Hospital Urbana, OH

Mercy Health - Urbana Hospital

Listed in its price file as “Community Mercy Health Partners”.

Mercy Health - Urbana Hospital in Urbana, OH publishes cash prices for 370 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 above the Ohio median for 220 of 367 procedures and below it for 145. By typical cash price it ranks #101 of 139 Ohio hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

904 Scioto St.,Urbana ,OH 43078 Collected Sep 23, 2026 Source price file Check a bill from this hospital (937) 653-5231

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 361312 · CMS hospital register NPI 1144286352

Financial assistance

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

Mercy Health - Urbana Hospital 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 Abd W&W/O Cont	$1,478.40	$2,464.00	—	11% above	40%
Abdominal CT scan without and with contrast inpatient CPT 74170 HC CT Abd W&W/O Cont	$1,842.60	$3,071.00	—	—	40%
Abdominal X-ray, 2 views CPT 74019 HC X-Ray Exam Abdomen 2 Views	$363.00	$605.00	—	7% above	40%
Abdominal X-ray, 2 views inpatient CPT 74019 HC X-Ray Exam Abdomen 2 Views	$765.60	$1,276.00	—	—	40%
Ankle X-ray, complete, 3 or more views CPT 73610 HC X-Ray Ankle Rout 3 Views	$386.40	$644.00	—	21% above	40%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 HC X-Ray Ankle Rout 3 Views	$808.80	$1,348.00	—	—	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 HC Tcp02/Abi 1-2 Levels	$937.80	$1,563.00	—	95% above	40%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient CPT 93922 HC Tcp02/Abi 1-2 Levels	$937.80	$1,563.00	—	—	40%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 HC CT Upper Extremity W/O Contrast	$1,212.60	$2,021.00	—	28% above	40%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 HC CT Upper Extremity W/O Contrast	$1,512.00	$2,520.00	—	—	40%
Barium swallow (esophagus X-ray with contrast) CPT 74220 HC Fluro Esophagram	$300.60	$501.00	—	32% below	40%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 HC Fluro Esophagram	$630.60	$1,051.00	—	—	40%
Bone scan, whole body (nuclear medicine) CPT 78306 HC NM Bone Scan Whole Body	$1,862.40	$3,104.00	—	21% above	40%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 HC NM Bone Scan Whole Body	$1,862.40	$3,104.00	—	—	40%
Breast ultrasound, complete, one breast CPT 76641 HC US Breast Comp	$591.00	$985.00	—	24% above	40%
Breast ultrasound, complete, one breast inpatient CPT 76641 HC US Breast Comp	$591.00	$985.00	—	—	40%
Breast ultrasound, limited (one breast or one area) CPT 76642 HC US Breast Ltd	$591.00	$985.00	—	44% above	40%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 HC US Breast Ltd	$591.00	$985.00	—	—	40%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$1,474.20	$2,457.00	—	31% below	40%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 HC Cta Abd & Pelvis W & W/O Cont	$1,474.20	$2,457.00	—	—	40%
CT angiography (CTA) of the head CPT 70496 HC Cta Head W & W/O Cont	$921.00	$1,535.00	—	31% below	40%
CT angiography (CTA) of the head inpatient CPT 70496 HC Cta Head W & W/O Cont	$1,340.40	$2,234.00	—	—	40%
CT angiography (CTA) of the neck CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$921.00	$1,535.00	—	29% below	40%
CT angiography (CTA) of the neck inpatient CPT 70498 HC Cta Neck/Carotid W & W/O Cont	$1,340.40	$2,234.00	—	—	40%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 HC CT Angio Chest W & W/O Cont	$1,023.60	$1,706.00	—	28% below	40%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 HC CT Angio Chest W & W/O Cont	$1,274.40	$2,124.00	—	—	40%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$227.00	$227.00	—	19% below	—
CT of the heart without contrast dye to measure coronary calcium inpatient CPT 75571 HC CT Heart No Contrast Quant Eval Coronry Calcium	$227.00	$227.00	—	—	—
CT scan of abdomen and pelvis, no contrast dye CPT 74176 HC CT Abd/Pelvis W/O Contrast	$1,940.40	$3,234.00	—	22% above	40%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 HC CT Abd/Pelvis W/O Contrast	$2,419.20	$4,032.00	—	—	40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abd/Pel W Cont	$2,181.60	$3,636.00	—	10% above	40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abd/Pel W Cont	$2,721.60	$4,536.00	—	—	40%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$2,274.00	$3,790.00	—	3% below	40%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 HC CT Abd/Pelvis W W/O Contrast	$2,833.80	$4,723.00	—	—	40%
CT scan of the abdomen with contrast CPT 74160 HC CT Abdomen W/ Cont	$1,363.80	$2,273.00	—	17% above	40%
CT scan of the abdomen with contrast inpatient CPT 74160 HC CT Abdomen W/ Cont	$1,700.40	$2,834.00	—	—	40%
CT scan of the abdomen without contrast CPT 74150 HC CT Abdomen W/O Cont	$1,212.60	$2,021.00	—	16% above	40%
CT scan of the abdomen without contrast inpatient CPT 74150 HC CT Abdomen W/O Cont	$1,512.00	$2,520.00	—	—	40%
CT scan of the face and sinuses, no contrast dye CPT 70486 HC CT Facial Bones W/O Contrast	$756.00	$1,260.00	—	14% below	40%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 HC CT Facial Bones W/O Contrast	$1,099.80	$1,833.00	—	—	40%
CT scan of the head or brain, no contrast dye CPT 70450 HC CT Brain W/O Contrast	$756.00	$1,260.00	—	9% below	40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Brain W/O Contrast	$1,099.80	$1,833.00	—	—	40%
CT scan of the head with contrast CPT 70460 HC CT Brain W/ Contrast	$1,062.60	$1,771.00	—	6% above	40%
CT scan of the head with contrast inpatient CPT 70460 HC CT Brain W/ Contrast	$1,545.60	$2,576.00	—	—	40%
CT scan of the head without and with contrast CPT 70470 HC CT Brain W/WO Contrast	$1,151.40	$1,919.00	—	3% below	40%
CT scan of the head without and with contrast inpatient CPT 70470 HC CT Brain W/WO Contrast	$1,675.20	$2,792.00	—	—	40%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 HC CT L-Spine W/O Contrast	$970.20	$1,617.00	—	12% below	40%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 HC CT L-Spine W/O Contrast	$1,209.60	$2,016.00	—	—	40%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 HC CT C-Spine W/O Contrast	$970.20	$1,617.00	—	10% below	40%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 HC CT C-Spine W/O Contrast	$1,209.60	$2,016.00	—	—	40%
CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/ Contrast	$1,363.80	$2,273.00	—	11% above	40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/ Contrast	$1,700.40	$2,834.00	—	—	40%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 HC Extracranial Bilat Study	$1,628.40	$2,714.00	—	—	40%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 HC Extracranial Bilat Study	$1,628.40	$2,714.00	—	—	40%
Chest CT scan without and with contrast CPT 71270 HC CT Chest W/WO Contrast	$1,478.40	$2,464.00	—	2% below	40%
Chest CT scan without and with contrast inpatient CPT 71270 HC CT Chest W/WO Contrast	$1,842.60	$3,071.00	—	—	40%
Chest X-ray, 2 views CPT 71046 HC X-Ray Exam Chest 2 Views	$295.20	$492.00	—	12% above	40%
Chest X-ray, 2 views inpatient CPT 71046 HC X-Ray Exam Chest 2 Views	$621.00	$1,035.00	—	—	40%
Chest X-ray, single view CPT 71045 HC X-Ray Exam Chest 1 View	$150.60	$251.00	—	33% below	40%
Chest X-ray, single view inpatient CPT 71045 HC X-Ray Exam Chest 1 View	$318.60	$531.00	—	—	40%
Collarbone (clavicle) X-ray, complete CPT 73000 HC X-Ray Clavicle	$196.20	$327.00	—	28% below	40%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 HC X-Ray Clavicle	$412.80	$688.00	—	—	40%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 HC US Retroperitoneal Complete	$1,032.00	$1,720.00	—	46% above	40%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 HC US Retroperitoneal Complete	$1,032.00	$1,720.00	—	—	40%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 HC Dexa Axial Skeleton	$272.40	$454.00	—	40% below	40%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 HC Dexa Axial Skeleton	$571.20	$952.00	—	—	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 HC Dexa Appendicular Skeleton	$69.60	$116.00	—	73% below	40%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 HC Dexa Appendicular Skeleton	$147.60	$246.00	—	—	40%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 HC US Fetal Anatomic Eval	$1,255.80	$2,093.00	—	48% above	40%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 HC US Fetal Anatomic Eval	$1,255.80	$2,093.00	—	—	40%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 HC CT Chest W/O Contrast	$970.20	$1,617.00	—	3% above	40%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 HC CT Chest W/O Contrast	$1,209.60	$2,016.00	—	—	40%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 HC CT Chest W/ Contrast	$1,090.80	$1,818.00	—	10% below	40%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 HC CT Chest W/ Contrast	$1,360.20	$2,267.00	—	—	40%
Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$268.80	$448.00	—	—	40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammo Dgx Bilateral Incl Cad if Perf	$268.80	$448.00	—	—	40%
Diagnostic mammogram, one breast one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$209.40	$349.00	—	42% below	40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammo Dgx Unilateral Incl Cad if Perf	$209.40	$349.00	—	—	40%
Duplex ultrasound of the leg arteries, both legs CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,462.20	$2,437.00	—	63% above	40%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 HC Bil Niv Arterial Low Ext Duplex	$1,462.20	$2,437.00	—	—	40%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$1,667.40	$2,779.00	—	—	40%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 HC Niv Venous Duplex Bilat Study	$1,667.40	$2,779.00	—	—	40%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$2,514.00	$4,190.00	—	49% above	40%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 HC 2d Echo Without Contrast - With Dop/Color Flow	$2,514.00	$4,190.00	—	—	40%
Elbow X-ray, 2 views CPT 73070 HC Elbow 2 Views	$219.00	$365.00	—	16% below	40%
Elbow X-ray, 2 views inpatient CPT 73070 HC Elbow 2 Views	$462.00	$770.00	—	—	40%
Elbow X-ray, complete, 3 or more views CPT 73080 HC Elbow Min 3 Views	$262.80	$438.00	—	17% below	40%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 HC Elbow Min 3 Views	$553.80	$923.00	—	—	40%
Eye socket (orbit) CT scan without contrast CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$945.00	$1,575.00	—	10% above	40%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 HC CT Orbit/Ear/Fossa W/O Contrast	$1,374.60	$2,291.00	—	—	40%
Facial bones X-ray, complete, 3 or more views CPT 70150 HC Facial Bones Min 3 Views	$315.00	$525.00	—	16% below	40%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 HC Facial Bones Min 3 Views	$661.80	$1,103.00	—	—	40%
Forearm X-ray (radius and ulna), 2 views CPT 73090 HC Forearm 2 Views	$213.60	$356.00	—	22% below	40%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 HC Forearm 2 Views	$450.00	$750.00	—	—	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$1,354.80	$2,258.00	—	15% below	40%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 HC NM Hepatobiliary Imaging WO Pharm	$1,354.80	$2,258.00	—	—	40%
Hand X-ray, 2 views CPT 73120 HC Hand 2 Views	$216.00	$360.00	—	19% below	40%
Hand X-ray, 2 views inpatient CPT 73120 HC Hand 2 Views	$216.00	$360.00	—	—	40%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 HC X-Ray Os Calcis Min 2 Views	$187.80	$313.00	—	31% below	40%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 HC X-Ray Os Calcis Min 2 Views	$393.00	$655.00	—	—	40%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 HC Sleep Study Unatt & Resp Efft	$778.20	$1,297.00	—	11% above	40%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 HC Sleep Study Unatt & Resp Efft	$778.20	$1,297.00	—	—	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 HC Adult Cpap Titration Study	$4,551.00	$7,585.00	—	11% above	40%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 HC Adult Cpap Titration Study	$4,551.00	$7,585.00	—	—	40%
Knee X-ray, 3 views CPT 73562 HC X-Ray Knee 3 Views	$226.80	$378.00	—	36% below	40%
Knee X-ray, 3 views inpatient CPT 73562 HC X-Ray Knee 3 Views	$476.40	$794.00	—	—	40%
Knee X-ray, complete, 4 or more views CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$310.20	$517.00	—	21% below	40%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 HC X-Ray Knee Rout Inc Tun Pat Min 4 View	$653.40	$1,089.00	—	—	40%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 HC CT Lower Ext W/O Cont	$1,091.40	$1,819.00	—	16% above	40%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 HC CT Lower Ext W/O Cont	$1,360.80	$2,268.00	—	—	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 HC US Abdominal Limited	$825.60	$1,376.00	—	50% above	40%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 HC US Abdominal Limited	$825.60	$1,376.00	—	—	40%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 HC US Extrem Limited Nonvasc	$736.20	$1,227.00	—	54% above	40%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 HC US Extrem Limited Nonvasc	$736.20	$1,227.00	—	—	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$267.60	$446.00	—	9% below	40%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 HC CT Chest Screening Low Dose Wout Cont	$267.60	$446.00	—	—	40%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$193.20	$322.00	—	29% below	40%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 HC X-Ray Tibia/Fibula 2 Views	$404.40	$674.00	—	—	40%
MR angiography (MRA) of the head without contrast CPT 70544 HC MRI-Angio Head WO Contrast	$1,899.00	$3,165.00	—	31% above	40%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 HC MRI-Angio Head WO Contrast	$2,413.80	$4,023.00	—	—	40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$1,388.40	$2,314.00	—	21% below	40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Ext Jnt W/O Cont	$2,605.20	$4,342.00	—	—	40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$1,761.60	$2,936.00	—	26% below	40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Ext Jnt W&W/O Cont	$3,306.60	$5,511.00	—	—	40%
MRI of the abdomen without contrast CPT 74181 HC MRI-Abdomen WO Contrast	$1,388.40	$2,314.00	—	25% below	40%
MRI of the abdomen without contrast inpatient CPT 74181 HC MRI-Abdomen WO Contrast	$2,605.20	$4,342.00	—	—	40%
MRI of the abdomen, without and then with contrast dye CPT 74183 HC MRI-Abdomen W & WO Contrast	$1,761.60	$2,936.00	—	23% below	40%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 HC MRI-Abdomen W & WO Contrast	$3,306.60	$5,511.00	—	—	40%
MRI of the brain, no contrast dye CPT 70551 HC MRI Brain WO Ctrst	$1,374.60	$2,291.00	—	15% below	40%
MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain WO Ctrst	$1,747.20	$2,912.00	—	—	40%
MRI of the brain, with and without contrast dye CPT 70553 HC MRI-Brain WO & W Contrast	$1,744.20	$2,907.00	—	20% below	40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI-Brain WO & W Contrast	$2,773.20	$4,622.00	—	—	40%
MRI of the lower back, no contrast dye CPT 72148 HC MRI-Spine Lumbar WO Contrast	$1,093.80	$1,823.00	—	34% below	40%
MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI-Spine Lumbar WO Contrast	$2,053.20	$3,422.00	—	—	40%
MRI of the lower back, without and then with contrast dye CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$1,735.20	$2,892.00	—	26% below	40%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 HC MRI-Spine Lumbar WO & W Cont	$3,259.20	$5,432.00	—	—	40%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 HC MRI-Spine Thoracic WO Contrast	$1,367.40	$2,279.00	—	18% below	40%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 HC MRI-Spine Thoracic WO Contrast	$2,566.80	$4,278.00	—	—	40%
MRI of the neck (cervical spine) without and with contrast CPT 72156 HC MRI-Spine Cervical W & WO Cont	$1,735.20	$2,892.00	—	23% below	40%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 HC MRI-Spine Cervical W & WO Cont	$3,259.20	$5,432.00	—	—	40%
MRI of the neck (cervical spine), no contrast dye CPT 72141 HC MRI-Spine Cervical WO Contrast	$1,367.40	$2,279.00	—	17% below	40%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 HC MRI-Spine Cervical WO Contrast	$2,566.80	$4,278.00	—	—	40%
MRI of the pelvis without and with contrast CPT 72197 HC MRI-Pelvis WO & W Contrast	$1,761.60	$2,936.00	—	10% below	40%
MRI of the pelvis without and with contrast inpatient CPT 72197 HC MRI-Pelvis WO & W Contrast	$3,306.60	$5,511.00	—	—	40%
MRI of the pelvis, no contrast dye CPT 72195 HC MRI-Pelvis WO Contrast	$1,388.40	$2,314.00	—	9% below	40%
MRI of the pelvis, no contrast dye inpatient CPT 72195 HC MRI-Pelvis WO Contrast	$2,605.20	$4,342.00	—	—	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$1,388.40	$2,314.00	—	8% below	40%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 HC MRI-Upper Ext Jnt WO Cont	$2,605.20	$4,342.00	—	—	40%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 HC C-Spine Min 4 Views	$347.40	$579.00	—	23% below	40%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 HC C-Spine Min 4 Views	$730.80	$1,218.00	—	—	40%
Neck soft tissue CT scan with contrast CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$1,062.60	$1,771.00	—	10% below	40%
Neck soft tissue CT scan with contrast inpatient CPT 70491 HC CT Soft Tissue Neck W/ Contrast	$1,545.60	$2,576.00	—	—	40%
Neck soft tissue CT scan without contrast CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$945.00	$1,575.00	—	2% above	40%
Neck soft tissue CT scan without contrast inpatient CPT 70490 HC CT Soft Tissue Neck W/O Contrast	$1,374.60	$2,291.00	—	—	40%
Neck soft tissue X-ray CPT 70360 HC Soft Tissue Lat Neck	$223.20	$372.00	—	14% below	40%
Neck soft tissue X-ray inpatient CPT 70360 HC Soft Tissue Lat Neck	$468.00	$780.00	—	—	40%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 HC NM Sest. Rest Stress Mult	$5,052.00	$8,420.00	—	26% above	40%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 HC NM Sest. Rest Stress Mult	$5,052.00	$8,420.00	—	—	40%
Pelvic CT scan without contrast CPT 72192 HC CT Pelvis W/O Contrast	$1,212.60	$2,021.00	—	21% above	40%
Pelvic CT scan without contrast inpatient CPT 72192 HC CT Pelvis W/O Contrast	$1,512.00	$2,520.00	—	—	40%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 HC US Pelvis Limited	$417.60	$696.00	—	4% below	40%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 HC US Pelvis Limited	$417.60	$696.00	—	—	40%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 HC US Pelvis Complete	$1,032.00	$1,720.00	—	105% above	40%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 HC US Pelvis Complete	$1,032.00	$1,720.00	—	—	40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$929.40	$1,549.00	—	55% above	40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC Fetal Eval 2-3 Trim Sgl Gest	$929.40	$1,549.00	—	—	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$863.40	$1,439.00	—	57% above	40%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 HC Fetal Eval 1st Tri Sgl Gest	$863.40	$1,439.00	—	—	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 HC US Fetal Evaluation-Limited	$604.80	$1,008.00	—	27% above	40%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 HC US Fetal Evaluation-Limited	$604.80	$1,008.00	—	—	40%
Rib X-ray, one side, 2 views one side CPT 71100 HC Ribs Unilateral 2 Views	$240.00	$400.00	—	21% below	40%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 HC Ribs Unilateral 2 Views	$504.60	$841.00	—	—	40%
Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$261.00	$435.00	—	32% below	40%
Rib X-ray, one side, with a chest view, 3 or more views inpatient CPT 71101 HC X-Ray, Ribs, Pa Chest, 3	$550.80	$918.00	—	—	40%
Screening mammogram, both breasts CPT 77067 HC Mammo Screening Incl Cad if Perf	$223.80	$373.00	—	17% above	40%
Screening mammogram, both breasts inpatient CPT 77067 HC Mammo Screening Incl Cad if Perf	$223.80	$373.00	—	—	40%
Shoulder X-ray, complete, 2 or more views CPT 73030 HC Shoulder Complete Min 2 Views	$225.00	$375.00	—	33% below	40%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 HC Shoulder Complete Min 2 Views	$471.60	$786.00	—	—	40%
Sinus X-ray, complete, 3 or more views CPT 70220 HC Sinuses Min 3 Views	$307.20	$512.00	—	15% below	40%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 HC Sinuses Min 3 Views	$646.20	$1,077.00	—	—	40%
Skull X-ray, fewer than 4 views CPT 70250 HC Skull Less Than 4 Views	$155.40	$259.00	—	46% below	40%
Skull X-ray, fewer than 4 views inpatient CPT 70250 HC Skull Less Than 4 Views	$327.60	$546.00	—	—	40%
Sleep study in a lab (polysomnography) CPT 95810 HC Adult Sleep Study (Polysomnogram)	$4,459.20	$7,432.00	—	24% above	40%
Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Adult Sleep Study (Polysomnogram)	$4,459.20	$7,432.00	—	—	40%
Swallow study (modified barium swallow, video X-ray) CPT 74230 HC Dysphagia/Swallowing Study	$402.60	$671.00	—	20% below	40%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 HC Dysphagia/Swallowing Study	$848.40	$1,414.00	—	—	40%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$268.20	$447.00	—	1% below	40%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 HC X-Ray Exam of Femur Min 2 Views	$564.60	$941.00	—	—	40%
Thoracic spine (mid back) CT scan without contrast CPT 72128 HC CT T-Spine W/O Contrast	$970.20	$1,617.00	—	7% above	40%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 HC CT T-Spine W/O Contrast	$1,209.60	$2,016.00	—	—	40%
Toe X-ray, 2 or more views CPT 73660 HC X-Ray Toes Min 2 Views	$140.40	$234.00	—	44% below	40%
Toe X-ray, 2 or more views inpatient CPT 73660 HC X-Ray Toes Min 2 Views	$293.40	$489.00	—	—	40%
Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal, Non OB	$969.60	$1,616.00	—	72% above	40%
Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal, Non OB	$969.60	$1,616.00	—	—	40%
Transvaginal ultrasound during pregnancy CPT 76817 HC US Transvaginal Obsetrical	$1,059.00	$1,765.00	—	111% above	40%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 HC US Transvaginal Obsetrical	$1,059.00	$1,765.00	—	—	40%
Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete	$2,063.40	$3,439.00	—	229% above	40%
Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete	$2,063.40	$3,439.00	—	—	40%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum & Contents	$1,032.00	$1,720.00	—	92% above	40%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Scrotum & Contents	$1,032.00	$1,720.00	—	—	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 HC Soft Tissue Neck US	$1,032.00	$1,720.00	—	80% above	40%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 HC Soft Tissue Neck US	$1,032.00	$1,720.00	—	—	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$579.60	$966.00	—	2% below	40%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 HC Rad Exam Upr GI Tract Single Contrast Study	$1,219.20	$2,032.00	—	—	40%
Upper arm X-ray (humerus), 2 views CPT 73060 HC Humerus Min 2 View	$220.80	$368.00	—	20% below	40%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 HC Humerus Min 2 View	$462.60	$771.00	—	—	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,111.20	$1,852.00	—	51% above	40%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient CPT 93971 HC Niv Venous Duplex Uni/Ltd Study	$1,111.20	$1,852.00	—	—	40%
Wrist X-ray, 2 views CPT 73100 HC Xr Wrist 2 Views	$213.60	$356.00	—	18% below	40%
Wrist X-ray, 2 views inpatient CPT 73100 HC Xr Wrist 2 Views	$450.00	$750.00	—	—	40%
Wrist X-ray, complete, 3 or more views CPT 73110 HC Wrist Min 3 Views	$240.00	$400.00	—	28% below	40%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 HC Wrist Min 3 Views	$504.00	$840.00	—	—	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$261.00	$435.00	—	15% below	40%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 HC X-Ray Exam Hip Uni 2-3 Views	$600.60	$1,001.00	—	—	40%
X-ray of the abdomen, 1 view CPT 74018 HC X-Ray Exam Abdomen 1 View	$139.20	$232.00	—	46% below	40%
X-ray of the abdomen, 1 view inpatient CPT 74018 HC X-Ray Exam Abdomen 1 View	$291.00	$485.00	—	—	40%
X-ray of the ankle, 2 views CPT 73600 HC X-Ray Ankle 2 Views	$151.20	$252.00	—	39% below	40%
X-ray of the ankle, 2 views inpatient CPT 73600 HC X-Ray Ankle 2 Views	$318.00	$530.00	—	—	40%
X-ray of the finger(s), 2 or more views CPT 73140 HC Fingers Min 2 Views	$196.20	$327.00	—	24% below	40%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 HC Fingers Min 2 Views	$412.80	$688.00	—	—	40%
X-ray of the foot, 2 views CPT 73620 HC X-Ray Foot 2 Views	$188.40	$314.00	—	19% below	40%
X-ray of the foot, 2 views inpatient CPT 73620 HC X-Ray Foot 2 Views	$397.80	$663.00	—	—	40%
X-ray of the foot, complete, 3 or more views CPT 73630 HC X-Ray Foot Min 3 Views Complete	$226.80	$378.00	—	26% below	40%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 HC X-Ray Foot Min 3 Views Complete	$477.00	$795.00	—	—	40%
X-ray of the hand, 3 or more views CPT 73130 HC Hand Routine Min 3 Views	$427.20	$712.00	—	31% above	40%
X-ray of the hand, 3 or more views inpatient CPT 73130 HC Hand Routine Min 3 Views	$900.00	$1,500.00	—	—	40%
X-ray of the knee, 1 or 2 views CPT 73560 HC X-Ray Knee 1-2 Views	$226.80	$378.00	—	17% below	40%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 HC X-Ray Knee 1-2 Views	$477.00	$795.00	—	—	40%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 HC L-Spine 2-3 Views	$252.00	$420.00	—	22% below	40%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 HC L-Spine 2-3 Views	$531.00	$885.00	—	—	40%
X-ray of the lower back, 4 or more views CPT 72110 HC L-Spine Min 4 Views	$293.40	$489.00	—	38% below	40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 HC L-Spine Min 4 Views	$617.40	$1,029.00	—	—	40%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 HC T-Spine 2 Views	$213.60	$356.00	—	29% below	40%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 HC T-Spine 2 Views	$450.00	$750.00	—	—	40%
X-ray of the nasal bones, 3 or more views CPT 70160 HC Nasal Bones Min 3 Views	$261.60	$436.00	—	10% below	40%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 HC Nasal Bones Min 3 Views	$551.40	$919.00	—	—	40%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 HC C-Spine 2-3 Views	$252.00	$420.00	—	25% below	40%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 HC C-Spine 2-3 Views	$531.00	$885.00	—	—	40%
X-ray of the pelvis, 1 or 2 views CPT 72170 HC Pelvis Ap Only	$196.20	$327.00	—	22% below	40%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 HC Pelvis Ap Only	$412.80	$688.00	—	—	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 HC Sacrum and Coccyx Min 2 Views	$213.60	$356.00	—	28% below	40%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 HC Sacrum and Coccyx Min 2 Views	$450.00	$750.00	—	—	40%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
ACTH blood test CPT 82024 HC Acth	$143.40	$239.00	—	9% above	40%
ACTH blood test CPT 82024 HC So Acth	$387.00	$645.00	—	193% above	40%
ACTH blood test inpatient CPT 82024 HC Acth	$143.40	$239.00	—	—	40%
ACTH blood test inpatient CPT 82024 HC So Acth	$387.00	$645.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC So Sgpt (Alt)	$46.80	$78.00	—	68% above	40%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 HC Sgpt (Alt)	$57.60	$96.00	—	106% above	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC So Sgpt (Alt)	$46.80	$78.00	—	—	40%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 HC Sgpt (Alt)	$57.60	$96.00	—	—	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC So Sgot (Ast)	$40.80	$68.00	—	62% above	40%
AST (aspartate aminotransferase) enzyme test CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$51.00	$85.00	—	102% above	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC So Sgot (Ast)	$40.80	$68.00	—	—	40%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 HC Transferase Aspartate Amino Ast Sgot	$51.00	$85.00	—	—	40%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 HC Acute Hepatitis Panel	$294.60	$491.00	—	35% above	40%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 HC Acute Hepatitis Panel	$294.60	$491.00	—	—	40%
Albumin blood test CPT 82040 HC Albumin	$42.00	$70.00	—	90% above	40%
Albumin blood test inpatient CPT 82040 HC Albumin	$42.00	$70.00	—	—	40%
Aldosterone blood test CPT 82088 HC So Aldosterone, Serum	$322.20	$537.00	—	130% above	40%
Aldosterone blood test CPT 82088 HC So Aldosterone, Serum	$322.20	$537.00	—	130% above	40%
Aldosterone blood test CPT 82088 HC Aldosterone, Serum	$391.80	$653.00	—	180% above	40%
Aldosterone blood test inpatient CPT 82088 HC So Aldosterone, Serum	$322.20	$537.00	—	—	40%
Aldosterone blood test inpatient CPT 82088 HC So Aldosterone, Serum	$322.20	$537.00	—	—	40%
Aldosterone blood test inpatient CPT 82088 HC Aldosterone, Serum	$391.80	$653.00	—	—	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC So Alkaline Phosphatase	$31.80	$53.00	—	32% above	40%
Alkaline phosphatase (ALP) blood test CPT 84075 HC Alkaline Phosphatase	$46.80	$78.00	—	95% above	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC So Alkaline Phosphatase	$31.80	$53.00	—	—	40%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 HC Alkaline Phosphatase	$46.80	$78.00	—	—	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So Allergen Specific	$36.00	$60.00	—	54% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC So1 Allergen Specific	$36.60	$61.00	—	56% above	40%
Allergy blood test, specific IgE, per allergen CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each	$36.60	$61.00	—	56% above	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So Allergen Specific	$36.00	$60.00	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC Allergen Spec Ige Crude Allergen Extract Each	$36.60	$61.00	—	—	40%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 HC So1 Allergen Specific	$36.60	$61.00	—	—	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC So Alpha Fetoprotein	$135.00	$225.00	—	123% above	40%
Alpha-fetoprotein (AFP) blood test CPT 82105 HC Alpha-Fetoprotein Serum	$135.00	$225.00	—	123% above	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC So Alpha Fetoprotein	$135.00	$225.00	—	—	40%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 HC Alpha-Fetoprotein Serum	$135.00	$225.00	—	—	40%
Ammonia blood test CPT 82140 HC So Ammonia	$149.40	$249.00	—	173% above	40%
Ammonia blood test CPT 82140 HC Ammonia	$165.60	$276.00	—	202% above	40%
Ammonia blood test inpatient CPT 82140 HC So Ammonia	$149.40	$249.00	—	—	40%
Ammonia blood test inpatient CPT 82140 HC Ammonia	$165.60	$276.00	—	—	40%
Amylase blood test CPT 82150 HC So Amylase	$87.00	$145.00	—	82% above	40%
Amylase blood test CPT 82150 HC Amylase	$112.80	$188.00	—	135% above	40%
Amylase blood test inpatient CPT 82150 HC So Amylase	$87.00	$145.00	—	—	40%
Amylase blood test inpatient CPT 82150 HC Amylase	$112.80	$188.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$374.40	$624.00	—	547% above	40%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$374.40	$624.00	—	547% above	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC Cyclic Citrullinated Peptide Antibody	$374.40	$624.00	—	—	40%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 HC So Cyclic Citrullinated Peptd,Ab	$374.40	$624.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC So Anti Nuclear Antibody	$168.60	$281.00	—	205% above	40%
Antinuclear antibody (ANA) blood test, screen CPT 86038 HC Antinuclear Antibodies Ana	$205.80	$343.00	—	272% above	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC So Anti Nuclear Antibody	$168.60	$281.00	—	—	40%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 HC Antinuclear Antibodies Ana	$205.80	$343.00	—	—	40%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 HC Natriuretic Peptide	$157.20	$262.00	—	5% above	40%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 HC Natriuretic Peptide	$157.20	$262.00	—	—	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 HC Culture, Aerobic	$116.40	$194.00	—	76% above	40%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 HC Culture, Aerobic	$116.40	$194.00	—	—	40%
Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel Calcium Total	$205.20	$342.00	—	213% above	40%
Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel Calcium Total	$205.20	$342.00	—	—	40%
Bilirubin blood test, total CPT 82247 HC So Bilirubin Total	$55.80	$93.00	—	133% above	40%
Bilirubin blood test, total CPT 82247 HC Bilirubin Total	$63.00	$105.00	—	163% above	40%
Bilirubin blood test, total inpatient CPT 82247 HC So Bilirubin Total	$55.80	$93.00	—	—	40%
Bilirubin blood test, total inpatient CPT 82247 HC Bilirubin Total	$63.00	$105.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC So Tissue Level IV	$249.60	$416.00	—	23% above	40%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 HC Tissue Level IV	$303.60	$506.00	—	49% above	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC So Tissue Level IV	$249.60	$416.00	—	—	40%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 HC Tissue Level IV	$303.60	$506.00	—	—	40%
Blood culture for bacteria CPT 87040 HC Culture Blood	$109.20	$182.00	—	17% above	40%
Blood culture for bacteria inpatient CPT 87040 HC Culture Blood	$109.20	$182.00	—	—	40%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Collection Venous Blood Venipuncture	$18.00	$30.00	—	13% above	40%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Collection Venous Blood Venipuncture	$18.00	$30.00	—	—	40%
Blood glucose (sugar) test CPT 82947 HC So Glucose	$37.20	$62.00	—	58% above	40%
Blood glucose (sugar) test CPT 82947 HC Glucose Quant, for Cmpk/Bmpk	$41.40	$69.00	—	76% above	40%
Blood glucose (sugar) test CPT 82947 HC Glucose, Fasting	$46.80	$78.00	—	98% above	40%
Blood glucose (sugar) test inpatient CPT 82947 HC So Glucose	$37.20	$62.00	—	—	40%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose Quant, for Cmpk/Bmpk	$41.40	$69.00	—	—	40%
Blood glucose (sugar) test inpatient CPT 82947 HC Glucose, Fasting	$46.80	$78.00	—	—	40%
Blood lead test CPT 83655 HC Assay of Lead	$103.20	$172.00	—	112% above	40%
Blood lead test CPT 83655 HC So Lead	$103.20	$172.00	—	112% above	40%
Blood lead test inpatient CPT 83655 HC Assay of Lead	$103.20	$172.00	—	—	40%
Blood lead test inpatient CPT 83655 HC So Lead	$103.20	$172.00	—	—	40%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$156.00	$260.00	—	186% above	40%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 HC Gonadotropin, Chorionic (Hcg) Qualitative	$156.00	$260.00	—	—	40%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 HC Blood Typing, Abo	$192.00	$320.00	—	223% above	40%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 HC Blood Typing, Abo	$192.00	$320.00	—	—	40%
Blood urea nitrogen (BUN) test CPT 84520 HC So Bun	$37.20	$62.00	—	59% above	40%
Blood urea nitrogen (BUN) test CPT 84520 HC Assay of Urea Nitrogen Quantitative	$40.80	$68.00	—	75% above	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC So Bun	$37.20	$62.00	—	—	40%
Blood urea nitrogen (BUN) test inpatient CPT 84520 HC Assay of Urea Nitrogen Quantitative	$40.80	$68.00	—	—	40%
C-peptide blood test CPT 84681 HC So Peptide,C	$133.80	$223.00	—	69% above	40%
C-peptide blood test CPT 84681 HC Assay of C-Peptide	$133.80	$223.00	—	69% above	40%
C-peptide blood test inpatient CPT 84681 HC So Peptide,C	$133.80	$223.00	—	—	40%
C-peptide blood test inpatient CPT 84681 HC Assay of C-Peptide	$133.80	$223.00	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC So Crp	$130.20	$217.00	—	159% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 HC C-Reactive Protein	$143.40	$239.00	—	185% above	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC So Crp	$130.20	$217.00	—	—	40%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 HC C-Reactive Protein	$143.40	$239.00	—	—	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$109.80	$183.00	—	16% below	40%
C. difficile toxin gene test (stool PCR) CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$210.60	$351.00	—	62% above	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC Inf Agent Det Nucleic Acid Clostridium Amp Probe	$109.80	$183.00	—	—	40%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 HC So Clost Diff,Toxin Gene,Amp Prbe	$210.60	$351.00	—	—	40%
CA 19-9 blood test (tumor marker) CPT 86301 HC Immunoassay Tumor Antigen Quantitative Ca 19-9	$261.60	$436.00	—	258% above	40%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 HC Immunoassay Tumor Antigen Quantitative Ca 19-9	$261.60	$436.00	—	—	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC So Ca 125	$42.60	$71.00	—	54% below	40%
CA-125 blood test (ovarian cancer marker) CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$248.40	$414.00	—	165% above	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC So Ca 125	$42.60	$71.00	—	—	40%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 HC Immunoassay Tumor Antigen Quantitative Ca 125	$248.40	$414.00	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$105.60	$176.00	—	25% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$116.40	$194.00	—	17% below	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC So Iadna Sars-Cov-2-19 Amp Probe Tq	$105.60	$176.00	—	—	40%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 HC Iadna Sars-Cov-2-19 Amp Probe Tq	$116.40	$194.00	—	—	40%
Calcium blood test, total CPT 82310 HC So Calcium,Serum	$45.60	$76.00	—	44% above	40%
Calcium blood test, total CPT 82310 HC Calcium Total	$55.20	$92.00	—	75% above	40%
Calcium blood test, total inpatient CPT 82310 HC So Calcium,Serum	$45.60	$76.00	—	—	40%
Calcium blood test, total inpatient CPT 82310 HC Calcium Total	$55.20	$92.00	—	—	40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC So Cea	$193.80	$323.00	—	123% above	40%
Carcinoembryonic antigen (CEA) test CPT 82378 HC Carcinoembryonic Antigen Cea	$213.60	$356.00	—	146% above	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC So Cea	$193.80	$323.00	—	—	40%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 HC Carcinoembryonic Antigen Cea	$213.60	$356.00	—	—	40%
Chickenpox (varicella) immunity blood test CPT 86787 HC So Varicella Igg Igm	$118.20	$197.00	—	104% above	40%
Chickenpox (varicella) immunity blood test CPT 86787 HC Antibody Varicella-Zoster	$140.40	$234.00	—	143% above	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC So Varicella Igg Igm	$118.20	$197.00	—	—	40%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 HC Antibody Varicella-Zoster	$140.40	$234.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC So2 Chylmd Trach Dna Amp Probe	$71.40	$119.00	—	23% below	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC Chlamydia Amp Probe Tech, 1	$262.20	$437.00	—	184% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 HC So Chylmd Trach Dna Amp Probe	$262.20	$437.00	—	184% above	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC So2 Chylmd Trach Dna Amp Probe	$71.40	$119.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC So Chylmd Trach Dna Amp Probe	$262.20	$437.00	—	—	40%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 HC Chlamydia Amp Probe Tech, 1	$262.20	$437.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel	$141.60	$236.00	—	168% above	40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC So Lipid Panel	$160.20	$267.00	—	203% above	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel	$141.60	$236.00	—	—	40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC So Lipid Panel	$160.20	$267.00	—	—	40%
Complete blood count (CBC) with differential CPT 85025 HC Cbc	$99.60	$166.00	—	174% above	40%
Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc	$99.60	$166.00	—	—	40%
Complete blood count (CBC), no differential CPT 85027 HC Cbc (Hemogram)	$63.60	$106.00	—	88% above	40%
Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc (Hemogram)	$63.60	$106.00	—	—	40%
Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel	$174.00	$290.00	—	174% above	40%
Comprehensive metabolic panel (blood test) CPT 80053 HC So Comp Metabolic Panel	$178.80	$298.00	—	181% above	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel	$174.00	$290.00	—	—	40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC So Comp Metabolic Panel	$178.80	$298.00	—	—	40%
Cortisol blood test, total CPT 82533 HC So Cortisol,Serum	$34.80	$58.00	—	52% below	40%
Cortisol blood test, total CPT 82533 HC Cortisol Total	$163.20	$272.00	—	125% above	40%
Cortisol blood test, total inpatient CPT 82533 HC So Cortisol,Serum	$34.80	$58.00	—	—	40%
Cortisol blood test, total inpatient CPT 82533 HC Cortisol Total	$163.20	$272.00	—	—	40%
Creatine kinase (CK) blood test, total CPT 82550 HC Creatine Kinase Total	$94.80	$158.00	—	168% above	40%
Creatine kinase (CK) blood test, total inpatient CPT 82550 HC Creatine Kinase Total	$94.80	$158.00	—	—	40%
Creatinine blood test CPT 82565 HC Creatinine,Serum	$40.80	$68.00	—	65% above	40%
Creatinine blood test inpatient CPT 82565 HC Creatinine,Serum	$40.80	$68.00	—	—	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC So Cytomegalovirus, Igg Antibody	$158.40	$264.00	—	131% above	40%
Cytomegalovirus (CMV) antibody test CPT 86644 HC Antibody Cytomegalovirus Cmv	$158.40	$264.00	—	131% above	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC Antibody Cytomegalovirus Cmv	$158.40	$264.00	—	—	40%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 HC So Cytomegalovirus, Igg Antibody	$158.40	$264.00	—	—	40%
D-dimer blood test (blood clot marker) CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$148.80	$248.00	—	114% above	40%
D-dimer blood test (blood clot marker) inpatient CPT 85379 HC Fibrin Dgradj Products D-Dimer Quantitative	$148.80	$248.00	—	—	40%
DHEA sulfate (DHEA-S) blood test CPT 82627 HC So Dhea Sulfate	$172.80	$288.00	—	74% above	40%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 HC So Dhea Sulfate	$172.80	$288.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$133.80	$223.00	—	40% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$148.20	$247.00	—	55% above	40%
Drug screen by lab instrument (any number of drug classes) CPT 80307 HC So Drg Scrn Class List A	$309.60	$516.00	—	224% above	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Test Prsmv Chem Anlyzr	$133.80	$223.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC Drug Tst Prsmv Instrmnt Chem Analyzers PR Date	$148.20	$247.00	—	—	40%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 HC So Drg Scrn Class List A	$309.60	$516.00	—	—	40%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 HC Electrolyte Panel	$146.40	$244.00	—	207% above	40%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 HC Electrolyte Panel	$146.40	$244.00	—	—	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$147.60	$246.00	—	127% above	40%
Epstein-Barr virus (EBV) antibody test CPT 86665 HC So Epstein-Barr Virus Vca	$147.60	$246.00	—	127% above	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC Antibody Epstein-Barr Eb Virus Viral Capsid Vca	$147.60	$246.00	—	—	40%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 HC So Epstein-Barr Virus Vca	$147.60	$246.00	—	—	40%
Estradiol blood test CPT 82670 HC Assay of Total Estradiol	$123.60	$206.00	—	10% above	40%
Estradiol blood test CPT 82670 HC So Estradiol	$123.60	$206.00	—	10% above	40%
Estradiol blood test inpatient CPT 82670 HC Assay of Total Estradiol	$123.60	$206.00	—	—	40%
Estradiol blood test inpatient CPT 82670 HC So Estradiol	$123.60	$206.00	—	—	40%
FSH (follicle-stimulating hormone) test CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$189.60	$316.00	—	121% above	40%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 HC Gonadotropin Follicle Stimulating Hormone	$189.60	$316.00	—	—	40%
Fecal calprotectin (stool inflammation test) CPT 83993 HC So Calprotectin Fecal	$107.40	$179.00	—	28% below	40%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 HC So Calprotectin Fecal	$107.40	$179.00	—	—	40%
Ferritin blood test (iron stores) CPT 82728 HC So Ferritin	$99.60	$166.00	—	31% above	40%
Ferritin blood test (iron stores) CPT 82728 HC Assay of Ferritin	$123.00	$205.00	—	62% above	40%
Ferritin blood test (iron stores) inpatient CPT 82728 HC So Ferritin	$99.60	$166.00	—	—	40%
Ferritin blood test (iron stores) inpatient CPT 82728 HC Assay of Ferritin	$123.00	$205.00	—	—	40%
Fibrinogen blood test CPT 85384 HC So Fibrinogen	$87.00	$145.00	—	93% above	40%
Fibrinogen blood test CPT 85384 HC Fibrinogen Activity	$87.00	$145.00	—	93% above	40%
Fibrinogen blood test inpatient CPT 85384 HC So Fibrinogen	$87.00	$145.00	—	—	40%
Fibrinogen blood test inpatient CPT 85384 HC Fibrinogen Activity	$87.00	$145.00	—	—	40%
Folate (folic acid) blood test CPT 82746 HC Assay of Folic Acid Serum	$157.80	$263.00	—	134% above	40%
Folate (folic acid) blood test inpatient CPT 82746 HC Assay of Folic Acid Serum	$157.80	$263.00	—	—	40%
Free T3 thyroid hormone test CPT 84481 HC So Triiodothyronine T-3, Free	$171.60	$286.00	—	126% above	40%
Free T3 thyroid hormone test CPT 84481 HC Assay of Triiodothyronine T3 Free	$189.00	$315.00	—	149% above	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC So Triiodothyronine T-3, Free	$171.60	$286.00	—	—	40%
Free T3 thyroid hormone test inpatient CPT 84481 HC Assay of Triiodothyronine T3 Free	$189.00	$315.00	—	—	40%
Free T4 (free thyroxine) thyroid blood test CPT 84439 HC Assay of Free Thyroxine	$133.80	$223.00	—	215% above	40%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 HC Assay of Free Thyroxine	$133.80	$223.00	—	—	40%
Free testosterone test CPT 84402 HC So Testosterone Free	$213.60	$356.00	—	120% above	40%
Free testosterone test CPT 84402 HC Assay of Testosterone Free	$213.60	$356.00	—	120% above	40%
Free testosterone test inpatient CPT 84402 HC Assay of Testosterone Free	$213.60	$356.00	—	—	40%
Free testosterone test inpatient CPT 84402 HC So Testosterone Free	$213.60	$356.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC So Ggtp	$80.40	$134.00	—	89% above	40%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 HC Assay of Glutamyltrase Gamma	$89.40	$149.00	—	110% above	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC So Ggtp	$80.40	$134.00	—	—	40%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 HC Assay of Glutamyltrase Gamma	$89.40	$149.00	—	—	40%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 HC General Health Panel	$317.40	$529.00	—	43% above	40%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 HC General Health Panel	$317.40	$529.00	—	—	40%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 HC Glucose Post Glucose Dose	$79.20	$132.00	—	106% above	40%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 HC Glucose Post Glucose Dose	$79.20	$132.00	—	—	40%
Glucose tolerance test, 3 samples CPT 82951 HC Glucose Tolerance Test	$137.40	$229.00	—	104% above	40%
Glucose tolerance test, 3 samples inpatient CPT 82951 HC Glucose Tolerance Test	$137.40	$229.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC So1 N.Gonorrhea, Dna, Amp Probe	$71.40	$119.00	—	23% below	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$205.20	$342.00	—	121% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$205.20	$342.00	—	121% above	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC So1 N.Gonorrhea, Dna, Amp Probe	$71.40	$119.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC N.Gonorrhea, Dna, Amp Probe	$205.20	$342.00	—	—	40%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 HC So N Gonorrhoeae Dna Amp Prob	$205.20	$342.00	—	—	40%
H. pylori antibody blood test CPT 86677 HC So H.Pylori. Serum	$301.80	$503.00	—	300% above	40%
H. pylori antibody blood test CPT 86677 HC Antibody Helicobacter Pylori	$301.80	$503.00	—	300% above	40%
H. pylori antibody blood test inpatient CPT 86677 HC So H.Pylori. Serum	$301.80	$503.00	—	—	40%
H. pylori antibody blood test inpatient CPT 86677 HC Antibody Helicobacter Pylori	$301.80	$503.00	—	—	40%
H. pylori stool antigen test CPT 87338 HC So H.Pylori Stool Antigen	$100.80	$168.00	—	44% above	40%
H. pylori stool antigen test CPT 87338 HC Iaad Ia Hpylori Stool	$100.80	$168.00	—	44% above	40%
H. pylori stool antigen test inpatient CPT 87338 HC So H.Pylori Stool Antigen	$100.80	$168.00	—	—	40%
H. pylori stool antigen test inpatient CPT 87338 HC Iaad Ia Hpylori Stool	$100.80	$168.00	—	—	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC So Hiv-1, Quantification	$622.20	$1,037.00	—	74% above	40%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 HC Iadna Hiv-1 Quant & Reverse Transcription	$622.20	$1,037.00	—	74% above	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC Iadna Hiv-1 Quant & Reverse Transcription	$622.20	$1,037.00	—	—	40%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 HC So Hiv-1, Quantification	$622.20	$1,037.00	—	—	40%
HIV-1 and HIV-2 antibody test CPT 86703 HC Antibody Hiv-1&Hiv-2 Single Result	$114.00	$190.00	—	85% above	40%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HC Antibody Hiv-1&Hiv-2 Single Result	$114.00	$190.00	—	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC So Hiv-1 & Hiv-2 Ab	$31.80	$53.00	—	57% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$54.00	$90.00	—	27% below	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC So Hiv-1 & Hiv-2 Ab	$31.80	$53.00	—	—	40%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HC Iaad Ia Hiv-1 Ag W/Hiv-1 & Hiv-2 Antbdy Single	$54.00	$90.00	—	—	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC So Hpv Dna Amp Probe	$139.80	$233.00	—	18% above	40%
HPV test for high-risk types, one combined (pooled) result CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$139.80	$233.00	—	18% above	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC So Hpv Dna Amp Probe	$139.80	$233.00	—	—	40%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 HC Iadna Human Papillomavirus Hi-Rsk Typ Poold Rslt	$139.80	$233.00	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC Hemoglobin Glycosylated A1c	$108.60	$181.00	—	138% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HC So Glycohemoglobin	$113.40	$189.00	—	149% above	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC Hemoglobin Glycosylated A1c	$108.60	$181.00	—	—	40%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 HC So Glycohemoglobin	$113.40	$189.00	—	—	40%
Hemoglobin blood test CPT 85018 HC Blood Count Hemoglobin	$124.20	$207.00	—	667% above	40%
Hemoglobin blood test inpatient CPT 85018 HC Blood Count Hemoglobin	$124.20	$207.00	—	—	40%
Hepatitis B core antibody test (total) CPT 86704 HC Hepatitis B Core Antibody Hbcab Total	$205.80	$343.00	—	281% above	40%
Hepatitis B core antibody test (total) inpatient CPT 86704 HC Hepatitis B Core Antibody Hbcab Total	$205.80	$343.00	—	—	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$220.80	$368.00	—	357% above	40%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 HC Hepatitis B Surf Antibody Hbsab	$220.80	$368.00	—	—	40%
Hepatitis B surface antigen (HBsAg) test CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$193.20	$322.00	—	308% above	40%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 HC Iaad Ia Hepatitis B Surface Antigen	$193.20	$322.00	—	—	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC So Hepatitis C Virus Antibody	$136.80	$228.00	—	114% above	40%
Hepatitis C antibody blood test (screening) CPT 86803 HC Hepatitis C Antibody	$166.80	$278.00	—	161% above	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC So Hepatitis C Virus Antibody	$136.80	$228.00	—	—	40%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 HC Hepatitis C Antibody	$166.80	$278.00	—	—	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So1 Hcv Ultraquant	$656.40	$1,094.00	—	241% above	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC So Hcv Ultraquant	$656.40	$1,094.00	—	241% above	40%
Hepatitis C viral load (HCV RNA) test CPT 87522 HC Iadna Hepatitis C Quant & Reverse Transcription	$656.40	$1,094.00	—	241% above	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So Hcv Ultraquant	$656.40	$1,094.00	—	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC So1 Hcv Ultraquant	$656.40	$1,094.00	—	—	40%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 HC Iadna Hepatitis C Quant & Reverse Transcription	$656.40	$1,094.00	—	—	40%
Herpes blood test, HSV-1 antibody CPT 86695 HC Antibody Herpes Smplx Type 1	$84.60	$141.00	—	43% above	40%
Herpes blood test, HSV-1 antibody CPT 86695 HC So Herpes Simplex, Type 1	$172.80	$288.00	—	192% above	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC Antibody Herpes Smplx Type 1	$84.60	$141.00	—	—	40%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 HC So Herpes Simplex, Type 1	$172.80	$288.00	—	—	40%
Herpes blood test, HSV-2 antibody CPT 86696 HC Antibody Herpes Smplx Type 2	$84.60	$141.00	—	28% above	40%
Herpes blood test, HSV-2 antibody CPT 86696 HC So Herpes Simplex, Type 2	$84.60	$141.00	—	28% above	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC So Herpes Simplex, Type 2	$84.60	$141.00	—	—	40%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 HC Antibody Herpes Smplx Type 2	$84.60	$141.00	—	—	40%
High-sensitivity CRP (hs-CRP) test CPT 86141 HC C-Reactive Protein High Sensitivity	$143.40	$239.00	—	112% above	40%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 HC C-Reactive Protein High Sensitivity	$143.40	$239.00	—	—	40%
Homocysteine blood test CPT 83090 HC So Homocystine	$246.60	$411.00	—	206% above	40%
Homocysteine blood test CPT 83090 HC Assay of Homocysteine	$300.60	$501.00	—	273% above	40%
Homocysteine blood test inpatient CPT 83090 HC So Homocystine	$246.60	$411.00	—	—	40%
Homocysteine blood test inpatient CPT 83090 HC Assay of Homocysteine	$300.60	$501.00	—	—	40%
Insulin blood test CPT 83525 HC So Insulin	$29.40	$49.00	—	43% below	40%
Insulin blood test CPT 83525 HC Assay of Insulin Total	$29.40	$49.00	—	43% below	40%
Insulin blood test inpatient CPT 83525 HC Assay of Insulin Total	$29.40	$49.00	—	—	40%
Insulin blood test inpatient CPT 83525 HC So Insulin	$29.40	$49.00	—	—	40%
Iron blood test (serum iron) CPT 83540 HC So Iron	$52.20	$87.00	—	37% above	40%
Iron blood test (serum iron) CPT 83540 HC Assay of Iron	$64.20	$107.00	—	69% above	40%
Iron blood test (serum iron) inpatient CPT 83540 HC So Iron	$52.20	$87.00	—	—	40%
Iron blood test (serum iron) inpatient CPT 83540 HC Assay of Iron	$64.20	$107.00	—	—	40%
Iron-binding capacity (TIBC) test CPT 83550 HC Iron Binding Capacity	$79.80	$133.00	—	105% above	40%
Iron-binding capacity (TIBC) test inpatient CPT 83550 HC Iron Binding Capacity	$79.80	$133.00	—	—	40%
Kidney function blood test panel CPT 80069 HC Renal Function Panel	$174.60	$291.00	—	143% above	40%
Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel	$174.60	$291.00	—	—	40%
LH (luteinizing hormone) test CPT 83002 HC Gonadotropin Luteinizing Hormone	$192.60	$321.00	—	102% above	40%
LH (luteinizing hormone) test inpatient CPT 83002 HC Gonadotropin Luteinizing Hormone	$192.60	$321.00	—	—	40%
Lactate (lactic acid) blood test CPT 83605 HC Assay of Lactate	$108.60	$181.00	—	109% above	40%
Lactate (lactic acid) blood test CPT 83605 HC So Lactic Acid	$122.40	$204.00	—	135% above	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Assay of Lactate	$108.60	$181.00	—	—	40%
Lactate (lactic acid) blood test inpatient CPT 83605 HC So Lactic Acid	$122.40	$204.00	—	—	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC So Ldh	$62.40	$104.00	—	129% above	40%
Lactate dehydrogenase (LDH) blood test CPT 83615 HC Lactate Dehydrogenase Ldh	$76.80	$128.00	—	181% above	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC So Ldh	$62.40	$104.00	—	—	40%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 HC Lactate Dehydrogenase Ldh	$76.80	$128.00	—	—	40%
Lipase blood test (pancreas enzyme) CPT 83690 HC Assay of Lipase	$84.60	$141.00	—	45% above	40%
Lipase blood test (pancreas enzyme) CPT 83690 HC So Lipase	$95.40	$159.00	—	64% above	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC Assay of Lipase	$84.60	$141.00	—	—	40%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 HC So Lipase	$95.40	$159.00	—	—	40%
Liver function blood test panel CPT 80076 HC Hepatic Function Panel	$106.20	$177.00	—	75% above	40%
Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel	$106.20	$177.00	—	—	40%
Lyme disease antibody test CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$234.60	$391.00	—	206% above	40%
Lyme disease antibody test CPT 86618 HC So Lyme Disease Total Anitbodies	$234.60	$391.00	—	206% above	40%
Lyme disease antibody test inpatient CPT 86618 HC So Lyme Disease Total Anitbodies	$234.60	$391.00	—	—	40%
Lyme disease antibody test inpatient CPT 86618 HC Antibody Borrelia Burgdorferi Lyme Disease	$234.60	$391.00	—	—	40%
Magnesium blood test CPT 83735 HC Assay of Magnesium	$76.20	$127.00	—	126% above	40%
Magnesium blood test CPT 83735 HC So Magnesium	$78.00	$130.00	—	131% above	40%
Magnesium blood test inpatient CPT 83735 HC Assay of Magnesium	$76.20	$127.00	—	—	40%
Magnesium blood test inpatient CPT 83735 HC So Magnesium	$78.00	$130.00	—	—	40%
Measles (rubeola) antibody test CPT 86765 HC Antibody Rubeola	$150.60	$251.00	—	164% above	40%
Measles (rubeola) antibody test CPT 86765 HC So Rubeola Igg / Igm	$150.60	$251.00	—	164% above	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC So Rubeola Igg / Igm	$150.60	$251.00	—	—	40%
Measles (rubeola) antibody test inpatient CPT 86765 HC Antibody Rubeola	$150.60	$251.00	—	—	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC Mono Spot Test,Agglutination	$10.20	$17.00	—	81% below	40%
Mono test (heterophile antibody, Monospot) CPT 86308 HC So Mono Antibody	$10.20	$17.00	—	81% below	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC Mono Spot Test,Agglutination	$10.20	$17.00	—	—	40%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 HC So Mono Antibody	$10.20	$17.00	—	—	40%
Mumps immunity blood test CPT 86735 HC Antibody Mumps	$112.80	$188.00	—	93% above	40%
Mumps immunity blood test CPT 86735 HC So Antibody; Mumps	$112.80	$188.00	—	93% above	40%
Mumps immunity blood test inpatient CPT 86735 HC Antibody Mumps	$112.80	$188.00	—	—	40%
Mumps immunity blood test inpatient CPT 86735 HC So Antibody; Mumps	$112.80	$188.00	—	—	40%
Obstetric blood test panel CPT 80055 HC Obstetric Panel	$187.80	$313.00	—	12% below	40%
Obstetric blood test panel inpatient CPT 80055 HC Obstetric Panel	$187.80	$313.00	—	—	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC Assay of Prostate Specific Antigen Free	$117.00	$195.00	—	42% above	40%
PSA (prostate-specific antigen) blood test, free CPT 84154 HC So Prostate Specific Antigen/Free	$136.20	$227.00	—	65% above	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Assay of Prostate Specific Antigen Free	$117.00	$195.00	—	—	40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC So Prostate Specific Antigen/Free	$136.20	$227.00	—	—	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC So Assay of Psa Total	$111.60	$186.00	—	41% above	40%
PSA (prostate-specific antigen) blood test, total CPT 84153 HC Assay of Prostate Specific Antigen Total	$136.20	$227.00	—	72% above	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC So Assay of Psa Total	$111.60	$186.00	—	—	40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Assay of Prostate Specific Antigen Total	$136.20	$227.00	—	—	40%
Pap test (liquid-based, automated screening with review) CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$92.40	$154.00	—	5% below	40%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 HC Cytp C/V Auto Thin Lyr Prepj Scr Mnl Rescr Phys	$92.40	$154.00	—	—	40%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$211.20	$352.00	—	132% above	40%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 HC Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen	$211.20	$352.00	—	—	40%
Parathyroid hormone (PTH) blood test CPT 83970 HC So Parathyroid Hormone	$314.40	$524.00	—	122% above	40%
Parathyroid hormone (PTH) blood test CPT 83970 HC Assay of Parathormone	$314.40	$524.00	—	122% above	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC Assay of Parathormone	$314.40	$524.00	—	—	40%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 HC So Parathyroid Hormone	$314.40	$524.00	—	—	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC So1 Ptt	$28.80	$48.00	—	23% below	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC So Ptt	$65.40	$109.00	—	74% above	40%
Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt	$79.80	$133.00	—	113% above	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC So1 Ptt	$28.80	$48.00	—	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC So Ptt	$65.40	$109.00	—	—	40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Ptt	$79.80	$133.00	—	—	40%
Phosphorus (phosphate) blood test CPT 84100 HC Assay of Phosphorus Inorganic	$57.00	$95.00	—	59% above	40%
Phosphorus (phosphate) blood test inpatient CPT 84100 HC Assay of Phosphorus Inorganic	$57.00	$95.00	—	—	40%
Potassium blood test CPT 84132 HC So Potassium	$36.00	$60.00	—	54% above	40%
Potassium blood test CPT 84132 HC Potassium Serum Plasma/Whole Blood	$39.60	$66.00	—	70% above	40%
Potassium blood test inpatient CPT 84132 HC So Potassium	$36.00	$60.00	—	—	40%
Potassium blood test inpatient CPT 84132 HC Potassium Serum Plasma/Whole Blood	$39.60	$66.00	—	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC So Fetal Chrmoml Aneuploidy	$616.80	$1,028.00	—	58% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 HC So1 Fetal Chrmoml Aneuploidy	$616.80	$1,028.00	—	58% below	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC So Fetal Chrmoml Aneuploidy	$616.80	$1,028.00	—	—	40%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 HC So1 Fetal Chrmoml Aneuploidy	$616.80	$1,028.00	—	—	40%
Progesterone blood test CPT 84144 HC So Progesterone	$81.00	$135.00	—	at median	40%
Progesterone blood test CPT 84144 HC Assay of Progesterone	$81.00	$135.00	—	at median	40%
Progesterone blood test inpatient CPT 84144 HC Assay of Progesterone	$81.00	$135.00	—	—	40%
Progesterone blood test inpatient CPT 84144 HC So Progesterone	$81.00	$135.00	—	—	40%
Prolactin blood test CPT 84146 HC So Prolactin	$132.60	$221.00	—	52% above	40%
Prolactin blood test CPT 84146 HC Assay of Prolactin	$210.00	$350.00	—	141% above	40%
Prolactin blood test inpatient CPT 84146 HC So Prolactin	$132.60	$221.00	—	—	40%
Prolactin blood test inpatient CPT 84146 HC Assay of Prolactin	$210.00	$350.00	—	—	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC So Prothrombin Time	$55.20	$92.00	—	130% above	40%
Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time	$67.20	$112.00	—	179% above	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC So Prothrombin Time	$55.20	$92.00	—	—	40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time	$67.20	$112.00	—	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC Drug Test Prsmv Read Direct Optical Obs PR Date	$46.80	$78.00	—	19% below	40%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 HC So Drug Test Prsmv Dir Optical Obs	$107.40	$179.00	—	86% above	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC Drug Test Prsmv Read Direct Optical Obs PR Date	$46.80	$78.00	—	—	40%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 HC So Drug Test Prsmv Dir Optical Obs	$107.40	$179.00	—	—	40%
Rapid flu test (influenza antigen) CPT 87804 HC Iaadiadoo Influenza	$91.20	$152.00	—	39% above	40%
Rapid flu test (influenza antigen) inpatient CPT 87804 HC Iaadiadoo Influenza	$91.20	$152.00	—	—	40%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 HC Iaadiadoo Streptococcus Group A	$111.60	$186.00	—	95% above	40%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 HC Iaadiadoo Streptococcus Group A	$111.60	$186.00	—	—	40%
Renin blood test CPT 84244 HC So Renin	$177.60	$296.00	—	108% above	40%
Renin blood test inpatient CPT 84244 HC So Renin	$177.60	$296.00	—	—	40%
Rh blood typing CPT 86901 HC Blood Typing, Rh(D)	$37.20	$62.00	—	at median	40%
Rh blood typing inpatient CPT 86901 HC Blood Typing, Rh(D)	$37.20	$62.00	—	—	40%
Rheumatoid factor (RF) test CPT 86431 HC So Ra Titer, Quantitative	$12.00	$20.00	—	64% below	40%
Rheumatoid factor (RF) test CPT 86431 HC Rheumatoid Factor Quantitative	$139.80	$233.00	—	322% above	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC So Ra Titer, Quantitative	$12.00	$20.00	—	—	40%
Rheumatoid factor (RF) test inpatient CPT 86431 HC Rheumatoid Factor Quantitative	$139.80	$233.00	—	—	40%
Rubella antibody test (immunity check) CPT 86762 HC So Rubella Latex Test	$158.40	$264.00	—	222% above	40%
Rubella antibody test (immunity check) CPT 86762 HC Antibody Rubella	$193.20	$322.00	—	293% above	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC So Rubella Latex Test	$158.40	$264.00	—	—	40%
Rubella antibody test (immunity check) inpatient CPT 86762 HC Antibody Rubella	$193.20	$322.00	—	—	40%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 HC Sed Rate	$30.60	$51.00	—	19% below	40%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 HC Sed Rate	$30.60	$51.00	—	—	40%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 HC Semen Analysis Complete	$264.60	$441.00	—	99% above	40%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 HC Semen Analysis Complete	$264.60	$441.00	—	—	40%
Sodium blood test CPT 84295 HC Sodium Serum Plasma or Whole Blood	$48.00	$80.00	—	76% above	40%
Sodium blood test inpatient CPT 84295 HC Sodium Serum Plasma or Whole Blood	$48.00	$80.00	—	—	40%
Stool ova and parasites exam CPT 87177 HC So1 Ova & Parasites	$66.00	$110.00	—	66% above	40%
Stool ova and parasites exam CPT 87177 HC Ova and Parasites	$111.60	$186.00	—	181% above	40%
Stool ova and parasites exam CPT 87177 HC So Ova and Parasites	$121.80	$203.00	—	207% above	40%
Stool ova and parasites exam inpatient CPT 87177 HC So1 Ova & Parasites	$66.00	$110.00	—	—	40%
Stool ova and parasites exam inpatient CPT 87177 HC Ova and Parasites	$111.60	$186.00	—	—	40%
Stool ova and parasites exam inpatient CPT 87177 HC So Ova and Parasites	$121.80	$203.00	—	—	40%
Stool test for hidden blood (guaiac FOBT) CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$41.40	$69.00	—	44% above	40%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 HC Blood Occult Peroxidase Actv Qual Feces 1 Deter	$41.40	$69.00	—	—	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$37.20	$62.00	—	31% below	40%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 HC So Occult Blood Fecal	$96.60	$161.00	—	80% above	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC Blood Occult Fecal Hgb Deter Ia Qual Feces 1-3	$37.20	$62.00	—	—	40%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 HC So Occult Blood Fecal	$96.60	$161.00	—	—	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC Antibody Treponema Pallidum	$170.40	$284.00	—	194% above	40%
Syphilis antibody test (Treponema pallidum) CPT 86780 HC So Fta-Abs	$170.40	$284.00	—	194% above	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC So Fta-Abs	$170.40	$284.00	—	—	40%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 HC Antibody Treponema Pallidum	$170.40	$284.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC So Vdrl / Rpr	$95.40	$159.00	—	300% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$115.80	$193.00	—	386% above	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC So Vdrl / Rpr	$95.40	$159.00	—	—	40%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 HC Syphilis Test Non-Treponemal Antibody Qual	$115.80	$193.00	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC TB Cell Mediated Antign Respnse Gamma Interferon	$93.00	$155.00	—	21% below	40%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 HC So TB Test, Cell Immun Measure	$126.60	$211.00	—	8% above	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC TB Cell Mediated Antign Respnse Gamma Interferon	$93.00	$155.00	—	—	40%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 HC So TB Test, Cell Immun Measure	$126.60	$211.00	—	—	40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC So Testosterone Total	$166.80	$278.00	—	81% above	40%
Testosterone blood test, total (not free testosterone) CPT 84403 HC Assay of Testosterone Total	$213.60	$356.00	—	132% above	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC So Testosterone Total	$166.80	$278.00	—	—	40%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 HC Assay of Testosterone Total	$213.60	$356.00	—	—	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC So Microsomal Antibody	$163.80	$273.00	—	152% above	40%
Thyroid peroxidase (TPO) antibody test CPT 86376 HC Microsomal Antibodies Each	$163.80	$273.00	—	152% above	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC So Microsomal Antibody	$163.80	$273.00	—	—	40%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 HC Microsomal Antibodies Each	$163.80	$273.00	—	—	40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone	$130.80	$218.00	—	74% above	40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone	$130.80	$218.00	—	—	40%
Total IgE blood test CPT 82785 HC Assay of Gammaglobulin Ige	$292.20	$487.00	—	371% above	40%
Total IgE blood test CPT 82785 HC So Immunoglobulin,Ige	$292.20	$487.00	—	371% above	40%
Total IgE blood test inpatient CPT 82785 HC So Immunoglobulin,Ige	$292.20	$487.00	—	—	40%
Total IgE blood test inpatient CPT 82785 HC Assay of Gammaglobulin Ige	$292.20	$487.00	—	—	40%
Total cholesterol blood test CPT 82465 HC Cholesterol Serum/Whole Blood Total	$79.20	$132.00	—	116% above	40%
Total cholesterol blood test inpatient CPT 82465 HC Cholesterol Serum/Whole Blood Total	$79.20	$132.00	—	—	40%
Total thyroxine (T4) blood test CPT 84436 HC So Thyroxine Total	$13.80	$23.00	—	67% below	40%
Total thyroxine (T4) blood test CPT 84436 HC Assay of Thyroxine Total	$76.80	$128.00	—	84% above	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC So Thyroxine Total	$13.80	$23.00	—	—	40%
Total thyroxine (T4) blood test inpatient CPT 84436 HC Assay of Thyroxine Total	$76.80	$128.00	—	—	40%
Total triiodothyronine (T3) blood test CPT 84480 HC So T-3 by Ria,Total	$28.80	$48.00	—	52% below	40%
Total triiodothyronine (T3) blood test CPT 84480 HC Assay of Triiodothyronine T3 Total Tt3	$205.80	$343.00	—	242% above	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC So T-3 by Ria,Total	$28.80	$48.00	—	—	40%
Total triiodothyronine (T3) blood test inpatient CPT 84480 HC Assay of Triiodothyronine T3 Total Tt3	$205.80	$343.00	—	—	40%
Transferrin blood test CPT 84466 HC So Transferrin	$155.40	$259.00	—	110% above	40%
Transferrin blood test CPT 84466 HC Assay of L7383transferrin	$155.40	$259.00	—	110% above	40%
Transferrin blood test inpatient CPT 84466 HC Assay of L7383transferrin	$155.40	$259.00	—	—	40%
Transferrin blood test inpatient CPT 84466 HC So Transferrin	$155.40	$259.00	—	—	40%
Trichomonas test (NAAT) CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$52.20	$87.00	—	40% below	40%
Trichomonas test (NAAT) CPT 87661 HC So Trichomonas Vaginalis Amplif	$52.20	$87.00	—	40% below	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC So Trichomonas Vaginalis Amplif	$52.20	$87.00	—	—	40%
Trichomonas test (NAAT) inpatient CPT 87661 HC Iadna Trichomonas Vaginalis Amplified Probe Tech	$52.20	$87.00	—	—	40%
Triglycerides blood test CPT 84478 HC Assay of Triglycerides	$107.40	$179.00	—	212% above	40%
Triglycerides blood test inpatient CPT 84478 HC Assay of Triglycerides	$107.40	$179.00	—	—	40%
Troponin test, quantitative CPT 84484 HC Assay of Troponin Quantitative	$129.60	$216.00	—	54% above	40%
Troponin test, quantitative inpatient CPT 84484 HC Assay of Troponin Quantitative	$129.60	$216.00	—	—	40%
Uric acid blood test CPT 84550 HC Assay of Blood/Uric Acid	$64.20	$107.00	—	82% above	40%
Uric acid blood test inpatient CPT 84550 HC Assay of Blood/Uric Acid	$64.20	$107.00	—	—	40%
Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis W/ Microscopy	$54.60	$91.00	—	102% above	40%
Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis W/ Microscopy	$54.60	$91.00	—	—	40%
Urinalysis with microscope exam, manual CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$52.20	$87.00	—	187% above	40%
Urinalysis with microscope exam, manual inpatient CPT 81000 HC Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy	$52.20	$87.00	—	—	40%
Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis, Auto, W/O Scope	$39.60	$66.00	—	69% above	40%
Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis, Auto, W/O Scope	$39.60	$66.00	—	—	40%
Urinalysis without microscope exam, manual CPT 81002 HC Non-Auto,Urine W/O Microscopy	$37.80	$63.00	—	133% above	40%
Urinalysis without microscope exam, manual inpatient CPT 81002 HC Non-Auto,Urine W/O Microscopy	$37.80	$63.00	—	—	40%
Urine culture for bacteria, with colony count CPT 87086 HC Urine Cult./Colony Count	$120.60	$201.00	—	112% above	40%
Urine culture for bacteria, with colony count inpatient CPT 87086 HC Urine Cult./Colony Count	$120.60	$201.00	—	—	40%
Urine microalbumin (albumin) test CPT 82043 HC Urine,Microalbumin,Quantitativ	$96.00	$160.00	—	89% above	40%
Urine microalbumin (albumin) test inpatient CPT 82043 HC Urine,Microalbumin,Quantitativ	$96.00	$160.00	—	—	40%
Urine pregnancy test, read by color change CPT 81025 HC Hcg (Urine) Pregnancy Test	$105.60	$176.00	—	117% above	40%
Urine pregnancy test, read by color change inpatient CPT 81025 HC Hcg (Urine) Pregnancy Test	$105.60	$176.00	—	—	40%
Vitamin B12 (cobalamin) blood test CPT 82607 HC Cyanocobalamin Vitamin B-12	$156.60	$261.00	—	110% above	40%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 HC Cyanocobalamin Vitamin B-12	$156.60	$261.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$67.80	$113.00	—	28% below	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC So1 Vit D 25 Hydroxy W/Frac	$222.00	$370.00	—	135% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 HC So Vitamin D Hydroxyvitamin D	$364.80	$608.00	—	287% above	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC 25 Hydroxy Includes Fractions if Performed	$67.80	$113.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC So1 Vit D 25 Hydroxy W/Frac	$222.00	$370.00	—	—	40%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 HC So Vitamin D Hydroxyvitamin D	$364.80	$608.00	—	—	40%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 HC So Dihydroxyvitamin D, 1 25	$376.20	$627.00	—	144% above	40%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 HC So Dihydroxyvitamin D, 1 25	$376.20	$627.00	—	—	40%
Zinc blood test CPT 84630 HC So Zinc, Serum	$84.60	$141.00	—	65% above	40%
Zinc blood test inpatient CPT 84630 HC So Zinc, Serum	$84.60	$141.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC So Hcg Quantitative	$198.00	$330.00	—	193% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 HC Hcg Quantitative	$240.60	$401.00	—	256% above	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC So Hcg Quantitative	$198.00	$330.00	—	—	40%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 HC Hcg Quantitative	$240.60	$401.00	—	—	40%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Arthroscopic rotator cuff repair of the shoulder one side CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr\|RIGHT SIDE	$24,140.63	$40,234.38	—	14% below	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 HC Bx Breast 1st Lesion Strtctc	$4,788.60	$7,981.00	—	20% above	40%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 HC Bx Breast 1st Lesion Strtctc	$4,788.60	$7,981.00	—	—	40%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 HC Treat Ankle Fx	$360.00	$600.00	—	5% below	40%
Broken ankle (outer ankle bone) treatment without surgery or setting inpatient CPT 27786 HC Treat Ankle Fx	$360.00	$600.00	—	—	40%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 HC Treat Metatarsal Fx	$360.00	$600.00	—	1% below	40%
Broken foot (metatarsal) treatment without surgery or setting inpatient CPT 28470 HC Treat Metatarsal Fx	$360.00	$600.00	—	—	40%
Cardioversion, elective (restoring heart rhythm) CPT 92960 HC Cardioversion	$1,266.60	$2,111.00	—	39% below	40%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 HC Cardioversion	$1,266.60	$2,111.00	—	—	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|LEFT SIDE	$4,372.98	$7,288.30	—	47% below	40%
Carpal tunnel release, open surgery one side CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne\|RIGHT SIDE	$7,998.84	$13,331.40	—	3% below	40%
Cataract surgery with lens implant CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp	$6,289.37	$10,482.28	—	16% below	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|LEFT SIDE	$7,662.71	$12,771.18	—	3% above	40%
Cataract surgery with lens implant one side CPT 66984 Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp\|RIGHT SIDE	$9,247.79	$15,412.98	—	24% above	40%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$8,230.56	$13,717.60	—	146% above	40%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$6,619.98	$11,033.30	—	98% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|RIGHT SIDE	$8,514.41	$14,190.68	—	19% above	40%
Complex cataract surgery with lens implant one side CPT 66982 Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx WO Ecp\|LEFT SIDE	$9,874.19	$16,456.98	—	38% above	40%
Earwax removal by irrigation (rinsing), one ear CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$300.00	$500.00	—	94% above	40%
Earwax removal by irrigation (rinsing), one ear one side CPT 69209 HC Removal Impacted Cerumen Irrigation/Lvg Unilat	$300.00	$500.00	—	94% above	40%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 HC Rem Impact Cerumen Irrigat Uni	$300.00	$500.00	—	—	40%
Earwax removal by irrigation (rinsing), one ear inpatient one side CPT 69209 HC Removal Impacted Cerumen Irrigation/Lvg Unilat	$300.00	$500.00	—	—	40%
Earwax removal with instruments, one ear CPT 69210 HC Remove Impacted Cerumen	$82.20	$137.00	—	47% below	40%
Earwax removal with instruments, one ear one side CPT 69210 HC Cerumen Removal,Unilat	$82.20	$137.00	—	47% below	40%
Earwax removal with instruments, one ear inpatient CPT 69210 HC Remove Impacted Cerumen	$82.20	$137.00	—	—	40%
Earwax removal with instruments, one ear inpatient one side CPT 69210 HC Cerumen Removal,Unilat	$82.20	$137.00	—	—	40%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 HC N Block Paravert Lumbar 1st	$6,136.80	$10,228.00	—	181% above	40%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 HC N Block Paravert Lumbar 1st	$6,136.80	$10,228.00	—	—	40%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible	$16,187.46	$26,979.10	—	1% below	40%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy	$11,749.26	$19,582.10	—	33% below	40%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Ntrnl & Xtrnl 1 Column/Group	$14,130.85	$23,551.42	—	51% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 HC Cath/Intro Sal Cont Hyst	$945.00	$1,575.00	—	148% above	40%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 HC Cath/Intro Sal Cont Hyst	$945.00	$1,575.00	—	—	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I&D Simple	$264.00	$440.00	—	32% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC Incision & Drainage-Simple	$264.00	$440.00	—	32% below	40%
Incision and drainage of a simple or single skin abscess CPT 10060 HC I & D Simple	$264.00	$440.00	—	32% below	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I & D Simple	$264.00	$440.00	—	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC I&D Simple	$264.00	$440.00	—	—	40%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 HC Incision & Drainage-Simple	$264.00	$440.00	—	—	40%
Inguinal (groin) hernia repair, age 5 or older one side CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible\|RIGHT SIDE	$15,048.38	$25,080.63	—	43% above	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Asp Injection Major Joint	$550.80	$918.00	—	21% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 HC Inj/Asp Maj Jnt or Bursa	$550.80	$918.00	—	21% below	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Inj/Asp Maj Jnt or Bursa	$550.80	$918.00	—	—	40%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 HC Asp Injection Major Joint	$550.80	$918.00	—	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Joint Bursa Inj Med Arm	$524.40	$874.00	—	15% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 HC Asp Inj Intermediate Joint	$524.40	$874.00	—	15% below	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Asp Inj Intermediate Joint	$524.40	$874.00	—	—	40%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 HC Joint Bursa Inj Med Arm	$524.40	$874.00	—	—	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Joint Bursa Inj Small Joint	$499.80	$833.00	—	1% above	40%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 HC Drain/Inject Joint/Bursa	$499.80	$833.00	—	1% above	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Joint Bursa Inj Small Joint	$499.80	$833.00	—	—	40%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 HC Drain/Inject Joint/Bursa	$499.80	$833.00	—	—	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$477.00	$795.00	—	11% below	40%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 HC Lyr Clos Sc Tk Ext <2.5 Cm	$477.00	$795.00	—	—	40%
Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$2,722.80	$4,538.00	—	34% above	40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$2,722.80	$4,538.00	—	—	40%
Nail removal (partial or complete), one nail CPT 11730 HC ED Avulsion Nail Plate Single	$353.40	$589.00	—	11% above	40%
Nail removal (partial or complete), one nail CPT 11730 HC Avulsion of Nail Plate	$353.40	$589.00	—	11% above	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC Avulsion of Nail Plate	$353.40	$589.00	—	—	40%
Nail removal (partial or complete), one nail inpatient CPT 11730 HC ED Avulsion Nail Plate Single	$353.40	$589.00	—	—	40%
Occipital nerve block (injection for headaches) CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$1,577.40	$2,629.00	—	100% above	40%
Occipital nerve block (injection for headaches) inpatient CPT 64405 HC Inj Aa&/Strd Greater Occipital Nerve	$1,577.40	$2,629.00	—	—	40%
Paracentesis with imaging guidance CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$3,688.80	$6,148.00	—	112% above	40%
Paracentesis with imaging guidance CPT 49083 HC Abd Paracentesis W Guide	$3,688.80	$6,148.00	—	112% above	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abd Paracentesis W Guide	$3,688.80	$6,148.00	—	—	40%
Paracentesis with imaging guidance inpatient CPT 49083 HC Abdom Paracentesis Dx/Ther W Imaging Guidance	$3,688.80	$6,148.00	—	—	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Excision of Nail & Nail Matrix	$1,988.40	$3,314.00	—	156% above	40%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 HC Excis Nail Matrix Perm Rmvl	$1,988.40	$3,314.00	—	156% above	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC Excis Nail Matrix Perm Rmvl	$1,988.40	$3,314.00	—	—	40%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 HC Excision of Nail & Nail Matrix	$1,988.40	$3,314.00	—	—	40%
Removal of a foreign object under the skin, simple CPT 10120 HC Removal FB Skin	$477.00	$795.00	—	29% below	40%
Removal of a foreign object under the skin, simple CPT 10120 HC Removal FB Skin	$5,773.74	$9,622.90	—	761% above	40%
Removal of a foreign object under the skin, simple inpatient CPT 10120 HC Removal FB Skin	$477.00	$795.00	—	—	40%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$4,549.38	$7,582.30	—	75% above	40%
Short arm splint (forearm and hand) CPT 29125 HC Splint App Short Arm Stat	$163.80	$273.00	—	44% below	40%
Short arm splint (forearm and hand) inpatient CPT 29125 HC Splint App Short Arm Stat	$163.80	$273.00	—	—	40%
Short leg splint (calf to foot) CPT 29515 HC Splint App/Short Leg	$199.80	$333.00	—	32% below	40%
Short leg splint (calf to foot) inpatient CPT 29515 HC Splint App/Short Leg	$199.80	$333.00	—	—	40%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) one side CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc\|RIGHT SIDE	$14,247.72	$23,746.20	—	47% below	40%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) one side CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls\|RIGHT SIDE	$16,592.99	$27,654.98	—	27% below	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$340.80	$568.00	—	3% above	40%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 HC Rep Lac Smp Not Face <2.5cm	$340.80	$568.00	—	—	40%
Skin biopsy, punch, one lesion CPT 11104 HC Punch Biopsy Skin Single Lesion	$366.00	$610.00	—	18% below	40%
Skin biopsy, punch, one lesion inpatient CPT 11104 HC Punch Biopsy Skin Single Lesion	$366.00	$610.00	—	—	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Diagnostic Lumbar Puncture	$1,395.00	$2,325.00	—	30% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture Lumbar Diagnos	$1,395.00	$2,325.00	—	30% above	40%
Spinal tap (lumbar puncture), diagnostic CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$1,395.00	$2,325.00	—	30% above	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Diagnostic Lumbar Puncture	$1,395.00	$2,325.00	—	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture, Lumbar, Diagnostic	$1,395.00	$2,325.00	—	—	40%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 HC Spinal Puncture Lumbar Diagnos	$1,395.00	$2,325.00	—	—	40%
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 Lac Smp Scalp 2.6-7.5	$261.60	$436.00	—	26% below	40%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 HC Repr Smp Not Face 2.6-7.5cm	$261.60	$436.00	—	26% below	40%
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 Lac Smp Scalp 2.6-7.5	$261.60	$436.00	—	—	40%
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 Repr Smp Not Face 2.6-7.5cm	$261.60	$436.00	—	—	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$261.60	$436.00	—	18% below	40%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 HC Simple Rep Wnd Face <2.5 Cm	$261.60	$436.00	—	—	40%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 HC Tangential Biopsy Skin Single Lesion	$366.00	$610.00	—	21% above	40%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 HC Tangential Biopsy Skin Single Lesion	$366.00	$610.00	—	—	40%
Thoracentesis with imaging guidance CPT 32555 HC Aspirate Pleura W/ Imaging	$2,601.00	$4,335.00	—	50% above	40%
Thoracentesis with imaging guidance inpatient CPT 32555 HC Aspirate Pleura W/ Imaging	$2,601.00	$4,335.00	—	—	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|RIGHT SIDE	$43,922.44	$73,204.07	—	1% below	40%
Total hip replacement one side CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft\|LEFT SIDE	$59,950.27	$99,917.12	—	35% above	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|RIGHT SIDE	$29,978.34	$49,963.90	—	30% below	40%
Total knee replacement one side CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments\|LEFT SIDE	$38,434.10	$64,056.83	—	10% below	40%
Trigger point injections, 1 or 2 muscles CPT 20552 HC Inj Trigger Points 1-2 Musc	$391.20	$652.00	—	44% below	40%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 HC Inj Trigger Points 1-2 Musc	$391.20	$652.00	—	—	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 HC Bx Breast 1st Lesion US Img	$3,874.80	$6,458.00	—	17% above	40%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 HC Bx Breast 1st Lesion US Img	$3,874.80	$6,458.00	—	—	40%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple	$4,842.60	$8,071.00	—	73% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Skin and Subcu	$1,228.80	$2,048.00	—	58% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 HC Debride Subq First 20 Sq Cm	$1,228.80	$2,048.00	—	58% above	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Subq First 20 Sq Cm	$1,228.80	$2,048.00	—	—	40%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 HC Debride Skin and Subcu	$1,228.80	$2,048.00	—	—	40%
Wrist fracture surgery (plate and screws), distal radius one side CPT 25607 Optx Dstl Radl X-Artic Fx/Epiphysl Sep\|LEFT SIDE	$15,455.93	$25,759.88	—	7% below	40%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Blood transfusion (giving blood or blood components) CPT 36430 HC Blood Administration	$1,099.20	$1,832.00	—	1% below	40%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 HC Blood Administration	$1,099.20	$1,832.00	—	—	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$316.80	$528.00	—	81% above	40%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 HC Aerosol, Hhn, Mdi, Ippb	$316.80	$528.00	—	—	40%
Chemotherapy IV infusion, first hour CPT 96413 HC Chemo Infusion 1st Hour Chemo	$373.20	$622.00	—	51% below	40%
Chemotherapy IV infusion, first hour inpatient CPT 96413 HC Chemo Infusion 1st Hour Chemo	$373.20	$622.00	—	—	40%
Critical care, first 30 to 74 minutes CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$2,438.40	$4,064.00	—	17% below	40%
Critical care, first 30 to 74 minutes inpatient CPT 99291 HC E/M Crit Care,ER, 1st 30-74min	$2,438.40	$4,064.00	—	—	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 HC >= 12 Lead Ekg	$272.40	$454.00	—	47% above	40%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 HC >= 12 Lead Ekg	$272.40	$454.00	—	—	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 HC ER Level 1	$292.80	$488.00	—	6% below	40%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 HC ER Level 1	$292.80	$488.00	—	—	40%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 HC ER Level 2	$945.00	$1,575.00	—	85% above	40%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 HC ER Level 2	$945.00	$1,575.00	—	—	40%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 HC ER Level 3	$1,259.40	$2,099.00	—	49% above	40%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 HC ER Level 3	$1,259.40	$2,099.00	—	—	40%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 HC ER Level 4	$1,385.40	$2,309.00	—	4% above	40%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 HC ER Level 4	$1,385.40	$2,309.00	—	—	40%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 HC ER Level 5	$1,575.00	$2,625.00	—	9% below	40%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 HC ER Level 5	$1,575.00	$2,625.00	—	—	40%
Exercise stress test, tracing only, the hospital charge CPT 93017 HC Cardiac Stress Test	$960.00	$1,600.00	—	7% above	40%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 HC Cardiac Stress Test	$960.00	$1,600.00	—	—	40%
Family therapy with the patient, 50 minutes CPT 90847 HC Iop Family Treatment	$256.80	$428.00	—	14% below	40%
Family therapy with the patient, 50 minutes CPT 90847 HC Php Psych Family	$256.80	$428.00	—	14% below	40%
Family therapy with the patient, 50 minutes CPT 90847 HC OP Psych Family W/Patient Present 50mins	$256.80	$428.00	—	14% below	40%
Family therapy with the patient, 50 minutes CPT 90847 HC Iop Sub Family Psychotherapy W/Patient Present 50 Mins	$256.80	$428.00	—	14% below	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Iop Sub Family Psychotherapy W/Patient Present 50 Mins	$256.80	$428.00	—	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Php Psych Family	$256.80	$428.00	—	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC OP Psych Family W/Patient Present 50mins	$256.80	$428.00	—	—	40%
Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Iop Family Treatment	$256.80	$428.00	—	—	40%
Family therapy without the patient, 50 minutes CPT 90846 HC Iop Family Tx WO Pt	$256.80	$428.00	—	17% below	40%
Family therapy without the patient, 50 minutes CPT 90846 HC Php Family Tx WO Pt	$256.80	$428.00	—	17% below	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Php Family Tx WO Pt	$256.80	$428.00	—	—	40%
Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Iop Family Tx WO Pt	$256.80	$428.00	—	—	40%
Group psychotherapy session CPT 90853 HC OP Group	$171.00	$285.00	—	at median	40%
Group psychotherapy session CPT 90853 HC Php Group	$171.00	$285.00	—	at median	40%
Group psychotherapy session CPT 90853 HC Iop Group	$279.00	$465.00	—	63% above	40%
Group psychotherapy session CPT 90853 HC Iop Sub Group Psychotherapy	$281.40	$469.00	—	65% above	40%
Group psychotherapy session inpatient CPT 90853 HC OP Group	$171.00	$285.00	—	—	40%
Group psychotherapy session inpatient CPT 90853 HC Php Group	$171.00	$285.00	—	—	40%
Group psychotherapy session inpatient CPT 90853 HC Iop Group	$279.00	$465.00	—	—	40%
Group psychotherapy session inpatient CPT 90853 HC Iop Sub Group Psychotherapy	$281.40	$469.00	—	—	40%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HC Inf 1st Hour Hyd	$274.20	$457.00	—	34% below	40%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 HC Inf 1st Hour Hyd	$274.20	$457.00	—	—	40%
IV infusion of a medicine, first hour CPT 96365 HC IV 1st Hour Init Drug	$274.80	$458.00	—	37% below	40%
IV infusion of a medicine, first hour inpatient CPT 96365 HC IV 1st Hour Init Drug	$274.80	$458.00	—	—	40%
IV push of a medicine, first drug CPT 96374 HC IV Push Initial Drug	$341.40	$569.00	—	33% above	40%
IV push of a medicine, first drug inpatient CPT 96374 HC IV Push Initial Drug	$341.40	$569.00	—	—	40%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 HC Injection Im Sub Q	$174.00	$290.00	—	23% above	40%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 HC Injection Im Sub Q	$174.00	$290.00	—	—	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Iop Psych Evaluation	$171.00	$285.00	—	45% below	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Php Psych Evaluation	$171.00	$285.00	—	45% below	40%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 HC Psych Evaluation	$342.00	$570.00	—	9% above	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Iop Psych Evaluation	$171.00	$285.00	—	—	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Php Psych Evaluation	$171.00	$285.00	—	—	40%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 HC Psych Evaluation	$342.00	$570.00	—	—	40%
Neuromuscular re-education, 15 minutes CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$167.40	$279.00	—	53% above	40%
Neuromuscular re-education, 15 minutes CPT 97112 HC Neuromuscular Re-Education, Ot	$167.40	$279.00	—	53% above	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Pt Neuro Facilitation Ea 15 Min	$167.40	$279.00	—	—	40%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 HC Neuromuscular Re-Education, Ot	$167.40	$279.00	—	—	40%
New patient office visit, about 30 minutes CPT 99203 HC New Pt, Outpt Visit Level 3	$433.80	$723.00	—	295% above	40%
New patient office visit, about 30 minutes inpatient CPT 99203 HC New Pt, Outpt Visit Level 3	$433.80	$723.00	—	—	40%
New patient office visit, about 45 minutes CPT 99204 HC New Pt, Outpt Visit Level 4	$544.80	$908.00	—	350% above	40%
New patient office visit, about 45 minutes inpatient CPT 99204 HC New Pt, Outpt Visit Level 4	$544.80	$908.00	—	—	40%
New patient office visit, about 60 minutes CPT 99205 HC New Pt, Outpt Visit Level 5	$710.40	$1,184.00	—	311% above	40%
New patient office visit, about 60 minutes inpatient CPT 99205 HC New Pt, Outpt Visit Level 5	$710.40	$1,184.00	—	—	40%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 HC New Pt, Outpt Visit Level 2	$327.00	$545.00	—	223% above	40%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 HC New Pt, Outpt Visit Level 2	$327.00	$545.00	—	—	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$75.00	$125.00	—	16% above	40%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 HC Med Nut Therapy Ind Init 15 Min	$75.00	$125.00	—	—	40%
Occupational therapy evaluation, low complexity CPT 97165 HC Ot Eval Low Complex	$338.40	$564.00	—	30% above	40%
Occupational therapy evaluation, low complexity inpatient CPT 97165 HC Ot Eval Low Complex	$338.40	$564.00	—	—	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 HC Pt Eval High Complex	$617.40	$1,029.00	—	105% above	40%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 HC Pt Eval High Complex	$617.40	$1,029.00	—	—	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 HC Pt Eval Low Complex	$457.20	$762.00	—	75% above	40%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 HC Pt Eval Low Complex	$457.20	$762.00	—	—	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 HC Pt Eval Mod Complex	$537.60	$896.00	—	93% above	40%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 HC Pt Eval Mod Complex	$537.60	$896.00	—	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Ot Manual Therapy per 15 Min.	$167.40	$279.00	—	51% above	40%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pt Manual Therapy Ea 15	$167.40	$279.00	—	51% above	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Ot Manual Therapy per 15 Min.	$167.40	$279.00	—	—	40%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pt Manual Therapy Ea 15	$167.40	$279.00	—	—	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Oral Motor Exercises 15 Min	$181.20	$302.00	—	53% above	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$181.20	$302.00	—	53% above	40%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Ther Ex per 15 Min	$181.20	$302.00	—	53% above	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Exercise,Ea 15 Min	$181.20	$302.00	—	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Ther Ex per 15 Min	$181.20	$302.00	—	—	40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Oral Motor Exercises 15 Min	$181.20	$302.00	—	—	40%
Psychiatric evaluation with medical services CPT 90792 HC Psych Eval W/Med Srvc	$162.00	$270.00	—	54% below	40%
Psychiatric evaluation with medical services CPT 90792 HC Php Psych Eval W/Med Srvc	$162.00	$270.00	—	54% below	40%
Psychiatric evaluation with medical services CPT 90792 HC Iop Psych Eval W/Med Srvc	$162.00	$270.00	—	54% below	40%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Php Psych Eval W/Med Srvc	$162.00	$270.00	—	—	40%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Iop Psych Eval W/Med Srvc	$162.00	$270.00	—	—	40%
Psychiatric evaluation with medical services inpatient CPT 90792 HC Psych Eval W/Med Srvc	$162.00	$270.00	—	—	40%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Iop Sub Psychotherapy for Crisis Initial 60 Minutes	$256.80	$428.00	—	18% below	40%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Php Crisis Tx First 60 Min	$256.80	$428.00	—	18% below	40%
Psychotherapy for crisis, first 60 minutes CPT 90839 HC Iop Crisis Tx First 60min	$256.80	$428.00	—	18% below	40%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Iop Sub Psychotherapy for Crisis Initial 60 Minutes	$256.80	$428.00	—	—	40%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Php Crisis Tx First 60 Min	$256.80	$428.00	—	—	40%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 HC Iop Crisis Tx First 60min	$256.80	$428.00	—	—	40%
Psychotherapy session, 30 minutes CPT 90832 HC Php Psych Tx 30 Min	$162.00	$270.00	—	14% below	40%
Psychotherapy session, 30 minutes CPT 90832 HC Iop Indiv Tx 16-37 Min	$162.00	$270.00	—	14% below	40%
Psychotherapy session, 30 minutes CPT 90832 HC OP Psych Tx 30 Min	$281.40	$469.00	—	49% above	40%
Psychotherapy session, 30 minutes CPT 90832 HC Iop Sub Psychotherapy W/Patient 30 Minutes	$281.40	$469.00	—	49% above	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Php Psych Tx 30 Min	$162.00	$270.00	—	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Iop Indiv Tx 16-37 Min	$162.00	$270.00	—	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC Iop Sub Psychotherapy W/Patient 30 Minutes	$281.40	$469.00	—	—	40%
Psychotherapy session, 30 minutes inpatient CPT 90832 HC OP Psych Tx 30 Min	$281.40	$469.00	—	—	40%
Psychotherapy session, 45 minutes CPT 90834 HC Php Psych Tx 45 Min	$171.00	$285.00	—	36% below	40%
Psychotherapy session, 45 minutes CPT 90834 HC Iop Tx 45 Min	$171.00	$285.00	—	36% below	40%
Psychotherapy session, 45 minutes CPT 90834 HC Iop Sub Psychotherapy W/Patient 45 Minutes	$342.00	$570.00	—	28% above	40%
Psychotherapy session, 45 minutes CPT 90834 HC OP Tx 45 Min	$342.00	$570.00	—	28% above	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Php Psych Tx 45 Min	$171.00	$285.00	—	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Iop Tx 45 Min	$171.00	$285.00	—	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC Iop Sub Psychotherapy W/Patient 45 Minutes	$342.00	$570.00	—	—	40%
Psychotherapy session, 45 minutes inpatient CPT 90834 HC OP Tx 45 Min	$342.00	$570.00	—	—	40%
Psychotherapy session, 60 minutes CPT 90837 HC Php Psych Tx 60 Min	$256.80	$428.00	—	18% below	40%
Psychotherapy session, 60 minutes CPT 90837 HC Iop Indiv Tx >53 Min	$256.80	$428.00	—	18% below	40%
Psychotherapy session, 60 minutes CPT 90837 HC OP Psych Tx 60 Min	$256.80	$428.00	—	18% below	40%
Psychotherapy session, 60 minutes CPT 90837 HC Iop Sub Psychotherapy W/Patient 60 Minutes	$256.80	$428.00	—	18% below	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Iop Indiv Tx >53 Min	$256.80	$428.00	—	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Php Psych Tx 60 Min	$256.80	$428.00	—	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC OP Psych Tx 60 Min	$256.80	$428.00	—	—	40%
Psychotherapy session, 60 minutes inpatient CPT 90837 HC Iop Sub Psychotherapy W/Patient 60 Minutes	$256.80	$428.00	—	—	40%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 HC Smoke/Tobac Counsel 3-10	$49.20	$82.00	—	12% above	40%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 HC Smoke/Tobac Counsel 3-10	$49.20	$82.00	—	—	40%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 HC Est Pt, Outpt Visit Level 5	$196.20	$327.00	—	17% above	40%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 HC Est Pt, Outpt Visit Level 5	$196.20	$327.00	—	—	40%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 HC Est Pt, Outpt Visit Level 3	$162.00	$270.00	—	39% above	40%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 HC Est Pt, Outpt Visit Level 3	$162.00	$270.00	—	—	40%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 HC Est Pt, Outpt Visit Level 4	$178.80	$298.00	—	31% above	40%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 HC Est Pt, Outpt Visit Level 4	$178.80	$298.00	—	—	40%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 HC Est Pt, Outpt Visit Level 2	$148.20	$247.00	—	47% above	40%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 HC Est Pt, Outpt Visit Level 2	$148.20	$247.00	—	—	40%
Speech and language evaluation CPT 92523 HC Eval Speech Sound Lang Comprhension	$414.00	$690.00	—	21% above	40%
Speech and language evaluation inpatient CPT 92523 HC Eval Speech Sound Lang Comprhension	$414.00	$690.00	—	—	40%
Speech therapy session, individual CPT 92507 HC Speech/Language Therapy	$272.40	$454.00	—	24% above	40%
Speech therapy session, individual inpatient CPT 92507 HC Speech/Language Therapy	$272.40	$454.00	—	—	40%
Spirometry (breathing test) CPT 94010 HC Pif (Copd Assessment)	$362.40	$604.00	—	17% above	40%
Spirometry (breathing test) CPT 94010 HC Spirometry / Tvc / Mvv	$362.40	$604.00	—	17% above	40%
Spirometry (breathing test) inpatient CPT 94010 HC Spirometry / Tvc / Mvv	$362.40	$604.00	—	—	40%
Spirometry (breathing test) inpatient CPT 94010 HC Pif (Copd Assessment)	$362.40	$604.00	—	—	40%
Spirometry before and after a bronchodilator CPT 94060 HC Before / After Bronchodilator	$484.20	$807.00	—	15% below	40%
Spirometry before and after a bronchodilator inpatient CPT 94060 HC Before / After Bronchodilator	$484.20	$807.00	—	—	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Ot Therapeutic Activities 15 Min	$172.80	$288.00	—	41% above	40%
Therapeutic activities (functional training), 15 minutes CPT 97530 HC Pt Therapeutic Activities 15 Min	$172.80	$288.00	—	41% above	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Pt Therapeutic Activities 15 Min	$172.80	$288.00	—	—	40%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 HC Ot Therapeutic Activities 15 Min	$172.80	$288.00	—	—	40%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 HC Phlebotomy Therapeutic	$196.80	$328.00	—	17% below	40%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 HC Phlebotomy Therapeutic	$196.80	$328.00	—	—	40%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Ohio	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$403.50	$672.50	—	8% above	40%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR	$403.50	$672.50	—	—	40%
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	$62.16	$103.60	—	4% below	40%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP	$62.16	$103.60	—	—	40%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$205.80	$343.00	—	1% below	40%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES, MUMPS & RUBELLA VAC IJ SOLR	$205.80	$343.00	—	—	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$245.88	$409.80	—	11% below	40%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ SOSY	$245.88	$409.80	—	—	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$88.74	$147.90	—	1% below	40%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LF/0.5ML IM SUSP	$88.74	$147.90	—	—	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$102.42	$170.70	—	7% below	40%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY	$102.42	$170.70	—	—	40%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 HC Immunization Administration	$48.00	$80.00	—	18% above	40%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 HC Immunization Administration	$48.00	$80.00	—	—	40%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 HC Subsequent Immun Admin	$48.00	$80.00	—	38% above	40%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 HC Subsequent Immun Admin	$48.00	$80.00	—	—	40%

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://www.mercy.com/-/media/mercy/patient-resources/hospital-pricing-transparency/310785684-1144286352_community-mercy-health-partners_standardcharges.ashx