Hospital Cincinnati, OH-KY-IN

The Good Samaritan Hospital of Cincinnati, OH

The Good Samaritan Hospital of Cincinnati, OH in Cincinnati, OH publishes cash prices for 393 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Ohio median for 283 of 390 procedures and above it for 102. By typical cash price it ranks #28 of 139 Ohio hospitals and #5 of 15 hospitals in the Cincinnati, OH area, cheapest first. Select a procedure to compare it with other hospitals nearby.

375 Dixmyth Avenue, Cincinnati, OH 45220 Collected Sep 23, 2026 Source price file Check a bill from this hospital (513) 862-2601

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 360134 · CMS hospital register NPI 1508835828

Financial assistance

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

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

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

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

State law

This state limits hospital bills for lower-income patients

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Abdominal CT scan without and with contrast CPT 74170 HC CT Abdomen WO&W Contrast	$302.99	$403.99	—	77% below	25%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abdomen WO&W Contrast	$302.99	$403.99	—	—	25%
Abdominal X-ray, 2 views CPT 74019 HC Xr Abdomen 2 Views	$342.86	$457.14	—	1% above	25%
Ankle X-ray, complete, 3 or more views CPT 73610 HC Xr Ankle 3+ Views	$381.92	$509.23	—	20% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Tcom Single Level	$236.30	$315.06	—	51% below	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Ankle/Brachial Index Bil 1 Lvl	$504.00	$672.00	—	5% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC Tcom Single Level Unilateral	$236.30	$315.06	—	51% below	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries one side CPT 93922 HC Laser Doppler Unilateral	$698.43	$931.24	—	45% above	25%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity WO Cont	$302.99	$403.99	—	68% below	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Xr Esophagus	$398.53	$531.37	—	10% below	25%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Xr Esophagus	$398.53	$531.37	—	—	25%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM Bone Imaging Whole Body	$2,074.26	$2,765.68	—	35% above	25%
Breast ultrasound, complete, one breast both sides CPT 76641 HC US Breast Scr Bilat Incls Axilla	$994.28	$1,325.70	—	—	25%
Breast ultrasound, complete, one breast one side CPT 76641 HC US Breast Scr Unilat Incls Axilla	$828.33	$1,104.44	—	74% above	25%
Breast ultrasound, complete, one breast inpatient both sides CPT 76641 HC US Breast Scr Bilat Incls Axilla	$994.28	$1,325.70	—	—	25%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 HC US Breast Scr Unilat Incls Axilla	$828.33	$1,104.44	—	—	25%
Breast ultrasound, limited (one breast or one area) both sides CPT 76642 HC US Breast Targeted Bilat	$617.71	$823.61	—	—	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 HC US Breast Targeted Unilat	$465.98	$621.30	—	14% above	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd & Pelvis W Con Incl WO	$605.98	$807.98	—	72% below	25%
CT angiography (CTA) of the head CPT 70496 HC Cta Head WO&W Contrast	$302.99	$403.99	—	77% below	25%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck WO&W Contrast	$302.99	$403.99	—	77% below	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC Cta Chest W or WO Contrast	$302.99	$403.99	—	79% below	25%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 HC Cta Card Evaluation W Con	$302.99	$403.99	—	81% below	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Cardiac Fr Calcium WO Con	$302.99	$403.99	—	8% above	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abdomen Pelvis Without Con	$605.98	$807.98	—	62% below	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen Pelvis With Con	$605.98	$807.98	—	69% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abdomen Pelvis WO & W Con	$605.98	$807.98	—	74% below	25%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen With Contrast	$302.99	$403.99	—	74% below	25%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen With Contrast	$302.99	$403.99	—	—	25%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen Without Contrast	$302.99	$403.99	—	71% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Sinus for Landmarking Study	$302.99	$403.99	—	65% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Facial/Sinus Without Contr	$302.99	$403.99	—	65% below	25%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Sinus for Landmarking Study	$302.99	$403.99	—	—	25%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head Without Contrast	$302.99	$403.99	—	64% below	25%
CT scan of the head with contrast CPT 70460 HC CT Head With Contrast	$302.99	$403.99	—	70% below	25%
CT scan of the head with contrast inpatient CPT 70460 HC CT Head With Contrast	$302.99	$403.99	—	—	25%
CT scan of the head without and with contrast CPT 70470 HC CT Head WO&W Contrast	$302.99	$403.99	—	75% below	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT Spine Lumbar WO Contrast	$302.99	$403.99	—	72% below	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT Spine Cervical WO Contrast	$302.99	$403.99	—	72% below	25%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis With Contrast	$302.99	$403.99	—	75% below	25%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis With Contrast	$302.99	$403.99	—	—	25%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 HC Extracranial Arteries Dplx Bil	$957.16	$1,276.21	—	32% above	25%
Carotid artery ultrasound (duplex), both sides of the neck inpatient CPT 93880 HC Extracranial Arteries Dplx Bil	$957.16	$1,276.21	—	—	25%
Chest CT scan without and with contrast CPT 71270 HC CT Chest/Lung WO&W Contrast	$302.99	$403.99	—	80% below	25%
Chest X-ray, 2 views CPT 71046 HC Xr Chest 2 Views	$260.98	$347.97	—	1% below	25%
Chest X-ray, single view CPT 71045 HC Xr Chest 1 View	$216.86	$289.14	—	3% below	25%
Collarbone (clavicle) X-ray, complete CPT 73000 HC Xr Clavicle 2 Views	$254.94	$339.92	—	6% below	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US Retroperitoneal Complete	$631.58	$842.11	—	11% below	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa Axial Skeleton	$498.16	$664.21	—	10% above	25%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC Dexa Appendicular Skeleton	$195.00	$260.00	—	24% below	25%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US OB Trnsabd W Fetal Exam	$866.25	$1,155.00	—	2% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest/Lung Without Contrast	$302.99	$403.99	—	68% below	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest/Lung With Contrast	$302.99	$403.99	—	75% below	25%
Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammogram Dx Bilat With Cad	$392.28	$523.04	—	—	25%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammogram Dx Bilat With Cad	$392.28	$523.04	—	—	25%
Diagnostic mammogram, one breast one side CPT 77065 HC Mammogram Dx Unilat With Cad	$276.36	$368.48	—	23% below	25%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 HC Lower Extrmty Artl Dplx Bilat	$1,159.06	$1,545.41	—	—	25%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 HC Lower Extrmty Artl Dplx Bilat	$1,159.06	$1,545.41	—	—	25%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Vein Duplx Complete Bilateral Study	$964.64	$1,286.19	—	—	25%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Vein Duplx Complete Bilateral Study	$964.64	$1,286.19	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Echocardiogram W Cd&Cf	$1,567.50	$2,090.00	—	7% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Echo 2d With Cont Doppler & Cf	$1,567.50	$2,090.00	—	7% below	25%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC Newborn 2d Echo W Cf & Doppler	$1,567.50	$2,090.00	—	7% below	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC Echo 2d With Cont Doppler & Cf	$1,567.50	$2,090.00	—	—	25%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC Echocardiogram W Cd&Cf	$1,567.50	$2,090.00	—	—	25%
Elbow X-ray, 2 views CPT 73070 HC Xr Elbow 2 Views	$309.64	$412.85	—	19% above	25%
Elbow X-ray, complete, 3 or more views CPT 73080 HC Xr Elbow 3 Views	$356.54	$475.38	—	13% above	25%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbits/Mstd/Sella WO Cont	$302.99	$403.99	—	65% below	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Xr Facial Bones	$453.23	$604.31	—	20% above	25%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Xr Facial Bones	$453.23	$604.31	—	—	25%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Xr Forearm 2 Views	$307.70	$410.26	—	13% above	25%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Xr Forearm 2 Views	$307.70	$410.26	—	—	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Heptobilary Ductal Sys Imaging	$2,200.95	$2,934.60	—	39% above	25%
Hand X-ray, 2 views CPT 73120 HC Xr Hand 2 Views	$266.66	$355.55	—	at median	25%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC Xr Heel	$284.24	$378.99	—	5% above	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Polysomnography > 6yrs Old W Cpap < 6 Hr	$3,129.31	$4,172.41	—	24% below	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Polysomnography > 6yrs Old W Cpap > 6 Hr	$3,540.77	$4,721.02	—	14% below	25%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC Polysomnography > 6yrs Old W Cpap < 6 Hr	$3,129.31	$4,172.41	—	—	25%
Knee X-ray, 3 views CPT 73562 HC Xr Knee 3 Views	$373.14	$497.52	—	6% above	25%
Knee X-ray, complete, 4 or more views CPT 73564 HC Xr Knee 4 Views	$421.98	$562.64	—	7% above	25%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC Xr Knee 4 Views	$421.98	$562.64	—	—	25%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Extremity WO Cont	$302.99	$403.99	—	68% below	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Abdomen Lmtd to Spcfic Org	$559.94	$746.59	—	1% above	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US Extremity Ltd Non-Vasc	$529.90	$706.54	—	11% above	25%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US Extremity Ltd Non-Vasc	$529.90	$706.54	—	—	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC Lung CT Screening	$195.00	$260.00	—	34% below	25%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC Xr Tibia Fibula	$293.04	$390.72	—	7% above	25%
MR angiography (MRA) of the head without contrast CPT 70544 HC Mra Head Without Contrast	$494.70	$659.60	—	66% below	25%
MRI of both breasts, without and then with contrast dye CPT 77049 HC MR Bil Breast Screening W and WO Cont	$225.00	$300.00	—	94% below	25%
MRI of both breasts, without and then with contrast dye CPT 77049 HC MR Breast Bil WO & W Contr & Cad	$495.00	$660.00	—	87% below	25%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 HC MR Bil Breast Screening W and WO Cont	$225.00	$300.00	—	—	25%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR Lower Ext Jnt WO Con	$494.70	$659.60	—	72% below	25%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR Lower Ext Jnt WO&W Con	$494.70	$659.60	—	79% below	25%
MRI of the abdomen without contrast CPT 74181 HC MR Abdomen Without Contrast	$494.70	$659.60	—	73% below	25%
MRI of the abdomen without contrast inpatient CPT 74181 HC MR Abdomen Without Contrast	$494.70	$659.60	—	—	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MR Abdomen WO&W Contrast	$494.70	$659.60	—	78% below	25%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MR Abdomen WO&W Contrast	$494.70	$659.60	—	—	25%
MRI of the brain, no contrast dye CPT 70551 HC MR Brain WO Contrast	$494.70	$659.60	—	69% below	25%
MRI of the brain, with and without contrast dye CPT 70553 HC MR Brain WO&W Contrast	$494.70	$659.60	—	77% below	25%
MRI of the lower back, no contrast dye CPT 72148 HC MR Spine Lumbar WO Contrast	$494.70	$659.60	—	70% below	25%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR Spine Lumbar WO Contrast	$494.70	$659.60	—	—	25%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MR Spine Lumbar WO&W Contrast	$494.70	$659.60	—	79% below	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MR Spine Thoracic WO Contrast	$494.70	$659.60	—	71% below	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MR Spine Cervical WO&W Cont	$494.70	$659.60	—	78% below	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MR Spine Cervicalwo Contrast	$494.70	$659.60	—	70% below	25%
MRI of the pelvis without and with contrast CPT 72197 HC MR Pelvis WO&W Contrast	$494.70	$659.60	—	75% below	25%
MRI of the pelvis, no contrast dye CPT 72195 HC MR Pelvis Without Contrast	$494.70	$659.60	—	67% below	25%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MR Pelvis Without Contrast	$494.70	$659.60	—	—	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MR Upperext Jnt WO Con	$494.70	$659.60	—	67% below	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC Xr Spine Cervical 4-5 Views	$575.33	$767.11	—	28% above	25%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC Xr Spine Cervical 4-5 Views	$575.33	$767.11	—	—	25%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Neck Sft Tissue W Contrast	$302.99	$403.99	—	74% below	25%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Neck Sft Tissue WO Contrast	$302.99	$403.99	—	67% below	25%
Neck soft tissue X-ray CPT 70360 HC Xr Neck Soft Tissue	$261.77	$349.03	—	1% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM Myocard Perf Spect Mult Comp	$5,169.94	$6,893.26	—	29% above	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 HC Pet CT Skull to Mid-Thigh	$5,850.00	$7,800.00	—	21% above	25%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis Without Contrast	$302.99	$403.99	—	70% below	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Pelvic Limited	$239.25	$319.00	—	45% below	25%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US Pelvic Complete	$546.86	$729.14	—	9% above	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB Transabd> 14 Weeks	$643.50	$858.00	—	7% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC US OB Trnsabd < 14 Weeks	$577.50	$770.00	—	5% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US OB Transabd Limited	$355.74	$474.32	—	25% below	25%
Rib X-ray, one side, 2 views CPT 71100 HC Xr Rib 2 Views	$394.62	$526.16	—	30% above	25%
Rib X-ray, one side, 2 views inpatient CPT 71100 HC Xr Rib 2 Views	$394.62	$526.16	—	—	25%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC Xr Rib 3 Views	$413.18	$550.91	—	8% above	25%
Screening mammogram, both breasts both sides CPT 77067 HC Mammogram Scr Bilat With Cad	$311.48	$415.30	—	—	25%
Screening mammogram, both breasts one side CPT 77067 HC Mammogram Scr Unilat With Cad	$231.01	$308.01	—	20% above	25%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Xr Shoulder 2+ Views	$337.97	$450.63	—	at median	25%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Xr Sinuses Paranasal 3+Views	$362.39	$483.19	—	at median	25%
Skull X-ray, fewer than 4 views CPT 70250 HC Xr Skull <4 Views	$380.95	$507.93	—	32% above	25%
Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography <6hrs	$2,672.76	$3,563.68	—	26% below	25%
Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography > 6yrs Old > 6 Hrs	$3,292.30	$4,389.74	—	8% below	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Swallowing Function W Cine	$607.56	$810.08	—	20% above	25%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC Xr Femur 2 or More Views	$305.74	$407.65	—	13% above	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT Spine Thoracic WO Contrast	$302.99	$403.99	—	67% below	25%
Toe X-ray, 2 or more views CPT 73660 HC Xr Toe Single Digit	$253.00	$337.33	—	1% above	25%
Toe X-ray, 2 or more views inpatient CPT 73660 HC Xr Toe Single Digit	$253.00	$337.33	—	—	25%
Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal	$570.90	$761.20	—	1% above	25%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal	$570.90	$761.20	—	—	25%
Transvaginal ultrasound during pregnancy CPT 76817 HC US OB Transvaginal	$570.90	$761.20	—	14% above	25%
Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete	$702.44	$936.58	—	12% above	25%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum & Contents	$619.24	$825.66	—	15% above	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC US Head & Neck Soft Tissue	$654.69	$872.92	—	14% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Xr Ugi Tract Incl Kub/Delayed Sngl Cont	$985.39	$1,313.85	—	66% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Xr Ugi Tract Incl Kub/Delayed Sngl Cont	$985.39	$1,313.85	—	—	25%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Xr Humerus 2 Views	$311.59	$415.46	—	13% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 HC Vein Duplx Unilateral or Limited Study	$850.97	$1,134.63	—	16% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 HC Vein Duplx Unilateral or Limited Study	$850.97	$1,134.63	—	—	25%
Wrist X-ray, 2 views CPT 73100 HC Xr Wrist 2 Views	$261.77	$349.03	—	at median	25%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Xr Wrist 3+ Views	$326.25	$435.00	—	3% below	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 HC Xr Hip 2-3 Vws Unilat Inclds Pelvis if Performed	$381.92	$509.23	—	24% above	25%
X-ray of the abdomen, 1 view CPT 74018 HC Xr Abdomen 1 View	$243.23	$324.30	—	5% below	25%
X-ray of the ankle, 2 views CPT 73600 HC Xr Ankle 2 Views	$264.71	$352.95	—	6% above	25%
X-ray of the ankle, 2 views inpatient CPT 73600 HC Xr Ankle 2 Views	$264.71	$352.95	—	—	25%
X-ray of the finger(s), 2 or more views CPT 73140 HC Xr Finger Single Digit	$231.50	$308.66	—	10% below	25%
X-ray of the foot, 2 views CPT 73620 HC Xr Foot 2 Views	$268.62	$358.16	—	16% above	25%
X-ray of the foot, complete, 3 or more views CPT 73630 HC Xr Foot 3+ Views	$381.92	$509.23	—	25% above	25%
X-ray of the hand, 3 or more views CPT 73130 HC Xr Hand 3+Views	$346.76	$462.35	—	6% above	25%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Xr Hand 3+Views	$346.76	$462.35	—	—	25%
X-ray of the knee, 1 or 2 views CPT 73560 HC Xr Knee 1 or 2 View	$282.29	$376.39	—	3% above	25%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC Xr Spine Lumbosacral 2 Views	$377.04	$502.72	—	17% above	25%
X-ray of the lower back, 4 or more views CPT 72110 HC Xr Spine Lumbosacral Min 4 Views	$595.84	$794.45	—	27% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC Xr Spine Thoracic 2views	$349.69	$466.25	—	16% above	25%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC Xr Spine Thoracic 2views	$349.69	$466.25	—	—	25%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Xr Nasal Bones Xr	$373.14	$497.52	—	28% above	25%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Xr Nasal Bones Xr	$373.14	$497.52	—	—	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC Xr Spine Cervical 3 or Less Views	$349.69	$466.25	—	5% above	25%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC Xr Spine Cervical 3 or Less Views	$349.69	$466.25	—	—	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Xr Pelvis 1 or 2 Views	$319.41	$425.88	—	27% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Xr Sacrum & Coccyx 2 Views	$373.14	$497.52	—	26% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Xr Sacrum & Coccyx 2 Views	$373.14	$497.52	—	—	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 HC Acth	$131.95	$175.93	—	at median	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Alt	$18.11	$24.15	—	35% below	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Ast	$17.68	$23.58	—	30% below	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$162.76	$217.01	—	25% below	25%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$162.76	$217.01	—	—	25%
Albumin blood test CPT 82040 HC Albumin	$16.91	$22.55	—	23% below	25%
Aldosterone blood test CPT 82088 HC Aldosterone Serum	$139.24	$185.65	—	at median	25%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Alkaline Phosphatase	$17.68	$23.58	—	26% below	25%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Alkaline Phosphatase	$17.68	$23.58	—	—	25%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige	$17.84	$23.78	—	24% below	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC Alpha-Fetoprotein	$57.32	$76.42	—	5% below	25%
Ammonia blood test CPT 82140 HC Ammonia Blood	$49.78	$66.38	—	9% below	25%
Amylase blood test CPT 82150 HC Amylase	$22.14	$29.52	—	54% below	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC Cyclic Citrul Pep Ab Igg	$44.25	$59.00	—	24% below	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Antinuclear Ab Screen	$41.30	$55.06	—	25% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Pro B Natriuretic Peptide	$120.73	$160.97	—	19% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$120.73	$160.97	—	19% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture Bacterial Except Urine	$29.43	$39.24	—	55% below	25%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel	$23.96	$31.94	—	64% below	25%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$17.13	$22.84	—	29% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Cyt Cell Blk Prep Int	$95.55	$127.40	—	53% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Gross & Micro Lev 4 (88305)	$95.55	$127.40	—	53% below	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Em Thick Prep	$122.08	$162.77	—	40% below	25%
Blood culture for bacteria CPT 87040 HC Blood Culture	$35.27	$47.03	—	62% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Venipuncture	$9.23	$12.30	—	42% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Venipuncture Pov	$9.23	$12.30	—	42% below	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Venipuncture for Study	$9.23	$12.30	—	42% below	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Venipuncture	$9.23	$12.30	—	—	25%
Blood glucose (sugar) test CPT 82947 HC Glucose Random	$13.44	$17.92	—	43% below	25%
Blood lead test CPT 83655 HC Lead (83655)	$41.36	$55.15	—	15% below	25%
Blood lead test inpatient CPT 83655 HC Lead (83655)	$41.36	$55.15	—	—	25%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadot Hcg Qualit	$25.71	$34.28	—	53% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Abo	$10.21	$13.61	—	83% below	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Abo Hxw Test	$10.21	$13.61	—	83% below	25%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Abo	$10.21	$13.61	—	—	25%
Blood urea nitrogen (BUN) test CPT 84520 HC Urea Nitrogen (84520)	$13.50	$18.00	—	42% below	25%
C-peptide blood test CPT 84681 HC C Peptide	$71.12	$94.83	—	10% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC Crp	$17.68	$23.58	—	65% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein	$17.68	$23.58	—	65% below	25%
C. difficile toxin gene test (stool PCR) CPT 87493 HC C Difficile Toxin Genes	$119.90	$159.86	—	8% below	25%
CA 19-9 blood test (tumor marker) CPT 86301 HC Ca 19 9	$71.12	$94.83	—	3% below	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Ca 125 II	$71.12	$94.83	—	24% below	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC POC Covid 19	$157.78	$210.37	—	12% above	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Covid 19	$307.50	$410.00	—	118% above	25%
Calcium blood test, total CPT 82310 HC Calcium Blood	$17.62	$23.49	—	44% below	25%
Calcium blood test, total inpatient CPT 82310 HC Calcium Blood	$17.62	$23.49	—	—	25%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Cea (82378)	$64.79	$86.39	—	26% below	25%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Cea (82378)	$64.79	$86.39	—	—	25%
Chickenpox (varicella) immunity blood test CPT 86787 HC Antibody Varicella Zoster	$44.00	$58.67	—	24% below	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Chlamydia Trachomatis, Amplified Probe	$119.90	$159.86	—	30% above	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Profile	$45.76	$61.01	—	14% below	25%
Complete blood count (CBC) with differential CPT 85025 HC Cbc With Differential	$26.54	$35.38	—	27% below	25%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc With Differential	$26.54	$35.38	—	—	25%
Complete blood count (CBC), no differential CPT 85027 HC Cbc WO Diff	$22.08	$29.44	—	35% below	25%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$36.10	$48.13	—	43% below	25%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$36.10	$48.13	—	—	25%
Cortisol blood test, total CPT 82533 HC Cortisol	$55.69	$74.25	—	23% below	25%
Creatine kinase (CK) blood test, total CPT 82550 HC CK	$22.23	$29.64	—	37% below	25%
Creatinine blood test CPT 82565 HC Creatinine	$17.50	$23.33	—	29% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Cmv Igg Level	$49.17	$65.56	—	28% below	25%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Cmv Igg Level Hxw Test	$49.17	$65.56	—	28% below	25%
D-dimer blood test (blood clot marker) CPT 85379 HC D-Dimer Quantitative	$34.78	$46.37	—	50% below	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC Dhea Sulfate	$75.98	$101.31	—	24% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Urine Drug Testing Dau7	$178.50	$238.00	—	87% above	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Test Presmv Instrmnt Chemisty	$198.80	$265.07	—	108% above	25%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Urine Drug Testing Dau7	$178.50	$238.00	—	—	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolytes Panel	$23.96	$31.94	—	50% below	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC Ebv Capsid Ab Vca	$62.00	$82.66	—	5% below	25%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Ebv Capsid Ab Vca	$62.00	$82.66	—	—	25%
Estradiol blood test CPT 82670 HC Estradiol Ovul E20	$95.44	$127.26	—	15% below	25%
FSH (follicle-stimulating hormone) test CPT 83001 HC Fsh Blood Serum	$63.50	$84.67	—	26% below	25%
Fecal calprotectin (stool inflammation test) CPT 83993 HC Calprotectin Fecal	$67.06	$89.42	—	55% below	25%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC Calprotectin Fecal	$67.06	$89.42	—	—	25%
Ferritin blood test (iron stores) CPT 82728 HC Ferritin	$46.59	$62.12	—	39% below	25%
Fibrinogen blood test CPT 85384 HC Fibrinogen	$29.89	$39.85	—	34% below	25%
Fibrinogen blood test CPT 85384 HC Fibrenogen POC	$29.89	$39.85	—	34% below	25%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen	$29.89	$39.85	—	—	25%
Fibrinogen blood test inpatient CPT 85384 HC Fibrenogen POC	$29.89	$39.85	—	—	25%
Folate (folic acid) blood test CPT 82746 HC Folate Level	$50.24	$66.99	—	26% below	25%
Free T3 thyroid hormone test CPT 84481 HC Free T3	$57.87	$77.16	—	24% below	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Free T4	$30.81	$41.08	—	27% below	25%
Free testosterone test CPT 84402 HC Testosterone Free	$87.02	$116.03	—	10% below	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Ggt	$24.60	$32.80	—	42% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Glucose 1hr P P	$16.21	$21.61	—	58% below	25%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Glucose 1hr P P	$16.21	$21.61	—	—	25%
Glucose tolerance test, 3 samples CPT 82951 HC Gtt Tolerance Test 3 Specimen	$43.97	$58.63	—	35% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC Neisseria Gonorrhoeae, Amplified Probe	$119.90	$159.86	—	29% above	25%
H. pylori antibody blood test CPT 86677 HC Heliobacter Pylori Ab	$51.82	$69.09	—	31% below	25%
H. pylori stool antigen test CPT 87338 HC H Pylori Ag Stool	$49.14	$65.52	—	30% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC Hiv 1 Rna Vir Load Quant	$290.74	$387.66	—	19% below	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC Hiv I/Hiv II Antibody	$46.83	$62.44	—	24% below	25%
HIV-1 and HIV-2 antibody test CPT 86703 HC Hiv I/Hiv II Antibody Hxw Test	$46.83	$62.44	—	24% below	25%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Hiv I/Hiv II Antibody Hxw Test	$46.83	$62.44	—	—	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Hiv1/2 Ag-Ab Combo	$82.26	$109.68	—	11% above	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Hiv1/2 Ag-Ab Combo Hxw Test	$82.26	$109.68	—	11% above	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Hpv High Risk	$119.90	$159.86	—	1% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hgb A1c	$33.18	$44.24	—	27% below	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Glycated Hgb	$33.18	$44.24	—	27% below	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Glycated Hgb	$33.18	$44.24	—	—	25%
Hemoglobin blood test CPT 85018 HC Hemoglobin	$8.08	$10.78	—	50% below	25%
Hemoglobin blood test CPT 85018 HC POC Hemoglobin	$8.08	$10.78	—	50% below	25%
Hemoglobin blood test inpatient CPT 85018 HC Hemoglobin	$8.08	$10.78	—	—	25%
Hepatitis B core antibody test (total) CPT 86704 HC Hepatitis B Core Ab Hxw Test	$41.18	$54.90	—	24% below	25%
Hepatitis B core antibody test (total) CPT 86704 HC Hepatitis B Core Ab Total	$41.18	$54.90	—	24% below	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Ab	$36.68	$48.91	—	24% below	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Hepatitis B Surf Ag Hxw Test	$35.30	$47.07	—	25% below	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Hepatitis B Surf Ag	$35.30	$47.07	—	25% below	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis Hcv Hxw Test	$48.74	$64.99	—	24% below	25%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis Hcv	$48.74	$64.99	—	24% below	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Hepatitis C Quantitative	$146.37	$195.16	—	24% below	25%
Herpes blood test, HSV-1 antibody CPT 86695 HC Hsv Type 1 Ab	$45.05	$60.07	—	24% below	25%
Herpes blood test, HSV-2 antibody CPT 86696 HC Hsv Type 2 Ab	$66.14	$88.19	—	at median	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C React Protin Hgh Sensit	$44.25	$59.00	—	34% below	25%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C React Protin Hgh Sensit	$44.25	$59.00	—	—	25%
Homocysteine blood test CPT 83090 HC Homocysteine Serum	$57.70	$76.93	—	28% below	25%
Insulin blood test CPT 83525 HC Insulin Total (83525)	$39.05	$52.07	—	24% below	25%
Iron blood test (serum iron) CPT 83540 HC Iron	$22.11	$29.48	—	42% below	25%
Iron blood test (serum iron) CPT 83540 HC Iron Liver	$22.11	$29.48	—	42% below	25%
Iron blood test (serum iron) inpatient CPT 83540 HC Iron Liver	$22.11	$29.48	—	—	25%
Iron-binding capacity (TIBC) test CPT 83550 HC T I B C	$29.86	$39.81	—	23% below	25%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$29.68	$39.57	—	59% below	25%
LH (luteinizing hormone) test CPT 83002 HC Lutenizing Hormone	$63.26	$84.34	—	34% below	25%
Lactate (lactic acid) blood test CPT 83605 HC POC Lactic Acid	$36.50	$48.67	—	30% below	25%
Lactate (lactic acid) blood test CPT 83605 HC Lactic Acid	$36.50	$48.67	—	30% below	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Ldh	$20.63	$27.51	—	24% below	25%
Lipase blood test (pancreas enzyme) CPT 83690 HC Lipase	$23.53	$31.37	—	60% below	25%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$27.95	$37.27	—	54% below	25%
Lyme disease antibody test CPT 86618 HC Bor Burgdorferi Ab	$58.18	$77.57	—	24% below	25%
Magnesium blood test CPT 83735 HC Magnesium (83735)	$22.88	$30.50	—	32% below	25%
Magnesium blood test inpatient CPT 83735 HC Magnesium (83735)	$22.88	$30.50	—	—	25%
Measles (rubeola) antibody test CPT 86765 HC Antibody Rubeola	$44.00	$58.67	—	23% below	25%
Measles (rubeola) antibody test inpatient CPT 86765 HC Antibody Rubeola	$44.00	$58.67	—	—	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Screen	$17.68	$23.58	—	67% below	25%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Test	$17.68	$23.58	—	67% below	25%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Mono Test	$17.68	$23.58	—	—	25%
Mumps immunity blood test CPT 86735 HC Mumps Ab	$44.59	$59.45	—	24% below	25%
Mumps immunity blood test inpatient CPT 86735 HC Mumps Ab	$44.59	$59.45	—	—	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC Psa Free	$56.55	$75.40	—	31% below	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Psa Total	$59.38	$79.17	—	25% below	25%
Pap test (liquid-based, automated screening with review) CPT 88175 HC Cyt Thin Prep Imaged Prep	$90.52	$120.70	—	7% below	25%
Pap test (liquid-based, automated screening with review) CPT 88175 HC Rescreen Thin Prep Pap	$90.52	$120.70	—	7% below	25%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC Rescreen Thin Prep Pap	$90.52	$120.70	—	—	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC Pth Intraoperative (83970)	$141.02	$188.03	—	at median	25%
Parathyroid hormone (PTH) blood test CPT 83970 HC Parathoromone (Pth)	$141.02	$188.03	—	at median	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Apc Ptt	$20.51	$27.35	—	45% below	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt	$20.51	$27.35	—	45% below	25%
Phosphorus (phosphate) blood test CPT 84100 HC Phosphorus	$16.21	$21.61	—	55% below	25%
Potassium blood test CPT 84132 HC Potassium Serum (84132)	$15.71	$20.95	—	33% below	25%
Potassium blood test inpatient CPT 84132 HC Potassium Serum (84132)	$15.71	$20.95	—	—	25%
Progesterone blood test CPT 84144 HC Progesterone	$71.28	$95.04	—	12% below	25%
Progesterone blood test inpatient CPT 84144 HC Progesterone	$71.28	$95.04	—	—	25%
Prolactin blood test CPT 84146 HC Prolactin	$66.20	$88.27	—	24% below	25%
Prolactin blood test inpatient CPT 84146 HC Prolactin	$66.20	$88.27	—	—	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$13.44	$17.92	—	44% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Istat Pt/Inr	$13.44	$17.92	—	44% below	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Drug Screen 10 Panel	$38.74	$51.66	—	33% below	25%
Rapid flu test (influenza antigen) CPT 87804 HC Influenza Virus	$50.90	$67.86	—	22% below	25%
Rapid flu test (influenza antigen) CPT 87804 HC Rapid Flu Screen	$50.90	$67.86	—	22% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Rapid Strep a Screen	$50.83	$67.77	—	11% below	25%
Renin blood test CPT 84244 HC Renin	$75.15	$100.20	—	12% below	25%
Rh blood typing CPT 86901 HC Rh Factor	$10.21	$13.61	—	73% below	25%
Rh blood typing CPT 86901 HC Rh Factor Hxw Test	$10.21	$13.61	—	73% below	25%
Rh blood typing inpatient CPT 86901 HC Rh Factor	$10.21	$13.61	—	—	25%
Rheumatoid factor (RF) test CPT 86431 HC Ra Titer	$19.37	$25.83	—	42% below	25%
Rubella antibody test (immunity check) CPT 86762 HC Rubella Antibody	$49.17	$65.56	—	at median	25%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sedimentation Rate	$9.23	$12.30	—	76% below	25%
Sodium blood test CPT 84295 HC Sodium Serum (84295)	$16.46	$21.94	—	39% below	25%
Stool ova and parasites exam CPT 87177 HC Oap Direct Smear	$30.41	$40.55	—	23% below	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Hemoccult	$13.47	$17.96	—	53% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Treponema Pallidum Ab Hxw Test	$45.23	$60.31	—	22% below	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Treponema Pallidum Ab	$45.23	$60.31	—	22% below	25%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Treponema Pallidum Ab	$45.23	$60.31	—	—	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC CSF Vdrl Hxw Test	$14.61	$19.48	—	39% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC CSF Vdrl	$14.61	$19.48	—	39% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC CSF Vdrl	$14.61	$19.48	—	—	25%
Testosterone blood test, total (not free testosterone) CPT 84403 HC Testosterone Total	$88.19	$117.59	—	4% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Microsomal Ab	$49.72	$66.30	—	24% below	25%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Microsomal Ab	$49.72	$66.30	—	—	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Tsh Hormone	$57.41	$76.55	—	24% below	25%
Total IgE blood test CPT 82785 HC Ige	$56.24	$74.99	—	9% below	25%
Total cholesterol blood test CPT 82465 HC Cholesterol	$14.88	$19.84	—	59% below	25%
Total thyroxine (T4) blood test CPT 84436 HC T4 Thyroxin	$23.46	$31.28	—	44% below	25%
Total triiodothyronine (T3) blood test CPT 84480 HC T3 Total	$48.44	$64.58	—	19% below	25%
Transferrin blood test CPT 84466 HC Transferrin	$43.60	$58.14	—	41% below	25%
Transferrin blood test inpatient CPT 84466 HC Transferrin	$43.60	$58.14	—	—	25%
Trichomonas test (NAAT) CPT 87661 HC Trichomonas Vaginalis by Tma	$119.90	$159.86	—	39% above	25%
Trichomonas test (NAAT) inpatient CPT 87661 HC Trichomonas Vaginalis by Tma	$119.90	$159.86	—	—	25%
Triglycerides blood test CPT 84478 HC Triglycerides	$19.62	$26.16	—	43% below	25%
Troponin test, quantitative CPT 84484 HC Troponin I	$38.35	$51.13	—	54% below	25%
Troponin test, quantitative CPT 84484 HC Troponin Ctnt	$38.35	$51.13	—	54% below	25%
Uric acid blood test CPT 84550 HC Uric Acid	$15.43	$20.58	—	56% below	25%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy	$10.82	$14.43	—	60% below	25%
Urinalysis without microscope exam, automated CPT 81003 HC Urine Routine WO Micro	$7.66	$10.21	—	67% below	25%
Urinalysis without microscope exam, automated CPT 81003 HC Ua Dipstick or Tablet Reagent Autom WO Microscpy	$7.66	$10.21	—	67% below	25%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Ua Dipstick or Tablet Reagent Autom WO Microscpy	$7.66	$10.21	—	—	25%
Urinalysis without microscope exam, manual CPT 81002 HC Urine Dip Stick	$10.70	$14.27	—	34% below	25%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Dip Stick	$10.70	$14.27	—	—	25%
Urine culture for bacteria, with colony count CPT 87086 HC Urine Culture	$27.58	$36.78	—	52% below	25%
Urine microalbumin (albumin) test CPT 82043 HC Urine Microalbumin	$19.74	$26.32	—	61% below	25%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Urine Microalbumin	$19.74	$26.32	—	—	25%
Urine pregnancy test, read by color change CPT 81025 HC Pregnancy Test Urine	$26.48	$35.30	—	46% below	25%
Urine pregnancy test, read by color change CPT 81025 HC Pregnancy Test Urine POCT	$26.48	$35.30	—	46% below	25%
Urine pregnancy test, read by color change CPT 81025 HC Gonadot Hcg Qualit	$26.48	$35.30	—	46% below	25%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Pregnancy Test Urine	$26.48	$35.30	—	—	25%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Vitamin B12 Test	$51.51	$68.68	—	31% below	25%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Vitamin B12 Test	$51.51	$68.68	—	—	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC Vit D25 Oh Cholecalciferol	$101.89	$135.85	—	8% above	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC Vitamin D 1 25 Dihyro	$131.55	$175.40	—	15% below	25%
Zinc blood test CPT 84630 HC Zinc	$38.90	$51.87	—	24% below	25%
Zinc blood test inpatient CPT 84630 HC Zinc	$38.90	$51.87	—	—	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Hcg Quantitative (84702)	$51.44	$68.59	—	24% below	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Botox injections for chronic migraine CPT 64615 HC Chemodenerv Musc Migraine	$642.75	$857.00	—	16% above	25%
Botox injections for chronic migraine inpatient CPT 64615 HC Chemodenerv Musc Migraine	$642.75	$857.00	—	—	25%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Biopsy Breast Localiz Device Specmn Imag Stereotactic Guide	$1,927.53	$2,570.04	—	52% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC Treatment of Ankle Fracture	$387.75	$517.00	—	3% above	25%
Cardiac catheterization with coronary angiogram one side CPT 93458 HC Coronaries W Lt Hrt Inc Inj	$11,489.74	$15,319.65	—	4% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion	$1,714.44	$2,285.92	—	17% below	25%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion	$1,714.44	$2,285.92	—	—	25%
Catheter ablation for atrial fibrillation CPT 93656 HC Comp Ep Eval W Abl a-Fib W Transptl/3d Map	$35,323.61	$47,098.15	—	4% above	25%
Cervical biopsy CPT 57500 HC Hod Endocervical Biopsy	$1,275.00	$1,700.00	—	27% below	25%
Cervical biopsy CPT 57500 HC Endocervical Biopsy	$1,275.00	$1,700.00	—	27% below	25%
Cervical biopsy inpatient CPT 57500 HC Endocervical Biopsy	$1,275.00	$1,700.00	—	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 HC Treat Fracture Radius/Ulna	$359.25	$479.00	—	12% below	25%
Colonoscopy with polyp removal CPT 45385 HC Colonoscopy W/Lesion Removal	$2,799.00	$3,732.00	—	16% below	25%
Colonoscopy with tissue sample CPT 45380 HC Colonoscopy and Biopsy	$2,617.50	$3,490.00	—	22% below	25%
Colonoscopy, diagnostic CPT 45378 HC Diagnostic Colonoscopy	$1,849.50	$2,466.00	—	32% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC Hod Colposcopy W Loop Electrode Cervical Bx	$2,137.50	$2,850.00	—	45% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 HC Colposcopy W Leep Procedure	$2,137.50	$2,850.00	—	45% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC Hod Colposcopy W Cervical Bx and Ecc	$590.96	$787.95	—	35% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 HC Colposcopy W Bx and Ecc	$590.96	$787.95	—	35% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal inpatient CPT 57454 HC Hod Colposcopy W Cervical Bx and Ecc	$590.96	$787.95	—	—	25%
Coronary stent placement, one artery CPT 92928 HC Des Plcmnt Single Cor Major Ves	$10,123.58	$13,498.11	—	22% below	25%
Coronary stent placement, one artery CPT 92928 HC Stent Plcmnt Single Cor Major Vessel W or WO Ptca	$10,123.58	$13,498.11	—	22% below	25%
Coronary stent placement, one artery inpatient CPT 92928 HC Stent Plcmnt Single Cor Major Vessel W or WO Ptca	$10,123.58	$13,498.11	—	—	25%
Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 HC and ASC Cystouretheroscopy	$1,501.50	$2,002.00	—	25% below	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Remove Impacted Ear Wax Uni	$38.25	$51.00	—	75% below	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Hod Cerumen Removal Irrigate per Ear	$67.50	$90.00	—	56% below	25%
Earwax removal with instruments, one ear CPT 69210 HC Remove Impacted Ear Wax Uni	$145.50	$194.00	—	6% below	25%
Earwax removal with instruments, one ear inpatient CPT 69210 HC Remove Impacted Ear Wax Uni	$145.50	$194.00	—	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC Hod Endometrial Biopsy	$311.25	$415.00	—	19% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 HC Endometrial Biopsy	$311.25	$415.00	—	19% below	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix inpatient CPT 58100 HC Hod Endometrial Biopsy	$311.25	$415.00	—	—	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Njx Interlaminar Crv/Thrc	$234.00	$312.00	—	90% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 HC Esi Inj Single Cervcl/Thoracic W Imaging	$1,890.50	$2,520.67	—	15% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 HC Esi Inj Single Cervcl/Thoracic W Imaging	$1,890.50	$2,520.67	—	—	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Inj Paravert F Jnt L/S 1 Lev	$198.00	$264.00	—	91% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Inj Para Fctjnt Ls 1st Lvl	$1,649.48	$2,199.30	—	24% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC Inj Para Fjnt Ls 1st Lvl Bil	$2,485.82	$3,314.43	—	14% above	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 HC Diagnostic Sigmoidoscopy	$2,051.25	$2,735.00	—	20% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Hod Cath/Inj Hystersalp/Sono	$432.70	$576.93	—	13% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Cath/Inj Hystersalp/Sono	$432.70	$576.93	—	13% above	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Hod Cath/Inj Hystersalp/Sono	$432.70	$576.93	—	—	25%
IUD insertion (the device itself billed separately) CPT 58300 HC Iud Insertion	$280.24	$373.65	—	44% below	25%
IUD insertion (the device itself billed separately) CPT 58300 HC Hod Iud Insertion	$280.24	$373.65	—	44% below	25%
IUD insertion (the device itself billed separately) inpatient CPT 58300 HC Iud Insertion	$280.24	$373.65	—	—	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Hod I&D Skin/Sq Abcess Simp/Single	$378.98	$505.30	—	2% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D Skin/Sq Abcess Simp/Single	$378.98	$505.30	—	2% below	25%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Hod I&D Skin/Sq Abcess Simp/Single	$378.98	$505.30	—	—	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Inj Tendon Sheath/Ligament	$87.00	$116.00	—	74% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Hod Inj Single Tendon Sheath Ligament or Aponeurosis	$195.75	$261.00	—	42% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 HC Inj Single Tendon Sheath Ligament or Aponeurosis	$195.75	$261.00	—	42% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 HC Inj Tendon Sheath/Ligament	$87.00	$116.00	—	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Hod Arthro Asp/Inj Lrg Joint WO US Guid	$345.75	$461.00	—	50% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Arthro Asp/Inj Lrg Joint WO US Guid	$345.75	$461.00	—	50% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Drain/Inj Joint/Bursa W/O US	$558.00	$744.00	—	20% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Insert Drug Implant Device	$108.90	$145.20	—	71% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 HC Hod Insert Drug Implant Device	$108.90	$145.20	—	71% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 HC Hod Insert Drug Implant Device	$108.90	$145.20	—	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Arthro Asp/Inj Med Joint WO US Guid	$195.75	$261.00	—	68% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Hod Arthro Asp/Inj Med Joint WO US Guid	$195.75	$261.00	—	68% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Drain/Inj Joint/Bursa W/O US	$558.00	$744.00	—	10% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Drain/Inj Joint/Bursa W/O US	$78.00	$104.00	—	84% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Arthro Asp/Inj Sm Joint WO US Guid	$195.75	$261.00	—	60% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Hod Arthro Asp/Inj Sm Joint WO US Guid	$195.75	$261.00	—	60% below	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Arthro Asp/Inj Sm Joint WO US Guid	$195.75	$261.00	—	—	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Hod Arthro Asp/Inj Sm Joint WO US Guid	$195.75	$261.00	—	—	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Hod Intmd Rpr S/a/T/Ext 2.5 Cm or <	$334.69	$446.25	—	37% below	25%
Left heart catheterization, diagnostic one side CPT 93452 HC Lt Heart Cath Includes Inj Lv	$9,187.81	$12,250.41	—	1% below	25%
Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Lt Heart Cath Includes Inj Lv	$9,187.81	$12,250.41	—	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Interlaminar Lmbr/Sac	$217.50	$290.00	—	89% below	25%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Esi Inj Single Lum/Sacral W Imaging	$1,587.04	$2,116.05	—	22% below	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj Foramen Epidural L/S	$242.25	$323.00	—	88% below	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Esi Transforaminal Lum/Sac	$1,575.00	$2,100.00	—	24% below	25%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Esi Transfrmnl Ls Same Lvl Bil	$2,362.50	$3,150.00	—	14% above	25%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Esi Transforaminal Lum/Sac	$1,575.00	$2,100.00	—	—	25%
Lumbar spinal fusion (posterior), one level CPT 22612 HC Lumbar Spine Fusion	$3,538.50	$4,718.00	—	88% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Excision Lesion 0.5 Cm or Less	$616.37	$821.83	—	54% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 HC Hod Excision Lesion 0.5 Cm or Less	$616.37	$821.83	—	54% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 HC Excision Lesion 0.5 Cm or Less	$616.37	$821.83	—	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 HC Hod Exc Face-Mm +Marg 0.5 Cm or <	$862.50	$1,150.00	—	37% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion 1 Nail Plate Simple	$195.00	$260.00	—	39% below	25%
Nail removal (partial or complete), one nail CPT 11730 HC Hod Avulsion 1 Nail Plate Simple	$195.00	$260.00	—	39% below	25%
Occipital nerve block (injection for headaches) CPT 64405 HC N Block Inj Occipital	$117.75	$157.00	—	85% below	25%
Occipital nerve block (injection for headaches) CPT 64405 HC Nerve Block Greater Occipital Nerve	$744.88	$993.17	—	5% below	25%
Pacemaker implant (dual chamber) CPT 33208 HC Ppm Insert Av Seq With Leads	$12,375.00	$16,500.00	—	21% below	25%
Paracentesis with imaging guidance CPT 49083 HC Abdominal Paracentesis W Img	$2,265.85	$3,021.13	—	31% above	25%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abdominal Paracentesis W Img	$2,265.85	$3,021.13	—	—	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Excision Nail & Matrix	$616.37	$821.83	—	21% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Hod Excision Nail & Matrix	$616.37	$821.83	—	21% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level both sides CPT 64635 HC Destroy Nrv Lbr/Sacr Fjt W Img Bilat	$4,077.22	$5,436.29	—	—	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC Destroy Lumb/Sac Facet Jnt	$419.25	$559.00	—	87% below	25%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 HC Destroy Nrv Lbr/Sacr Fjt W Img	$2,038.60	$2,718.14	—	39% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC Hod Foreign Body Incisn/Remov Sim	$334.69	$446.25	—	50% below	25%
Removal of a foreign object under the skin, simple CPT 10120 HC Foreign Body Incisn/Remov Sim	$412.50	$550.00	—	38% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC Hod Foreign Body Incisn/Remov Sim	$334.69	$446.25	—	—	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 HC Colon Ca Scrn Not Hi Rsk Ind	$1,849.50	$2,466.00	—	29% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 HC Colorectal Scrn; Hi Risk Ind	$1,849.50	$2,466.00	—	29% below	25%
Short arm cast (elbow to hand) CPT 29075 HC Appl Cast Short Arm-Elbw/Fingr	$203.77	$271.70	—	32% below	25%
Short arm splint (forearm and hand) CPT 29125 HC Apply Forearm Splint	$80.25	$107.00	—	72% below	25%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Apply Forearm Splint	$80.25	$107.00	—	—	25%
Short leg cast (below the knee) CPT 29405 HC Appl Short Leg Cast-Bknee/Toes	$203.77	$271.70	—	47% below	25%
Short leg splint (calf to foot) CPT 29515 HC Application Lower Leg Splint	$99.75	$133.00	—	66% below	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Repair Simple All but Face	$206.25	$275.00	—	38% below	25%
Skin biopsy, punch, one lesion CPT 11104 HC Hod Punch Biopsy Skin Single Lesion	$375.00	$500.00	—	16% below	25%
Skin biopsy, punch, one lesion CPT 11104 HC Biopsy Punch Skin Single Lesion	$375.00	$500.00	—	16% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC Hod Exc Malignant Tral Lesion .5cm	$862.50	$1,150.00	—	37% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 HC Excision Malignant Tral Lesion .5 Cm	$862.50	$1,150.00	—	37% below	25%
Skin tag removal, up to 15 tags CPT 11200 HC Remvl Skin Tags or Polydactyly	$407.29	$543.05	—	39% above	25%
Skin tag removal, up to 15 tags CPT 11200 HC Hod Remove Skin Tags Up to 15 Lesions	$407.29	$543.05	—	39% above	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Lumbar Puncture Diagnostic	$553.22	$737.62	—	48% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Rpr S/N/Ax/Gen/Trnk2.6-7.5cm	$255.00	$340.00	—	28% below	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 HC Rpr S/N/Ax/Gen/Trnk2.6-7.5cm	$255.00	$340.00	—	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Rpr F/E/E/N/L/M 2.5 Cm/<	$240.75	$321.00	—	24% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC Rpr F/E/E/N/L/M 2.5 Cm/<	$240.75	$321.00	—	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Sngl Lesion	$178.54	$238.06	—	41% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Hod Biopsy Skin Tangential Skin Single Lesion	$178.54	$238.06	—	41% below	25%
Thoracentesis with imaging guidance CPT 32555 HC Thoracentesis Aspirate Only W Imaging	$1,687.50	$2,250.00	—	3% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Hod Inj 1+ Trigger Pts 1-2musc Grp	$320.10	$426.80	—	54% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inj 1+ Trigger Pts 1-2musc Grp	$352.11	$469.48	—	50% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Biopsy Breast Localiz Devic Specmn Imag US Guide	$1,927.53	$2,570.04	—	42% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 HC Esoph Egd Dilation <30 Mm	$4,268.25	$5,691.00	—	22% above	25%
Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Biopsy Single/Multiple	$2,109.75	$2,813.00	—	25% below	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 HC Egd Remove Lesion Snare	$4,268.25	$5,691.00	—	32% above	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 HC Egd Guide Wire Insertion	$2,544.00	$3,392.00	—	9% below	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire inpatient CPT 43248 HC Egd Guide Wire Insertion	$2,544.00	$3,392.00	—	—	25%
Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash	$1,815.00	$2,420.00	—	30% below	25%
Wart removal, up to 14 warts CPT 17110 HC Destruction 1 to 14 Benign Skin Lesions or Warts	$180.00	$240.00	—	43% below	25%
Wart removal, up to 14 warts CPT 17110 HC Hod Destruction 1 to 14 Benign Skin Lesions or Warts	$180.00	$240.00	—	43% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 HC Destruction 1 to 14 Benign Skin Lesions or Warts	$180.00	$240.00	—	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Hod Debride Subq First 20 Sq Cm or Less	$503.12	$670.82	—	35% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debridement Subq 20 Sq Cm	$525.00	$700.00	—	33% below	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD ADMINISTRATION IN THE OR	$687.72	$916.96	—	38% below	25%
Blood transfusion (giving blood or blood components) CPT 36430 HC Blood Admin Up to 2 Units	$687.72	$916.96	—	38% below	25%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Inhalation Treatment Hhn/Mdi/Heliox	$153.75	$205.00	—	12% below	25%
Chemotherapy IV infusion, first hour CPT 96413 HC Infusion Chemo 1st 16-90m	$592.50	$790.00	—	23% below	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 HC Aud Evaluation Comprehensive	$262.08	$349.44	—	at median	25%
Critical care, first 30 to 74 minutes CPT 99291 HC ED Visit Critical Care	$3,300.00	$4,400.00	—	12% above	25%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC ED Visit Critical Care	$3,300.00	$4,400.00	—	—	25%
EEG (brain wave test), awake and drowsy, routine CPT 95816 HC Eeg	$460.68	$614.24	—	52% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC Hod Ekg 12 Lead Tracing Only	$151.80	$202.40	—	18% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC Ekg 12 Lead Tracing Only	$166.98	$222.64	—	10% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC Ekg 12 Lead Tracing Only	$166.98	$222.64	—	—	25%
Electroconvulsive therapy (ECT), one session CPT 90870 HC Ect Procedure	$534.60	$712.80	—	60% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ED Visit Level 1	$489.04	$652.05	—	57% above	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ED Visit Level 2	$532.50	$710.00	—	4% above	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ED Visit Level 3	$1,591.31	$2,121.75	—	89% above	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ED Visit Level 4	$2,018.25	$2,691.00	—	52% above	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ED Visit Level 5	$2,437.50	$3,250.00	—	40% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Treadmill With Isotope	$1,059.82	$1,413.10	—	18% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Pharmacologic Stress	$1,059.82	$1,413.10	—	18% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Treadmill Without Isotope	$1,059.82	$1,413.10	—	18% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Pharmacologic Stress	$1,059.82	$1,413.10	—	—	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Treadmill Without Isotope	$1,059.82	$1,413.10	—	—	25%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Intervention W/ Patient	$109.20	$145.60	—	63% below	25%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy With Patient	$170.94	$227.92	—	42% below	25%
Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy With Patient Ph	$262.92	$350.56	—	11% below	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Intervention W/ Patient	$109.20	$145.60	—	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy With Patient	$170.94	$227.92	—	—	25%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy With Patient Ph	$262.92	$350.56	—	—	25%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Intervention W/O Patient	$108.37	$144.49	—	65% below	25%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy W/O Pt	$170.94	$227.92	—	45% below	25%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Education W Rn	$254.76	$339.68	—	18% below	25%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy W/O Pt Ph	$324.24	$432.32	—	5% above	25%
Family therapy without the patient, 50 minutes CPT 90846 HC Family Education W Rn Ph	$357.00	$476.00	—	15% above	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Intervention W/O Patient	$108.37	$144.49	—	—	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy W/O Pt	$170.94	$227.92	—	—	25%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy W/O Pt Ph	$324.24	$432.32	—	—	25%
Group psychotherapy session CPT 90853 HC Goal Psychothrpy Track 1&2	$198.00	$264.00	—	16% above	25%
Group psychotherapy session CPT 90853 HC Stress Mgmt Group	$200.64	$267.52	—	17% above	25%
Group psychotherapy session CPT 90853 HC Assertive Group	$200.64	$267.52	—	17% above	25%
Group psychotherapy session CPT 90853 HC Sensory Awareness Group Tx	$200.64	$267.52	—	17% above	25%
Group psychotherapy session CPT 90853 HC Cognitive Behavior Group	$200.64	$267.52	—	17% above	25%
Group psychotherapy session CPT 90853 HC Group Treatment	$210.00	$280.00	—	23% above	25%
Group psychotherapy session CPT 90853 HC Stress Mgmt Group Ph	$255.36	$340.48	—	49% above	25%
Group psychotherapy session CPT 90853 HC Group Psychotherapy	$281.25	$375.00	—	64% above	25%
Group psychotherapy session CPT 90853 HC Group Psychotherapy Ph	$281.40	$375.20	—	65% above	25%
Group psychotherapy session CPT 90853 HC Assertive Group Ph	$281.40	$375.20	—	65% above	25%
Group psychotherapy session CPT 90853 HC Goal Psychothrpy Track 1&2 Ph	$281.40	$375.20	—	65% above	25%
Group psychotherapy session CPT 90853 HC Sensory Awareness Group Tx Ph	$281.40	$375.20	—	65% above	25%
Group psychotherapy session CPT 90853 HC Cognitive Behavior Group Ph	$281.40	$375.20	—	65% above	25%
Group psychotherapy session CPT 90853 HC Intensive OP Prog (Iop)	$460.32	$613.76	—	169% above	25%
Group psychotherapy session inpatient CPT 90853 HC Stress Mgmt Group	$200.64	$267.52	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Assertive Group	$200.64	$267.52	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Cognitive Behavior Group	$200.64	$267.52	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Cognitive Behavior Group Ph	$281.40	$375.20	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Goal Psychothrpy Track 1&2 Ph	$281.40	$375.20	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy Ph	$281.40	$375.20	—	—	25%
Group psychotherapy session inpatient CPT 90853 HC Sensory Awareness Group Tx Ph	$281.40	$375.20	—	—	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Infusion Hydration 1st 31-90 M	$213.75	$285.00	—	49% below	25%
IV infusion of a medicine, first hour CPT 96365 HC Infusion Drug 1st 16-90 Min	$438.75	$585.00	—	1% above	25%
IV infusion of a medicine, first hour inpatient CPT 96365 HC Infusion Drug 1st 16-90 Min	$438.75	$585.00	—	—	25%
IV push of a medicine, first drug CPT 96374 HC Injection 1st Ivp/Infsn <= 15m	$243.75	$325.00	—	5% below	25%
IV push of a medicine, first drug inpatient CPT 96374 HC Injection 1st Ivp/Infsn <= 15m	$243.75	$325.00	—	—	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Inject Med Im/Subq	$131.25	$175.00	—	7% below	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Initial Visit/Tx Planning	$209.88	$279.84	—	33% below	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Initial Visit/Tx Planning Ph	$294.00	$392.00	—	6% below	25%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Diagnostic Evaluation	$475.44	$633.92	—	52% above	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Initial Visit/Tx Planning	$209.88	$279.84	—	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Initial Visit/Tx Planning Ph	$294.00	$392.00	—	—	25%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Diagnostic Evaluation	$475.44	$633.92	—	—	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC Pta Neuromuscular Re-ED Each 15 Min	$93.00	$124.00	—	15% below	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC Cota Neuromuscular Re-ED Each 15 Min	$93.00	$124.00	—	15% below	25%
Neuromuscular re-education, 15 minutes CPT 97112 HC Neuromuscular Re-ED Each 15 Min	$106.57	$142.10	—	3% below	25%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Neuromuscular Re-ED Each 15 Min	$106.57	$142.10	—	—	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Medical Nutr Thrpy Initial/15 Min	$41.58	$55.44	—	36% below	25%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Eval Low Complexity	$229.68	$306.24	—	12% below	25%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Driver Eval Low Complexity	$229.68	$306.24	—	12% below	25%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Complexity	$281.16	$374.88	—	7% below	25%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Eval Low Complexity	$229.65	$306.20	—	12% below	25%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Moderate Complexity	$255.42	$340.56	—	8% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Cota Manual Techn Therapy Each 15 Min	$93.00	$124.00	—	16% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pta Manual Techn Therapy Each 15 Min	$93.30	$124.40	—	16% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Manual Techn Therapy Each 15 Min	$106.57	$142.10	—	4% below	25%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Manual Techn Therapy Each 15 Min	$106.57	$142.10	—	—	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Cota Therapeutic Exer/Isokin Trng Each 15 Min	$93.00	$124.00	—	22% below	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pta Ther Exer/Isokin Trng Each 15 Min	$93.00	$124.00	—	22% below	25%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Therapeutic Exer/Isokin Trng Each 15 Min	$106.57	$142.10	—	10% below	25%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pta Ther Exer/Isokin Trng Each 15 Min	$93.00	$124.00	—	—	25%
Psychiatric evaluation with medical services CPT 90792 HC Diagnostic Evaluation W/ Med Svcs	$436.80	$582.40	—	24% above	25%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Diagnostic Evaluation W/ Med Svcs	$436.80	$582.40	—	—	25%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 HC Np Psychological Testing 1st Hour	$423.75	$565.00	—	at median	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Psychotherapy Crisis Init 30 - 74 Mins Ph	$371.28	$495.04	—	19% above	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Psychotherapy Crisis Init 30 - 74 Mins	$371.28	$495.04	—	19% above	25%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Psychotherapy Crisis Init 30 - 74 Mins Ph	$371.28	$495.04	—	—	25%
Psychotherapy session, 30 minutes CPT 90832 HC Indiv Therapy 16-37 Mins	$113.52	$151.36	—	40% below	25%
Psychotherapy session, 30 minutes CPT 90832 HC Indiv Therapy 16-37 Mins Ph	$155.40	$207.20	—	18% below	25%
Psychotherapy session, 30 minutes CPT 90832 HC Discharge Conference	$196.02	$261.36	—	4% above	25%
Psychotherapy session, 30 minutes CPT 90832 HC Indiv. Psychotherapy 16 -37 Mins	$236.04	$314.72	—	25% above	25%
Psychotherapy session, 30 minutes CPT 90832 HC Discharge Conference Ph	$274.68	$366.24	—	45% above	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Indiv Therapy 16-37 Mins Ph	$155.40	$207.20	—	—	25%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Discharge Conference	$196.02	$261.36	—	—	25%
Psychotherapy session, 45 minutes CPT 90834 HC Indiv Therapy 38-52 Mins	$184.80	$246.40	—	31% below	25%
Psychotherapy session, 45 minutes CPT 90834 HC Indiv Therapy 38 - 52 Mins Ph	$274.68	$366.24	—	3% above	25%
Psychotherapy session, 45 minutes CPT 90834 HC Indiv. Psychotherapy 38-52 Mins	$352.80	$470.40	—	32% above	25%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Indiv Therapy 38-52 Mins	$184.80	$246.40	—	—	25%
Psychotherapy session, 60 minutes CPT 90837 HC Indiv Therapy 53+Min	$274.56	$366.08	—	12% below	25%
Psychotherapy session, 60 minutes CPT 90837 HC Indiv Therapy 53+ Min Ph	$384.72	$512.96	—	23% above	25%
Psychotherapy session, 60 minutes CPT 90837 HC Indiv. Psychotherapy 53+ Mins	$389.76	$519.68	—	24% above	25%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Indiv Therapy 53+ Min Ph	$384.72	$512.96	—	—	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Smoke/Tobacco Counseling 3-10m	$23.76	$31.68	—	46% below	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Hod Smoke/Tobacco Counseling 3-10m	$23.76	$31.68	—	46% below	25%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Hod Smoke/Tobacco Counseling 3-10m	$23.76	$31.68	—	—	25%
Speech and language evaluation CPT 92523 HC Eval Speech & Lang	$269.93	$359.91	—	21% below	25%
Speech and language evaluation inpatient CPT 92523 HC Eval Speech & Lang	$269.93	$359.91	—	—	25%
Speech therapy session, individual CPT 92507 HC Therapy Speech	$198.75	$265.00	—	9% below	25%
Speech therapy session, individual inpatient CPT 92507 HC Therapy Speech	$198.75	$265.00	—	—	25%
Spirometry (breathing test) CPT 94010 HC Hod Peak Expiratory Flow Rate	$240.00	$320.00	—	23% below	25%
Spirometry (breathing test) CPT 94010 HC Spirometry Single	$240.00	$320.00	—	23% below	25%
Spirometry before and after a bronchodilator CPT 94060 HC Spirometry Double	$470.40	$627.20	—	18% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Cota Functional Activities Each 15 Min	$93.00	$124.00	—	24% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Pta Functional Activities Each 15 Min	$93.00	$124.00	—	24% below	25%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Functional/Therapeutic Activities Ea 15 Min	$106.57	$142.10	—	13% below	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Leech Therapy	$83.25	$111.00	—	65% below	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Therapeutic Phlebotomy	$227.04	$302.72	—	4% below	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 COVID-19 MRNA VACC (MODERNA) 50 MCG/0.5ML IM SUSY	$382.86	$510.48	—	85% above	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 HC Varicella Virus Vaccine	$215.25	$287.00	—	42% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$518.38	$691.17	—	39% above	25%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$518.38	$691.17	—	—	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$81.84	$109.12	—	26% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY	$298.58	$398.11	—	53% above	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) inpatient CPT 90723 DTAP-HEPATITIS B RECOMB-IPV IM SUSY	$298.58	$398.11	—	—	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR	$350.74	$467.66	—	121% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) inpatient CPT 90698 DTAP-IPV-HIB VACCINE IM SUSR	$350.74	$467.66	—	—	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$54.99	$73.32	—	20% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY	$54.99	$73.32	—	—	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HC Gardasil 9 Vaccine	$552.80	$737.07	—	7% above	25%
Hepatitis A vaccine, adult dose CPT 90632 HC Hepatitis a Vaccine	$182.05	$242.73	—	6% below	25%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP	$241.49	$321.99	—	24% above	25%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HC Hepatitis a Vaccine	$182.05	$242.73	—	—	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY	$202.43	$269.91	—	30% above	25%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY	$202.43	$269.91	—	—	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	$420.52	$560.70	—	92% above	25%
Hepatitis B vaccine, adult, 2-dose schedule (Heplisav-B) inpatient CPT 90739 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY	$420.52	$560.70	—	—	25%
Japanese encephalitis vaccine (Ixiaro), 2-dose schedule CPT 90738 JAPANESE ENCEPHALITIS VAC INAC IM SUSP	$796.72	$1,062.30	—	42% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 HC Measlesmumps&Rubella Vaccine	$124.50	$166.00	—	40% below	25%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$263.56	$351.42	—	26% above	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 HC Measlesmumps&Rubella Vaccine	$124.50	$166.00	—	—	25%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$263.56	$351.42	—	—	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLN	$476.78	$635.70	—	50% above	25%
Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 MENINGOCOCCAL A C Y&W-135 OLIG IM SOLN	$476.78	$635.70	—	—	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$678.20	$904.26	—	23% above	25%
Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY	$483.64	$644.85	—	—	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 HC Prevnar Pneumococcal Vaccine 13 Valent	$508.30	$677.73	—	16% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$807.64	$1,076.85	—	22% above	25%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY	$671.96	$895.95	—	—	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 HC Pneumococcal Vaccine 23 Valent	$270.52	$360.69	—	2% below	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$316.12	$421.50	—	15% above	25%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,173.44	$1,564.59	—	23% above	25%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE, PCEC IM SUSR	$1,173.44	$1,564.59	—	—	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR	$633.66	$844.88	—	26% above	25%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR	$633.66	$844.88	—	—	25%
Typhoid vaccine, injectable (Vi polysaccharide) CPT 90691 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY	$436.32	$581.76	—	52% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Admin Influenza Vaccine	$60.00	$80.00	—	47% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Admin of Vaccine	$60.00	$80.00	—	47% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Admin of Hepatitis B Vaccine	$60.00	$80.00	—	47% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Admin of Pneumococcal Vaccine	$60.00	$80.00	—	47% above	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Admin of Vaccine	$60.00	$80.00	—	—	25%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Admin Influenza Vaccine	$60.00	$80.00	—	—	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Vaccine Adm (Ea Addtl)	$60.00	$80.00	—	72% above	25%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Vaccine Adm (Ea Addtl)	$60.00	$80.00	—	—	25%

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

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

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

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

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

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

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

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

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

Source file: https://apps.trihealth.com/static/pricing/310537486_THEGOODSAMARITANHOSPITAL_STANDARDCHARGES.csv