	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LEFT INC 1 JNT	$284.25	$379.00	$121.28–$379.00	4% above	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM RIGHT INC 1 JNT	$284.25	$379.00	$121.28–$379.00	4% above	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 FOREARM LT INC 1 JNT	$284.25	$379.00	$121.28–$379.00	4% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RADIOLOGIC EXAM; FOREARM, ANTEROPOSTERIO	$78.75	$105.00	$720.00	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 BILIARY HIDA - ROUTINE	$1,413.75	$1,885.00	$160.18–$633.27	11% below	25%
Hand X-ray, 2 views inpatient CPT 73120 RADIOLOGIC EXAM, HAND; 2 VIEWS	$66.00	$88.00	$720.00	—	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL LT. OS CALCIS/M 2V	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL RT OS CALCIS MIN 2V	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL LT OS CALCIS MIN 2V	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL RT. OS CALCIS/M 2V	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL LT OS CALCIS MIN 2	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 HEEL RIGHT OS CALCIS MIN	$261.75	$349.00	$111.68–$349.00	4% below	25%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RADIOLOGIC EXAM; CALCANEUS, 2+ VIEWS	$93.75	$125.00	$720.00	—	25%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 SLEEP STUDY, UNATTENDED	$75.00	$100.00	$720.00	—	25%
Knee X-ray, 3 views one side CPT 73562 KNEE RIGHT	$353.25	$471.00	$150.72–$471.00	at median	25%
Knee X-ray, 3 views one side CPT 73562 KNEE LEFT	$353.25	$471.00	$150.72–$471.00	at median	25%
Knee X-ray, 3 views inpatient CPT 73562 RADIOLOGIC EXAM, KNEE; 3 VIEWS	$89.25	$119.00	$720.00	—	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 RADIOLOGIC EXAM, KNEE; COMPLETE, 4+ VIEW	$96.75	$129.00	$720.00	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXT WO CONT	$1,465.50	$1,954.00	$42.39–$231.18	55% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMEN LIMITED ECHO	$271.50	$362.00	$42.39–$167.59	51% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ABDOMINAL (LIMITED) ECHO	$271.50	$362.00	$42.39–$167.59	51% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 BILIARY ECHO	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 SPLEEN ECHO	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 LOWER QUAD (L OR R) ECHO	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 UPPER QUADRANT (L OR R)	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 PORTABLE ABDM LIMIT ECHO	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 UPPER RT OR LT QUAD ECHO	$721.50	$962.00	$42.39–$167.59	31% above	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US AXILLARY LYMPH NODES	$373.50	$498.00	$42.39–$167.59	22% below	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 EXTREMITY ECHO LIMITED	$373.50	$498.00	$42.39–$167.59	22% below	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 UlLTRASOUND OF EXTREMEITY, LTD	$82.50	$110.00	$720.00	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT LUNG SCREENING	$277.50	$370.00	$42.39–$245.45	6% below	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA-FIBULA LT 2 VWS	$309.00	$412.00	$131.84–$412.00	13% above	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 XR TIBIA-FIBULA RT 2 VWS	$309.00	$412.00	$131.84–$412.00	13% above	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORT XR TIB-FIB LT 2 VWS	$309.00	$412.00	$131.84–$412.00	13% above	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 PORT XR TIB-FIB RT 2 VWS	$309.00	$412.00	$131.84–$412.00	13% above	25%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RADIOLOGIC EXAM; TIBIA & FIBULA, ANTEROP	$79.50	$106.00	$720.00	—	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRAST	$2,076.75	$2,769.00	$96.36–$381.84	43% above	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI JOINT LWR EXT WO CON	$2,499.75	$3,333.00	$96.36–$380.94	43% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI JOINT LW EXT W&WO CO	$3,025.50	$4,034.00	$142.36–$679.41	27% above	25%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST	$2,124.75	$2,833.00	$96.36–$380.94	15% above	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W&W/O CONT	$2,718.75	$3,625.00	$142.36–$600.00	19% above	25%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN W/O CONTRAST	$2,136.75	$2,849.00	$96.36–$380.94	33% above	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & W/O CONT	$3,366.75	$4,489.00	$142.36–$567.84	54% above	25%
MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE WO CONT	$2,152.50	$2,870.00	$96.36–$380.94	29% above	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI LUMBAR SPN W&WO CONT	$3,271.50	$4,362.00	$142.36–$568.41	40% above	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI THORACIC SPN WO CONT	$2,391.75	$3,189.00	$96.36–$380.94	43% above	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI CERV SPN W&WO CONT	$3,221.25	$4,295.00	$142.36–$569.55	42% above	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI CERVICAL SPIN WO CON	$2,583.00	$3,444.00	$96.36–$380.94	57% above	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W&W/O CONT	$2,592.75	$3,457.00	$142.36–$597.70	33% above	25%
MRI of the pelvis without and with contrast CPT 72197 MRI PROSTATE W& W/O CONT	$2,592.75	$3,457.00	$142.36–$597.70	33% above	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONT	$1,724.25	$2,299.00	$96.36–$404.86	14% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI JOINT UPR EXT WO CON	$2,457.00	$3,276.00	$96.36–$380.94	63% above	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 OP CERVICAL SPINE 4/5 V	$585.00	$780.00	$42.39–$167.59	30% above	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 CERVICAL SPINE 4/5 VIEWS	$585.00	$780.00	$42.39–$167.59	30% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RADIOLOGIC EXAM, SPINE, CERVICAL; 4+ VIE	$72.75	$97.00	$720.00	—	25%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK/LARYNX W CONT.	$1,586.25	$2,115.00	$70.96–$327.66	34% above	25%
Neck soft tissue CT scan with contrast CPT 70491 CT NECK/LARYNX WITH CONT	$1,586.25	$2,115.00	$70.96–$327.66	34% above	25%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK/LARYNX W/O CONT.	$1,340.25	$1,787.00	$42.39–$268.12	45% above	25%
Neck soft tissue CT scan without contrast CPT 70490 CT NECK/LARYNX/ WO CONT	$1,340.25	$1,787.00	$42.39–$268.12	45% above	25%
Neck soft tissue X-ray CPT 70360 NECK SFT TISSUE EXAM	$261.75	$349.00	$35.10–$138.76	1% above	25%
Neck soft tissue X-ray CPT 70360 NECK SOFT TISSUE	$261.75	$349.00	$35.10–$138.76	1% above	25%
Neck soft tissue X-ray inpatient CPT 70360 RADIOLOGIC EXAM; NECK, SOFT TISSUE	$66.75	$89.00	$720.00	—	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 STRESS TEST MULT VIS SPC	$3,345.75	$4,461.00	$520.40–$2,057.39	17% below	25%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 SPECT MULT STUDIES HOPD	$551.25	$735.00	$720.00	—	25%
Pelvic CT scan without contrast CPT 72192 CT PELVIS WO IV CONTRAST	$1,446.00	$1,928.00	$42.39–$237.40	44% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 BLADDER ECHO	$786.00	$1,048.00	$42.39–$167.59	81% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS ECHO	$719.25	$959.00	$42.39–$183.38	43% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PELVIS ECHOGRAM	$719.25	$959.00	$42.39–$183.38	43% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 PORT PELVIS (COMPL) ECHO	$719.25	$959.00	$42.39–$183.38	43% above	25%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 ECHOGRAPHY, PELVIC, REAL TIME W IMAGE DO	$120.00	$160.00	$720.00	—	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 GRAVID 14 WKS OR GREATER	$787.50	$1,050.00	$42.39–$235.22	31% above	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 MFM GRAVID 14 WKS OR >	$787.50	$1,050.00	$42.39–$235.22	31% above	25%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 ULTRASOUND, PREG UTER, AFTER 1ST TRI, TR	$168.75	$225.00	$720.00	—	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 MFM GRAVID < 14 WKS	$849.00	$1,132.00	$42.39–$204.80	55% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 GRAVID LESS THAN 14 WKS	$849.00	$1,132.00	$42.39–$204.80	55% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 ULTRASOUND, PREG UTER, 1ST TRI, TRANSAB	$161.25	$215.00	$720.00	—	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 MFM GRAVID LIMITED ECHO	$525.00	$700.00	$42.39–$167.59	10% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 GRAVID/UTERINE LTD. ECHO	$525.00	$700.00	$42.39–$167.59	10% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 GRAVID LIMITED ECHO	$525.00	$700.00	$42.39–$167.59	10% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 PORT GRAVID (LIMTD) ECHO	$525.00	$700.00	$42.39–$167.59	10% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 ULTRASOUND, PREGNANT UTERUS, REAL TIME;	$97.50	$130.00	$720.00	—	25%
Rib X-ray, one side, 2 views one side CPT 71100 RIBS UNILATERAL	$315.00	$420.00	$35.10–$138.76	4% above	25%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RADIOLOGIC EXAM, RIBS, UNILAT; 2 VIEWS	$37.50	$50.00	$720.00	—	25%
Rib X-ray, one side, with a chest view, 3 or more views both sides CPT 71101 XR RIBS BILAT W CHEST	$250.50	$334.00	$42.39–$167.59	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 XR RIBS UNI W CHEST	$250.50	$334.00	$42.39–$167.59	34% below	25%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 RADIOLOGIC EXAM, RIBS, UNILAT; W/ POSTER	$106.50	$142.00	$720.00	—	25%
Screening mammogram, both breasts both sides CPT 77067 DIGITAL MAMM SCRN BILAT	$468.00	$624.00	$49.63–$225.75	—	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LEFT 2 VWS	$288.00	$384.00	$122.88–$384.00	15% below	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT 2 VWS	$288.00	$384.00	$122.88–$384.00	15% below	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT 2 VIEWS	$288.00	$384.00	$122.88–$384.00	15% below	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER LEFT MIN 2 VWS	$288.00	$384.00	$122.88–$384.00	15% below	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 SHOULDER RIGHT MIN 2 VWS	$288.00	$384.00	$122.88–$384.00	15% below	25%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RADIOLOGIC EXAM, SHOULDER; COMPLETE, 2+	$87.75	$117.00	$720.00	—	25%
Sinus X-ray, complete, 3 or more views CPT 70220 PARANASAL SINUSES	$480.00	$640.00	$35.10–$138.76	33% above	25%
Sinus X-ray, complete, 3 or more views CPT 70220 PARANASAL SINUSES 3 VW	$480.00	$640.00	$35.10–$138.76	33% above	25%
Sinus X-ray, complete, 3 or more views CPT 70220 SINUS PARANASAL 3 VIEWS	$480.00	$640.00	$35.10–$138.76	33% above	25%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RADIOLOGIC EXAM, SINUSES, PARANASAL, COM	$98.25	$131.00	$720.00	—	25%
Skull X-ray, fewer than 4 views CPT 70250 SKULL 2 VIEWS	$250.50	$334.00	$42.39–$167.59	13% below	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS ECHOCARDIOGRAM	$2,225.25	$2,967.00	$218.57–$864.10	9% above	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 DOBUTAMINE STRESS ECHO	$2,225.25	$2,967.00	$218.57–$864.10	9% above	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 STRESS ECHO	$2,262.75	$3,017.00	$218.57–$864.10	10% above	25%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 STRESS TTE COMPLETE GLOBAL	$318.75	$425.00	$720.00	—	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 DYSPHAG-MOD BARIUM SWALW	$810.00	$1,080.00	$70.96–$280.55	60% above	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 FEMUR MIN 2 VIEWS	$186.00	$248.00	$35.10–$138.76	31% below	25%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X RAY MUSCOSKELETAL	$48.00	$64.00	$720.00	—	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 THORACIC SPINE WO CONT	$1,660.50	$2,214.00	$42.39–$231.18	83% above	25%
Toe X-ray, 2 or more views one side CPT 73660 TOES RIGHT FOOT	$234.75	$313.00	$100.16–$313.00	6% below	25%
Toe X-ray, 2 or more views one side CPT 73660 TOES LEFT FOOT	$234.75	$313.00	$100.16–$313.00	6% below	25%
Toe X-ray, 2 or more views one side CPT 73660 TOES RIGHT FOOT	$234.75	$313.00	$35.10–$138.76	6% below	25%
Toe X-ray, 2 or more views one side CPT 73660 TOES LEFT FOOT	$234.75	$313.00	$35.10–$138.76	6% below	25%
Toe X-ray, 2 or more views inpatient CPT 73660 RADIOLOGIC EXAM; TOE(S), 2+ VIEWS	$64.50	$86.00	$720.00	—	25%
Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ECHO NONOB	$548.25	$731.00	$42.39–$205.73	3% below	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 ECHOGRAPHY, TRANSVAGINAL	$165.00	$220.00	$720.00	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL ECHO OB	$591.00	$788.00	$42.39–$167.59	18% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 MFM TV ECHO OBSTETRICAL	$591.00	$788.00	$42.39–$167.59	18% above	25%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ULTRASOUND, PREGNANT UTERUS, REAL TIME;	$105.00	$140.00	$720.00	—	25%
Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL (COMPLETE)ECHO	$277.50	$370.00	$42.39–$202.33	56% below	25%
Ultrasound of the abdomen, complete CPT 76700 ABDOMEN COMPLETE ECHO	$277.50	$370.00	$42.39–$202.33	56% below	25%
Ultrasound of the abdomen, complete CPT 76700 PORTABLE ABDM COMPL ECHO	$985.50	$1,314.00	$42.39–$202.33	57% above	25%
Ultrasound of the scrotum and testicles CPT 76870 TESTES ECHO	$633.00	$844.00	$42.39–$174.57	18% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 THYROID ECHO	$604.50	$806.00	$42.39–$190.82	5% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TIS HEAD OR NECK	$604.50	$806.00	$42.39–$190.82	5% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 LYMPH NODE ECHO	$604.50	$806.00	$42.39–$190.82	5% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 UPPER G-I SERIES	$593.25	$791.00	$70.96–$280.55	at median	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RIGHT INC 1 JNT	$288.75	$385.00	$123.20–$385.00	5% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LEFT INC 1 JNT	$288.75	$385.00	$35.10–$138.76	5% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RIGHT INC 1 JNT	$288.75	$385.00	$35.10–$138.76	5% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LEFT INC 1 JNT	$288.75	$385.00	$123.20–$385.00	5% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS LT INC 1 JNT	$288.75	$385.00	$123.20–$385.00	5% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 HUMERUS RT INC 1 JNT	$288.75	$385.00	$123.20–$385.00	5% above	25%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RADIOLOGIC EXAM; HUMERUS, 2+ VIEWS	$87.75	$117.00	$720.00	—	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 VENOUS DUPLEX UPPER UNIL	$932.25	$1,243.00	$42.39–$205.21	27% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VEIN MAP LOWER UNILAT	$932.25	$1,243.00	$42.39–$205.21	27% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VENOUS REFLUX UNILATERAL	$932.25	$1,243.00	$42.39–$205.21	27% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 VEN DUPLX LOWER UNILAT	$932.25	$1,243.00	$42.39–$205.21	27% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 REFLUX UNILATERAL	$932.25	$1,243.00	$42.39–$205.21	27% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUPLEX VENOUS EXT UNILAT / LTD	$112.50	$150.00	$720.00	—	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST LEFT AP LAT	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST LEFT 2 VIEWS	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST RIGHT AP LAT	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST RIGHT 2 VIEWS	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST LT-2 VIEWS	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views one side CPT 73100 WRIST RT-2 VIEWS	$300.00	$400.00	$128.00–$400.00	15% above	25%
Wrist X-ray, 2 views inpatient CPT 73100 RADIOLOGIC EXAM, WRIST; ANTEROPOSTERIOR	$66.75	$89.00	$720.00	—	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LT COMP MIN 3 V	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RIGHT COMPLETE	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LEFT COMPLETE	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RT COM MIN 3 V	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST LEFT COM MIN 3V	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 WRIST RT COMP MIN 3 V	$372.00	$496.00	$158.72–$496.00	11% above	25%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RADIOLOGIC EXAM, WRIST; COMPLETE, 3+ VIE	$81.75	$109.00	$720.00	—	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP/PELV C-ARM UNI 2-3 V	$186.00	$248.00	$35.10–$138.76	40% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HIP UNI 2-3 VW W PELVIS	$186.00	$248.00	$35.10–$138.76	40% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 XRAY HIP WITH PELVIS, 2-3 VIEWS	$64.50	$86.00	$720.00	—	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW	$252.00	$336.00	$35.10–$138.76	2% below	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW OPC	$252.00	$336.00	$35.10–$138.76	2% below	25%
X-ray of the abdomen, 1 view CPT 74018 ABDOMEN 1 VIEW PORTABLE	$252.00	$336.00	$35.10–$138.76	2% below	25%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE RT-2 VIEWS	$261.75	$349.00	$111.68–$349.00	5% above	25%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE RIGHT 2 VIEWS	$261.75	$349.00	$111.68–$349.00	5% above	25%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LEFT 2 VIEWS	$261.75	$349.00	$111.68–$349.00	5% above	25%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE RIGHT 2 VIEW	$261.75	$349.00	$111.68–$349.00	5% above	25%
X-ray of the ankle, 2 views one side CPT 73600 ANKLE LT-2 VIEWS	$261.75	$349.00	$111.68–$349.00	5% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 RADIOLOGIC EXAM, ANKLE; ANTEROPOSTERIOR	$43.50	$58.00	$720.00	—	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS LEFT HAND	$259.50	$346.00	$35.10–$138.76	1% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS RT HAND	$259.50	$346.00	$110.72–$346.00	1% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS LEFT HAND	$259.50	$346.00	$110.72–$346.00	1% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS RIGHT HAND	$259.50	$346.00	$35.10–$138.76	1% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 FINGERS RIGHT HAND	$259.50	$346.00	$110.72–$346.00	1% above	25%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RADIOLOGIC EXAM, FINGER(S), 2+ VIEWS	$63.00	$84.00	$720.00	—	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT RT-2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT LT 2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT LEFT 2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT LT-2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT RIGHT 2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, 2 views one side CPT 73620 FOOT RT 2 VIEWS	$276.75	$369.00	$118.08–$369.00	19% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LT COMPLETE	$299.25	$399.00	$127.68–$399.00	2% below	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT COMP STUDY	$299.25	$399.00	$127.68–$399.00	2% below	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RIGHT COMPLETE	$347.25	$463.00	$148.16–$463.00	13% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT LEFT COMPLETE	$347.25	$463.00	$148.16–$463.00	13% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 FOOT RT COMPLETE	$347.25	$463.00	$148.16–$463.00	13% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 HAND RIGHT	$300.75	$401.00	$128.32–$401.00	8% below	25%
X-ray of the hand, 3 or more views one side CPT 73130 HAND LEFT	$300.75	$401.00	$128.32–$401.00	8% below	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 RADIOLOGIC EXAM, HAND; 3+ VIEWS	$81.75	$109.00	$720.00	—	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE LEFT-2 VIEWS	$319.50	$426.00	$136.32–$426.00	17% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RIGHT 2 VWS	$319.50	$426.00	$136.32–$426.00	17% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE LEFT 2 VIEWS	$319.50	$426.00	$136.32–$426.00	17% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RIGHT-2 VIEWS	$319.50	$426.00	$136.32–$426.00	17% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 KNEE RIGHT 2 VIEWS	$319.50	$426.00	$136.32–$426.00	17% above	25%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RADIOLOGIC EXAM, KNEE; 1/2 VIEWS	$81.75	$109.00	$720.00	—	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE < 4 VWS	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMB SPN LESS THAN 4V	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBAR SPINE <4 VWS	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 LUMBO SACRAL SPINE	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBO SACRAL	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 SPINE LUMBAR LESS THEN 4	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 PORTABLE LUMBAR SPINE	$435.00	$580.00	$42.39–$167.59	35% above	25%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR W OBLIQUES	$569.25	$759.00	$42.39–$167.59	21% above	25%
X-ray of the lower back, 4 or more views CPT 72110 LUMBO-SACRAL SPINE	$569.25	$759.00	$42.39–$167.59	21% above	25%
X-ray of the lower back, 4 or more views CPT 72110 SPINE LUMBAR W/OBLIQUES	$569.25	$759.00	$42.39–$167.59	21% above	25%
X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE OBLIQUES	$569.25	$759.00	$42.39–$167.59	21% above	25%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RADIOLOGIC EXAM, SPINE, LUMBOSACRAL; COM	$138.75	$185.00	$720.00	—	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RADIOLOGIC EXAM, SPINE; THORACIC, ANTERO	$45.00	$60.00	$720.00	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 NASAL BONES	$312.75	$417.00	$35.10–$138.76	7% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RADIOLOGIC EXAM, NASAL BONES, COMPLETE,	$79.50	$106.00	$720.00	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 CERVICAL SPINE 2-3 VIEWS	$413.25	$551.00	$35.10–$138.76	24% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 PORT CERVICAL SPINE 2-3V	$413.25	$551.00	$35.10–$138.76	24% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 OP CERVICAL SPINE 2-3 V	$413.25	$551.00	$35.10–$138.76	24% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 PELVIS AP	$276.00	$368.00	$42.39–$167.59	10% above	25%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RADIOLOGIC EXAM, PELVIS; ANTEROPOSTERIOR	$79.50	$106.00	$720.00	—	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 SACRUM AND COCCYX	$379.50	$506.00	$35.10–$138.76	28% above	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 ACTH	$345.00	$460.00	$16.61–$65.65	161% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 GPT TRANSMINASE	$55.50	$74.00	$2.28–$9.01	99% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 GOT TRANSMINASE	$48.75	$65.00	$2.23–$8.81	93% above	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL	$326.25	$435.00	$139.20–$435.00	50% above	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 ACUTE HEPATITIS PANEL	$197.25	$263.00	$720.00	—	25%
Albumin blood test CPT 82040 OLIGO AS OF SERUM ALBUMN	$30.75	$41.00	$13.12–$41.00	39% above	25%
Albumin blood test CPT 82040 ALBUMIN SERUM-OLIGOCL BA	$42.00	$56.00	$17.92–$56.00	90% above	25%
Albumin blood test CPT 82040 ALBUMIN	$48.00	$64.00	$2.13–$8.42	117% above	25%
Aldosterone blood test CPT 82088 ALDOSTERONE URINE	$76.50	$102.00	$32.64–$102.00	45% below	25%
Aldosterone blood test CPT 82088 ALDOSTERONE 30 MINUTE TS	$76.50	$102.00	$32.64–$102.00	45% below	25%
Aldosterone blood test CPT 82088 ALDOSTERONE SERUM	$76.50	$102.00	$32.64–$102.00	45% below	25%
Aldosterone blood test CPT 82088 ALDOSTERONE 60 MINUTE TS	$76.50	$102.00	$17.52–$69.28	45% below	25%
Alkaline phosphatase (ALP) blood test CPT 84075 ALK PHOS TOTAL	$45.75	$61.00	$19.52–$61.00	91% above	25%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKALINE PHOSPHATASE	$52.50	$70.00	$2.23–$8.81	119% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 3001715 ALLG SPEC IGE EA	$12.00	$16.00	$2.24–$8.87	49% below	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP TM	$38.25	$51.00	$7.21–$28.51	37% below	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP MATERNAL	$206.25	$275.00	$7.21–$28.51	240% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 AFP - AFP MATERNAL	$206.25	$275.00	$88.00–$275.00	240% above	25%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN; SERUM	$49.50	$66.00	$720.00	—	25%
Ammonia blood test CPT 82140 AMMONIA	$97.50	$130.00	$41.60–$130.00	78% above	25%
Amylase blood test CPT 82150 AMYLASE FULID	$12.00	$16.00	$5.12–$16.00	75% below	25%
Amylase blood test CPT 82150 U AMYLASE	$19.50	$26.00	$8.32–$26.00	59% below	25%
Amylase blood test CPT 82150 AMYLASE	$84.00	$112.00	$35.84–$112.00	75% above	25%
Amylase blood test CPT 82150 AMYLASE FLUID	$111.75	$149.00	$2.79–$11.02	133% above	25%
Amylase blood test inpatient CPT 82150 ASSAY OF AMYLASE	$36.00	$48.00	$720.00	—	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP IGG IGA	$26.25	$35.00	$11.20–$35.00	55% below	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODY	$117.75	$157.00	$50.24–$157.00	113% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 B-TYPE NATRIURETIC PEPTI	$184.50	$246.00	$78.72–$246.00	23% above	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 PROBNP	$184.50	$246.00	$78.72–$246.00	23% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE GENITAL	$103.50	$138.00	$44.16–$138.00	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 SPINAL FLUID CULTURE	$103.50	$138.00	$44.16–$138.00	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE MISC I	$103.50	$138.00	$44.16–$138.00	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 RESPIRATORY CULTURE	$103.50	$138.00	$44.16–$138.00	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 THROAT CULTURE	$103.50	$138.00	$3.71–$14.65	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 BODY FLUID CULTURE	$103.50	$138.00	$44.16–$138.00	57% above	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BACT; BLOOD, AEROBIC, W/ ISOLAT	$12.00	$16.00	$720.00	—	25%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$86.25	$115.00	$36.80–$115.00	31% above	25%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL (DO NOT USE W/ 800	$47.25	$63.00	$720.00	—	25%
Bilirubin blood test, total CPT 82247 TOTAL BILIRUBIN	$57.75	$77.00	$2.16–$8.53	141% above	25%
Bilirubin blood test, total CPT 82247 TOTAL BULIRUBIN	$76.50	$102.00	$2.16–$8.53	219% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CCL TISSUE EXAM PATHMD	$139.50	$186.00	$21.30–$126.71	31% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 CCL TISSUE EXAM TC	$139.50	$186.00	$21.30–$126.71	31% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 LEVEL IV SURG PATHOLOGY	$393.00	$524.00	$21.30–$126.71	93% above	25%
Blood culture for bacteria CPT 87040 BLOOD CULTURE	$180.75	$241.00	$77.12–$241.00	93% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 VENIPUNCTURE	$30.75	$41.00	$13.12–$41.00	93% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 OPC VENIPUNCTURE	$30.75	$41.00	$3.91–$15.45	93% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 SCC VENIPUNCTURE	$33.75	$45.00	$14.40–$45.00	112% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 MHMC VENIPUNCTURE	$33.75	$45.00	$3.91–$15.45	112% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 COLLECTION OF VENOUS BLOOD BY VENIPUNCTU	$11.25	$15.00	$720.00	—	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE SC NURSERY	$32.25	$43.00	$1.69–$6.68	37% above	25%
Blood glucose (sugar) test CPT 82947 GLUCOSE	$34.50	$46.00	$1.69–$6.68	46% above	25%
Blood lead test CPT 83655 LEAD URINE	$86.25	$115.00	$5.21–$20.59	77% above	25%
Blood lead test CPT 83655 LEAD - HEAVY METALS UR	$90.00	$120.00	$38.40–$120.00	85% above	25%
Blood lead test CPT 83655 LEAD - HEAVY METALS	$90.00	$120.00	$38.40–$120.00	85% above	25%
Blood lead test CPT 83655 LEAD	$90.00	$120.00	$38.40–$120.00	85% above	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HUM CHORIONIC GONADOTROP	$90.75	$121.00	$38.72–$121.00	67% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 REF ABO	$44.25	$59.00	$18.88–$59.00	26% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD TYPING; ABO	$66.00	$88.00	$28.16–$88.00	11% above	25%
Blood urea nitrogen (BUN) test CPT 84520 BLOOD UREA NITROG (BUN)	$39.75	$53.00	$1.70–$6.72	70% above	25%
Blood urea nitrogen (BUN) test CPT 84520 BLOOD UREA NITROGEN(BUN)	$39.75	$53.00	$16.96–$53.00	70% above	25%
C-peptide blood test CPT 84681 C PEPTIDE	$182.25	$243.00	$8.95–$35.38	130% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 PROMETHEUS-CRP	$33.75	$45.00	$2.23–$8.81	33% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 PROMETHEUS-CPT 86140 $30	$53.25	$71.00	$22.72–$71.00	6% above	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN QUANT	$78.00	$104.00	$33.28–$104.00	55% above	25%
C. difficile toxin gene test (stool PCR) CPT 87493 C. DIFFICILE TOXIN	$183.75	$245.00	$78.40–$245.00	41% above	25%
CA 19-9 blood test (tumor marker) CPT 86301 CA 19-9 TM	$47.25	$63.00	$20.16–$63.00	35% below	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 CA 125 TM	$47.25	$63.00	$20.16–$63.00	50% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV19 RHEONIX SWGH	$51.75	$69.00	$51.31–$356.78	63% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV19 HTP GX SWGH	$72.00	$96.00	$51.31–$356.78	49% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV19 RAPID ABT BMC	$77.25	$103.00	$22.06–$87.23	45% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 COV19 RAPID ABT SWGH	$77.25	$103.00	$51.31–$356.78	45% below	25%
Calcium blood test, total CPT 82310 CALCIUM	$37.50	$50.00	$2.22–$8.77	19% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 CARCINOEMBRYONIC ANTIGEN	$127.50	$170.00	$8.15–$32.23	47% above	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 ASSAY OF CARCINOEMBRYONIC ANTIGEN (CEA)	$84.75	$113.00	$720.00	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER AB	$120.00	$160.00	$51.20–$160.00	107% above	25%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 ANTIBODY; VARICELLA-ZOSTER	$18.75	$25.00	$720.00	—	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 GENE PROBE CHLAMYDIA	$180.75	$241.00	$15.09–$59.65	96% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA; Infectious agent detection by	$48.75	$65.00	$720.00	—	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL	$114.00	$152.00	$5.76–$22.76	115% above	25%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL	$45.75	$61.00	$720.00	—	25%
Complete blood count (CBC) with differential CPT 85025 CBC WITH AUTOMATED DIFF	$63.75	$85.00	$3.34–$13.21	75% above	25%
Complete blood count (CBC), no differential CPT 85027 CBC WITHOUT DIFF	$48.75	$65.00	$2.78–$11.00	44% above	25%
Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC	$175.50	$234.00	$74.88–$234.00	176% above	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL (DO NOT US	$48.00	$64.00	$720.00	—	25%
Cortisol blood test, total CPT 82533 CORTISOL, SALIVA	$72.00	$96.00	$30.72–$96.00	1% below	25%
Cortisol blood test, total CPT 82533 CORTISOL - RANDOM	$143.25	$191.00	$7.01–$27.71	98% above	25%
Cortisol blood test, total CPT 82533 CORTISOL - PM	$143.25	$191.00	$7.01–$27.71	98% above	25%
Cortisol blood test, total CPT 82533 CORTISOL - AM	$143.25	$191.00	$7.01–$27.71	98% above	25%
Cortisol blood test, total inpatient CPT 82533 CORTISOL; TOTAL	$42.75	$57.00	$720.00	—	25%
Creatine kinase (CK) blood test, total CPT 82550 CREATINE KINASE (CPK)	$67.50	$90.00	$28.80–$90.00	91% above	25%
Creatinine blood test CPT 82565 CREATININE BLOOD	$15.75	$21.00	$6.72–$21.00	36% below	25%
Creatinine blood test CPT 82565 CREATININE	$40.50	$54.00	$2.20–$8.70	64% above	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV ANTIBODY IGG	$33.00	$44.00	$6.19–$24.46	52% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 REF ANTI-CMV NEG PR TEST	$76.50	$102.00	$6.19–$24.46	11% above	25%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV AB IGG	$179.25	$239.00	$6.19–$24.46	161% above	25%
D-dimer blood test (blood clot marker) CPT 85379 D-DIMER	$73.50	$98.00	$4.38–$17.31	6% above	25%
D-dimer blood test (blood clot marker) CPT 85379 DVT D-DIMER QUANTITATIVE	$138.00	$184.00	$58.88–$184.00	98% above	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEAS	$172.50	$230.00	$9.56–$37.79	73% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 COC URINE DRUG SCREEN	$66.00	$88.00	$28.16–$88.00	31% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U PAIN PAN W INT 2009288	$127.50	$170.00	$26.72–$105.64	33% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U FENTANYL SCR W REFLEX	$139.50	$186.00	$26.72–$105.64	46% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U ETHYL GLUCUONIDE SCR	$140.25	$187.00	$59.84–$187.00	47% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U SYNTHETIC THC	$140.25	$187.00	$26.72–$105.64	47% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUCORONIDE WITH R	$140.25	$187.00	$26.72–$105.64	47% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U PAIN PAN 2007479	$141.00	$188.00	$26.72–$105.64	48% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 TOXOCOLOGY SCREEN BLOOD	$239.25	$319.00	$26.72–$105.64	150% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 SALICYLATE	$271.50	$362.00	$26.72–$105.64	184% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ACETAMINOPHEN	$271.50	$362.00	$26.72–$105.64	184% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ALCOHOL SERUM	$299.25	$399.00	$26.72–$105.64	213% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 URINE DRUG ABUS	$301.50	$402.00	$26.72–$105.64	216% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 U DOA WITH FENTANYL	$309.75	$413.00	$132.16–$413.00	224% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTES PANEL	$101.25	$135.00	$3.01–$11.92	112% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IGG	$183.00	$244.00	$7.80–$30.84	182% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV VCA IGM	$183.00	$244.00	$7.80–$30.84	182% above	25%
Estradiol blood test CPT 82670 ESTRADIOL	$52.50	$70.00	$12.01–$47.50	53% below	25%
Estradiol blood test CPT 82670 ESTRADIOL TMS	$53.25	$71.00	$22.72–$71.00	52% below	25%
Estradiol blood test CPT 82670 TOTAL ESTRADIOL MASSSPEC	$63.00	$84.00	$12.01–$47.50	44% below	25%
Estradiol blood test CPT 82670 ESTRADIOL- TOTAL	$142.50	$190.00	$60.80–$190.00	27% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 FOLLICLE STIMULATNG HORM	$144.75	$193.00	$7.99–$31.59	69% above	25%
Fecal calprotectin (stool inflammation test) CPT 83993 FECAL CALPROTECTIN	$44.25	$59.00	$8.44–$33.37	70% below	25%
Fecal calprotectin (stool inflammation test) CPT 83993 CALPROTECTIN FECAL	$302.25	$403.00	$8.44–$33.37	102% above	25%
Ferritin blood test (iron stores) CPT 82728 FERRITIN	$88.50	$118.00	$5.86–$23.17	16% above	25%
Fibrinogen blood test CPT 85384 FIBRINOGEN	$101.25	$135.00	$4.18–$16.52	125% above	25%
Folate (folic acid) blood test CPT 82746 FOLATE	$101.25	$135.00	$6.32–$24.99	50% above	25%
Free T3 thyroid hormone test CPT 84481 FREE T3	$163.50	$218.00	$69.76–$218.00	115% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FT4 ED TMS	$54.00	$72.00	$23.04–$72.00	27% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 FREE T4	$84.75	$113.00	$36.16–$113.00	99% above	25%
Free testosterone test CPT 84402 ASSAY FREE TESTO-CHILD	$57.75	$77.00	$10.95–$43.30	41% below	25%
Free testosterone test CPT 84402 ASSAY FREE TESTO-MS MALE	$71.25	$95.00	$10.95–$43.30	27% below	25%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$72.75	$97.00	$31.04–$97.00	25% below	25%
Free testosterone test CPT 84402 ARUP TESTOS FREE FEMALE	$150.00	$200.00	$64.00–$200.00	54% above	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GAMMA GT	$54.75	$73.00	$3.10–$12.24	29% above	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 GENERAL HEALTH PANEL	$206.25	$275.00	$88.00–$275.00	7% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 1 HR POST COLA	$60.75	$81.00	$2.04–$8.08	58% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 2HR POST COLA GLUCOSE	$79.50	$106.00	$2.04–$8.08	107% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE 2 HR POST PRAND	$79.50	$106.00	$2.04–$8.08	107% above	25%
Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE - 2 HR	$93.00	$124.00	$39.68–$124.00	38% above	25%
Glucose tolerance test, 3 samples CPT 82951 TOL TEST 3 SPEC INCL GL	$93.00	$124.00	$39.68–$124.00	38% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GENE PROBE GC	$180.00	$240.00	$15.09–$59.65	94% above	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria gonorrhoeae, amplified probe t	$48.75	$65.00	$720.00	—	25%
H. pylori stool antigen test CPT 87338 H PYLORI ANTIGEN STOOL	$89.25	$119.00	$38.08–$119.00	28% above	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HIV QNT BY NAAT	$166.50	$222.00	$36.59–$144.67	54% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV1 / HIV2	$112.50	$150.00	$48.00–$150.00	52% above	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 GP HUM PAPILLOMAVIR(HPV)	$163.50	$218.00	$15.09–$59.65	38% above	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HUMAN PAPILLOMAVIRUS	$183.75	$245.00	$78.40–$245.00	55% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 GLYCOSYLATED HEMOGLOBIN	$86.25	$115.00	$36.80–$115.00	89% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 GLYCOSYLATED(A1C)	$18.75	$25.00	$720.00	—	25%
Hemoglobin blood test CPT 85018 HEMOGLOBIN ROUTINE	$25.50	$34.00	$10.88–$34.00	57% above	25%
Hemoglobin blood test inpatient CPT 85018 BLOOD COUNT; HEMOGLOBIN (HGB)	$22.50	$30.00	$720.00	—	25%
Hepatitis B core antibody test (total) CPT 86704 HEP B CORE AB TOTAL	$27.75	$37.00	$5.18–$20.49	49% below	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEPATITIS B SURFCE ANTIB	$100.50	$134.00	$42.88–$134.00	108% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB)	$15.00	$20.00	$720.00	—	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B ANTIGEN	$107.25	$143.00	$45.76–$143.00	127% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C ANTIBODY	$153.75	$205.00	$65.60–$205.00	140% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HEPC QNT BY NAAT	$180.00	$240.00	$18.42–$72.83	6% below	25%
Herpes blood test, HSV-1 antibody CPT 86695 HERPES I QUANT IGB	$69.75	$93.00	$29.76–$93.00	18% above	25%
Herpes blood test, HSV-2 antibody CPT 86696 HERPES SIMPLEX TYPE 2	$69.75	$93.00	$29.76–$93.00	5% above	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROT HIGH SEN	$126.75	$169.00	$5.57–$22.02	88% above	25%
Homocysteine blood test CPT 83090 HOMOCYSTEINE	$147.00	$196.00	$7.71–$30.46	82% above	25%
Insulin blood test CPT 83525 INSULIN	$104.25	$139.00	$4.91–$19.43	103% above	25%
Insulin blood test inpatient CPT 83525 ASSAY OF INSULIN; TOTAL	$27.00	$36.00	$720.00	—	25%
Iron blood test (serum iron) CPT 83540 IRON	$60.75	$81.00	$25.92–$81.00	60% above	25%
Iron blood test (serum iron) inpatient CPT 83540 ASSAY OF IRON	$9.00	$12.00	$720.00	—	25%
Iron-binding capacity (TIBC) test CPT 83550 TOTAL IRON BINDING CAPAC	$63.00	$84.00	$26.88–$84.00	62% above	25%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL	$111.00	$148.00	$47.36–$148.00	54% above	25%
LH (luteinizing hormone) test CPT 83002 LUTEINIZING HORMONE	$135.75	$181.00	$57.92–$181.00	42% above	25%
Lactate (lactic acid) blood test CPT 83605 POC LACTIC ACID	$63.75	$85.00	$27.20–$85.00	23% above	25%
Lactate (lactic acid) blood test CPT 83605 LACTATES SC NURSERY	$86.25	$115.00	$4.98–$19.67	66% above	25%
Lactate (lactic acid) blood test CPT 83605 LACTIC ACID	$93.00	$124.00	$39.68–$124.00	79% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LDH FLUID	$13.50	$18.00	$5.76–$18.00	51% below	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 LACTATE DEHYDROGENASE	$49.50	$66.00	$2.60–$10.27	81% above	25%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE	$101.25	$135.00	$43.20–$135.00	74% above	25%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL	$93.75	$125.00	$40.00–$125.00	55% above	25%
Liver function blood test panel inpatient CPT 80076 HEPATITIS FUNCTION PANEL (DO NOT USE W/	$33.00	$44.00	$720.00	—	25%
Lyme disease antibody test CPT 86618 LYME ACUTE AB REFLEX	$28.50	$38.00	$7.32–$28.95	63% below	25%
Magnesium blood test CPT 83735 MAGNESIUM	$48.00	$64.00	$20.48–$64.00	42% above	25%
Magnesium blood test CPT 83735 URINE FOR MAGNESIUM	$55.50	$74.00	$23.68–$74.00	64% above	25%
Magnesium blood test CPT 83735 MAGNESIUM, RBC	$62.25	$83.00	$2.88–$11.39	84% above	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IGM	$23.25	$31.00	$5.54–$21.90	59% below	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA AB IGG	$29.25	$39.00	$5.54–$21.90	49% below	25%
Measles (rubeola) antibody test CPT 86765 RUBEOLA SCREEN	$66.75	$89.00	$5.54–$21.90	17% above	25%
Measles (rubeola) antibody test CPT 86765 MEASLE ABIGG/RUBEOLA IGB	$82.50	$110.00	$5.54–$21.90	44% above	25%
Measles (rubeola) antibody test inpatient CPT 86765 ANTIBODY; RUBEOLA	$18.75	$25.00	$720.00	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 INFECTIOUS MONO SCREEN	$68.25	$91.00	$2.23–$8.81	28% above	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HETEROPHILE ANTIBODIES; SCREENING	$22.50	$30.00	$720.00	—	25%
Mumps immunity blood test CPT 86735 MUMPS ANITBODY	$62.25	$83.00	$26.56–$83.00	6% above	25%
Mumps immunity blood test CPT 86735 MUMPS G	$80.25	$107.00	$34.24–$107.00	37% above	25%
Mumps immunity blood test inpatient CPT 86735 ANTIBODY; MUMPS	$18.75	$25.00	$720.00	—	25%
Obstetric blood test panel CPT 80055 OBSTETRIC PANEL	$124.50	$166.00	$20.56–$81.28	42% below	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$145.50	$194.00	$62.08–$194.00	76% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATIC SPECIFIC AG	$108.00	$144.00	$7.91–$31.26	37% above	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA TOTAL (ARUP-REF LAB)	$131.25	$175.00	$56.00–$175.00	66% above	25%
Pap test (liquid-based, automated screening with review) CPT 88175 THIN PREP IMAGE SEND OUT	$47.25	$63.00	$20.16–$63.00	52% below	25%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMO INTACT	$242.25	$323.00	$103.36–$323.00	71% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTI-PTT-D	$20.25	$27.00	$2.58–$10.22	46% below	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 ARUP-REFLEX PTT	$36.00	$48.00	$15.36–$48.00	4% below	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 ARUP-PTT-D	$39.00	$52.00	$16.64–$52.00	4% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 ARUP REFL PTT RATIO TREA	$59.25	$79.00	$25.28–$79.00	58% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 ACTIV PARTL THROMBO TIME	$96.00	$128.00	$40.96–$128.00	156% above	25%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHORUS	$35.25	$47.00	$15.04–$47.00	1% below	25%
Potassium blood test CPT 84132 POTASSIUM SC NURSERY	$33.00	$44.00	$2.05–$8.09	41% above	25%
Potassium blood test CPT 84132 POTASSIUM	$35.25	$47.00	$2.05–$8.09	51% above	25%
Progesterone blood test CPT 84144 PROGESTERONE	$144.00	$192.00	$8.97–$35.46	78% above	25%
Prolactin blood test CPT 84146 PROLACTIN	$148.50	$198.00	$63.36–$198.00	70% above	25%
Prothrombin time (PT/INR) clotting test CPT 85610 LUPUS ANTI-PROTH TIME-D	$9.75	$13.00	$1.84–$7.29	59% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 POC INR	$9.75	$13.00	$4.16–$13.00	59% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME	$9.75	$13.00	$1.84–$7.29	59% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 ARUP-PROTHROMBIN TIME-D	$36.75	$49.00	$15.68–$49.00	53% above	25%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME;	$9.00	$12.00	$720.00	—	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 POC DRUG SCREEN	$53.25	$71.00	$5.42–$21.42	8% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 SUBOXONE STRIP POC	$53.25	$71.00	$5.42–$21.42	8% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 DRUG TEST, ANY NUMBER READ BY OBSERVATIO	$22.50	$30.00	$720.00	—	25%
Rapid flu test (influenza antigen) inpatient CPT 87804 INFECTIOUS AGENT ANTIGEN DETECT IMMUNOAS	$22.50	$30.00	$720.00	—	25%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 INFECTIOUS AGENT DETECT IMMUNOASSAY W/ D	$22.50	$30.00	$720.00	—	25%
Renin blood test CPT 84244 RENIN	$49.50	$66.00	$21.12–$66.00	42% below	25%
Rh blood typing CPT 86901 REF RH	$78.00	$104.00	$33.28–$104.00	109% above	25%
Rh blood typing CPT 86901 RH (D)	$78.00	$104.00	$33.28–$104.00	109% above	25%
Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT	$69.00	$92.00	$29.44–$92.00	108% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY IGG	$33.00	$44.00	$6.19–$24.46	33% below	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY IGM	$33.00	$44.00	$6.19–$24.46	33% below	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM	$33.00	$44.00	$6.19–$24.46	33% below	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG AB	$67.50	$90.00	$28.80–$90.00	37% above	25%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG	$73.50	$98.00	$31.36–$98.00	49% above	25%
Rubella antibody test (immunity check) inpatient CPT 86762 ANTIBODY; RUBELLA	$22.50	$30.00	$720.00	—	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SED RATE	$50.25	$67.00	$1.16–$4.59	32% above	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE	$50.25	$67.00	$21.44–$67.00	32% above	25%
Sodium blood test CPT 84295 SODIUM SC NURSERY	$28.50	$38.00	$2.07–$8.18	5% above	25%
Sodium blood test CPT 84295 SODIUM	$30.75	$41.00	$2.07–$8.18	13% above	25%
Stool ova and parasites exam CPT 87177 SMEAR O&P CONC/ID	$146.25	$195.00	$62.40–$195.00	269% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD STOOL SCR	$47.25	$63.00	$20.16–$63.00	64% above	25%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 BLOOD, OCCULT; PEROXIDASE, QUAL; FECES,	$11.25	$15.00	$720.00	—	25%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 ASSAY TEST FOR BLOOD FECAL	$30.00	$40.00	$720.00	—	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 FTA ABS SERUM	$132.00	$176.00	$56.32–$176.00	128% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 RAPID PLSM REAG QUAL	$54.75	$73.00	$23.36–$73.00	130% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 CSF VDRL	$69.75	$93.00	$29.76–$93.00	192% above	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 ARUP-VDRL SERUM	$69.75	$93.00	$29.76–$93.00	192% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB QUANTIFERON	$139.50	$186.00	$26.65–$105.37	19% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 ARUP-QUANTIFERN 4TUBE TB	$139.50	$186.00	$59.52–$186.00	19% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 ARUP-QUANTFRN 1TUBE TB G	$139.50	$186.00	$59.52–$186.00	19% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY TOTAL TESTO-CHILD	$58.50	$78.00	$11.10–$43.88	37% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 ASSAY TOTL TESTO-MS MALE	$71.25	$95.00	$11.10–$43.88	23% below	25%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL	$135.75	$181.00	$57.92–$181.00	47% above	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 ARUP THYR PEROXIDASE AB	$13.50	$18.00	$5.76–$18.00	79% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 LIVER KID MICROSOME AB I	$26.25	$35.00	$6.26–$24.74	60% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 ANTIMICROSOML ANTIBODIES	$33.00	$44.00	$14.08–$44.00	49% below	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULAT HORMONE	$100.50	$134.00	$42.88–$134.00	34% above	25%
Total IgE blood test CPT 82785 IGE	$37.50	$50.00	$16.00–$50.00	40% below	25%
Total IgE blood test CPT 82785 3001715 ASSAY OF IGE	$37.50	$50.00	$16.00–$50.00	40% below	25%
Total cholesterol blood test CPT 82465 CHOLESTEROL TOTAL	$40.50	$54.00	$1.87–$7.40	11% above	25%
Total thyroxine (T4) blood test CPT 84436 THYROXINE	$63.75	$85.00	$2.95–$11.68	52% above	25%
Total triiodothyronine (T3) blood test CPT 84480 T3	$119.25	$159.00	$50.88–$159.00	98% above	25%
Transferrin blood test CPT 84466 TRANSFERRIN	$91.50	$122.00	$5.49–$21.69	23% above	25%
Trichomonas test (NAAT) CPT 87661 GP TRICH	$163.50	$218.00	$15.09–$59.65	89% above	25%
Triglycerides blood test CPT 84478 TRIGLYCERIDES	$60.75	$81.00	$25.92–$81.00	76% above	25%
Troponin test, quantitative CPT 84484 TROPONIN	$150.75	$201.00	$64.32–$201.00	79% above	25%
Troponin test, quantitative CPT 84484 TROPONIN HS	$159.00	$212.00	$5.36–$21.20	89% above	25%
Uric acid blood test CPT 84550 URIC ACID	$57.75	$77.00	$24.64–$77.00	64% above	25%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/SCOPE	$60.75	$81.00	$1.36–$5.39	125% above	25%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS, DIP STICK/TABLET REAGENT; NO	$30.75	$41.00	$720.00	—	25%
Urinalysis without microscope exam, automated CPT 81003 PH URINE	$38.25	$51.00	$0.97–$3.83	63% above	25%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO WO MICRO	$38.25	$51.00	$0.97–$3.83	63% above	25%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY URINE	$38.25	$51.00	$0.97–$3.83	63% above	25%
Urinalysis without microscope exam, automated CPT 81003 GLUCOSE QUAL URINE	$38.25	$51.00	$0.97–$3.83	63% above	25%
Urinalysis without microscope exam, automated CPT 81003 KETONES URINE	$38.25	$51.00	$0.97–$3.83	63% above	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, DIP STICK/TABLET REAGENT; AU	$15.00	$20.00	$720.00	—	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS, DIP STICK/TABLET REAGENT; NO	$22.50	$30.00	$720.00	—	25%
Urine culture for bacteria, with colony count CPT 87086 CULTURE URINE	$78.00	$104.00	$33.28–$104.00	37% above	25%
Urine microalbumin (albumin) test CPT 82043 MICROALBUMIN URINE	$82.50	$110.00	$2.49–$9.83	62% above	25%
Urine microalbumin (albumin) test inpatient CPT 82043 ALBUMIN; URINE, MICROALBUMIN, QUANTITATI	$38.25	$51.00	$720.00	—	25%
Urine pregnancy test, read by color change CPT 81025 URINE HCG	$19.50	$26.00	$3.70–$14.64	60% below	25%
Urine pregnancy test, read by color change CPT 81025 POC URINE HCG (PREG)	$19.50	$26.00	$8.32–$26.00	60% below	25%
Urine pregnancy test, read by color change CPT 81025 POC U PREG	$68.25	$91.00	$29.12–$91.00	40% above	25%
Urine pregnancy test, read by color change inpatient CPT 81025 URINE PREGNANCY TEST, VISUAL COLOR COMPA	$22.50	$30.00	$720.00	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B12	$123.00	$164.00	$6.48–$25.64	65% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 ARUP VITAMIN D2 D3	$42.75	$57.00	$18.24–$57.00	55% below	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25-OH	$173.25	$231.00	$12.73–$50.32	84% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 ASSAY OF CALCIFEDIOL (25-OH VITAMIN D-3)	$54.75	$73.00	$720.00	—	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25	$208.50	$278.00	$88.96–$278.00	35% above	25%
Zinc blood test CPT 84630 ZINC	$117.75	$157.00	$4.90–$19.36	129% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG (REF LAB)	$51.00	$68.00	$6.47–$25.59	25% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 QUANTITIVE HCG	$138.00	$184.00	$58.88–$184.00	104% above	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA-HCG QN TUMOR MARKER	$180.00	$240.00	$76.80–$240.00	166% above	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Anterior cervical discectomy and fusion (ACDF), one level inpatient CPT 22551 ARTHRODESIS ANT CERVICAL	$3,225.00	$4,300.00	$720.00	—	25%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 APPENDECTOMY; RUPTURED APPENDIX W/ ABSCE	$1,065.00	$1,420.00	$720.00	—	25%
Appendectomy, open surgery inpatient CPT 44950 APPENDECTOMY;	$787.50	$1,050.00	$720.00	—	25%
Arthroscopic ACL reconstruction or repair of the knee inpatient CPT 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE	$1,518.75	$2,025.00	$720.00	—	25%
Arthroscopic rotator cuff repair of the shoulder inpatient CPT 29827 ARTHROSCOPY, SHOULDER, SURGICAL; W ROTAT	$1,668.75	$2,225.00	$720.00	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 MAMM STEREOTACTIC	$4,314.75	$5,753.00	$645.87–$3,027.00	8% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting one side CPT 27786 TREATMENT ANKLE FX RT	$474.00	$632.00	$1,127.00–$2,485.00	25% above	25%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLOSED TREATMENT, DISTAL FIBULAR FX (LAT	$452.25	$603.00	$720.00	—	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FX	$474.00	$632.00	$95.62–$2,485.00	30% above	25%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TREATMENT, METATARSAL FX; W/O MAN	$311.25	$415.00	$720.00	—	25%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 HALLUX VALGUS CORRECTION; W/WO SESAMOIDE	$723.75	$965.00	$720.00	—	25%
Bunion correction with removal of part of the big toe joint inpatient CPT 28292 HALLUX VALGUS CORRECTION; W/WO SESAMOIDE	$637.50	$850.00	$720.00	—	25%
Cardiac catheterization with coronary angiogram CPT 93458 LHC CA LV	$11,373.00	$15,164.00	$1,282.15–$6,593.00	5% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE	$1,523.25	$2,031.00	$194.17–$1,031.28	26% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 3ET CARDIOVERSION PROC	$1,523.25	$2,031.00	$194.17–$1,031.28	26% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 1D CARDIOVERSION PROC	$1,523.25	$2,031.00	$194.17–$1,031.28	26% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION PROCEDURE	$1,523.25	$2,031.00	$194.17–$1,031.28	26% below	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION, ELECTIVE; EXTERNAL	$225.00	$300.00	$720.00	—	25%
Carpal tunnel release, open surgery inpatient CPT 64721 NEUROPLASTY &/OR TRANSPOSITION; MEDIAN N	$750.00	$1,000.00	$720.00	—	25%
Catheter ablation for atrial fibrillation CPT 93656 EPS TRANSSEPTAL AFIB ABL	$43,607.25	$58,143.00	$6,593.00–$38,662.12	28% above	25%
Cervical biopsy inpatient CPT 57500 BX/EXCISION, CERVIX LESION W/WO FULGURAT	$206.25	$275.00	$720.00	—	25%
Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 ROUTINE OBSTETRIC CARE W/ ANTEPARTUM CAR	$3,712.50	$4,950.00	$720.00	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 CIRCUMCISION-INPATIENT	$5,340.75	$7,121.00	$816.59–$3,228.39	202% above	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 CIRCUMCISION, USING CLAMP/OTHER DEVICE;	$206.25	$275.00	$720.00	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting one side CPT 25600 TREAT FX RADIUS/ULNA	$474.00	$632.00	$2,485.00	16% above	25%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLOSED TREATMENT, DISTAL RADIAL FX; W/O	$491.25	$655.00	$720.00	—	25%
Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY, FLEXIBLE; W/ REMOVAL, LESIO	$543.75	$725.00	$720.00	—	25%
Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLEN	$487.50	$650.00	$720.00	—	25%
Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLEN	$262.50	$350.00	$720.00	—	25%
Colposcopy with LEEP (loop electrosurgical excision) inpatient CPT 57460 COLPOSCOPY CERVIX INC UP/ADJ VAGINA; WIT	$356.25	$475.00	$720.00	—	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 COLPOSCOPY CERVIX INC UP/ADJ VAGINA; W B	$202.50	$270.00	$720.00	—	25%
Coronary stent placement, one artery CPT 92928 STNT PLACEMENT PROCEDURE	$12,009.75	$16,013.00	$1,054.29–$17,872.38	7% below	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 CYSTOURETHROSCOPY	$2,509.50	$3,346.00	$266.07–$2,485.00	26% above	25%
Cystoscopy, diagnostic look inside the bladder and urethra inpatient CPT 52000 CYSTOURETHROSCOPY (SEP PROC)	$236.25	$315.00	$720.00	—	25%
D&C (dilation and curettage), not related to pregnancy inpatient CPT 58120 DILATION & CURETTAGE, DX &/OR THERAPEUTI	$262.50	$350.00	$720.00	—	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION, BENIGN/PREMALIG LESIONS, EX	$82.50	$110.00	$720.00	—	25%
Ear tube placement (tympanostomy) under general anesthesia, one ear inpatient CPT 69436 TYMPANOSTOMY (REQUIRING INSERTION, VENTI	$213.75	$285.00	$720.00	—	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear inpatient CPT 69433 TYMPANOSTOMY (REQUIRING INSERTION, VENTI	$255.00	$340.00	$720.00	—	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REM IMPACTED EAR WAX	$128.25	$171.00	$23.68–$2,485.00	17% below	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVAL IMPACTED CERUMAN, IRRIGATION	$30.00	$40.00	$720.00	—	25%
Earwax removal with instruments, one ear CPT 69210 REM IMPACTD EAR WAX UNI	$195.00	$260.00	$23.68–$2,485.00	26% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVAL IMPACTED CERUMEN (SEP PROC), ONE	$75.00	$100.00	$720.00	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING	$373.50	$498.00	$80.19–$2,485.00	3% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 ENDOMETRIAL BX W/WO ENDOCERVICAL BX, W/O	$131.25	$175.00	$720.00	—	25%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 NASAL/SINUS ENDOSCOPY, SURGICAL; W/ ETHM	$412.50	$550.00	$720.00	—	25%
Endoscopic sinus surgery: opening the frontal sinus inpatient CPT 31276 NASAL/SINUS ENDOSCOPY, SURGICAL W/ FRONT	$506.25	$675.00	$720.00	—	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 NASAL/SINUS ENDOSCOPY, SURGICAL, W/ MAXI	$225.00	$300.00	$720.00	—	25%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue inpatient CPT 31267 NASAL/SINUS ENDOSCOPY, SURGICAL, W/ MAXI	$356.25	$475.00	$720.00	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 INTRLMR EPI INJ C/T CTGD	$1,937.25	$2,583.00	$276.06–$2,485.00	13% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 THERAPUETIC INJ CERV OR THOR, W/IMAGING	$225.00	$300.00	$720.00	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 FACET INJ LUM/SAC 1 LVL	$2,711.25	$3,615.00	$354.89–$2,485.00	24% above	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm inpatient CPT 49593 REPAIR AA HERNIA 1ST, 3-10 RDC	$795.00	$1,060.00	$720.00	—	25%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 Repair of anterior abdominal hernia	$750.00	$1,000.00	$720.00	—	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm inpatient CPT 49591 REPAIR AA HERNIA 1ST < 3 CM	$487.50	$650.00	$720.00	—	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY	$937.50	$1,250.00	$720.00	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY W	$1,087.50	$1,450.00	$720.00	—	25%
Gallbladder removal, open surgery through a larger incision inpatient CPT 47600 CHOLECYSTECTOMY;	$1,312.50	$1,750.00	$720.00	—	25%
Hammertoe correction surgery inpatient CPT 28285 CORRECTION, HAMMERTOE	$573.75	$765.00	$720.00	—	25%
Hemorrhoid banding (rubber band ligation) inpatient CPT 46221 HEMORRHOIDECTOMY, SIMPLE LIGATURE	$228.75	$305.00	$720.00	—	25%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 HEMORRHOIDECTOMY, INT & EXT, SIMPLE;	$450.00	$600.00	$720.00	—	25%
Hip replacement after an earlier hip surgery (conversion to total hip) inpatient CPT 27132 CONVERSION, PREVIOUS HIP SURGERY TO TOTA	$2,205.00	$2,940.00	$720.00	—	25%
Hysterectomy through an abdominal incision (total) inpatient CPT 58150 TOTAL ABDOMINAL HYSTERECTOMY W/WO REMOVA	$1,218.75	$1,625.00	$720.00	—	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Z INJECT FOR UTER/TUB XR	$302.25	$403.00	$2,485.00	21% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 CATHETERIZATION & INTRODUCTION, HYSTEROS	$225.00	$300.00	$720.00	—	25%
Hysteroscopy with endometrial ablation inpatient CPT 58563 HYSTEROSCOPY, SURGICAL; W/ ENDOMETRIAL A	$2,632.50	$3,510.00	$720.00	—	25%
Hysteroscopy with uterine lining sampling and/or polyp removal inpatient CPT 58558 HYSTEROSCOPY, SURGICAL; W/ ENDOMETRIAL B	$1,672.50	$2,230.00	$720.00	—	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 INSERTION, INTRAUTERINE DEVICE	$150.00	$200.00	$720.00	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$596.25	$795.00	$79.21–$2,485.00	54% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 10060 I&D ABSCESS SIMPLE	$633.75	$845.00	$79.21–$2,485.00	64% above	25%
Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMP OR SING	$633.75	$845.00	$79.21–$2,485.00	64% above	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION/DRAINAGE, ABSCESS; SIMPLE/SING	$165.00	$220.00	$720.00	—	25%
Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR, INITIAL INGUINAL HERNIA, AGE 5+;	$738.75	$985.00	$720.00	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION(S), TENDON SHEATH, LIGAMENT	$81.00	$108.00	$720.00	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTSIS MAJOR JNT	$600.75	$801.00	$117.67–$2,485.00	14% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 MAJOR JOINT INJECTION	$600.75	$801.00	$117.67–$2,485.00	14% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN INJECT JOINT LARGE	$708.75	$945.00	$117.67–$2,485.00	2% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS, ASPIRATION/INJECTION; MA	$90.75	$121.00	$720.00	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 INSERT DRUG IMPLANT DEVICE	$187.50	$250.00	$720.00	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTH INT JT WRIST ANKLE	$600.75	$801.00	$117.67–$2,485.00	3% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JT/BURS W/O US	$723.00	$964.00	$117.67–$2,485.00	17% above	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS, ASPIRATION/INJECTION; IN	$76.50	$102.00	$720.00	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA	$600.75	$801.00	$117.67–$2,485.00	22% above	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS, ASPIRATION/INJECTION; SM	$75.00	$100.00	$720.00	—	25%
Knee arthroscopy with meniscus repair (one side of the knee) inpatient CPT 29882 ARTHROSCOPY, KNEE, SURGICAL; W/ MENISCUS	$993.75	$1,325.00	$720.00	—	25%
Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY, KNEE, SURGICAL; W/ MENISCEC	$1,350.00	$1,800.00	$720.00	—	25%
Knee arthroscopy with removal of both torn meniscus parts inpatient CPT 29880 ARTHROSCOPY, KNEE, SURGICAL; W/ MENISCEC	$1,050.00	$1,400.00	$720.00	—	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) inpatient CPT 29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT	$1,500.00	$2,000.00	$720.00	—	25%
Laparoscopic Roux-en-Y gastric bypass, standard limb length inpatient CPT 43644 LAP GASTRIC BYPASS/ROUX-EN-Y	$5,625.00	$7,500.00	$720.00	—	25%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 LAPAROSCOPY, SURGICAL; APPENDECTOMY	$731.25	$975.00	$720.00	—	25%
Laparoscopic hysterectomy (uterus 250 g or less) inpatient CPT 58570 TLH,UTERUS 250 G OR LESS	$1,012.50	$1,350.00	$720.00	—	25%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries inpatient CPT 58571 TLH W/T/O 250 G OR LESS	$1,125.00	$1,500.00	$720.00	—	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side inpatient CPT 49650 LAPAROSCOPY, SURGICAL; REPAIR, INGUINAL	$600.00	$800.00	$720.00	—	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia inpatient CPT 49651 LAPAROSCOPY, SURGICAL; REPAIR, INGUINAL	$750.00	$1,000.00	$720.00	—	25%
Laparoscopic removal of an adjustable gastric band and its port inpatient CPT 43774 REMOVAL OF ADJUSTABLE GASTRIC BAND AND S	$1,387.50	$1,850.00	$720.00	—	25%
Laparoscopic removal of fallopian tubes and/or ovaries inpatient CPT 58661 LAPAROSCOPY, SURGICAL; W REMOVAL, ADNEXA	$780.00	$1,040.00	$720.00	—	25%
Laparoscopic sleeve gastrectomy for weight loss inpatient CPT 43775 LAP SLEEVE GASTRECTOMY	$4,875.00	$6,500.00	$720.00	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INT REP SCA TO 2.5 CM	$794.25	$1,059.00	$159.26–$2,485.00	49% above	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE, WOUNDS, SCALP/AXILLAE/TRU	$213.00	$284.00	$720.00	—	25%
Left heart catheterization, diagnostic CPT 93452 LV ONLY	$5,358.75	$7,145.00	$1,282.15–$6,593.00	42% below	25%
Lower-back epidural injection, with imaging guidance CPT 62323 INTRLMR EPI INJ L/S CTGD	$1,989.75	$2,653.00	$276.06–$2,485.00	2% below	25%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJECTION LUMBAR OR SACRAL W/GUIDANCE	$138.75	$185.00	$720.00	—	25%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJECTION LUMBAR OR SACRAL W/OUT GUIDANC	$112.50	$150.00	$720.00	—	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 TRFM EPI INJ L/S SGL LVL	$1,892.25	$2,523.00	$354.89–$2,485.00	9% below	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 NRV BLK LUMB OR SAC SGL	$1,892.25	$2,523.00	$354.89–$2,485.00	9% below	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJECTION, ANESTHETIC/STEROID, TRANSFORA	$262.50	$350.00	$720.00	—	25%
Lumbar discectomy or laminotomy to free a nerve root, one level inpatient CPT 63030 LAMINOTOMY W/ PARTIAL FACETECTOMY/FORAMI	$1,650.00	$2,200.00	$720.00	—	25%
Lumbar fusion with interbody cage and posterolateral graft (TLIF), one level inpatient CPT 22633 ARTHRODESIS, COMBINED A/P, LUMBAR	$2,400.00	$3,200.00	$720.00	—	25%
Lumbar interbody fusion (PLIF or TLIF), one level inpatient CPT 22630 ARTHRODESIS, POSTERIOR INTERBODY W/ LAMI	$2,475.00	$3,300.00	$720.00	—	25%
Lumbar laminectomy (spinal decompression), one level inpatient CPT 63047 LAMINECTOMY. FACETECTOMY & FORAMINOTOMY,	$1,875.00	$2,500.00	$720.00	—	25%
Lumbar spinal fusion (posterior), one level inpatient CPT 22612 ARTHRODESIS, POSTERIOR/POSTEROLATERAL, S	$2,625.00	$3,500.00	$720.00	—	25%
Lumpectomy (partial mastectomy) inpatient CPT 19301 MASTECTOMY; PARTIAL	$787.50	$1,050.00	$720.00	—	25%
Mastectomy (total removal of the breast) inpatient CPT 19303 MASTECTOMY; SINGLE, COMPLETE	$1,500.00	$2,000.00	$720.00	—	25%
Miscarriage treatment with D&C, first trimester inpatient CPT 59820 TREATMENT, MISSED ABORTION, COMPLETED SU	$431.25	$575.00	$720.00	—	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC LES TRK 0.5 CM OR L	$1,430.25	$1,907.00	$280.47–$2,485.00	6% above	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXCISION, BEN LESN, TRNK/ARM/LEG, <=.5cm	$146.25	$195.00	$720.00	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 EXC LES FAC 0.5 CM OR L	$1,430.25	$1,907.00	$280.47–$3,027.00	4% above	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 EXCISION, BEN LESN, FACE/EAR/EYE, <=.5cm	$157.50	$210.00	$720.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 AVUL NAIL PLATE SINGLE	$413.25	$551.00	$79.21–$2,485.00	30% above	25%
Nail removal (partial or complete), one nail CPT 11730 NAIL PLATE REMOVAL 1ST	$518.25	$691.00	$79.21–$2,485.00	63% above	25%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION, NAIL PLATE, PRT/CMP, SIMP; SIN	$150.00	$200.00	$720.00	—	25%
Occipital nerve block (injection for headaches) CPT 64405 INJ GREATER OCCIPITL NRV	$1,116.00	$1,488.00	$117.67–$2,485.00	42% above	25%
Occipital nerve block (injection for headaches) CPT 64405 INJ ANES AGNT OCCIPIT	$1,186.50	$1,582.00	$117.67–$2,485.00	51% above	25%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION, ANESTHETIC AGENT; GREATER OCC	$120.00	$160.00	$720.00	—	25%
Pacemaker implant (dual chamber) CPT 33208 DUAL CHMB PACR+LD INSERT	$12,236.25	$16,315.00	$4,171.77–$16,493.03	22% below	25%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W IMAG	$1,860.00	$2,480.00	$373.74–$3,027.00	7% above	25%
Paracentesis with imaging guidance CPT 49083 PARACENTESIS DIAG/THERAP	$2,445.00	$3,260.00	$373.74–$3,027.00	41% above	25%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOMINAL PARACENTESIS	$138.75	$185.00	$720.00	—	25%
Partial knee replacement (one compartment) inpatient CPT 27446 ARTHROPLASTY, KNEE, CONDYLE & PLATEAU; M	$1,800.00	$2,400.00	$720.00	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC NAIL & N MATRIX PERM	$1,369.50	$1,826.00	$159.26–$2,485.00	76% above	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXC OF NAIL/NAIL MATRIX	$1,369.50	$1,826.00	$159.26–$2,485.00	76% above	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION, NAIL/MATRIX, PERMANENT REMOVAL	$217.50	$290.00	$720.00	—	25%
Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAPAROSCOPY, SURGICAL PROSTATECTOMY, RET	$1,987.50	$2,650.00	$720.00	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 RF ABLATION LUMB	$3,088.50	$4,118.00	$778.43–$3,077.50	7% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level inpatient CPT 64635 DEST PARAVERTEBRAL FACET,LUMBAR/SACRAL	$562.50	$750.00	$720.00	—	25%
Removal of a breast lump, open surgery inpatient CPT 19120 EXCISION, BREAST LESION, MALE/FEMALE; 1+	$525.00	$700.00	$720.00	—	25%
Removal of a foreign object under the skin, simple CPT 10120 FOREIGN BODY REM SQ SIMP	$1,264.50	$1,686.00	$159.26–$2,485.00	89% above	25%
Removal of a foreign object under the skin, simple CPT 10120 INCIS/REMOVAL FB SIMP	$1,293.75	$1,725.00	$159.26–$2,485.00	93% above	25%
Removal of a foreign object under the skin, simple CPT 10120 INSCISION/RMVL FB SIMPLE	$1,344.00	$1,792.00	$159.26–$2,485.00	100% above	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION/REMOVAL, FB, SUBQ TISSUES; SIMP	$202.50	$270.00	$720.00	—	25%
Removal of one lobe of the thyroid (lobectomy) inpatient one side CPT 60220 TOTAL THYROID LOBECTOMY, UNILAT; W/WO IS	$900.00	$1,200.00	$720.00	—	25%
Screening colonoscopy for a person at average risk (Medicare code) inpatient HCPCS G0121 COLOREC CNCR SCR;COLNSCPY NO HI RSK	$558.75	$745.00	$720.00	—	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) inpatient HCPCS G0105 COLOREC CANCR SCR; COLNSCPY HI RISK	$431.25	$575.00	$720.00	—	25%
Septoplasty to straighten the nasal septum inpatient CPT 30520 SEPTOPLASTY/SUBMUCOUS RESECTION W/WO CAR	$825.00	$1,100.00	$720.00	—	25%
Shock-wave lithotripsy to break up kidney stones (from outside the body) CPT 50590 SHOCKWAVE LITHOTRIPSY	$7,543.50	$10,058.00	$1,374.85–$7,862.00	24% below	25%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION; ELBOW TO FINGER (SHORT ARM)	$126.00	$168.00	$720.00	—	25%
Short arm splint (forearm and hand) CPT 29125 SHT ARM SPLINT FRARM-HND	$259.50	$346.00	$51.38–$203.14	11% below	25%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION, SHORT ARM SPLINT (FOREARM T	$101.25	$135.00	$720.00	—	25%
Short leg cast (below the knee) CPT 29405 APPL OF SHORT LEG CAST	$555.00	$740.00	$105.87–$418.55	46% above	25%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION, SHORT LEG CAST (BELOW KNEE	$114.75	$153.00	$720.00	—	25%
Short leg splint (calf to foot) CPT 29515 APPL OF SHORT LEG SPLIN	$432.00	$576.00	$62.90–$248.67	47% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION, SHORT LEG SPLINT (CALF TO F	$103.50	$138.00	$720.00	—	25%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) inpatient CPT 29824 SHOULDER ARTHROSCOPY/SURGERY	$675.00	$900.00	$720.00	—	25%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPR	$690.00	$920.00	$720.00	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIM REP SCA TO 2.5 CM	$530.25	$707.00	$79.21–$2,485.00	61% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE RPR SCALP < 2.5CM	$530.25	$707.00	$79.21–$2,485.00	61% above	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP	$150.00	$200.00	$720.00	—	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BX OF SKIN LESION	$794.25	$1,059.00	$159.26–$2,485.00	78% above	25%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SGL LESION	$794.25	$1,059.00	$159.26–$2,485.00	78% above	25%
Skin biopsy, punch, one lesion CPT 11104 CT PUNCH BX 1ST LESION	$794.25	$1,059.00	$159.26–$2,485.00	78% above	25%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BX OF SKIN, SINGLE LESION	$161.25	$215.00	$720.00	—	25%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKIN TAGS	$413.25	$551.00	$79.21–$2,485.00	41% above	25%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKIN TAGS; UP / INCL 15 LESIONS	$123.75	$165.00	$720.00	—	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 LUMBAR PUNCTURE	$1,459.50	$1,946.00	$276.06–$2,485.00	36% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE LUMBAR	$1,459.50	$1,946.00	$276.06–$2,485.00	36% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LUMBAR PUNCTURE	$1,459.50	$1,946.00	$276.06–$2,485.00	36% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIM REP SCA 2.6-7.5 CM	$555.75	$741.00	$79.21–$313.14	58% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SIMP RPR SCALP 2.6-7.5CM	$555.75	$741.00	$79.21–$313.14	58% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SIMPLE REPAIR, SUPERFICIAL WOUNDS, SCALP	$127.50	$170.00	$720.00	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIM REP FAC TO 2.5 CM	$491.25	$655.00	$79.21–$313.14	55% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR, SUPERFICIAL WOUNDS, FACE/	$127.50	$170.00	$720.00	—	25%
TURP (transurethral resection of the prostate) inpatient CPT 52601 TRANSURETHRAL ELECTROSURGICAL RESECTION,	$711.00	$948.00	$720.00	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGNTL BX SKIN SING LES	$413.25	$551.00	$79.21–$2,485.00	37% above	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Tangential biopsy of skin	$120.00	$160.00	$720.00	—	25%
Thoracentesis with imaging guidance CPT 32555 CT THORACENTESIS WWO TUB	$2,001.75	$2,669.00	$246.46–$2,485.00	15% above	25%
Thoracentesis with imaging guidance CPT 32555 IR THORACENTSIS WORWO TB	$2,001.75	$2,669.00	$246.46–$2,485.00	15% above	25%
Thoracentesis with imaging guidance CPT 32555 US THORACENT WORWO TUBE	$2,001.75	$2,669.00	$246.46–$2,485.00	15% above	25%
Thoracentesis with imaging guidance CPT 32555 ASPIRATE PLEURA W IMAG	$2,127.00	$2,836.00	$246.46–$2,485.00	22% above	25%
Thoracentesis with imaging guidance CPT 32555 CHEST NEEDLE ASPRT W GDD	$3,557.25	$4,743.00	$246.46–$2,485.00	105% above	25%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS, W/IMAGING	$138.75	$185.00	$720.00	—	25%
Tonsil and adenoid removal, age 12 or older inpatient CPT 42821 TONSILLECTOMY & ADENOIDECTOMY; AGE 12+	$375.00	$500.00	$720.00	—	25%
Tonsil removal (tonsillectomy) only, age 12 or older inpatient CPT 42826 TONSILLECTOMY, PRIMARY/SECONDARY; AGE 12	$318.75	$425.00	$720.00	—	25%
Tonsil removal (tonsillectomy) only, child under 12 inpatient CPT 42825 TONSILLECTOMY, PRIMARY/SECONDARY; < AGE	$375.00	$500.00	$720.00	—	25%
Total hip replacement inpatient CPT 27130 ARTHROPLASTY, ACETABULAR/PROXIMAL FEMORA	$3,375.00	$4,500.00	$720.00	—	25%
Total knee replacement inpatient CPT 27447 ARTHROPLASTY, KNEE/CONDYLE/PLATEAU; MEDI	$2,625.00	$3,500.00	$720.00	—	25%
Total shoulder replacement inpatient CPT 23472 ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL	$2,006.25	$2,675.00	$720.00	—	25%
Total thyroid removal (thyroidectomy) inpatient CPT 60240 THYROIDECTOMY, TOTAL/COMPLETE	$1,113.75	$1,485.00	$720.00	—	25%
Trigger finger release surgery inpatient CPT 26055 TENDON SHEATH INCISION	$882.75	$1,177.00	$720.00	—	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ SINGLE/MULT TRIGGER	$600.75	$801.00	$117.67–$2,485.00	14% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER PT 1/2 MUSCL	$627.75	$837.00	$117.67–$2,485.00	10% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 TRIGGER PT INJ 1-2 MUSCL	$627.75	$837.00	$117.67–$2,485.00	10% below	25%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION(S), SINGLE OR MULTIPLE TRIGGER	$72.75	$97.00	$720.00	—	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) inpatient CPT 58670 LAPAROSCOPY, SURGICAL; W FULGURATION OF	$487.50	$650.00	$720.00	—	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 US BREAST CORE BIOPSY	$3,493.50	$4,658.00	$645.87–$3,027.00	5% above	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST 1ST LESION US IMAG	$669.48	$892.64	$720.00	—	25%
Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY; W/ BX, SINGLE/MULTIP	$337.50	$450.00	$720.00	—	25%
Upper endoscopy (EGD) with injection into the lining inpatient CPT 43236 UPPER GI ENDOSCOPY; DX (SEP PROC), WITH	$187.50	$250.00	$720.00	—	25%
Upper endoscopy (EGD) with polyp removal by snare inpatient CPT 43251 UPPER GI ENDOSCOPY; W/ REMOVAL, LESION,	$281.25	$375.00	$720.00	—	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 UPPER GI ENDOSCOPY; W/ INSERTION, GUIDE	$206.25	$275.00	$720.00	—	25%
Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GI ENDOSCOPY; DX (SEP PROC)	$337.50	$450.00	$720.00	—	25%
Upper endoscopy with drainage of a pseudocyst through the stomach wall inpatient CPT 43240 UPR GI NDSC TRANSMURAL DRG PSEUDOCST	$487.50	$650.00	$720.00	—	25%
Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 ROUTINE OBSTETRIC CARE, VAGINAL DELIVERY	$3,506.25	$4,675.00	$720.00	—	25%
Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 ROUTINE OBSTETRIC CARE, ANTEPARTUM CARE,	$3,000.00	$4,000.00	$720.00	—	25%
Vein ablation, radiofrequency, first vein CPT 36475 RFA EXTREMITY FIRST VEIN	$6,214.50	$8,286.00	$1,254.68–$4,960.36	5% below	25%
Vein ablation, radiofrequency, first vein CPT 36475 RFA EXTREMITY 1ST VEIN	$6,214.50	$8,286.00	$1,254.68–$4,960.36	5% below	25%
Vein ablation, radiofrequency, first vein CPT 36475 ENDOVENOUS RFA 1ST VEIN	$8,206.50	$10,942.00	$1,254.68–$4,960.36	26% above	25%
Vein ablation, radiofrequency, first vein inpatient CPT 36475 ENDOVENOUS RF, 1ST VEIN	$487.50	$650.00	$720.00	—	25%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION, ANY METHOD, FLAT WARTS, MOL	$150.00	$200.00	$720.00	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRD SUBQ TISSUE 20CM	$1,017.00	$1,356.00	$159.26–$3,027.00	30% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCUT 1ST 2	$1,041.00	$1,388.00	$159.26–$3,027.00	34% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEB SKIN & SUBCUT TISS	$1,080.75	$1,441.00	$159.26–$3,027.00	39% above	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDE; SUBQ, 1ST 20sq cm or LESS	$176.25	$235.00	$720.00	—	25%
Wrist fracture surgery (plate and screws), distal radius inpatient CPT 25607 OPEN TREATMENT DISTAL RADICAL FRACT	$1,004.25	$1,339.00	$720.00	—	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 1D BLOOD TRANSFUSION	$1,110.75	$1,481.00	$174.27–$2,485.00	at median	25%
Blood transfusion (giving blood or blood components) CPT 36430 PACU BLOOD TRANFUSION	$1,110.75	$1,481.00	$174.27–$2,485.00	at median	25%
Blood transfusion (giving blood or blood components) CPT 36430 4E BLOOD TRANSFUSION	$1,110.75	$1,481.00	$174.27–$2,485.00	at median	25%
Blood transfusion (giving blood or blood components) CPT 36430 3ET BLOOD TRANSFUSION	$1,110.75	$1,481.00	$174.27–$2,485.00	at median	25%
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$1,125.75	$1,501.00	$174.27–$2,485.00	1% above	25%
Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLOOD COMPO	$1,169.25	$1,559.00	$174.27–$2,485.00	5% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 AEROSOL TREATMENT	$197.25	$263.00	$13.82–$320.54	12% above	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSURIZED/NONPRESSURIZED INHALATION TR	$22.50	$30.00	$720.00	—	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INFUSION UP TO 1HR	$847.50	$1,130.00	$132.22–$522.73	11% above	25%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO INF UP TO 1HR	$847.50	$1,130.00	$132.22–$522.73	11% above	25%
Chemotherapy IV infusion, first hour CPT 96413 3ET CHEMO INFSN UP TO 1H	$942.00	$1,256.00	$132.22–$522.73	23% above	25%
Chemotherapy IV infusion, first hour CPT 96413 1D CHEMO INFSN INITL HR	$942.00	$1,256.00	$132.22–$522.73	23% above	25%
Chemotherapy IV infusion, first hour CPT 96413 5E CHEMO INFSN UP TO 1HR	$942.00	$1,256.00	$132.22–$522.73	23% above	25%
Chemotherapy IV infusion, first hour CPT 96413 4E CHEMO INFSN UP TO 1HR	$942.00	$1,256.00	$132.22–$522.73	23% above	25%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVAL	$67.50	$90.00	$720.00	—	25%
Critical care, first 30 to 74 minutes CPT 99291 99291 ED CRITICAL CARE	$3,034.50	$4,046.00	$335.89–$5,557.00	3% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE, EVAL & MGMT, 1ST 30-74MIN	$270.00	$360.00	$720.00	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 EEG AWAKE & DROWSY	$587.25	$783.00	$124.13–$671.17	39% below	25%
Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 EKG; COMPLETE INT & REPORT	$37.50	$50.00	$720.00	—	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/ER	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG (STRONGSVILLE)	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG HEALTH & WELLNESS	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/CATH LAB	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/BRED	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/CVS	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG/PAT	$252.00	$336.00	$10.96–$93.61	36% above	25%
Electroconvulsive therapy (ECT), one session CPT 90870 ELECTROCONVULSIVE THERPY	$1,122.00	$1,496.00	$190.82–$836.21	17% below	25%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ELECTROCONVULSIVE THERAPY (W/ MONITORING	$206.25	$275.00	$720.00	—	25%
Electroconvulsive therapy (ECT), one session inpatient CPT 90870 ELECTROCONVULSIVE THERPY	$1,122.00	$1,496.00	—	—	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED VISIT LEVEL 1	$255.75	$341.00	$35.10–$610.00	18% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED VISIT LEVEL 2	$450.75	$601.00	$63.13–$758.00	12% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED LEVEL 3	$792.00	$1,056.00	$110.38–$1,199.00	6% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 99284 ED LEVEL 4	$1,169.25	$1,559.00	$169.74–$1,908.00	12% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 99285 ED LEVEL 5	$1,963.50	$2,618.00	$244.40–$3,480.00	13% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST	$1,056.75	$1,409.00	$66.04–$490.76	18% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 STRESS TEST TREADMILL	$1,056.75	$1,409.00	$66.04–$490.76	18% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 NUCLEAR STRESS TEST	$1,056.75	$1,409.00	$66.04–$490.76	18% above	25%
Family therapy with the patient, 50 minutes CPT 90847 FAM PSYTX W PT 26+ MIN	$240.00	$320.00	$64.05–$253.21	19% below	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHE	$127.50	$170.00	$720.00	—	25%
Family therapy without the patient, 50 minutes CPT 90846 FAM PSYTX WO PT 26+ MIN	$240.00	$320.00	$64.05–$253.21	23% below	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 FAMILY PSYCHOTHERAPY (W/O PATIENT PRESEN	$123.75	$165.00	$720.00	—	25%
Group psychotherapy session CPT 90853 IOP PSYCHOEDUCATION 1 HR	$184.50	$246.00	$36.87–$145.78	8% above	25%
Group psychotherapy session CPT 90853 LOP GRP PSYC THERAPY 1HR	$184.50	$246.00	$36.87–$145.78	8% above	25%
Group psychotherapy session CPT 90853 LOP GRP PSYC EDUCATN 1HR	$184.50	$246.00	$36.87–$145.78	8% above	25%
Group psychotherapy session CPT 90853 MH CONTINUE CARE ADOLEST	$184.50	$246.00	$36.87–$145.78	8% above	25%
Group psychotherapy session CPT 90853 IOP GRP PSYC EDUCATN 1HR	$240.75	$321.00	$36.87–$145.78	41% above	25%
Group psychotherapy session CPT 90853 MH CONTINUE CARE ADULT	$240.75	$321.00	$36.87–$145.78	41% above	25%
Group psychotherapy session CPT 90853 IOP COGNITIVE THERPY 1HR	$240.75	$321.00	$36.87–$145.78	41% above	25%
Group psychotherapy session CPT 90853 IOP GRP PSYC THERAPY 1HR	$240.75	$321.00	$36.87–$145.78	41% above	25%
Group psychotherapy session CPT 90853 CONTINUING CARE 1 HR	$240.75	$321.00	$36.87–$145.78	41% above	25%
Group psychotherapy session CPT 90853 LOP MULTIFAM GROUP 1HR	$287.25	$383.00	$36.87–$145.78	68% above	25%
Holter monitor, heart rhythm recording up to 48 hours, with report inpatient CPT 93224 ECG MONITOR/24 HRS, W/ VISUAL SUPERIMPOS	$105.00	$140.00	$720.00	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 4E IV INFUSIN HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 3ET IV INFUSN HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 CCE IV INFUS HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 TJC IV INFUSN HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 LD IV INFUSIN HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 5E IV INFUSIN HYD 1ST HR	$470.25	$627.00	$54.12–$332.04	13% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION UP TO 1 HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 2DMO IV INFS HYD 1ST HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 1D IV INF HYD 1ST HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV INFUSION HYD 1ST HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRAT CT 1ST HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATION FIRST HR	$549.75	$733.00	$54.12–$332.04	32% above	25%
IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF 1	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 THERAP INF 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 1D THERA INFUSE 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 MH THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 TJC THERP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 THERAPEUTIC INF 1ST HOUR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 CCE THER INFUS 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 HD THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 3ET THERAP INFUSN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 4E THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 5E THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 96365 2BEX IN INF INIT	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV infusion of a medicine, first hour CPT 96365 LD THERAP INFUSIN 1ST HR	$470.25	$627.00	$83.99–$332.04	9% above	25%
IV push of a medicine, first drug CPT 96374 1D THERA/DX INJ IVPUSH	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 TJC THERAPUT/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 IV PUSH	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 4E THERAPEUT/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 5E THERAPEUT/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 96374 2BEX IVP SNLG INIT	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 THERAPEUTIC/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 LD THERAPEUT/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 CCE THER/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 IVP THERAP SGL OR INIT	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 HD THERAPEUT/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 3ET THERAPEUT/DX INJ INT	$470.25	$627.00	$61.12–$332.04	83% above	25%
IV push of a medicine, first drug CPT 96374 THERA/DX INJ INTR	$470.25	$627.00	$61.12–$332.04	83% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CD OP RN INJECTION	$147.00	$196.00	$25.49–$112.16	4% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 OAKV OP RN INJECTION	$147.00	$196.00	$25.49–$112.16	4% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 MH THERAPEUTIC/DX INJ	$162.00	$216.00	$25.49–$112.16	15% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 CCE THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 LD THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERA/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 TJC THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 2BEX THER INJ SQIM	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 5E THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 4E THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPUTIC/DX INJ INTR	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC INJECTION	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 96372 THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 3ET THERAPEUTIC/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 1D THERA/DX INJ	$165.75	$221.00	$25.49–$112.16	17% above	25%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC DIAGNOSTIC INJECTION ADMIN	$30.00	$40.00	$720.00	—	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CD ASSESSMENT OP	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 OAKVIEW CONSULT-BMC	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CD REASSESSMENT OP	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 MH CONSULT	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 CD CONSULT	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 MH ASSESSMENT OP	$362.25	$483.00	$64.05–$271.34	16% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC EXAM W/O MEDICAL	$243.75	$325.00	$720.00	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 AR OT NEUROMUSC RE ED EA	$162.75	$217.00	$13.06–$59.06	48% above	25%
Neuromuscular re-education, 15 minutes CPT 97112 PT NEUROMUSC RE-ED EA 15	$162.75	$217.00	$13.06–$59.06	48% above	25%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE VISIT-NEW PT DETAILED	$156.75	$209.00	$720.00	—	25%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE VISIT-NEW PT COMPREHENSIVE MOD	$235.50	$314.00	$720.00	—	25%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE VISIT-NEW PT COMPREHENS HI COMPLX	$312.00	$416.00	$720.00	—	25%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OFFICE VISIT-NEW PT EXPANDED	$99.75	$133.00	$720.00	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 MEDICAL NUTRITION, INDIV, per 15mins	$70.50	$94.00	$720.00	—	25%
Occupational therapy evaluation, low complexity CPT 97165 EVAL LOW COMPLEXITY	$158.25	$211.00	$41.02–$185.44	39% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 EVAL HIGH COMPLEXITY	$279.00	$372.00	$40.00–$180.85	7% below	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVAL LOW COMPLEXITY	$167.25	$223.00	$40.00–$180.85	36% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 EVAL MODERATE COMPLEXITY	$213.75	$285.00	$40.00–$180.85	23% below	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 AR OT THERE EX(EA.15 M)	$145.50	$194.00	$11.74–$53.09	23% above	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXER EA 15 M	$145.50	$194.00	$11.74–$53.09	23% above	25%
Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INIT COMP 18-39YR PREVNT MED, EVAL/MGMT	$153.75	$205.00	$720.00	—	25%
Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INIT COMP 40-64YR PREVNT MED, EVAL/MGMT	$180.00	$240.00	$720.00	—	25%
Preventive checkup, new patient aged 65 or older inpatient CPT 99387 INIT COMP 65+ YR PREVNT MED, EVAL/MGMT	$195.00	$260.00	$720.00	—	25%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PERIOD COMP 18-39YR PREVNT MED,EVAL/MGMT	$138.75	$185.00	$720.00	—	25%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PERIOD COMP 40-64YR PREVNT MED,EVAL/MGMT	$150.00	$200.00	$720.00	—	25%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PERIOD COMP 65YR+ PREVNT MED,EVAL/MGMT	$161.25	$215.00	$720.00	—	25%
Psychiatric evaluation with medical services inpatient CPT 90792 PSYCHIATRIC EXAM W/MEDICAL	$273.75	$365.00	$720.00	—	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 PSYTX CRISIS INITL 60MIN	$241.50	$322.00	$64.05–$253.21	23% below	25%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 PSYCHOTHERAPY FOR CRISIS FIRST 60 MINS	$210.00	$280.00	$720.00	—	25%
Psychotherapy session, 30 minutes CPT 90832 PT PSYTX 16-37 MIN	$316.50	$422.00	$64.05–$253.21	67% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY, 30 MINS	$112.50	$150.00	$720.00	—	25%
Psychotherapy session, 45 minutes CPT 90834 PT PSYTX 38-52 MIN	$364.50	$486.00	$64.05–$253.21	37% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY 45 MINS	$138.75	$185.00	$720.00	—	25%
Psychotherapy session, 60 minutes CPT 90837 PT PSYTX 53+ MIN	$419.25	$559.00	$64.05–$255.36	34% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY 60 MINS	$180.00	$240.00	$720.00	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESS VISIT<10MIN	$63.00	$84.00	$11.88–$46.95	44% above	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 BEHAV CHNG SMOKING 3-10 MIN	$18.75	$25.00	$720.00	—	25%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OFFICE VISIT-EST PT COMP HIGH COMPLEX	$281.25	$375.00	$720.00	—	25%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE VISIT-EST PT EXPANDED LOW COMPLEX	$127.50	$170.00	$720.00	—	25%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OFFICE VISIT-EST PT DETAILED MOD COMPLEX	$180.00	$240.00	$720.00	—	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE VISIT-EST PT FOCUSED	$78.75	$105.00	$720.00	—	25%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE CONSULT, DETAILED; LOW COMPLX	$146.25	$195.00	$720.00	—	25%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE CONSULT, COMPREHENSV; MOD COMPLEX	$217.50	$290.00	$720.00	—	25%
Speech and language evaluation CPT 92523 EVAL SPECH PROD W/LANG	$315.75	$421.00	$91.57–$413.99	7% below	25%
Speech therapy session, individual CPT 92507 SPEECH THERAPY EA 15 MIN	$224.25	$299.00	$30.75–$139.02	2% above	25%
Spirometry (breathing test) CPT 94010 INC SPIR VISIT	$321.00	$428.00	$47.90–$246.58	4% above	25%
Spirometry (breathing test) CPT 94010 PFT SCREENING	$321.00	$428.00	$47.90–$246.58	4% above	25%
Spirometry (breathing test) CPT 94010 PEAK FLOW MEASUREMENT	$321.00	$428.00	$47.90–$246.58	4% above	25%
Spirometry (breathing test) inpatient CPT 94010 SPIROMETRY W/ GRAPHIC RECORD/VITAL CAPAC	$41.25	$55.00	$720.00	—	25%
Spirometry before and after a bronchodilator CPT 94060 PFT BEF/AFT BRNCH DIALTR	$608.25	$811.00	$68.18–$490.76	6% above	25%
Spirometry before and after a bronchodilator inpatient CPT 94060 SPIROMETRY, EVAL BRONCHOSPASM, BEFORE/AF	$71.25	$95.00	$720.00	—	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 OT FUNC EXER TRT 15M EA	$168.00	$224.00	$14.01–$63.35	37% above	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 FUNCTIONAL ACTIVI EA 15M	$168.00	$224.00	$14.01–$63.35	37% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 BLOOD DRAW THERAPUTIC	$267.75	$357.00	$51.38–$203.14	13% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 THERAPUTIC PHLEBOTOMY	$298.50	$398.00	$51.38–$203.14	26% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPUTIC	$298.50	$398.00	$51.38–$203.14	26% above	25%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 STRESS TEST W/ ECG S&I OFFICE	$97.50	$130.00	$720.00	—	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE SUBQ	$187.50	$250.00	$720.00	—	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTaP-IPV VACCINE, AGES 4-6 IM	$75.00	$100.00	$720.00	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 TDAP PEDS	$89.10	$118.80	$38.02–$118.80	37% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 TDAP PEDS	$89.10	$118.80	$38.02–$118.80	37% above	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP, IM 7 YRS<	$45.00	$60.00	$720.00	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 TDAP PEDS	$89.10	$118.80	$38.02–$118.80	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTaP-IPV/Hib VACCINE IM	$150.00	$200.00	$720.00	—	25%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 INFLUENZA VACCINE, TRIVALENT INTRAMUSC	$138.75	$185.00	$720.00	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free Sus	$34.50	$46.00	$14.72–$46.00	25% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free Sus	$34.50	$46.00	$14.72–$46.00	25% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated 0.5 ML Injection	$34.50	$46.00	$14.72–$46.00	25% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated 0.5 ML Injection	$34.50	$46.00	$14.72–$46.00	25% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE	$38.80	$51.73	$16.55–$51.73	15% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VACCINE	$38.80	$51.73	$16.55–$51.73	15% below	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus	$82.50	$110.00	$35.20–$110.00	80% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus	$82.50	$110.00	$35.20–$110.00	80% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLUZONE 6 MNTHS> .5 ML	$33.75	$45.00	$720.00	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine inactivated 0.5 ML Injection	$34.50	$46.00	$14.72–$46.00	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine inactivated preservative-free Sus	$34.50	$46.00	$14.72–$46.00	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VACCINE	$38.80	$51.73	$16.55–$51.73	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 influenza virus vaccine inactivated preservative-free trivalent Sus	$82.50	$110.00	$35.20–$110.00	—	25%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 GARDASIL (9vHPV)	$337.50	$450.00	$720.00	—	25%
Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 HEPATITIS A & HEPATITIS B VACCINE (HEPA-	$112.50	$150.00	$720.00	—	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VACCINE, ADULT DOSAGE, IM US	$97.50	$130.00	$720.00	—	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEPATITIS A VACCINE, PEDIATRIC/ADOLESCEN	$56.25	$75.00	$720.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITUS B ADULT 20MCG	$337.05	$449.40	$143.81–$449.40	116% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITUS B ADULT 20MCG	$337.05	$449.40	$143.81–$449.40	116% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VACCINE, ADULT DOSAGE, IM US	$97.50	$130.00	$720.00	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITUS B ADULT 20MCG	$337.05	$449.40	$143.81–$449.40	—	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPB VACC 2 DOSE ADULT IM	$187.50	$250.00	$720.00	—	25%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VACCINE, PEDIATRIC/ADOLESCEN	$41.25	$55.00	$720.00	—	25%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLUZONE VACCINE HIGH DOSE 65+	$138.75	$185.00	$720.00	—	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMRII(MEASLES MUMPS RUBE	$153.98	$205.30	$65.70–$205.30	26% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MMRII(MEASLES MUMPS RUBE	$153.98	$205.30	$65.70–$205.30	26% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine - Pow	$154.50	$206.00	$65.92–$206.00	26% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine - Pow	$154.50	$206.00	$65.92–$206.00	26% below	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA SUBQ	$112.50	$150.00	$720.00	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MMRII(MEASLES MUMPS RUBE	$153.98	$205.30	$65.70–$205.30	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine - Pow	$154.50	$206.00	$65.92–$206.00	—	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MEASLES, MUMPS, RUBELLA, & VARICELLA VAC	$255.00	$340.00	$720.00	—	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCOCCAL CONJUGATE VACCINE,SEROGR	$187.50	$250.00	$720.00	—	25%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENACWY-TT VACCINE IM	$112.50	$150.00	$720.00	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGITIS (MenB-4C) 2 DOSE VACCINE	$225.00	$300.00	$720.00	—	25%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 MenB-FHbp VACCINE 2 OR 3 DOSE	$206.25	$275.00	$720.00	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) inpatient CPT 90670 PNEUMOCOCCAL CONJ (PCV13) 13 VALENT IM	$337.50	$450.00	$720.00	—	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL VACC (PCV20), 20 VALENT	$337.50	$450.00	$720.00	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VACCINE, 23-VALENT, ADULT,	$195.00	$260.00	$720.00	—	25%
Polio vaccine, inactivated (IPV) inpatient CPT 90713 POLIOVIRUS VACCINE, INACTIVATED, (IPV),	$37.50	$50.00	$720.00	—	25%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RSV VACCINE preF IM	$438.75	$585.00	$720.00	—	25%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Pow	$728.25	$971.00	$150.56–$595.24	23% below	25%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Pow	$728.25	$971.00	$310.72–$971.00	23% below	25%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Inj	$1,266.75	$1,689.00	$540.48–$1,689.00	33% above	25%
Rabies vaccine, one dose CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Inj	$1,266.75	$1,689.00	$540.48–$1,689.00	33% above	25%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Pow	$728.25	$971.00	$310.72–$971.00	—	25%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Inj	$1,266.75	$1,689.00	$540.48–$1,689.00	—	25%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine purified chick embryo cell 2.5 intl units Inj	$1,266.75	$1,689.00	$540.48–$1,689.00	—	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE-INJ	$1,346.54	$1,795.39	$574.52–$1,795.39	—	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) inpatient CPT 90681 ROTAVIRUS (RV1) VACCINE 2 DOSE ORAL	$123.75	$165.00	$720.00	—	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTAVIRUS (RV5), PENTAVALENT 3 DOSE ORAL	$105.00	$140.00	$720.00	—	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 SHINGRIX SHINGLES VACCINE	$210.00	$280.00	$720.00	—	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS & DIPTHERIA (Td) 7+ Years IM	$41.25	$55.00	$720.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX 0.5ML	$131.01	$174.68	$55.90–$174.68	19% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 BOOSTRIX 0.5ML	$131.01	$174.68	$55.90–$174.68	19% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus	$249.00	$332.00	$106.24–$332.00	125% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus	$249.00	$332.00	$106.24–$332.00	125% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Tdap 7+ years of age IM	$75.00	$100.00	$720.00	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 BOOSTRIX 0.5ML	$131.01	$174.68	$55.90–$174.68	—	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertuss (Tdap) adult/adol 5 units-2.5 units-18.5 mcg/0.5 mL Sus	$249.00	$332.00	$106.24–$332.00	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RABIES VAX ADMIN SUBSQNT	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 1D IMMUNIZATION ADMINIST	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 CCE IMMUNIZATION ADMIN	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 5E IMMUNIZATION ADMINIST	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 4E IMMUNIZATION ADMINIST	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 3ET IMMUNIZATION ADMINIS	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINISTRAT	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMINIST	$142.50	$190.00	$28.37–$112.16	250% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 IMMUN ADMIN; 1 SINGLE/COMBINATION VACCIN	$30.00	$40.00	$720.00	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 3ET IMMUNIZ ADMIN EA ADD	$117.75	$157.00	$25.95	238% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 2D IMMUNIZ ADMIN EA ADD	$117.75	$157.00	$25.95	238% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 CCE IMMUNIZ ADMIN EA ADD	$117.75	$157.00	$25.95	238% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 5E IMMUNIZ ADMIN EA ADD	$117.75	$157.00	$25.95	238% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATN ADMIN EA ADD	$135.00	$180.00	$25.95	288% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 4E IMMUNIZ ADMIN EA ADD	$135.00	$180.00	$25.95	288% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 1D IMMUNIZ ADMIN EA ADD	$135.00	$180.00	$25.95	288% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 IMMUN ADMIN; 2+ SINGLE/COMBINATION VACCI	$18.75	$25.00	$720.00	—	25%

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://southwestgeneral.pt.panaceainc.com/MRFDownload/southwestgeneral/southwestgeneral