Lima Memorial Health System
Lima Memorial Health System in Lima, OH publishes cash prices for 72 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
1001 Bellefontaine Avenue, Lima, OH 45804 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abd & Pelv Wcontrast | $462.60 | $514.00 | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abdomen Pelvis W Contrast | $3,155.40 | $3,506.00 | 10% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 Ct Abdomen & Pelvis W Contrast | $3,155.40 | $3,506.00 | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abd & Pelv Wcontrast | $462.60 | $514.00 | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abdomen Pelvis W Contrast | $3,155.40 | $3,506.00 | 10% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 Ct Abdomen & Pelvis W Contrast | $3,155.40 | $3,506.00 | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Headbrain Wo Dye | $137.70 | $153.00 | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Or Brain Without Contr | $1,539.00 | $1,710.00 | 10% |
| CT scan of the head or brain, no contrast dye CPT 70450 Ct Head Or Brain W/O Contrast | $1,539.00 | $1,710.00 | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Headbrain Wo Dye | $137.70 | $153.00 | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Or Brain Without Contr | $1,539.00 | $1,710.00 | 10% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 Ct Head Or Brain W/O Contrast | $1,539.00 | $1,710.00 | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis Wdye | $224.10 | $249.00 | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis With Contrast | $1,794.60 | $1,994.00 | 10% |
| CT scan of the pelvis, with contrast dye CPT 72193 Ct Pelvis W Contrast | $1,794.60 | $1,994.00 | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis Wdye | $224.10 | $249.00 | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis W Contrast | $1,794.60 | $1,994.00 | 10% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 Ct Pelvis With Contrast | $1,794.60 | $1,994.00 | 10% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Dx Mammo Incl Cad Bi | $538.20 | $598.00 | 10% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Dx Mammo Incl Cad Bi | $538.20 | $598.00 | 10% |
| Diagnostic mammogram, one breast CPT 77065 Dx Mammo Incl Cad Uni | $468.00 | $520.00 | 10% |
| Diagnostic mammogram, one breast inpatient CPT 77065 Dx Mammo Incl Cad Uni | $468.00 | $520.00 | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Jnt Of Lwr Extre Wo Dye | $289.80 | $322.00 | 10% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Mri Lower Extrem Joint Wo Cont | $1,568.70 | $1,743.00 | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Jnt Of Lwr Extre Wo Dye | $289.80 | $322.00 | 10% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Mri Lower Extrem Joint Wo Cont | $1,568.70 | $1,743.00 | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Joint Lwr Extr Wo&Wdye | $462.60 | $514.00 | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Mri Lower Extrem Joint W&Wo Co | $1,898.10 | $2,109.00 | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Joint Lwr Extr Wo&Wdye | $462.60 | $514.00 | 10% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Mri Lower Extrem Joint W&Wo Co | $1,898.10 | $2,109.00 | 10% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Stem Wo Dye | $289.80 | $322.00 | 10% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain Wo Contrast Client | $1,989.00 | $2,210.00 | 10% |
| MRI of the brain, no contrast dye CPT 70551 Mri Brain W/O Contrast | $2,088.90 | $2,321.00 | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Stem Wo Dye | $289.80 | $322.00 | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain Wo Contrast Client | $1,989.00 | $2,210.00 | 10% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Mri Brain W/O Contrast | $2,088.90 | $2,321.00 | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain Stem Wo & Wdye | $462.60 | $514.00 | 10% |
| MRI of the brain, with and without contrast dye CPT 70553 Mri Brain W/O Cont Follow W/C | $2,731.50 | $3,035.00 | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain Stem Wo & Wdye | $462.60 | $514.00 | 10% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Mri Brain W/O Cont Follow W/C | $2,731.50 | $3,035.00 | 10% |
| MRI of the lower back, no contrast dye CPT 72148 Mri Lumbar Spine Wo Dye | $289.80 | $322.00 | 10% |
| MRI of the lower back, no contrast dye CPT 72148 Mri Lumbar Spine W/O Contrast | $2,777.40 | $3,086.00 | 10% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri Lumbar Spine Wo Dye | $289.80 | $322.00 | 10% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Mri Lumbar Spine W/O Contrast | $2,777.40 | $3,086.00 | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ob Us 14 Wks Sngl Fetus | $137.70 | $153.00 | 10% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ob Ultrasound >14 Wks-Sng Ges | $1,395.90 | $1,551.00 | 10% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob Us 14 Wks Sngl Fetus | $137.70 | $153.00 | 10% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ob Ultrasound >14 Wks-Sng Ges | $1,395.90 | $1,551.00 | 10% |
| Screening mammogram, both breasts both sides CPT 77067 Scr Mammo Bi Incl Cad | $406.80 | $452.00 | 10% |
| Screening mammogram, both breasts CPT 77067 Scr Mammo Uni Incl Cad | $406.80 | $452.00 | 10% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 Scr Mammo Bi Incl Cad | $406.80 | $452.00 | 10% |
| Screening mammogram, both breasts inpatient CPT 77067 Scr Mammo Uni Incl Cad | $406.80 | $452.00 | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Staging W 4> Param,Atten | $7,653.60 | $8,504.00 | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Staging W 4> Param,At*52 | $7,653.60 | $8,504.00 | 10% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom 6 Yrs 4 Param | $7,845.30 | $8,717.00 | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Staging W 4> Param,At*52 | $7,653.60 | $8,504.00 | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Sleep Staging W 4> Param,Atten | $7,653.60 | $8,504.00 | 10% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 Polysom 6 Yrs 4 Param | $7,845.30 | $8,717.00 | 10% |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal Us Non-Ob | $137.70 | $153.00 | 10% |
| Transvaginal pelvic ultrasound CPT 76830 Transvaginal Ultrasound | $1,395.90 | $1,551.00 | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Us Non-Ob | $137.70 | $153.00 | 10% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Transvaginal Ultrasound | $1,395.90 | $1,551.00 | 10% |
| Ultrasound of the abdomen, complete CPT 76700 Us Exam Abdom Complete | $137.70 | $153.00 | 10% |
| Ultrasound of the abdomen, complete CPT 76700 Abdominal Echo Complete | $2,792.70 | $3,103.00 | 10% |
| Ultrasound of the abdomen, complete CPT 76700 Abdominal Echo-Complete | $2,792.70 | $3,103.00 | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Us Exam Abdom Complete | $137.70 | $153.00 | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Abdominal Echo Complete | $2,792.70 | $3,103.00 | 10% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Abdominal Echo-Complete | $2,792.70 | $3,103.00 | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray Exam L-2 Spine 4Vws | $137.70 | $153.00 | 10% |
| X-ray of the lower back, 4 or more views CPT 72110 Lumbar Spine Min 4 Views | $317.70 | $353.00 | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-Ray Exam L-2 Spine 4Vws | $137.70 | $153.00 | 10% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 Lumbar Spine Min 4 Views | $317.70 | $353.00 | 10% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Metabolic Panel Total Ca | $10.80 | $12.00 | 10% |
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Panel Bmp | $39.60 | $44.00 | 10% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Metabolic Panel Total Ca | $10.80 | $12.00 | 10% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic Metabolic Panel Bmp | $39.60 | $44.00 | 10% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $36.90 | $41.00 | 10% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel | $36.90 | $41.00 | 10% |
| Complete blood count (CBC) with differential CPT 85025 Complete Cbc Wauto Diff Wbc | $9.00 | $10.00 | 10% |
| Complete blood count (CBC) with differential CPT 85025 Complete Blood Count Mayo | $24.30 | $27.00 | 10% |
| Complete blood count (CBC) with differential CPT 85025 Complete Blood Count | $24.30 | $27.00 | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete Cbc Wauto Diff Wbc | $9.00 | $10.00 | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count | $24.30 | $27.00 | 10% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete Blood Count Mayo | $24.30 | $27.00 | 10% |
| Complete blood count (CBC), no differential CPT 85027 Complete Cbc Automated | $7.20 | $8.00 | 10% |
| Complete blood count (CBC), no differential CPT 85027 Cbc Without Diff | $18.90 | $21.00 | 10% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete Cbc Automated | $7.20 | $8.00 | 10% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Cbc Without Diff | $18.90 | $21.00 | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel | $12.60 | $14.00 | 10% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $66.60 | $74.00 | 10% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel | $12.60 | $14.00 | 10% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive Metabolic Panel | $66.60 | $74.00 | 10% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $47.70 | $53.00 | 10% |
| Kidney function blood test panel inpatient CPT 80069 Renal Function Panel | $47.70 | $53.00 | 10% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $9.00 | $10.00 | 10% |
| Liver function blood test panel CPT 80076 Hepatic Panel | $33.30 | $37.00 | 10% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel | $9.00 | $10.00 | 10% |
| Liver function blood test panel inpatient CPT 80076 Hepatic Panel | $33.30 | $37.00 | 10% |
| Obstetric blood test panel CPT 80055 Obstetric Panel | $59.40 | $66.00 | 10% |
| Obstetric blood test panel inpatient CPT 80055 Obstetric Panel | $59.40 | $66.00 | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Assay Of Psa Free | $23.40 | $26.00 | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Free Psa.Freps | $104.40 | $116.00 | 10% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Free Psa, Hybritech | $185.40 | $206.00 | 10% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Assay Of Psa Free | $23.40 | $26.00 | 10% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Free Psa.Freps | $104.40 | $116.00 | 10% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Free Psa, Hybritech | $185.40 | $206.00 | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Assay Of Psa Total | $23.40 | $26.00 | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa,Total Diagnostic.Psa | $45.90 | $51.00 | 10% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa.Freps | $50.40 | $56.00 | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Assay Of Psa Total | $23.40 | $26.00 | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa,Total Diagnostic.Psa | $45.90 | $51.00 | 10% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Psa.Freps | $50.40 | $56.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Aptt | $15.30 | $17.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 *Lupus Anti-Coagulant-Ptt.M552 | $55.80 | $62.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 *Thromboplastin Time; Ptt | $64.80 | $72.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Thromboplastin Time Partial | $74.70 | $83.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 *Thromboplastin Time;Ptt | $74.70 | $83.00 | 10% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 *Thromboplastin,Partial Ptt | $81.90 | $91.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Aptt | $15.30 | $17.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 *Lupus Anti-Coagulant-Ptt.M552 | $55.80 | $62.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 *Thromboplastin Time; Ptt | $64.80 | $72.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 *Thromboplastin Time;Ptt | $74.70 | $83.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Thromboplastin Time Partial | $74.70 | $83.00 | 10% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 *Thromboplastin,Partial Ptt | $81.90 | $91.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time(Mp).Mppt | $18.00 | $20.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $18.00 | $20.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Protime | $23.40 | $26.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 *Protime.M552 | $36.00 | $40.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Pharmacy Prothrombin Time | $40.50 | $45.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Phpt Ml | $40.50 | $45.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 *Prothrombin Time (Coag Bleed) | $45.90 | $51.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 *Prothrombin Time (Proclot) | $48.60 | $54.00 | 10% |
| Prothrombin time (PT/INR) clotting test CPT 85610 *Prothrombin Time (Hypercoag) | $54.00 | $60.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time(Mp).Mppt | $18.00 | $20.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time | $18.00 | $20.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Protime | $23.40 | $26.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 *Protime.M552 | $36.00 | $40.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Pharmacy Prothrombin Time | $40.50 | $45.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time Phpt Ml | $40.50 | $45.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 *Prothrombin Time (Coag Bleed) | $45.90 | $51.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 *Prothrombin Time (Proclot) | $48.60 | $54.00 | 10% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 *Prothrombin Time (Hypercoag) | $54.00 | $60.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Assay Thyroid Stim Hormone | $21.60 | $24.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Sensitive.Thyfc | $38.70 | $43.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh | $55.80 | $62.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Sensitive.M8939 | $71.10 | $79.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh 30 Min | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Sensitive.Tshs | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh 60 Min | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh 15 Min | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Assay Thyroid Stim Hormone | $21.60 | $24.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh Sensitive.Thyfc | $38.70 | $43.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh | $55.80 | $62.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh Sensitive.M8939 | $71.10 | $79.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh 30 Min | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh Sensitive.Tshs | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh 15 Min | $205.20 | $228.00 | 10% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Tsh 60 Min | $205.20 | $228.00 | 10% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto Wscope | $4.36 | $4.84 | 10% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis W Req Micr.Uam | $12.60 | $14.00 | 10% |
| Urinalysis with microscope exam, automated CPT 81001 Urflx,Possible Culture.Urflx | $12.60 | $14.00 | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto Wscope | $4.36 | $4.84 | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis W Req Micr.Uam | $12.60 | $14.00 | 10% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urflx,Possible Culture.Urflx | $12.60 | $14.00 | 10% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Nonauto Wscope | $5.40 | $6.00 | 10% |
| Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis Nonauto Wscope | $5.40 | $6.00 | 10% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Auto Wo Scope | $3.27 | $3.63 | 10% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis (Umac) | $12.60 | $14.00 | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis Auto Wo Scope | $3.27 | $3.63 | 10% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis (Umac) | $12.60 | $14.00 | 10% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Nonauto Wo Scope | $4.36 | $4.84 | 10% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis Nonauto Wo Scope | $4.36 | $4.84 | 10% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 Xcapsl Ctrc Rmvl Wo Ecp | $2,607.30 | $2,897.00 | 10% |
| Cataract surgery with lens implant inpatient CPT 66984 Xcapsl Ctrc Rmvl Wo Ecp | $2,607.30 | $2,897.00 | 10% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Cesarean Delivery | $4,074.30 | $4,527.00 | 10% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 Cesarean Delivery | $4,074.30 | $4,527.00 | 10% |
| Colonoscopy with endoscopic ultrasound CPT 45391 Colonoscopy Wendoscope Us | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 Colonoscopy Wendoscope Us | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy with polyp removal CPT 45385 Colonoscopy Wlesion Removal | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy with polyp removal inpatient CPT 45385 Colonoscopy Wlesion Removal | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy with tissue sample CPT 45380 Colonoscopy And Biopsy | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy with tissue sample inpatient CPT 45380 Colonoscopy And Biopsy | $1,301.40 | $1,446.00 | 10% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic Colonoscopy | $995.40 | $1,106.00 | 10% |
| Colonoscopy, diagnostic inpatient CPT 45378 Diagnostic Colonoscopy | $995.40 | $1,106.00 | 10% |
| Gallbladder removal, laparoscopic CPT 47562 Laparoscopic Cholecystectomy | $6,349.50 | $7,055.00 | 10% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 Laparoscopic Cholecystectomy | $6,349.50 | $7,055.00 | 10% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Prp Ihern Init Reduc 5 Yr | $3,993.30 | $4,437.00 | 10% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 Prp Ihern Init Reduc 5 Yr | $3,993.30 | $4,437.00 | 10% |
| Knee arthroscopy with meniscus trim CPT 29881 Knee Arthroscopysurgery | $3,553.20 | $3,948.00 | 10% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 Knee Arthroscopysurgery | $3,553.20 | $3,948.00 | 10% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 After Cataract Laser Surgery | $631.80 | $702.00 | 10% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 After Cataract Laser Surgery | $631.80 | $702.00 | 10% |
| Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath Wventrclgrphy | $3,639.60 | $4,044.00 | 10% |
| Left heart catheterization, diagnostic one side CPT 93452 Left Heart Cath | $10,838.70 | $12,043.00 | 10% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath Wventrclgrphy | $3,639.60 | $4,044.00 | 10% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Heart Cath | $10,838.70 | $12,043.00 | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Njx Interlaminar Lmbrsac | $797.40 | $886.00 | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inj,Epidural Lumbar/Sacr W Si | $2,738.70 | $3,043.00 | 10% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Cisternogram Injection | $2,738.70 | $3,043.00 | 10% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Interlaminar Lmbrsac | $797.40 | $886.00 | 10% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Cisternogram Injection | $2,738.70 | $3,043.00 | 10% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Inj,Epidural Lumbar/Sacr W Si | $2,738.70 | $3,043.00 | 10% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Njx Interlaminar Lmbrsac | $797.40 | $886.00 | 10% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Interlaminar Lmbrsac | $797.40 | $886.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&Strd Tfrm Epi Ls 1 | $1,032.30 | $1,147.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Lumbar Nerve Root Inj | $2,210.40 | $2,456.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Lumbar Epidural Nerve Block | $2,210.40 | $2,456.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&Strd Tfrm Epi Ls 1 | $1,032.30 | $1,147.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Lumbar Nerve Root Inj | $2,210.40 | $2,456.00 | 10% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Lumbar Epidural Nerve Block | $2,210.40 | $2,456.00 | 10% |
| Prostate biopsy CPT 55700 Biopsy Of Prostate | $2,246.40 | $2,496.00 | 10% |
| Prostate biopsy inpatient CPT 55700 Biopsy Of Prostate | $2,246.40 | $2,496.00 | 10% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 Laparo Radical Prostatectomy | $11,178.00 | $12,420.00 | 10% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 Laparo Radical Prostatectomy | $11,178.00 | $12,420.00 | 10% |
| Removal of a breast lump, open surgery CPT 19120 Removal Of Breast Lesion | $3,962.70 | $4,403.00 | 10% |
| Removal of a breast lump, open surgery inpatient CPT 19120 Removal Of Breast Lesion | $3,962.70 | $4,403.00 | 10% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Sho Arthrs Srg Decompression | $265.50 | $295.00 | 10% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 Sho Arthrs Srg Decompression | $265.50 | $295.00 | 10% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Remove Tonsils And Adenoids | $6,382.80 | $7,092.00 | 10% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 Remove Tonsils And Adenoids | $6,382.80 | $7,092.00 | 10% |
| Total hip replacement CPT 27130 Total Hip Arthroplasty | $15,472.80 | $17,192.00 | 10% |
| Total hip replacement inpatient CPT 27130 Total Hip Arthroplasty | $15,472.80 | $17,192.00 | 10% |
| Total knee replacement CPT 27447 Total Knee Arthroplasty | $15,472.80 | $17,192.00 | 10% |
| Total knee replacement inpatient CPT 27447 Total Knee Arthroplasty | $15,472.80 | $17,192.00 | 10% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Egd Biopsy Singlemultiple | $1,016.10 | $1,129.00 | 10% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 Egd Biopsy Singlemultiple | $1,016.10 | $1,129.00 | 10% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Egd Diagnostic Brush Wash | $1,016.10 | $1,129.00 | 10% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Egd Diagnostic Brush Wash | $1,016.10 | $1,129.00 | 10% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 Vbac Delivery | $3,859.20 | $4,288.00 | 10% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 Vbac Delivery | $3,859.20 | $4,288.00 | 10% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Obstetrical Care | $3,681.00 | $4,090.00 | 10% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 Obstetrical Care | $3,681.00 | $4,090.00 | 10% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 Electrocardiogram Comp | $24.30 | $27.00 | 10% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 Electrocardiogram Comp | $24.30 | $27.00 | 10% |
| Family therapy with the patient, 50 minutes CPT 90847 Family Psytx Wpt 50 Min | $167.40 | $186.00 | 10% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Psytx Wpt 50 Min | $167.40 | $186.00 | 10% |
| Family therapy without the patient, 50 minutes CPT 90846 Family Psytx Wo Pt 50 Min | $167.40 | $186.00 | 10% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Psytx Wo Pt 50 Min | $167.40 | $186.00 | 10% |
| Group psychotherapy session CPT 90853 Group Psychotherapy | $93.60 | $104.00 | 10% |
| Group psychotherapy session inpatient CPT 90853 Group Psychotherapy | $93.60 | $104.00 | 10% |
| New patient office visit, about 30 minutes CPT 99203 E&M First Visit Level Iii | $369.00 | $410.00 | 10% |
| New patient office visit, about 30 minutes CPT 99203 Occ Health First Visit Iii Er | $369.00 | $410.00 | 10% |
| New patient office visit, about 30 minutes CPT 99203 Initial Visit - Level Iii | $369.00 | $410.00 | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Initial Visit - Level Iii | $369.00 | $410.00 | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 Occ Health First Visit Iii Er | $369.00 | $410.00 | 10% |
| New patient office visit, about 30 minutes inpatient CPT 99203 E&M First Visit Level Iii | $369.00 | $410.00 | 10% |
| New patient office visit, about 45 minutes CPT 99204 Initial Visit - Level Iv | $398.70 | $443.00 | 10% |
| New patient office visit, about 45 minutes CPT 99204 Initial Visit-Level Iv | $398.70 | $443.00 | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Initial Visit - Level Iv | $398.70 | $443.00 | 10% |
| New patient office visit, about 45 minutes inpatient CPT 99204 Initial Visit-Level Iv | $398.70 | $443.00 | 10% |
| New patient office visit, about 60 minutes CPT 99205 Initial Visit - Level V | $439.20 | $488.00 | 10% |
| New patient office visit, about 60 minutes inpatient CPT 99205 Initial Visit - Level V | $439.20 | $488.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exerc-15 Min* Bwc | $30.60 | $34.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises | $44.10 | $49.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeatic Exer15 Min-Lmhs Wc | $90.00 | $100.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Tilt Table - Ea 15 Min | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot-Therapeutic Exercise | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot-Rehab-Therapeutic Exercise | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exerc-15 Min - Pt | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exerc-15 Min-Rhab | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exerc-15 Min* Bwc | $30.60 | $34.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises | $44.10 | $49.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeatic Exer15 Min-Lmhs Wc | $90.00 | $100.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exerc-15 Min-Rhab | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exerc-15 Min - Pt | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot-Therapeutic Exercise | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Tilt Table - Ea 15 Min | $96.30 | $107.00 | 10% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Ot-Rehab-Therapeutic Exercise | $96.30 | $107.00 | 10% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Prev Care New Age 18-39 | $193.50 | $215.00 | 10% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 Prev Care New Age 18-39 | $193.50 | $215.00 | 10% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Prev Care New Age 40-64 | $244.80 | $272.00 | 10% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 Prev Care New Age 40-64 | $244.80 | $272.00 | 10% |
| Psychotherapy session, 30 minutes CPT 90832 Psytx W Pt 30 Minutes | $167.40 | $186.00 | 10% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx W Pt 30 Minutes | $167.40 | $186.00 | 10% |
| Psychotherapy session, 45 minutes CPT 90834 Psytx W Pt 45 Minutes | $167.40 | $186.00 | 10% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx W Pt 45 Minutes | $167.40 | $186.00 | 10% |
| Psychotherapy session, 60 minutes CPT 90837 Psytx W Pt 60 Minutes | $167.40 | $186.00 | 10% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx W Pt 60 Minutes | $167.40 | $186.00 | 10% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office Consult New Est Patient | $422.10 | $469.00 | 10% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 Office Consult New Est Patient | $422.10 | $469.00 | 10% |
Source file: https://www.limamemorial.org/media/bahnfbgb/344434676_lima-memorial-health-system_standardcharges.json