Hospital Cleveland, OH

Ashtabula County Medical Center

Ashtabula County Medical Center in Ashtabula, OH publishes cash prices for 359 common procedures listed here, from its own machine-readable price file updated Sep 8, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Ohio median for 187 of 351 procedures and above it for 163. By typical cash price it ranks #62 of 137 Ohio hospitals and #2 of 26 hospitals in the Cleveland, OH area, cheapest first. Click a procedure to compare it with other hospitals nearby.

2420 Lake Ave, Ashtabula, OH 44004 Collected Sep 29, 2026 Source price file (440) 997-2262

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 360125 · CMS hospital register NPI 1285607416

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 3 actions for a hospital named Ashtabula County Medical Center in Ashtabula, OH:

Jul 30, 2025 Warning notice
Nov 12, 2025 Case closed
Jul 1, 2026 Warning notice

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/O & W/CONTRAST MATERIAL	$2,680.30	$3,829.00	$78.84–$3,599.26	104% above	30%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT ABDOMEN W/O & W/CONTRAST MATERIAL	$2,680.30	$3,829.00	$1,646.47–$3,599.26	—	30%
Abdominal X-ray, 2 views CPT 74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS	$385.00	$550.00	$13.10–$517.00	12% above	30%
Abdominal X-ray, 2 views inpatient CPT 74019 RADIOLOGIC EXAM ABDOMEN 2 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
Ankle X-ray, complete, 3 or more views CPT 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$10.24–$431.46	1% below	30%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$247.80	$354.00	$14.40–$478.00	49% below	30%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL	$247.80	$354.00	$152.22–$332.76	—	30%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$1,673.70	$2,391.00	$57.06–$2,247.54	77% above	30%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT UPPER EXTREMITY W/O CONTRAST MATERIAL	$1,673.70	$2,391.00	$1,028.13–$2,247.54	—	30%
Barium swallow (esophagus X-ray with contrast) CPT 74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$384.30	$549.00	$34.08–$516.06	12% below	30%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY	$384.30	$549.00	$236.07–$516.06	—	30%
Bone scan, whole body (nuclear medicine) CPT 78306 BONE &/JOINT IMAGING WHOLE BODY	$819.70	$1,171.00	$47.66–$1,545.00	47% below	30%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 BONE &/JOINT IMAGING WHOLE BODY	$819.70	$1,171.00	$503.53–$1,100.74	—	30%
Breast ultrasound, complete, one breast CPT 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$231.00	$330.00	$41.44–$764.00	52% below	30%
Breast ultrasound, complete, one breast inpatient CPT 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE	$231.00	$330.00	$141.90–$310.20	—	30%
Breast ultrasound, limited (one breast or one area) CPT 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED	$189.70	$271.00	$38.58–$764.00	54% below	30%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED	$189.70	$271.00	$116.53–$254.74	—	30%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG	$1,489.60	$2,128.00	$124.06–$2,000.32	30% below	30%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG	$1,489.60	$2,128.00	$915.04–$2,000.32	—	30%
CT angiography (CTA) of the head CPT 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST	$1,005.20	$1,436.00	$98.54–$1,349.84	24% below	30%
CT angiography (CTA) of the head inpatient CPT 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST	$1,005.20	$1,436.00	$617.48–$1,349.84	—	30%
CT angiography (CTA) of the neck CPT 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST	$1,005.20	$1,436.00	$98.54–$1,349.84	23% below	30%
CT angiography (CTA) of the neck inpatient CPT 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST	$1,005.20	$1,436.00	$617.48–$1,349.84	—	30%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$384.30	$549.00	$102.68–$910.51	73% below	30%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST	$384.30	$549.00	$236.07–$516.06	—	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$384.30	$549.00	$135.83–$1,133.64	76% below	30%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST	$384.30	$549.00	$236.07–$516.06	—	30%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$188.30	$269.00	$32.85–$862.00	33% below	30%
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM	$188.30	$269.00	$115.67–$252.86	—	30%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$653.10	$933.00	$98.13–$877.02	58% below	30%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL	$653.10	$933.00	$401.19–$877.02	—	30%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$777.70	$1,111.00	$103.05–$1,044.34	60% below	30%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL	$777.70	$1,111.00	$477.73–$1,044.34	—	30%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABDOMEN & PELVIS W/WO CONTRST 1/> BODY RE	$777.70	$1,111.00	$114.14–$1,171.41	67% below	30%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT ABDOMEN & PELVIS W/WO CONTRST 1/> BODY RE	$777.70	$1,111.00	$477.73–$1,044.34	—	30%
CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST MATERIAL	$384.30	$549.00	$71.85–$862.00	67% below	30%
CT scan of the abdomen with contrast inpatient CPT 74160 CT ABDOMEN W/CONTRAST MATERIAL	$384.30	$549.00	$236.07–$516.06	—	30%
CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST MATERIAL	$1,731.10	$2,473.00	$67.34–$2,324.62	65% above	30%
CT scan of the abdomen without contrast inpatient CPT 74150 CT ABDOMEN W/O CONTRAST MATERIAL	$1,731.10	$2,473.00	$1,063.39–$2,324.62	—	30%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$231.00	$330.00	$48.81–$862.00	74% below	30%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT MAXILLOFACIAL W/O CONTRAST MATERIAL	$231.00	$330.00	$141.90–$310.20	—	30%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL	$1,769.60	$2,528.00	$48.44–$2,376.32	112% above	30%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O CONTRAST MATERIAL	$1,769.60	$2,528.00	$1,087.04–$2,376.32	—	30%
CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL	$2,216.90	$3,167.00	$64.06–$2,976.98	121% above	30%
CT scan of the head with contrast inpatient CPT 70460 CT HEAD/BRAIN W/CONTRAST MATERIAL	$2,216.90	$3,167.00	$1,361.81–$2,976.98	—	30%
CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,005.20	$1,436.00	$71.85–$1,349.84	13% below	30%
CT scan of the head without and with contrast inpatient CPT 70470 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL	$1,005.20	$1,436.00	$617.48–$1,349.84	—	30%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL	$2,405.90	$3,437.00	$57.06–$3,230.78	120% above	30%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL	$2,405.90	$3,437.00	$1,477.91–$3,230.78	—	30%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,820.70	$2,601.00	$57.06–$2,444.94	70% above	30%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL	$1,820.70	$2,601.00	$1,118.43–$2,444.94	—	30%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/CONTRAST MATERIAL	$2,032.10	$2,903.00	$65.70–$2,728.82	66% above	30%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/CONTRAST MATERIAL	$2,032.10	$2,903.00	$1,248.29–$2,728.82	—	30%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$504.00	$720.00	$46.04–$676.80	—	30%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY	$504.00	$720.00	$309.60–$676.80	—	30%
Chest X-ray, 2 views CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS	$385.00	$550.00	$12.30–$517.00	41% above	30%
Chest X-ray, 2 views inpatient CPT 71046 RADIOLOGIC EXAM CHEST 2 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
Chest X-ray, single view CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW	$314.30	$449.00	$10.28–$422.06	35% above	30%
Chest X-ray, single view inpatient CPT 71045 RADIOLOGIC EXAM CHEST SINGLE VIEW	$314.30	$449.00	$193.07–$422.06	—	30%
Collarbone (clavicle) X-ray, complete CPT 73000 RADEX CLAVICLE COMPLETE	$192.50	$275.00	$9.81–$405.00	30% below	30%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 RADEX CLAVICLE COMPLETE	$192.50	$275.00	$118.25–$258.50	—	30%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$231.00	$330.00	$41.86–$764.00	67% below	30%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE	$231.00	$330.00	$141.90–$310.20	—	30%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$425.60	$608.00	$11.50–$571.52	6% below	30%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL	$425.60	$608.00	$261.44–$571.52	—	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$189.70	$271.00	$11.50–$405.00	26% below	30%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL	$189.70	$271.00	$116.53–$254.74	—	30%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	$1,727.60	$2,468.00	$60.78–$2,319.92	84% above	30%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	$1,727.60	$2,468.00	$1,061.24–$2,319.92	—	30%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	$2,189.60	$3,128.00	$66.09–$2,940.32	91% above	30%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST	$2,189.60	$3,128.00	$1,345.04–$2,940.32	—	30%
Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$322.70	$461.00	$57.06–$544.92	—	30%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI	$322.70	$461.00	$198.23–$433.34	—	30%
Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$253.40	$362.00	$46.38–$430.28	29% below	30%
Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI	$253.40	$362.00	$155.66–$340.28	—	30%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$607.60	$868.00	$45.26–$816.60	—	30%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY	$607.60	$868.00	$373.24–$815.92	—	30%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 DUP SCAN EXT VEIN BILAT	$495.60	$708.00	$39.50–$665.52	—	30%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 DUP SCAN EXT VEIN BILAT	$495.60	$708.00	$304.44–$665.52	—	30%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 ECHO TTHRC R-T 2D M-MODE COMPL SPEC&COLR D W/O CONTRAST	$1,120.00	$1,600.00	$82.76–$1,504.00	34% below	30%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 ECHO TTHRC R-T 2D M-MODE COMPL SPEC&COLR D W/O CONTRAST	$1,120.00	$1,600.00	$688.00–$1,504.00	—	30%
Elbow X-ray, 2 views CPT 73070 RADEX ELBOW 2 VIEWS	$192.50	$275.00	$9.81–$405.00	28% below	30%
Elbow X-ray, 2 views inpatient CPT 73070 RADEX ELBOW 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%
Elbow X-ray, complete, 3 or more views CPT 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$10.24–$431.46	1% above	30%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
Eye socket (orbit) CT scan without contrast CPT 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL	$231.00	$330.00	$72.65–$862.00	73% below	30%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL	$231.00	$330.00	$141.90–$310.20	—	30%
Facial bones X-ray, complete, 3 or more views CPT 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	$231.00	$330.00	$15.13–$405.00	40% below	30%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS	$231.00	$330.00	$141.90–$310.20	—	30%
Forearm X-ray (radius and ulna), 2 views CPT 73090 RADEX FOREARM 2 VIEWS	$256.90	$367.00	$9.44–$405.00	6% below	30%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 RADEX FOREARM 2 VIEWS	$256.90	$367.00	$157.81–$344.98	—	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER	$819.70	$1,171.00	$41.48–$1,545.00	48% below	30%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER	$819.70	$1,171.00	$503.53–$1,100.74	—	30%
Hand X-ray, 2 views CPT 73120 RADEX HAND 2 VIEWS	$231.00	$330.00	$9.81–$405.00	13% below	30%
Hand X-ray, 2 views inpatient CPT 73120 RADEX HAND 2 VIEWS	$231.00	$330.00	$141.90–$310.20	—	30%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 RADEX CALCANEUS MINIMUM 2 VIEWS	$192.50	$275.00	$9.44–$405.00	30% below	30%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 RADEX CALCANEUS MINIMUM 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	$4,330.90	$6,187.00	$151.84–$5,815.78	13% above	30%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND	$4,330.90	$6,187.00	$2,660.41–$5,815.78	—	30%
Knee X-ray, 3 views CPT 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$385.00	$550.00	$11.43–$517.00	9% above	30%
Knee X-ray, 3 views inpatient CPT 73562 RADIOLOGIC EXAMINATION KNEE 3 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
Knee X-ray, complete, 4 or more views CPT 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	$357.70	$511.00	$13.45–$480.34	9% below	30%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS	$357.70	$511.00	$219.73–$480.34	—	30%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,710.80	$2,444.00	$57.06–$2,297.36	81% above	30%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT LOWER EXTREMITY W/O CONTRAST MATERIAL	$1,710.80	$2,444.00	$1,050.92–$2,297.36	—	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED	$633.50	$905.00	$33.65–$850.70	15% above	30%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US ABDOMINAL REAL TIME W/IMAGE LIMITED	$633.50	$905.00	$389.15–$850.70	—	30%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG	$231.00	$330.00	$36.81–$764.00	52% below	30%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG	$231.00	$330.00	$141.90–$310.20	—	30%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$321.30	$459.00	$9.44–$431.46	16% above	30%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
MR angiography (MRA) of the head without contrast CPT 70544 MRA HEAD W/O CONTRST MATERIAL	$3,059.70	$4,371.00	$67.76–$4,108.74	113% above	30%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRA HEAD W/O CONTRST MATERIAL	$3,059.70	$4,371.00	$1,879.53–$4,108.74	—	30%
MRI of both breasts, without and then with contrast dye both sides CPT 77049 MRI BREAST BILAT WO/W CONTR	$735.70	$1,051.00	$130.14–$1,252.00	—	30%
MRI of both breasts, without and then with contrast dye inpatient both sides CPT 77049 MRI BREAST BILAT WO/W CONTR	$735.70	$1,051.00	$451.93–$987.94	—	30%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$3,690.40	$5,272.00	$77.11–$4,955.68	116% above	30%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL	$3,690.40	$5,272.00	$2,266.96–$4,955.68	—	30%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$4,067.70	$5,811.00	$121.93–$5,462.34	72% above	30%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL	$4,067.70	$5,811.00	$2,498.73–$5,462.34	—	30%
MRI of the abdomen without contrast CPT 74181 MRI ABDOMEN W/O CONTRAST MATERIAL	$2,961.70	$4,231.00	$81.70–$3,977.14	61% above	30%
MRI of the abdomen without contrast inpatient CPT 74181 MRI ABDOMEN W/O CONTRAST MATERIAL	$2,961.70	$4,231.00	$1,819.33–$3,977.14	—	30%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL	$3,689.00	$5,270.00	$124.83–$4,953.80	62% above	30%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI ABDOMEN W/O & W/CONTRAST MATERIAL	$3,689.00	$5,270.00	$2,266.10–$4,953.80	—	30%
MRI of the brain, no contrast dye CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$3,224.90	$4,607.00	$83.34–$4,330.58	103% above	30%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL	$3,224.90	$4,607.00	$1,981.01–$4,330.58	—	30%
MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$4,770.50	$6,815.00	$129.34–$6,406.10	118% above	30%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL	$4,770.50	$6,815.00	$2,930.45–$6,406.10	—	30%
MRI of the lower back, no contrast dye CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$3,828.30	$5,469.00	$84.11–$5,140.86	132% above	30%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL	$3,828.30	$5,469.00	$2,351.67–$5,140.86	—	30%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$5,163.90	$7,377.00	$129.71–$6,934.38	121% above	30%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL	$5,163.90	$7,377.00	$3,172.11–$6,934.38	—	30%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$3,138.80	$4,484.00	$83.73–$4,214.96	93% above	30%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL	$3,138.80	$4,484.00	$1,928.12–$4,214.96	—	30%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$4,622.80	$6,604.00	$129.71–$6,207.76	105% above	30%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL	$4,622.80	$6,604.00	$2,839.72–$6,207.76	—	30%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$1,085.70	$1,551.00	$83.73–$1,457.94	33% below	30%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL	$1,085.70	$1,551.00	$666.93–$1,457.94	—	30%
MRI of the pelvis without and with contrast CPT 72197 MRI PELVIS W/O & W/CONTRAST MATERIAL	$3,558.80	$5,084.00	$124.83–$4,778.96	79% above	30%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI PELVIS W/O & W/CONTRAST MATERIAL	$3,558.80	$5,084.00	$2,186.12–$4,778.96	—	30%
MRI of the pelvis, no contrast dye CPT 72195 MRI PELVIS W/O CONTRAST MATERIAL	$2,982.00	$4,260.00	$82.08–$4,004.40	96% above	30%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI PELVIS W/O CONTRAST MATERIAL	$2,982.00	$4,260.00	$1,831.80–$4,004.40	—	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$3,656.80	$5,224.00	$77.50–$4,910.56	152% above	30%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL	$3,656.80	$5,224.00	$2,246.32–$4,910.56	—	30%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS	$531.30	$759.00	$15.98–$713.46	18% above	30%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 RADEX SPINE CERVICAL 4 OR 5 VIEWS	$531.30	$759.00	$326.37–$713.46	—	30%
Neck soft tissue CT scan with contrast CPT 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL	$2,176.30	$3,109.00	$78.00–$2,922.46	86% above	30%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL	$2,176.30	$3,109.00	$1,336.87–$2,922.46	—	30%
Neck soft tissue CT scan without contrast CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL	$1,960.00	$2,800.00	$72.65–$2,632.00	113% above	30%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL	$1,960.00	$2,800.00	$1,204.00–$2,632.00	—	30%
Neck soft tissue X-ray CPT 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE	$321.30	$459.00	$10.66–$431.46	23% above	30%
Neck soft tissue X-ray inpatient CPT 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE	$321.30	$459.00	$197.37–$431.46	—	30%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES	$2,780.40	$3,972.00	$91.44–$3,733.68	31% below	30%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 MYOCARDIAL SPECT MULTIPLE STUDIES	$2,780.40	$3,972.00	$1,707.96–$3,733.68	—	30%
OCT scan of the retina (optical coherence tomography) both sides CPT 92134 CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA	$60.90	$87.00	$17.28–$155.96	—	30%
OCT scan of the retina (optical coherence tomography) inpatient both sides CPT 92134 CPTRIZED OPH DX IMG PST SEGMENT UNI/BI RETINA	$60.90	$87.00	$37.41–$81.78	—	30%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$5,371.10	$7,673.00	$134.83–$7,212.62	11% above	30%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH	$5,371.10	$7,673.00	$3,299.39–$7,212.62	—	30%
Pelvic CT scan without contrast CPT 72192 CT PELVIS W/O CONTRAST MATERIAL	$1,693.30	$2,419.00	$61.19–$2,273.86	68% above	30%
Pelvic CT scan without contrast inpatient CPT 72192 CT PELVIS W/O CONTRAST MATERIAL	$1,693.30	$2,419.00	$1,040.17–$2,273.86	—	30%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$231.00	$330.00	$29.11–$764.00	47% below	30%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U	$231.00	$330.00	$141.90–$310.20	—	30%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$231.00	$330.00	$39.76–$764.00	55% below	30%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE	$231.00	$330.00	$141.90–$310.20	—	30%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$304.50	$435.00	$57.75–$764.00	49% below	30%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION	$304.50	$435.00	$187.05–$408.90	—	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$403.20	$576.00	$56.99–$764.00	26% below	30%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT	$403.20	$576.00	$247.68–$541.44	—	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES	$391.30	$559.00	$37.70–$764.00	18% below	30%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US PREGNANT UTERUS LIMITED 1/> FETUSES	$391.30	$559.00	$240.37–$525.46	—	30%
Rib X-ray, one side, 2 views one side CPT 71100 RADEX RIBS UNILATERAL 2 VIEWS	$189.70	$271.00	$12.69–$405.00	39% below	30%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 RADEX RIBS UNILATERAL 2 VIEWS	$189.70	$271.00	$116.53–$254.74	—	30%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$425.60	$608.00	$15.59–$571.52	8% above	30%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS	$425.60	$608.00	$261.44–$571.52	—	30%
Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$259.70	$371.00	$43.09–$437.57	—	30%
Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD	$259.70	$371.00	$159.53–$348.74	—	30%
Shoulder X-ray, complete, 2 or more views CPT 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$385.00	$550.00	$11.04–$517.00	14% above	30%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
Sinus X-ray, complete, 3 or more views CPT 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$189.70	$271.00	$12.69–$405.00	48% below	30%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS	$189.70	$271.00	$116.53–$254.74	—	30%
Skull X-ray, fewer than 4 views CPT 70250 RADIOLOGIC EXAMINATION SKULL 4< VIEWS	$318.50	$455.00	$10.66–$427.70	10% above	30%
Skull X-ray, fewer than 4 views inpatient CPT 70250 RADIOLOGIC EXAMINATION SKULL 4< VIEWS	$318.50	$455.00	$195.65–$427.70	—	30%
Sleep study in a lab (polysomnography) CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$4,102.70	$5,861.00	$146.49–$5,509.34	14% above	30%
Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND	$4,102.70	$5,861.00	$2,520.23–$5,509.34	—	30%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG	$1,099.70	$1,571.00	$99.58–$1,476.74	46% below	30%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG	$1,099.70	$1,571.00	$675.53–$1,476.74	—	30%
Swallow study (modified barium swallow, video X-ray) CPT 74230 RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$637.70	$911.00	$30.36–$856.34	26% above	30%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY	$637.70	$911.00	$391.73–$856.34	—	30%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$385.00	$550.00	$10.66–$517.00	42% above	30%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL	$1,815.80	$2,594.00	$57.06–$2,438.36	105% above	30%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL	$1,815.80	$2,594.00	$1,115.42–$2,438.36	—	30%
Toe X-ray, 2 or more views CPT 73660 RADEX TOE MINIMUM 2 VIEWS	$192.50	$275.00	$7.79–$405.00	23% below	30%
Toe X-ray, 2 or more views inpatient CPT 73660 RADEX TOE MINIMUM 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL	$231.00	$330.00	$39.76–$764.00	58% below	30%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL	$231.00	$330.00	$141.90–$310.20	—	30%
Transvaginal ultrasound during pregnancy CPT 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$434.70	$621.00	$43.44–$764.00	13% below	30%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG	$434.70	$621.00	$267.03–$583.74	—	30%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$1,096.20	$1,566.00	$45.95–$1,472.04	75% above	30%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION	$1,096.20	$1,566.00	$673.38–$1,472.04	—	30%
Ultrasound of the scrotum and testicles CPT 76870 US SCROTUM & CONTENTS	$231.00	$330.00	$36.51–$764.00	57% below	30%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US SCROTUM & CONTENTS	$231.00	$330.00	$141.90–$310.20	—	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$576.10	$823.00	$32.39–$773.62	1% above	30%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM	$576.10	$823.00	$353.89–$773.62	—	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$384.30	$549.00	$46.30–$516.06	35% below	30%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY	$384.30	$549.00	$236.07–$516.06	—	30%
Upper arm X-ray (humerus), 2 views CPT 73060 RADEX HUMERUS MINIMUM 2 VIEWS	$189.70	$271.00	$9.81–$405.00	33% below	30%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 RADEX HUMERUS MINIMUM 2 VIEWS	$189.70	$271.00	$116.53–$254.74	—	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$378.00	$540.00	$25.10–$507.60	48% below	30%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY	$378.00	$540.00	$232.20–$507.60	—	30%
Wrist X-ray, 2 views CPT 73100 RADEX WRIST 2 VIEWS	$321.30	$459.00	$10.20–$431.46	23% above	30%
Wrist X-ray, 2 views inpatient CPT 73100 RADEX WRIST 2 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
Wrist X-ray, complete, 3 or more views CPT 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$10.63–$431.46	7% below	30%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 RADEX WRIST COMPLETE MINIMUM 3 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$385.00	$550.00	$13.06–$517.00	25% above	30%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS	$385.00	$550.00	$236.50–$517.00	—	30%
X-ray of the abdomen, 1 view CPT 74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW	$314.30	$449.00	$10.66–$422.06	22% above	30%
X-ray of the abdomen, 1 view inpatient CPT 74018 RADIOLOGIC EXAM ABDOMEN 1 VIEW	$314.30	$449.00	$193.07–$422.06	—	30%
X-ray of the ankle, 2 views CPT 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$192.50	$275.00	$9.81–$405.00	27% below	30%
X-ray of the ankle, 2 views inpatient CPT 73600 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%
X-ray of the finger(s), 2 or more views CPT 73140 RADEX FINGR MINIMUM 2 VIEWS	$321.30	$459.00	$8.18–$431.46	24% above	30%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 RADEX FINGR MINIMUM 2 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
X-ray of the foot, 2 views CPT 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$192.50	$275.00	$9.44–$405.00	18% below	30%
X-ray of the foot, 2 views inpatient CPT 73620 RADIOLOGIC EXAMINATION FOOT 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%
X-ray of the foot, complete, 3 or more views CPT 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$314.30	$449.00	$9.85–$422.06	2% above	30%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 RADEX FOOT COMPLETE MINIMUM 3 VIEWS	$314.30	$449.00	$193.07–$422.06	—	30%
X-ray of the hand, 3 or more views CPT 73130 RADEX HAND MINIMUM 3 VIEWS	$303.10	$433.00	$10.63–$407.02	8% below	30%
X-ray of the hand, 3 or more views inpatient CPT 73130 RADEX HAND MINIMUM 3 VIEWS	$303.10	$433.00	$186.19–$407.02	—	30%
X-ray of the knee, 1 or 2 views CPT 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$321.30	$459.00	$9.81–$431.46	15% above	30%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS	$321.30	$459.00	$197.37–$431.46	—	30%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$425.60	$608.00	$13.06–$571.52	30% above	30%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 RADEX SPINE LUMBOSACRAL 2/3 VIEWS	$425.60	$608.00	$261.44–$571.52	—	30%
X-ray of the lower back, 4 or more views CPT 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$531.30	$759.00	$15.55–$713.46	13% above	30%
X-ray of the lower back, 4 or more views inpatient CPT 72110 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS	$531.30	$759.00	$326.37–$713.46	—	30%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 RADEX SPINE THORACIC 2 VIEWS	$231.00	$330.00	$11.88–$405.00	24% below	30%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 RADEX SPINE THORACIC 2 VIEWS	$231.00	$330.00	$141.90–$310.20	—	30%
X-ray of the nasal bones, 3 or more views CPT 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$189.70	$271.00	$10.24–$405.00	35% below	30%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS	$189.70	$271.00	$116.53–$254.74	—	30%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS	$318.50	$455.00	$12.69–$427.70	6% below	30%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 RADEX SPINE CERVICAL 2 OR 3 VIEWS	$318.50	$455.00	$195.65–$427.70	—	30%
X-ray of the pelvis, 1 or 2 views CPT 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$318.50	$455.00	$10.24–$427.70	27% above	30%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS	$318.50	$455.00	$195.65–$427.70	—	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$192.50	$275.00	$10.24–$405.00	35% below	30%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS	$192.50	$275.00	$118.25–$258.50	—	30%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 ACTH	$362.60	$518.00	$6.81–$486.92	177% above	30%
ACTH blood test inpatient CPT 82024 ACTH	$362.60	$518.00	$222.74–$486.92	—	30%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 ALT/SGPT	$17.50	$25.00	$0.94–$23.50	39% below	30%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 ALT/SGPT	$17.50	$25.00	$10.75–$23.50	—	30%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HEPATITIS ACUTE PANEL	$536.90	$767.00	$8.40–$720.98	151% above	30%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HEPATITIS ACUTE PANEL	$536.90	$767.00	$329.81–$720.98	—	30%
Albumin blood test CPT 82040 ALBUMIN SERUM ASSAY	$67.20	$96.00	$0.87–$90.24	204% above	30%
Albumin blood test inpatient CPT 82040 ALBUMIN SERUM ASSAY	$67.20	$96.00	$41.28–$90.24	—	30%
Aldosterone blood test CPT 82088 ALDOSTERONE	$398.30	$569.00	$7.19–$534.86	184% above	30%
Aldosterone blood test inpatient CPT 82088 ALDOSTERONE	$398.30	$569.00	$244.67–$534.86	—	30%
Alkaline phosphatase (ALP) blood test CPT 84075 ALKA PHOSPHTA	$39.90	$57.00	$0.92–$53.58	66% above	30%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 ALKA PHOSPHTA	$39.90	$57.00	$24.51–$53.58	—	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, TOTAL VENOM PANEL IGE WITH REFLEX TO COMPONENTS	$72.10	$103.00	$0.92–$96.82	208% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN IGE QUANT/SEMI EA	$72.10	$103.00	$0.92–$96.82	208% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, HONEY BEE IGE WITH REFLEX TO COMPONENTS	$72.10	$103.00	$0.92–$96.82	208% above	30%
Allergy blood test, specific IgE, per allergen CPT 86003 ALLERGEN, FUNGI/MOLD, CURVULARIA LUNATA	$72.10	$103.00	$0.92–$96.82	208% above	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, TOTAL VENOM PANEL IGE WITH REFLEX TO COMPONENTS	$72.10	$103.00	$44.29–$96.82	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, FUNGI/MOLD, CURVULARIA LUNATA	$72.10	$103.00	$44.29–$96.82	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN, HONEY BEE IGE WITH REFLEX TO COMPONENTS	$72.10	$103.00	$44.29–$96.82	—	30%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 ALLERGEN IGE QUANT/SEMI EA	$72.10	$103.00	$44.29–$96.82	—	30%
Alpha-fetoprotein (AFP) blood test CPT 82105 ALPHA-FETOPROTEIN SERUM	$11.74	$16.77	$2.96–$41.51	81% below	30%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 ALPHA-FETOPROTEIN SERUM	$11.74	$16.77	$7.21–$15.76	—	30%
Ammonia blood test CPT 82140 AMMONIA	$10.20	$14.57	$2.57–$36.07	81% below	30%
Ammonia blood test inpatient CPT 82140 AMMONIA	$10.20	$14.57	$6.27–$13.70	—	30%
Amylase blood test CPT 82150 AMYLASE	$133.70	$191.00	$1.14–$179.54	170% above	30%
Amylase blood test inpatient CPT 82150 AMYLASE	$133.70	$191.00	$82.13–$179.54	—	30%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CYCLIC CITRU PEPT ANTI IG	$146.30	$209.00	$2.28–$196.46	153% above	30%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CYCLIC CITRU PEPT ANTI IG	$146.30	$209.00	$89.87–$196.46	—	30%
Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR	$8.47	$12.09	$2.13–$29.93	85% below	30%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 ANTINUCLEAR	$8.47	$12.09	$5.20–$11.36	—	30%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE ASSAY	$156.80	$224.00	$6.93–$210.56	5% above	30%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NATRIURETIC PEPTIDE ASSAY	$156.80	$224.00	$96.32–$210.56	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 CULTURE, BACTERIAL, AEROBIC	$171.50	$245.00	$1.52–$230.30	150% above	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 %IOHWC CULTURE	$171.50	$245.00	$1.52–$230.30	150% above	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 %IOHWC CULTURE	$171.50	$245.00	$105.35–$230.30	—	30%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 CULTURE, BACTERIAL, AEROBIC	$171.50	$245.00	$105.35–$230.30	—	30%
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL	$144.20	$206.00	$1.49–$193.64	120% above	30%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL	$144.20	$206.00	$88.58–$193.64	—	30%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 SURGERY PATH GROSS MICRO LEVEL 4	$303.10	$433.00	$8.85–$407.02	49% above	30%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 SURGERY PATH GROSS MICRO LEVEL 4	$303.10	$433.00	$186.19–$407.02	—	30%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 ROUTINE VENIPUNCTURE	$30.80	$44.00	$1.51–$41.36	94% above	30%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 ROUTINE VENIPUNCTURE	$30.80	$44.00	$18.92–$41.36	—	30%
Blood glucose (sugar) test CPT 82947 GLUC BLOOD QUANT ASSAY	$60.20	$86.00	$0.69–$80.84	155% above	30%
Blood glucose (sugar) test inpatient CPT 82947 GLUC BLOOD QUANT ASSAY	$60.20	$86.00	$36.98–$80.84	—	30%
Blood lead test CPT 83655 %OSHA LEAD	$117.60	$168.00	$2.14–$157.92	142% above	30%
Blood lead test CPT 83655 LEAD UR 24HR	$117.60	$168.00	$2.14–$157.92	142% above	30%
Blood lead test CPT 83655 %UTXM4 LEAD	$117.60	$168.00	$2.14–$157.92	142% above	30%
Blood lead test inpatient CPT 83655 %OSHA LEAD	$117.60	$168.00	$72.24–$157.92	—	30%
Blood lead test inpatient CPT 83655 LEAD UR 24HR	$117.60	$168.00	$72.24–$157.92	—	30%
Blood lead test inpatient CPT 83655 %UTXM4 LEAD	$117.60	$168.00	$72.24–$157.92	—	30%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HCG TEST QUAL	$103.60	$148.00	$1.33–$139.12	82% above	30%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HCG TEST QUAL	$103.60	$148.00	$63.64–$139.12	—	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 WHIVF BLD BYPE ABO	$114.10	$163.00	$0.53–$351.74	100% above	30%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO BLOOD TYPING	$114.10	$163.00	$0.53–$351.74	100% above	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO BLOOD TYPING	$114.10	$163.00	$70.09–$153.22	—	30%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 WHIVF BLD BYPE ABO	$114.10	$163.00	$70.09–$153.22	—	30%
Blood urea nitrogen (BUN) test CPT 84520 BUN	$77.70	$111.00	$0.70–$104.34	232% above	30%
Blood urea nitrogen (BUN) test inpatient CPT 84520 BUN	$77.70	$111.00	$47.73–$104.34	—	30%
C-peptide blood test CPT 84681 C-PEPTIDE SERUM	$14.57	$20.81	$3.67–$51.52	81% below	30%
C-peptide blood test inpatient CPT 84681 C-PEPTIDE SERUM	$14.57	$20.81	$8.95–$19.56	—	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-REACTIVE PROTEIN	$23.10	$33.00	$0.92–$31.02	55% below	30%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-REACTIVE PROTEIN	$23.10	$33.00	$14.19–$31.02	—	30%
C. difficile toxin gene test (stool PCR) CPT 87493 AMPLIFICATION, CLOSTRIDIUM DIFFICILE	$118.30	$169.00	$6.57–$158.86	11% below	30%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 AMPLIFICATION, CLOSTRIDIUM DIFFICILE	$118.30	$169.00	$72.67–$158.86	—	30%
CA 19-9 blood test (tumor marker) CPT 86301 IMMUNOASSY TUMOR CA 19-9	$14.57	$20.81	$3.67–$51.52	80% below	30%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 IMMUNOASSY TUMOR CA 19-9	$14.57	$20.81	$8.95–$19.56	—	30%
CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSY TUMOR CA 125	$336.00	$480.00	$3.67–$451.20	259% above	30%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 IMMUNOASSY TUMOR CA 125	$336.00	$480.00	$206.40–$451.20	—	30%
Calcium blood test, total CPT 82310 CALCIUM	$100.80	$144.00	$0.91–$135.36	219% above	30%
Calcium blood test, total inpatient CPT 82310 CALCIUM	$100.80	$144.00	$61.92–$135.36	—	30%
Carcinoembryonic antigen (CEA) test CPT 82378 CEA AG	$217.70	$311.00	$3.34–$292.34	156% above	30%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 CEA AG	$217.70	$311.00	$133.73–$292.34	—	30%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGM	$39.90	$57.00	$2.27–$53.58	31% below	30%
Chickenpox (varicella) immunity blood test CPT 86787 VZV IGG AB, CSF	$39.90	$57.00	$2.27–$53.58	31% below	30%
Chickenpox (varicella) immunity blood test CPT 86787 VARICELLA ZOSTER IGG AB	$39.90	$57.00	$2.27–$53.58	31% below	30%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGG AB	$39.90	$57.00	$24.51–$53.58	—	30%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VZV IGG AB, CSF	$39.90	$57.00	$24.51–$53.58	—	30%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 VARICELLA ZOSTER IGM	$39.90	$57.00	$24.51–$53.58	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 WHIIVF CHLAMYDIA TRACH AM	$118.30	$169.00	$6.19–$158.86	26% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLAMYDIA TRACH AMPLIFY	$118.30	$169.00	$6.19–$158.86	26% above	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 WHIIVF CHLAMYDIA TRACH AM	$118.30	$169.00	$72.67–$158.86	—	30%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 CHLAMYDIA TRACH AMPLIFY	$118.30	$169.00	$72.67–$158.86	—	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID-LIPO PANEL 1	$170.10	$243.00	$2.36–$228.42	219% above	30%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 %NMRLIP CHOLESTEROL	$170.10	$243.00	$2.36–$228.42	219% above	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID-LIPO PANEL 1	$170.10	$243.00	$104.49–$228.42	—	30%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 %NMRLIP CHOLESTEROL	$170.10	$243.00	$104.49–$228.42	—	30%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO WO DIFF	$72.10	$103.00	$1.14–$96.82	119% above	30%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO WO DIFF	$72.10	$103.00	$44.29–$96.82	—	30%
Comprehensive metabolic panel (blood test) CPT 80053 COMPRE META PANL	$210.00	$300.00	$1.86–$282.00	230% above	30%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPRE META PANL	$210.00	$300.00	$129.00–$282.00	—	30%
Cortisol blood test, total CPT 82533 CORTISOL TOTAL	$11.41	$16.30	$2.88–$40.35	84% below	30%
Cortisol blood test, total inpatient CPT 82533 CORTISOL TOTAL	$11.41	$16.30	$7.01–$15.32	—	30%
Creatine kinase (CK) blood test, total CPT 82550 *CREATINE KINASE TOTAL ASSAY	$124.60	$178.00	$1.15–$167.32	258% above	30%
Creatine kinase (CK) blood test, total inpatient CPT 82550 *CREATINE KINASE TOTAL ASSAY	$124.60	$178.00	$76.54–$167.32	—	30%
Creatinine blood test CPT 82565 CREATININE BLOOD ASSAY	$72.10	$103.00	$0.90–$96.82	195% above	30%
Creatinine blood test CPT 82565 *CREATININE BLOOD	$72.10	$103.00	$0.90–$96.82	195% above	30%
Creatinine blood test inpatient CPT 82565 *CREATININE BLOOD	$72.10	$103.00	$44.29–$96.82	—	30%
Creatinine blood test inpatient CPT 82565 CREATININE BLOOD ASSAY	$72.10	$103.00	$44.29–$96.82	—	30%
Cytomegalovirus (CMV) antibody test CPT 86644 WHIIVF2 CMV IGG AB	$195.30	$279.00	$2.54–$262.26	190% above	30%
Cytomegalovirus (CMV) antibody test CPT 86644 CMV IGG ANTIBODY	$195.30	$279.00	$2.54–$262.26	190% above	30%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 CMV IGG ANTIBODY	$195.30	$279.00	$119.97–$262.26	—	30%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 WHIIVF2 CMV IGG AB	$195.30	$279.00	$119.97–$262.26	—	30%
DHEA sulfate (DHEA-S) blood test CPT 82627 DHEA-S	$189.00	$270.00	$3.92–$253.80	90% above	30%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 DHEA-S	$189.00	$270.00	$116.10–$253.80	—	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRG SCRN 9 PANEL SER OR PL	$91.00	$130.00	$10.96–$153.83	6% below	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TESTS PRESUMPTIVE	$91.00	$130.00	$10.96–$153.83	6% below	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG SCRN, BLD	$91.00	$130.00	$10.96–$153.83	6% below	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG ANALYSIS UR	$91.00	$130.00	$10.96–$153.83	6% below	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 ETHYL GLUC UR SCRN	$91.00	$130.00	$10.96–$153.83	6% below	30%
Drug screen by lab instrument (any number of drug classes) CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$133.00	$190.00	$10.96–$178.60	37% above	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRG SCRN 9 PANEL SER OR PL	$91.00	$130.00	$55.90–$122.20	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TESTS PRESUMPTIVE	$91.00	$130.00	$55.90–$122.20	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 ETHYL GLUC UR SCRN	$91.00	$130.00	$55.90–$122.20	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG SCRN, BLD	$91.00	$130.00	$55.90–$122.20	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG ANALYSIS UR	$91.00	$130.00	$55.90–$122.20	—	30%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 DRUG TEST PRSMV CHEM ANLYZR	$133.00	$190.00	$81.70–$178.60	—	30%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 ELECTROLYTE PANEL	$124.60	$178.00	$1.23–$167.32	161% above	30%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 ELECTROLYTE PANEL	$124.60	$178.00	$76.54–$167.32	—	30%
Epstein-Barr virus (EBV) antibody test CPT 86665 EBV-VCA IFA IGG	$149.80	$214.00	$3.20–$201.16	130% above	30%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 EBV-VCA IFA IGG	$149.80	$214.00	$92.02–$201.16	—	30%
Estradiol blood test CPT 82670 ESTRADIOL-17B	$193.20	$276.00	$4.93–$259.44	72% above	30%
Estradiol blood test CPT 82670 ESTRADIOL TANDEM MASS SP	$193.20	$276.00	$4.93–$259.44	72% above	30%
Estradiol blood test inpatient CPT 82670 ESTRADIOL-17B	$193.20	$276.00	$118.68–$259.44	—	30%
Estradiol blood test inpatient CPT 82670 ESTRADIOL TANDEM MASS SP	$193.20	$276.00	$118.68–$259.44	—	30%
FSH (follicle-stimulating hormone) test CPT 83001 GONADOTROPIN FSH	$207.20	$296.00	$3.28–$278.24	141% above	30%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 GONADOTROPIN FSH	$207.20	$296.00	$127.28–$278.24	—	30%
Fecal calprotectin (stool inflammation test) CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$63.00	$90.00	$3.46–$84.60	58% below	30%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 ASSAY FOR CALPROTECTIN FECAL	$63.00	$90.00	$38.70–$84.60	—	30%
Ferritin blood test (iron stores) CPT 82728 FERRITIN ASSAY	$43.40	$62.00	$2.40–$58.28	43% below	30%
Ferritin blood test (iron stores) inpatient CPT 82728 FERRITIN ASSAY	$43.40	$62.00	$26.66–$58.28	—	30%
Fibrinogen blood test CPT 85384 MANUAL HEME- FIBRINOGEN	$120.40	$172.00	$1.71–$161.68	168% above	30%
Fibrinogen blood test inpatient CPT 85384 MANUAL HEME- FIBRINOGEN	$120.40	$172.00	$73.96–$161.68	—	30%
Folate (folic acid) blood test CPT 82746 FOLIC ACID SERUM ASSAY	$156.80	$224.00	$2.59–$210.56	134% above	30%
Folate (folic acid) blood test inpatient CPT 82746 FOLIC ACID SERUM ASSAY	$156.80	$224.00	$96.32–$210.56	—	30%
Free T3 thyroid hormone test CPT 84481 TRIIODOTHYRONINE FREE(FT-3)	$11.86	$16.94	$2.99–$41.93	84% below	30%
Free T3 thyroid hormone test inpatient CPT 84481 TRIIODOTHYRONINE FREE(FT-3)	$11.86	$16.94	$7.28–$15.92	—	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXIN FREE	$242.90	$347.00	$1.59–$326.18	483% above	30%
Free T4 (free thyroxine) thyroid blood test CPT 84439 THYROXINE FREE ASSAY	$242.90	$347.00	$1.59–$326.18	483% above	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXINE FREE ASSAY	$242.90	$347.00	$149.21–$326.18	—	30%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 THYROXIN FREE	$242.90	$347.00	$149.21–$326.18	—	30%
Free testosterone test CPT 84402 BTSTFC TESTOSTERONE FR	$270.20	$386.00	$4.49–$362.84	184% above	30%
Free testosterone test CPT 84402 TESTOSTERONE, FREE, SERUM	$270.20	$386.00	$4.49–$362.84	184% above	30%
Free testosterone test CPT 84402 TESTOSTERONE FREE	$270.20	$386.00	$4.49–$362.84	184% above	30%
Free testosterone test inpatient CPT 84402 TESTOSTERONE FREE	$270.20	$386.00	$165.98–$362.84	—	30%
Free testosterone test inpatient CPT 84402 TESTOSTERONE, FREE, SERUM	$270.20	$386.00	$165.98–$362.84	—	30%
Free testosterone test inpatient CPT 84402 BTSTFC TESTOSTERONE FR	$270.20	$386.00	$165.98–$362.84	—	30%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT ASSAY	$5.04	$7.20	$1.27–$17.82	88% below	30%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT ASSAY	$5.04	$7.20	$3.10–$6.77	—	30%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE SCRN POST DOSE	$81.20	$116.00	$0.84–$109.04	131% above	30%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 GLUCOSE SCRN POST DOSE	$81.20	$116.00	$49.88–$109.04	—	30%
Glucose tolerance test, 3 samples CPT 82951 GTT 3SPEC	$172.90	$247.00	$2.27–$232.18	157% above	30%
Glucose tolerance test, 3 samples inpatient CPT 82951 GTT 3SPEC	$172.90	$247.00	$106.21–$232.18	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 GC AMPLIFICATION	$24.57	$35.09	$6.19–$86.87	74% below	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 WHIIVF GC AMP	$118.30	$169.00	$6.19–$158.86	27% above	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 GC AMPLIFICATION	$24.57	$35.09	$15.09–$32.98	—	30%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 WHIIVF GC AMP	$118.30	$169.00	$72.67–$158.86	—	30%
H. pylori antibody blood test CPT 86677 H PYLORI AB	$44.80	$64.00	$2.97–$60.16	37% below	30%
H. pylori antibody blood test inpatient CPT 86677 H PYLORI AB	$44.80	$64.00	$27.52–$60.16	—	30%
H. pylori stool antigen test CPT 87338 IMMUNOASSAY, H. PYLORI	$10.07	$14.38	$2.54–$35.60	86% below	30%
H. pylori stool antigen test CPT 87338 H. PYLORI STOOL ANTIGEN (87338)	$172.90	$247.00	$2.54–$232.18	147% above	30%
H. pylori stool antigen test inpatient CPT 87338 IMMUNOASSAY, H. PYLORI	$10.07	$14.38	$6.18–$13.52	—	30%
H. pylori stool antigen test inpatient CPT 87338 H. PYLORI STOOL ANTIGEN (87338)	$172.90	$247.00	$106.21–$232.18	—	30%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 QUANTIFICATION, HIV-1	$581.70	$831.00	$15.01–$781.14	62% above	30%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 QUANTIFICATION, HIV-1	$581.70	$831.00	$357.33–$781.14	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 WHIIVF HIV 1&2 AG/AB	$92.40	$132.00	$4.25–$124.08	25% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV 1&2 ANTIGEN/ANTIBODY	$92.40	$132.00	$4.25–$124.08	25% above	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV 1&2 ANTIGEN/ANTIBODY	$92.40	$132.00	$56.76–$124.08	—	30%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 WHIIVF HIV 1&2 AG/AB	$92.40	$132.00	$56.76–$124.08	—	30%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HPV DNA 16 18 PCR	$51.10	$73.00	$6.19–$86.87	57% below	30%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HPV DNA 16 18 PCR	$51.10	$73.00	$31.39–$68.62	—	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HGB A1C GLYCOSYLATED	$8.58	$12.25	$1.71–$24.04	81% below	30%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HGB A1C GLYCOSYLATED	$8.58	$12.25	$5.27–$11.52	—	30%
Hemoglobin blood test CPT 85018 *BLOOD COUNT HGB	$46.90	$67.00	$0.42–$62.98	190% above	30%
Hemoglobin blood test inpatient CPT 85018 *BLOOD COUNT HGB	$46.90	$67.00	$28.81–$62.98	—	30%
Hepatitis B core antibody test (total) CPT 86704 *HEP B CORE AB TOTAL	$8.44	$12.05	$2.13–$29.83	84% below	30%
Hepatitis B core antibody test (total) CPT 86704 WHIIVF HEP B CORE AB TOTA	$53.20	$76.00	$2.13–$71.44	1% below	30%
Hepatitis B core antibody test (total) inpatient CPT 86704 *HEP B CORE AB TOTAL	$8.44	$12.05	$5.18–$11.33	—	30%
Hepatitis B core antibody test (total) inpatient CPT 86704 WHIIVF HEP B CORE AB TOTA	$53.20	$76.00	$32.68–$71.44	—	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 *HEP B SURFACE AB	$7.52	$10.74	$1.89–$26.59	84% below	30%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 *HEP B SURFACE AB	$7.52	$10.74	$4.62–$10.10	—	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 WHIIVF *%HEP HBSAG	$49.00	$70.00	$1.82–$65.80	6% above	30%
Hepatitis B surface antigen (HBsAg) test CPT 87340 *%HEP HBSAG	$49.00	$70.00	$1.82–$65.80	6% above	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 WHIIVF *%HEP HBSAG	$49.00	$70.00	$30.10–$65.80	—	30%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 *%HEP HBSAG	$49.00	$70.00	$30.10–$65.80	—	30%
Hepatitis C antibody blood test (screening) CPT 86803 WHIIVF HEP C AB	$38.50	$55.00	$2.52–$51.70	40% below	30%
Hepatitis C antibody blood test (screening) CPT 86803 *HEP C AB	$38.50	$55.00	$2.52–$51.70	40% below	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 *HEP C AB	$38.50	$55.00	$23.65–$51.70	—	30%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 WHIIVF HEP C AB	$38.50	$55.00	$23.65–$51.70	—	30%
Hepatitis C viral load (HCV RNA) test CPT 87522 QUANTIFICATION, HEPATITIS C VIRUS	$417.90	$597.00	$7.56–$561.18	117% above	30%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 QUANTIFICATION, HEPATITIS C VIRUS	$417.90	$597.00	$256.71–$561.18	—	30%
Herpes blood test, HSV-1 antibody CPT 86695 %HSVG12 IGG 1	$75.60	$108.00	$2.33–$101.52	28% above	30%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 %HSVG12 IGG 1	$75.60	$108.00	$46.44–$101.52	—	30%
Herpes blood test, HSV-2 antibody CPT 86696 %HSVG12 IGG 2	$14.00	$20.00	$3.41–$47.90	79% below	30%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 %HSVG12 IGG 2	$14.00	$20.00	$8.60–$18.80	—	30%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HIGH SENSE	$156.80	$224.00	$2.28–$210.56	132% above	30%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-REACTIVE PROTEIN HIGH SENSE	$156.80	$224.00	$96.32–$210.56	—	30%
Homocysteine blood test CPT 83090 HOMOCYSTEINE ASSAY	$210.00	$300.00	$3.16–$282.00	161% above	30%
Homocysteine blood test inpatient CPT 83090 HOMOCYSTEINE ASSAY	$210.00	$300.00	$129.00–$282.00	—	30%
Insulin blood test CPT 83525 INSULIN ASSAY	$126.70	$181.00	$2.02–$170.14	147% above	30%
Insulin blood test inpatient CPT 83525 INSULIN ASSAY	$126.70	$181.00	$77.83–$170.14	—	30%
Iron blood test (serum iron) CPT 83540 *FE ASSAY	$94.50	$135.00	$1.14–$126.90	148% above	30%
Iron blood test (serum iron) inpatient CPT 83540 *FE ASSAY	$94.50	$135.00	$58.05–$126.90	—	30%
Iron-binding capacity (TIBC) test CPT 83550 *FE BINDING CAPACITY	$133.00	$190.00	$1.54–$178.60	241% above	30%
Iron-binding capacity (TIBC) test inpatient CPT 83550 *FE BINDING CAPACITY	$133.00	$190.00	$81.70–$178.60	—	30%
Kidney function blood test panel CPT 80069 RENAL FUNC PANL	$210.00	$300.00	$1.53–$282.00	188% above	30%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNC PANL	$210.00	$300.00	$129.00–$282.00	—	30%
LH (luteinizing hormone) test CPT 83002 GONADOTROPIN LH	$205.80	$294.00	$3.27–$276.36	115% above	30%
LH (luteinizing hormone) test CPT 83002 LH, PEDIATRIC	$205.80	$294.00	$3.27–$276.36	115% above	30%
LH (luteinizing hormone) test inpatient CPT 83002 LH, PEDIATRIC	$205.80	$294.00	$126.42–$276.36	—	30%
LH (luteinizing hormone) test inpatient CPT 83002 GONADOTROPIN LH	$205.80	$294.00	$126.42–$276.36	—	30%
Lactate (lactic acid) blood test CPT 83605 ASSAY LACTIC ACID	$85.40	$122.00	$2.04–$114.68	64% above	30%
Lactate (lactic acid) blood test inpatient CPT 83605 ASSAY LACTIC ACID	$85.40	$122.00	$52.46–$114.68	—	30%
Lactate dehydrogenase (LDH) blood test CPT 83615 LAC (LD)(LDH)	$4.23	$6.04	$1.07–$14.95	85% below	30%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 LAC (LD)(LDH)	$4.23	$6.04	$2.60–$5.68	—	30%
Lipase blood test (pancreas enzyme) CPT 83690 LIPASE ASSAY	$151.90	$217.00	$1.21–$203.98	161% above	30%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 LIPASE ASSAY	$151.90	$217.00	$93.31–$203.98	—	30%
Liver function blood test panel CPT 80076 HEP FUNC PANL	$210.00	$300.00	$1.44–$282.00	237% above	30%
Liver function blood test panel inpatient CPT 80076 HEP FUNC PANL	$210.00	$300.00	$129.00–$282.00	—	30%
Lyme disease antibody test CPT 86618 LYME IGG & IGM SERUM	$14.70	$21.00	$3.00–$42.16	81% below	30%
Lyme disease antibody test CPT 86618 BORELIA BURGDORFERI LYME	$49.00	$70.00	$3.00–$65.80	36% below	30%
Lyme disease antibody test inpatient CPT 86618 LYME IGG & IGM SERUM	$14.70	$21.00	$9.03–$19.74	—	30%
Lyme disease antibody test inpatient CPT 86618 BORELIA BURGDORFERI LYME	$49.00	$70.00	$30.10–$65.80	—	30%
Magnesium blood test CPT 83735 MAG ASSAY	$99.40	$142.00	$1.18–$133.48	195% above	30%
Magnesium blood test CPT 83735 MAGNESIUM RBC	$99.40	$142.00	$1.18–$133.48	195% above	30%
Magnesium blood test CPT 83735 SSAT24 MAGNESIUM, UR	$128.10	$183.00	$1.18–$172.02	280% above	30%
Magnesium blood test inpatient CPT 83735 MAG ASSAY	$99.40	$142.00	$61.06–$133.48	—	30%
Magnesium blood test inpatient CPT 83735 MAGNESIUM RBC	$99.40	$142.00	$61.06–$133.48	—	30%
Magnesium blood test inpatient CPT 83735 SSAT24 MAGNESIUM, UR	$128.10	$183.00	$78.69–$172.02	—	30%
Measles (rubeola) antibody test CPT 86765 MEASLES-RUBEOLA IGM AB	$103.60	$148.00	$2.27–$139.12	82% above	30%
Measles (rubeola) antibody test CPT 86765 MEASLES-RUBEOLA IGG AB	$103.60	$148.00	$2.27–$139.12	82% above	30%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES-RUBEOLA IGG AB	$103.60	$148.00	$63.64–$139.12	—	30%
Measles (rubeola) antibody test inpatient CPT 86765 MEASLES-RUBEOLA IGM AB	$103.60	$148.00	$63.64–$139.12	—	30%
Mono test (heterophile antibody, Monospot) CPT 86308 HTEROPHIL AB SCREEN	$79.80	$114.00	$0.92–$107.16	53% above	30%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HTEROPHIL AB SCREEN	$79.80	$114.00	$49.02–$107.16	—	30%
Mumps immunity blood test CPT 86735 MUMPS IGG ANTIBODY	$103.60	$148.00	$2.30–$139.12	77% above	30%
Mumps immunity blood test inpatient CPT 86735 MUMPS IGG ANTIBODY	$103.60	$148.00	$63.64–$139.12	—	30%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA FREE	$408.10	$583.00	$3.24–$548.02	394% above	30%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA FREE	$408.10	$583.00	$250.69–$548.02	—	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA DIAGNOSTIC	$12.88	$18.39	$3.24–$45.52	84% below	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PHI PROST SPEC AG TOT	$198.10	$283.00	$3.24–$266.02	151% above	30%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA SCREENING	$198.10	$283.00	$3.24–$266.02	151% above	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA DIAGNOSTIC	$12.88	$18.39	$7.91–$17.29	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA SCREENING	$198.10	$283.00	$121.69–$266.02	—	30%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PHI PROST SPEC AG TOT	$198.10	$283.00	$121.69–$266.02	—	30%
Pap test (liquid-based, automated screening with review) CPT 88175 CYTO IMAGER GYN TP DIAG	$40.60	$58.00	$4.70–$65.87	60% below	30%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 CYTO IMAGER GYN TP DIAG	$40.60	$58.00	$24.94–$54.52	—	30%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 PAP SMR THN PRP	$29.40	$42.00	$3.57–$50.15	68% below	30%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 PAP SMR THN PRP	$29.40	$42.00	$18.06–$39.48	—	30%
Parathyroid hormone (PTH) blood test CPT 83970 PARATHYROID HORMONE ASSAY	$28.90	$41.28	$7.28–$102.19	80% below	30%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PARATHYROID HORMONE ASSAY	$28.90	$41.28	$17.75–$38.80	—	30%
Partial thromboplastin time (PTT) clotting test CPT 85730 *PTT PLASMA/WHOLE BLOOD	$95.90	$137.00	$1.06–$128.78	159% above	30%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 *PTT PLASMA/WHOLE BLOOD	$95.90	$137.00	$58.91–$128.78	—	30%
Phosphorus (phosphate) blood test CPT 84100 PHOSPHOROUS ASSAY	$94.50	$135.00	$0.84–$126.90	164% above	30%
Phosphorus (phosphate) blood test inpatient CPT 84100 PHOSPHOROUS ASSAY	$94.50	$135.00	$58.05–$126.90	—	30%
Potassium blood test CPT 84132 POTASSIUM	$20.30	$29.00	$0.84–$27.26	13% below	30%
Potassium blood test inpatient CPT 84132 POTASSIUM	$20.30	$29.00	$12.47–$27.26	—	30%
Progesterone blood test CPT 84144 PROGESTERONE	$211.40	$302.00	$3.68–$283.88	161% above	30%
Progesterone blood test inpatient CPT 84144 PROGESTERONE	$211.40	$302.00	$129.86–$283.88	—	30%
Prolactin blood test CPT 84146 PROLACTIN	$13.57	$19.38	$3.42–$47.98	84% below	30%
Prolactin blood test CPT 84146 *PROLACTIN ASSAY	$314.30	$449.00	$3.42–$422.06	261% above	30%
Prolactin blood test CPT 84146 PROLACTIN MACROADENOMA	$314.30	$449.00	$3.42–$422.06	261% above	30%
Prolactin blood test inpatient CPT 84146 PROLACTIN	$13.57	$19.38	$8.33–$18.22	—	30%
Prolactin blood test inpatient CPT 84146 *PROLACTIN ASSAY	$314.30	$449.00	$193.07–$422.06	—	30%
Prolactin blood test inpatient CPT 84146 PROLACTIN MACROADENOMA	$314.30	$449.00	$193.07–$422.06	—	30%
Prothrombin time (PT/INR) clotting test CPT 85610 *PRO TIME	$44.80	$64.00	$0.76–$60.16	86% above	30%
Prothrombin time (PT/INR) clotting test CPT 85610 PRO TIME (POINT OF CARE LAB)	$44.80	$64.00	$0.76–$60.16	86% above	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PRO TIME (POINT OF CARE LAB)	$44.80	$64.00	$27.52–$60.16	—	30%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 *PRO TIME	$44.80	$64.00	$27.52–$60.16	—	30%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 STREP ASSAY (POINT OF CARE LAB)	$30.80	$44.00	$2.91–$41.36	46% below	30%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 STREP ASSAY (POINT OF CARE LAB)	$30.80	$44.00	$18.92–$41.36	—	30%
Renin blood test CPT 84244 RENIN PLASMA	$228.90	$327.00	$3.88–$307.38	168% above	30%
Renin blood test inpatient CPT 84244 RENIN PLASMA	$228.90	$327.00	$140.61–$307.38	—	30%
Rh blood typing CPT 86901 WHIVF BLD TYPE RHD	$44.80	$64.00	$0.53–$98.74	20% above	30%
Rh blood typing inpatient CPT 86901 WHIVF BLD TYPE RHD	$44.80	$64.00	$27.52–$60.16	—	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGM IFA	$19.60	$28.00	$2.54–$35.62	60% below	30%
Rubella antibody test (immunity check) CPT 86762 WHIIVF2 RUBELLA IGG SEMI-QUANT	$103.60	$148.00	$2.54–$139.12	113% above	30%
Rubella antibody test (immunity check) CPT 86762 RUBELLA IGG SEMI-QUANT	$103.60	$148.00	$2.54–$139.12	113% above	30%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGM IFA	$19.60	$28.00	$12.04–$26.32	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 RUBELLA IGG SEMI-QUANT	$103.60	$148.00	$63.64–$139.12	—	30%
Rubella antibody test (immunity check) inpatient CPT 86762 WHIIVF2 RUBELLA IGG SEMI-QUANT	$103.60	$148.00	$63.64–$139.12	—	30%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 SEDIMENTATION RATE AUTO	$52.50	$75.00	$0.47–$70.50	41% above	30%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 SEDIMENTATION RATE AUTO	$52.50	$75.00	$32.25–$70.50	—	30%
Sodium blood test CPT 84295 SODIUM	$60.20	$86.00	$0.85–$80.84	121% above	30%
Sodium blood test inpatient CPT 84295 SODIUM	$60.20	$86.00	$36.98–$80.84	—	30%
Stool ova and parasites exam CPT 87177 CONCENTRATION AND ID, OVA AND PARASITE	$14.70	$21.00	$1.57–$22.03	63% below	30%
Stool ova and parasites exam inpatient CPT 87177 CONCENTRATION AND ID, OVA AND PARASITE	$14.70	$21.00	$9.03–$19.74	—	30%
Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD SCREEN	$16.80	$24.00	$0.77–$22.56	36% below	30%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 OCCULT BLOOD SCREEN	$16.80	$24.00	$10.32–$22.56	—	30%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 IMMUNOASSAY, FECAL OCCULT BLOOD	$25.90	$37.00	$2.81–$39.41	52% below	30%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 IMMUNOASSAY, FECAL OCCULT BLOOD	$25.90	$37.00	$15.91–$34.78	—	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 SYPHILIS T PALLIDUM IGG	$56.70	$81.00	$2.34–$76.14	2% below	30%
Syphilis antibody test (Treponema pallidum) CPT 86780 WHIIVF SYPHILIS	$198.10	$283.00	$2.34–$266.02	242% above	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 SYPHILIS T PALLIDUM IGG	$56.70	$81.00	$34.83–$76.14	—	30%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 WHIIVF SYPHILIS	$198.10	$283.00	$121.69–$266.02	—	30%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB GOLD PLUS	$205.10	$293.00	$10.93–$275.42	64% above	30%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB GOLD PLUS	$205.10	$293.00	$125.99–$275.42	—	30%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE TOTAL ASSAY	$72.80	$104.00	$4.55–$97.76	21% below	30%
Testosterone blood test, total (not free testosterone) CPT 84403 *TESTOSTERONE TOTAL ASSAY	$243.60	$348.00	$4.55–$327.12	164% above	30%
Testosterone blood test, total (not free testosterone) CPT 84403 TESTOSTERONE, TOTAL, SERUM	$243.60	$348.00	$4.55–$327.12	164% above	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE TOTAL ASSAY	$72.80	$104.00	$44.72–$97.76	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 *TESTOSTERONE TOTAL ASSAY	$243.60	$348.00	$149.64–$327.12	—	30%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 TESTOSTERONE, TOTAL, SERUM	$243.60	$348.00	$149.64–$327.12	—	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 MICROSOMAL ANTIBODIES EA	$137.20	$196.00	$2.57–$184.24	111% above	30%
Thyroid peroxidase (TPO) antibody test CPT 86376 THYROID PEROXIDASE AB	$137.20	$196.00	$2.57–$184.24	111% above	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 MICROSOMAL ANTIBODIES EA	$137.20	$196.00	$84.28–$184.24	—	30%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 THYROID PEROXIDASE AB	$137.20	$196.00	$84.28–$184.24	—	30%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE (TSH)	$91.00	$130.00	$2.97–$122.20	21% above	30%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE (TSH)	$91.00	$130.00	$55.90–$122.20	—	30%
Total IgE blood test CPT 82785 GAMMAGLOBULIN ASSAY IGE	$11.53	$16.46	$2.90–$40.75	82% below	30%
Total IgE blood test inpatient CPT 82785 GAMMAGLOBULIN ASSAY IGE	$11.53	$16.46	$7.08–$15.47	—	30%
Total cholesterol blood test CPT 82465 CHOLESTEROL BLOOD TOTAL	$112.00	$160.00	$0.77–$150.40	206% above	30%
Total cholesterol blood test inpatient CPT 82465 CHOLESTEROL BLOOD TOTAL	$112.00	$160.00	$68.80–$150.40	—	30%
Total thyroxine (T4) blood test CPT 84436 THYROXINE TOTAL ASSAY	$40.60	$58.00	$1.21–$54.52	at median	30%
Total thyroxine (T4) blood test inpatient CPT 84436 THYROXINE TOTAL ASSAY	$40.60	$58.00	$24.94–$54.52	—	30%
Total triiodothyronine (T3) blood test CPT 84480 TRIIODOTHYRONINE TOTAL(TT-3)	$9.93	$14.18	$2.50–$35.10	83% below	30%
Total triiodothyronine (T3) blood test inpatient CPT 84480 TRIIODOTHYRONINE TOTAL(TT-3)	$9.93	$14.18	$6.10–$13.33	—	30%
Transferrin blood test CPT 84466 TRANSFERRIN	$123.20	$176.00	$2.25–$165.44	69% above	30%
Transferrin blood test inpatient CPT 84466 TRANSFERRIN	$123.20	$176.00	$75.68–$165.44	—	30%
Trichomonas test (NAAT) CPT 87661 AMPLIFIED PROBE, TRICHOMONAS VAGINALIS	$147.70	$211.00	$6.19–$198.34	71% above	30%
Trichomonas test (NAAT) inpatient CPT 87661 AMPLIFIED PROBE, TRICHOMONAS VAGINALIS	$147.70	$211.00	$90.73–$198.34	—	30%
Troponin test, quantitative CPT 84484 TROPONIN I	$186.20	$266.00	$2.20–$250.04	122% above	30%
Troponin test, quantitative CPT 84484 TROPONIN T	$186.20	$266.00	$2.20–$250.04	122% above	30%
Troponin test, quantitative inpatient CPT 84484 TROPONIN I	$186.20	$266.00	$114.38–$250.04	—	30%
Troponin test, quantitative inpatient CPT 84484 TROPONIN T	$186.20	$266.00	$114.38–$250.04	—	30%
Uric acid blood test CPT 84550 URIC ACID BLOOD ASSAY	$61.60	$88.00	$0.80–$82.72	75% above	30%
Uric acid blood test inpatient CPT 84550 URIC ACID BLOOD ASSAY	$61.60	$88.00	$37.84–$82.72	—	30%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W SCPE	$38.50	$55.00	$0.56–$51.70	43% above	30%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W SCPE	$38.50	$55.00	$23.65–$51.70	—	30%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO WO SCPE	$9.80	$14.00	$0.40–$13.16	59% below	30%
Urinalysis without microscope exam, automated CPT 81003 URINALYSIS AUTO WO SCPE (POINT OF CARE LAB)	$35.00	$50.00	$0.40–$47.00	46% above	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO WO SCPE	$9.80	$14.00	$6.02–$13.16	—	30%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS AUTO WO SCPE (POINT OF CARE LAB)	$35.00	$50.00	$21.50–$47.00	—	30%
Urinalysis without microscope exam, manual CPT 81002 UA NON-AUTO W/O MICRO (POINT OF CARE LAB)	$52.50	$75.00	$0.61–$70.50	218% above	30%
Urinalysis without microscope exam, manual inpatient CPT 81002 UA NON-AUTO W/O MICRO (POINT OF CARE LAB)	$52.50	$75.00	$32.25–$70.50	—	30%
Urine culture for bacteria, with colony count CPT 87086 CULTURE, BACTERIAL, URINE, QUANTITATIVE	$34.30	$49.00	$1.42–$46.06	40% below	30%
Urine culture for bacteria, with colony count inpatient CPT 87086 CULTURE, BACTERIAL, URINE, QUANTITATIVE	$34.30	$49.00	$21.07–$46.06	—	30%
Urine microalbumin (albumin) test CPT 82043 *MICROALBUMIN URINE QUANT	$151.90	$217.00	$1.02–$203.98	199% above	30%
Urine microalbumin (albumin) test inpatient CPT 82043 *MICROALBUMIN URINE QUANT	$151.90	$217.00	$93.31–$203.98	—	30%
Urine pregnancy test, read by color change CPT 81025 HCG QUAL FLUID/URINE	$94.50	$135.00	$1.52–$126.90	94% above	30%
Urine pregnancy test, read by color change CPT 81025 PREGNANCY TEST URINE (POINT OF CARE LAB)	$94.50	$135.00	$1.52–$126.90	94% above	30%
Urine pregnancy test, read by color change inpatient CPT 81025 HCG QUAL FLUID/URINE	$94.50	$135.00	$58.05–$126.90	—	30%
Urine pregnancy test, read by color change inpatient CPT 81025 PREGNANCY TEST URINE (POINT OF CARE LAB)	$94.50	$135.00	$58.05–$126.90	—	30%
Vitamin B12 (cobalamin) blood test CPT 82607 VIT B-12	$10.56	$15.08	$2.66–$37.33	86% below	30%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 VIT B-12	$10.56	$15.08	$6.48–$14.18	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY	$120.40	$172.00	$5.22–$161.68	31% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 D2D3 25-OH VITAMIN	$242.90	$347.00	$5.22–$326.18	165% above	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 VITAMIN D 25 HYDROXY	$120.40	$172.00	$73.96–$161.68	—	30%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 D2D3 25-OH VITAMIN	$242.90	$347.00	$149.21–$326.18	—	30%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 VIT D 1 25 DIHYDROXY	$289.10	$413.00	$6.79–$388.22	88% above	30%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 VIT D 1 25 DIHYDROXY	$289.10	$413.00	$177.59–$388.22	—	30%
Zinc blood test CPT 84630 ZINC BLOOD	$56.70	$81.00	$2.01–$76.14	10% above	30%
Zinc blood test CPT 84630 ZINC WHOL BLOOD	$56.70	$81.00	$2.01–$76.14	10% above	30%
Zinc blood test inpatient CPT 84630 ZINC BLOOD	$56.70	$81.00	$34.83–$76.14	—	30%
Zinc blood test inpatient CPT 84630 ZINC WHOL BLOOD	$56.70	$81.00	$34.83–$76.14	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 BETA HCG QUANT TUMOR MARKER	$91.70	$131.00	$2.65–$123.14	36% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HCG QUANT SERUM	$91.70	$131.00	$2.65–$123.14	36% above	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 BETA HCG QUANT TUMOR MARKER	$91.70	$131.00	$56.33–$123.14	—	30%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HCG QUANT SERUM	$91.70	$131.00	$56.33–$123.14	—	30%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Botox injections for chronic migraine CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$390.60	$558.00	$134.31–$1,307.00	31% below	30%
Botox injections for chronic migraine inpatient CPT 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE	$390.60	$558.00	$239.94–$524.52	—	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID	$3,140.20	$4,486.00	$171.71–$4,366.31	22% below	30%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID	$3,140.20	$4,486.00	$1,928.98–$4,216.84	—	30%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$309.40	$442.00	$199.00–$1,473.00	18% below	30%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ	$309.40	$442.00	$190.06–$415.48	—	30%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION	$309.40	$442.00	$176.80–$1,307.00	15% below	30%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION	$309.40	$442.00	$190.06–$415.48	—	30%
Cardiac catheterization with coronary angiogram CPT 93458 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$9,184.70	$13,121.00	$353.69–$12,333.74	24% below	30%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I	$9,184.70	$13,121.00	$5,642.03–$12,333.74	—	30%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,906.10	$2,723.00	$116.51–$2,559.62	7% below	30%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL	$1,906.10	$2,723.00	$1,170.89–$2,559.62	—	30%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$309.40	$442.00	$176.80–$1,307.00	23% below	30%
Closed treatment of a wrist (distal radius) fracture, no resetting inpatient CPT 25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ	$309.40	$442.00	$190.06–$415.48	—	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 DESTRUCTION PREMALIGNANT LESION 1ST	$179.20	$256.00	$57.18–$1,307.00	11% below	30%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion inpatient CPT 17000 DESTRUCTION PREMALIGNANT LESION 1ST	$179.20	$256.00	$110.08–$240.64	—	30%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$95.90	$137.00	$19.58–$1,307.00	38% below	30%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT	$95.90	$137.00	$58.91–$128.78	—	30%
Earwax removal with instruments, one ear one side CPT 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$72.80	$104.00	$33.46–$1,307.00	53% below	30%
Earwax removal with instruments, one ear inpatient one side CPT 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT	$72.80	$104.00	$44.72–$97.76	—	30%
Eye injection into the vitreous (intravitreal injection) CPT 67028 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$303.80	$434.00	$92.13–$1,473.00	23% below	30%
Eye injection into the vitreous (intravitreal injection) inpatient CPT 67028 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX	$303.80	$434.00	$186.62–$407.96	—	30%
Incision and drainage of a simple or single skin abscess CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$315.70	$451.00	$120.18–$1,307.00	18% below	30%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE	$315.70	$451.00	$193.93–$423.94	—	30%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$291.90	$417.00	$41.34–$1,473.00	14% below	30%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	$291.90	$417.00	$179.31–$391.98	—	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$605.50	$865.00	$48.91–$1,473.00	13% below	30%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	$605.50	$865.00	$371.95–$813.10	—	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$338.10	$483.00	$39.50–$1,473.00	46% below	30%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	$338.10	$483.00	$207.69–$454.02	—	30%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$243.60	$348.00	$38.66–$1,473.00	51% below	30%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	$243.60	$348.00	$149.64–$327.12	—	30%
Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY	$1,107.40	$1,582.00	$328.81–$2,129.00	22% below	30%
Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST-CATARACT LASER SURGERY	$1,107.40	$1,582.00	$680.26–$1,487.08	—	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$441.70	$631.00	$160.89–$1,307.00	21% below	30%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<	$441.70	$631.00	$271.33–$593.14	—	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$522.20	$746.00	$91.38–$1,872.08	62% below	30%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<	$522.20	$746.00	$320.78–$701.24	—	30%
Nail removal (partial or complete), one nail CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$177.10	$253.00	$59.98–$1,307.00	44% below	30%
Nail removal (partial or complete), one nail inpatient CPT 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1	$177.10	$253.00	$108.79–$237.82	—	30%
Occipital nerve block (injection for headaches) CPT 64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$438.90	$627.00	$57.06–$1,473.00	54% below	30%
Occipital nerve block (injection for headaches) inpatient CPT 64405 INJECTION AA&/STRD GREATER OCCIPITAL NERVE	$438.90	$627.00	$269.61–$589.38	—	30%
Pacemaker implant (dual chamber) CPT 33208 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT	$22,038.80	$31,484.00	$561.03–$29,594.96	46% above	30%
Pacemaker implant (dual chamber) inpatient CPT 33208 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT	$22,038.80	$31,484.00	$13,538.12–$29,594.96	—	30%
Paracentesis with imaging guidance CPT 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$1,407.00	$2,010.00	$114.45–$2,397.78	19% below	30%
Paracentesis with imaging guidance inpatient CPT 49083 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE	$1,407.00	$2,010.00	$864.30–$1,889.40	—	30%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL	$760.90	$1,087.00	$114.21–$1,473.00	2% below	30%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL	$760.90	$1,087.00	$467.41–$1,021.78	—	30%
Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH	$4,198.60	$5,998.00	$1,319.00–$5,638.12	96% above	30%
Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH	$4,198.60	$5,998.00	$2,579.14–$5,638.12	—	30%
Removal of a foreign object under the skin, simple CPT 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$582.40	$832.00	$122.13–$1,307.00	13% below	30%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE	$582.40	$832.00	$357.76–$782.08	—	30%
Short arm cast (elbow to hand) CPT 29075 APPLICATION CAST ELBOW FINGER SHORT ARM	$226.10	$323.00	$70.73–$739.42	25% below	30%
Short arm cast (elbow to hand) inpatient CPT 29075 APPLICATION CAST ELBOW FINGER SHORT ARM	$226.10	$323.00	$138.89–$303.62	—	30%
Short arm splint (forearm and hand) CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$231.70	$331.00	$49.26–$351.74	20% below	30%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC	$231.70	$331.00	$142.33–$311.14	—	30%
Short leg cast (below the knee) CPT 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$226.10	$323.00	$67.34–$739.42	43% below	30%
Short leg cast (below the knee) inpatient CPT 29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE	$226.10	$323.00	$138.89–$303.62	—	30%
Short leg splint (calf to foot) CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT	$231.70	$331.00	$60.15–$429.60	24% below	30%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION SHORT LEG SPLINT CALF FOOT	$231.70	$331.00	$142.33–$311.14	—	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$281.40	$402.00	$54.28–$1,307.00	15% below	30%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<	$281.40	$402.00	$172.86–$377.88	—	30%
Skin biopsy, punch, one lesion CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION	$319.20	$456.00	$46.99–$1,307.00	29% below	30%
Skin biopsy, punch, one lesion inpatient CPT 11104 PUNCH BIOPSY SKIN SINGLE LESION	$319.20	$456.00	$196.08–$428.64	—	30%
Skin tag removal, up to 15 tags CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$186.90	$267.00	$82.54–$1,307.00	36% below	30%
Skin tag removal, up to 15 tags inpatient CPT 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15	$186.90	$267.00	$114.81–$250.98	—	30%
Spinal tap (lumbar puncture), diagnostic CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$779.80	$1,114.00	$72.93–$1,866.13	28% below	30%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 DIAGNOSTIC LUMBAR SPINAL PUNCTURE	$779.80	$1,114.00	$479.02–$1,047.16	—	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$281.40	$402.00	$70.90–$530.41	20% below	30%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM	$281.40	$402.00	$172.86–$377.88	—	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$281.40	$402.00	$67.16–$530.41	11% below	30%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<	$281.40	$402.00	$172.86–$377.88	—	30%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION	$405.30	$579.00	$37.05–$1,307.00	33% above	30%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION	$405.30	$579.00	$248.97–$544.26	—	30%
Thoracentesis with imaging guidance CPT 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,216.60	$1,738.00	$116.59–$1,658.39	33% below	30%
Thoracentesis with imaging guidance inpatient CPT 32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING	$1,216.60	$1,738.00	$747.34–$1,633.72	—	30%
Trigger point injections, 1 or 2 muscles CPT 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$243.60	$348.00	$43.60–$1,473.00	65% below	30%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	$243.60	$348.00	$149.64–$327.12	—	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$3,140.20	$4,486.00	$162.16–$4,366.31	6% below	30%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID	$3,140.20	$4,486.00	$1,928.98–$4,216.84	—	30%
Wart removal, up to 14 warts CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14	$186.90	$267.00	$74.40–$1,307.00	40% below	30%
Wart removal, up to 14 warts inpatient CPT 17110 DESTRUCTION BENIGN LESIONS UP TO 14	$186.90	$267.00	$114.81–$250.98	—	30%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$1,085.70	$1,551.00	$68.08–$2,129.00	39% above	30%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<	$1,085.70	$1,551.00	$666.93–$1,457.94	—	30%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMIN ED	$865.90	$1,237.00	$54.51–$1,473.00	22% below	30%
Blood transfusion (giving blood or blood components) CPT 36430 TXFUS BLOOD/BLOOD COMPONENT	$865.90	$1,237.00	$54.51–$1,473.00	22% below	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD ADMIN ED	$865.90	$1,237.00	$531.91–$1,162.78	—	30%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 TXFUS BLOOD/BLOOD COMPONENT	$865.90	$1,237.00	$531.91–$1,162.78	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$351.40	$502.00	$10.00–$578.91	99% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 DAILY PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$351.40	$502.00	$10.00–$578.91	99% above	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 DAILY PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$351.40	$502.00	$215.86–$471.88	—	30%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT	$351.40	$502.00	$215.86–$471.88	—	30%
Chemotherapy IV infusion, first hour CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$315.00	$450.00	$154.15–$873.22	59% below	30%
Chemotherapy IV infusion, first hour CPT 96413 CHEMO,IV INFUSION, 1 HR	$315.00	$450.00	$154.15–$873.22	59% below	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG	$315.00	$450.00	$193.50–$423.00	—	30%
Chemotherapy IV infusion, first hour inpatient CPT 96413 CHEMO,IV INFUSION, 1 HR	$315.00	$450.00	$193.50–$423.00	—	30%
Comprehensive eye exam, returning patient CPT 92014 OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>	$262.50	$375.00	$76.60–$352.50	14% above	30%
Comprehensive eye exam, returning patient inpatient CPT 92014 OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>	$262.50	$375.00	$161.25–$352.50	—	30%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$140.70	$201.00	$31.73–$340.17	47% below	30%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ	$140.70	$201.00	$86.43–$188.94	—	30%
Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$1,624.00	$2,320.00	$246.59–$2,183.76	45% below	30%
Critical care, first 30 to 74 minutes inpatient CPT 99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN	$1,624.00	$2,320.00	$997.60–$2,180.80	—	30%
EEG (brain wave test), awake and drowsy, routine CPT 95816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$535.50	$765.00	$68.78–$1,417.47	44% below	30%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY	$535.50	$765.00	$328.95–$719.10	—	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$281.40	$402.00	$8.09–$377.88	52% above	30%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R	$281.40	$402.00	$172.86–$377.88	—	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$183.40	$262.00	$13.68–$1,200.00	41% below	30%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP	$183.40	$262.00	$112.66–$246.28	—	30%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$324.10	$463.00	$50.19–$1,200.00	36% below	30%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM	$324.10	$463.00	$199.09–$435.22	—	30%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT LOW MDM	$564.20	$806.00	$86.33–$1,200.00	33% below	30%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 EMERGENCY DEPARTMENT VISIT LOW MDM	$564.20	$806.00	$346.58–$757.64	—	30%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM	$873.60	$1,248.00	$147.01–$1,200.00	34% below	30%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM	$873.60	$1,248.00	$536.64–$1,173.12	—	30%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT HIGH MDM	$1,267.00	$1,810.00	$213.04–$1,701.40	27% below	30%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 EMERGENCY DEPARTMENT VISIT HIGH MDM	$1,267.00	$1,810.00	$778.30–$1,701.40	—	30%
Exercise stress test, tracing only, the hospital charge CPT 93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$1,272.60	$1,818.00	$44.90–$1,708.92	42% above	30%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY	$1,272.60	$1,818.00	$781.74–$1,708.92	—	30%
Eye exam, returning patient, intermediate CPT 92012 OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT	$112.00	$160.00	$50.98–$351.97	63% below	30%
Eye exam, returning patient, intermediate inpatient CPT 92012 OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT	$112.00	$160.00	$68.80–$150.40	—	30%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV HYDRATE INIT 31-60MIN	$256.20	$366.00	$38.98–$492.92	39% below	30%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV HYDRATE INIT 31-60MIN	$256.20	$366.00	$157.38–$344.04	—	30%
IV infusion of a medicine, first hour CPT 96365 IV INF INIT UP TO 1 HR	$483.00	$690.00	$77.93–$648.60	12% above	30%
IV infusion of a medicine, first hour CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$483.00	$690.00	$77.93–$648.60	12% above	30%
IV infusion of a medicine, first hour inpatient CPT 96365 THERAPEUTIC IV INFUSION 1ST HR	$483.00	$690.00	$288.49–$648.60	—	30%
IV infusion of a medicine, first hour inpatient CPT 96365 IV INF INIT UP TO 1 HR	$483.00	$690.00	$288.49–$648.60	—	30%
IV push of a medicine, first drug CPT 96374 INJ IVPUSH INIT DRUG	$200.20	$286.00	$44.03–$562.32	18% below	30%
IV push of a medicine, first drug CPT 96374 INJECTION IV PUSH INIT	$200.20	$286.00	$44.03–$492.92	18% below	30%
IV push of a medicine, first drug inpatient CPT 96374 INJ IVPUSH INIT DRUG	$200.20	$286.00	$122.98–$268.84	—	30%
IV push of a medicine, first drug inpatient CPT 96374 INJECTION IV PUSH INIT	$200.20	$286.00	$122.98–$288.49	—	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 IM/SC INJECTION (MONTHLY)	$93.10	$133.00	$18.29–$166.86	34% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ SQ/IM	$93.10	$133.00	$18.29–$166.86	34% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$93.10	$133.00	$18.29–$166.86	34% below	30%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJ THERAPEUTIC PROPHYACTIC	$93.10	$133.00	$18.29–$166.86	34% below	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 IM/SC INJECTION (MONTHLY)	$93.10	$133.00	$57.19–$125.02	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ SQ/IM	$93.10	$133.00	$57.19–$125.02	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM	$93.10	$133.00	$57.19–$125.02	—	30%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 INJ THERAPEUTIC PROPHYACTIC	$93.10	$133.00	$57.19–$125.02	—	30%
Neuromuscular re-education, 15 minutes CPT 97112 NEURMSCL THERAPY 15MIN	$133.00	$190.00	$31.37–$178.60	24% above	30%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 NEURMSCL THERAPY 15MIN	$133.00	$190.00	$81.70–$178.60	—	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 NUTRITION THERAPY, INITIAL 15 MIN	$96.60	$138.00	$32.24–$129.72	48% above	30%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 NUTRITION THERAPY, INITIAL 15 MIN	$96.60	$138.00	$59.34–$129.72	—	30%
Occupational therapy evaluation, low complexity CPT 97165 OT EVAL - LOW	$245.70	$351.00	$96.30–$358.37	6% below	30%
Occupational therapy evaluation, low complexity inpatient CPT 97165 OT EVAL - LOW	$245.70	$351.00	$150.93–$329.94	—	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 PT EVAL - HIGH	$204.40	$292.00	$93.86–$349.29	32% below	30%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 PT EVAL - HIGH	$204.40	$292.00	$125.56–$274.48	—	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL - LOW	$185.50	$265.00	$93.86–$349.29	29% below	30%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 PT EVAL - LOW	$185.50	$265.00	$113.95–$249.10	—	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL - MOD	$194.60	$278.00	$93.86–$349.29	30% below	30%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 PT EVAL - MOD	$194.60	$278.00	$119.54–$261.32	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15MIN	$117.60	$168.00	$26.59–$176.00	10% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 15MIN GP	$117.60	$168.00	$26.59–$176.00	10% above	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15MIN	$117.60	$168.00	$72.24–$157.92	—	30%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 MANUAL THERAPY 15MIN GP	$117.60	$168.00	$72.24–$157.92	—	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERA EXER 15MIN	$121.10	$173.00	$27.87–$176.00	5% above	30%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERA EXER 1	$123.20	$176.00	$27.87–$176.00	6% above	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERA EXER 15MIN	$121.10	$173.00	$74.39–$162.62	—	30%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERA EXER 1	$123.20	$176.00	$75.68–$165.44	—	30%
Preventive checkup, returning patient aged 18–39 CPT 99395 PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$124.60	$178.00	$46.99–$288.24	1% below	30%
Preventive checkup, returning patient aged 18–39 inpatient CPT 99395 PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS	$124.60	$178.00	$76.54–$167.32	—	30%
Preventive checkup, returning patient aged 40–64 CPT 99396 PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$124.60	$178.00	$46.99–$306.00	7% below	30%
Preventive checkup, returning patient aged 40–64 inpatient CPT 99396 PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS	$124.60	$178.00	$76.54–$167.32	—	30%
Preventive checkup, returning patient aged 65 or older CPT 99397 PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$124.60	$178.00	$46.99–$329.37	8% below	30%
Preventive checkup, returning patient aged 65 or older inpatient CPT 99397 PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER	$124.60	$178.00	$76.54–$167.32	—	30%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$63.00	$90.00	$13.21–$114.00	44% above	30%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES	$63.00	$90.00	$38.70–$84.60	—	30%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	$217.00	$310.00	$71.00–$291.40	88% above	30%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN	$217.00	$310.00	$133.30–$291.40	—	30%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN	$192.50	$275.00	$38.43–$258.50	97% above	30%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN	$192.50	$275.00	$118.25–$258.50	—	30%
Speech and language evaluation CPT 92523 EVAL SPEECH SOUND LANG COMPREH	$410.20	$586.00	$116.00–$811.05	24% above	30%
Speech and language evaluation inpatient CPT 92523 EVAL SPEECH SOUND LANG COMPREH	$410.20	$586.00	$251.98–$550.84	—	30%
Speech therapy session, individual CPT 92507 SPEECH/HEARING THERAPY INDIV	$270.20	$386.00	$73.34–$362.84	23% above	30%
Speech therapy session, individual inpatient CPT 92507 SPEECH/HEARING THERAPY INDIV	$270.20	$386.00	$165.98–$362.84	—	30%
Spirometry (breathing test) CPT 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$289.10	$413.00	$10.24–$570.83	7% below	30%
Spirometry (breathing test) inpatient CPT 94010 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ	$289.10	$413.00	$177.59–$388.22	—	30%
Spirometry before and after a bronchodilator CPT 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$688.10	$983.00	$12.69–$986.51	20% above	30%
Spirometry before and after a bronchodilator inpatient CPT 94060 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN	$688.10	$983.00	$422.69–$924.02	—	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERA ACTIVITY DIR 15MIN	$129.50	$185.00	$33.33–$176.00	9% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERA FUNC ACTIVITIES 15M	$129.50	$185.00	$33.33–$176.00	9% above	30%
Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$129.50	$185.00	$33.33–$176.00	9% above	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERA FUNC ACTIVITIES 15M	$129.50	$185.00	$79.55–$173.90	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERA ACTIVITY DIR 15MIN	$129.50	$185.00	$79.55–$173.90	—	30%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN	$129.50	$185.00	$79.55–$173.90	—	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY	$212.80	$304.00	$112.83–$351.74	10% below	30%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$212.80	$304.00	$112.83–$351.74	10% below	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY	$212.80	$304.00	$130.72–$285.76	—	30%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE	$212.80	$304.00	$130.72–$285.76	—	30%
Visual field test, extended both sides CPT 92083 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM	$99.40	$142.00	$32.09–$351.74	—	30%
Visual field test, extended inpatient both sides CPT 92083 VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM	$99.40	$142.00	$61.06–$133.48	—	30%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$174.30	$249.00	$99.60–$416.80	47% below	30%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE	$174.30	$249.00	$107.07–$234.06	—	30%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 DTAP-IPV VACC 4-6 YR IM	$17.50	$25.00	$6.30–$23.50	86% below	30%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) inpatient CPT 90696 DTAP-IPV VACC 4-6 YR IM	$17.50	$25.00	$10.75–$23.50	—	30%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DTAP IMMUNIZATION	$28.70	$41.00	$10.33–$38.54	56% below	30%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DTAP IMMUNIZATION	$28.70	$41.00	$17.63–$38.54	—	30%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-HIB-IP VACCINE, IM	$149.80	$214.00	$53.93–$201.16	6% below	30%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-HIB-IP VACCINE, IM	$149.80	$214.00	$92.02–$201.16	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACC TRIVALENT PRSV FREE	$37.80	$54.00	$21.60–$50.76	17% below	30%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$43.79	$62.55	$23.22–$58.80	4% below	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACC TRIVALENT PRSV FREE	$37.80	$54.00	$23.22–$50.76	—	30%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$43.79	$62.55	$26.90–$58.80	—	30%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HPV VIRUS VACCINE 9 VAL IM	$287.00	$410.00	$103.32–$385.40	45% below	30%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HPV VIRUS VACCINE 9 VAL IM	$287.00	$410.00	$176.30–$385.40	—	30%
Hepatitis A vaccine, adult dose CPT 90632 HEP A/ADULT	$104.30	$149.00	$37.55–$140.06	46% below	30%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEP A/ADULT	$104.30	$149.00	$64.07–$140.06	—	30%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 HEP A/PEDIATRIC ADOLESEN	$17.50	$25.00	$6.30–$23.50	80% below	30%
Hepatitis A vaccine, child and teen dose (2-dose schedule) inpatient CPT 90633 HEP A/PEDIATRIC ADOLESEN	$17.50	$25.00	$10.75–$23.50	—	30%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 IMMUNIZATION HEPATITIS	$95.90	$137.00	$54.80–$163.06	39% below	30%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 IMMUNIZATION HEPATITIS	$95.90	$137.00	$58.91–$128.78	—	30%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPB VACC 2 DOSE ADULT IM	$105.00	$150.00	$60.00–$408.42	53% below	30%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPB VACC 2 DOSE ADULT IM	$105.00	$150.00	$64.50–$239.03	—	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEP B/PEDIATRIC/ADOLESCEN	$57.40	$82.00	$32.80–$77.08	6% below	30%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEP B/PEDIATRIC/ADOLESCEN	$57.40	$82.00	$35.26–$77.08	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACC PRSV FREE INC ANTIG	$102.20	$146.00	$58.40–$213.01	14% below	30%
High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$122.75	$175.35	$70.14–$213.01	3% above	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACC PRSV FREE INC ANTIG	$102.20	$146.00	$62.78–$137.24	—	30%
High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$122.75	$175.35	$75.40–$164.83	—	30%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MUMPS RUBELLA MEA	$17.50	$25.00	$6.30–$23.50	92% below	30%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MUMPS RUBELLA MEA	$17.50	$25.00	$10.75–$23.50	—	30%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 MMRV VACCINE	$104.30	$149.00	$37.55–$140.06	80% below	30%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) inpatient CPT 90710 MMRV VACCINE	$104.30	$149.00	$64.07–$140.06	—	30%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL VACCINE, IM	$174.30	$249.00	$62.75–$234.06	45% below	30%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL VACCINE, IM	$174.30	$249.00	$107.07–$234.06	—	30%
Meningococcal ACWY vaccine (MenQuadfi) CPT 90619 MENINGOCOCCAL VACCINE, QUADRIVALENT (MENQUADFI)	$151.90	$217.00	$54.68–$203.98	62% below	30%
Meningococcal ACWY vaccine (MenQuadfi) inpatient CPT 90619 MENINGOCOCCAL VACCINE, QUADRIVALENT (MENQUADFI)	$151.90	$217.00	$93.31–$203.98	—	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB RP W/OMV VACCINE IM	$66.50	$95.00	$23.94–$89.30	88% below	30%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENB RP W/OMV VACCINE IM	$66.50	$95.00	$40.85–$89.30	—	30%
Nasal spray flu vaccine, live (FluMist) CPT 90660 FLUMIST VACC NSPR 0.2ML	$35.00	$50.00	$20.00–$64.48	12% below	30%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 FLUMIST VACC NSPR 0.2ML	$35.00	$50.00	$21.50–$47.00	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE CODE 90677	$275.80	$394.00	$157.60–$739.97	58% below	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$648.80	$926.85	$341.00–$871.24	2% below	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJUGATE VACCINE CODE 90677	$275.80	$394.00	$169.42–$433.07	—	30%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$648.80	$926.85	$398.55–$871.24	—	30%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$123.90	$177.00	$44.60–$166.38	90% below	30%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) inpatient CPT 90381 RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE	$123.90	$177.00	$76.11–$166.38	—	30%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$944.65	$1,349.50	$331.98–$1,268.53	1% below	30%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP	$944.65	$1,349.50	$421.61–$1,268.53	—	30%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 ROTOVIRUS VAC ORAL USE	$24.50	$35.00	$8.82–$32.90	81% below	30%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) inpatient CPT 90680 ROTOVIRUS VAC ORAL USE	$24.50	$35.00	$15.05–$32.90	—	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACCINE NO PRSRV >= 7 IM	$52.50	$75.00	$18.90–$70.50	42% below	30%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TD VACCINE NO PRSRV >= 7 IM	$52.50	$75.00	$32.25–$70.50	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$102.06	$145.80	$36.74–$137.05	8% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE >7 IM	$104.30	$149.00	$37.55–$140.06	6% below	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$102.06	$145.80	$62.69–$137.05	—	30%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TDAP VACCINE >7 IM	$104.30	$149.00	$64.07–$140.06	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN VACCINE SNGL	$117.60	$168.00	$25.95–$190.35	207% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN VACCINE FLU	$117.60	$168.00	$25.95–$190.35	207% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 ADMIN VACCINE PNEUMONIA	$117.60	$168.00	$25.95–$190.35	207% above	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN VACCINE PNEUMONIA	$117.60	$168.00	$72.24–$157.92	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN VACCINE SNGL	$117.60	$168.00	$72.24–$157.92	—	30%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 ADMIN VACCINE FLU	$117.60	$168.00	$72.24–$157.92	—	30%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 ADMIN VACCINE EA ADD	$81.20	$116.00	$15.11–$109.04	133% above	30%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 ADMIN VACCINE EA ADD	$81.20	$116.00	$49.88–$109.04	—	30%

Source file: https://sthpiprd.blob.core.windows.net/machine-readable-files/7982/340726081_ashtabula-county-medical-center_standardcharges.csv