Surgery and procedures CPT 58340 Outpatient

HSG (tube test) cost in Bellefontaine, OH

In Bellefontaine, OH, 1 hospital lists a cash price for hysterosalpingogram (HSG): contrast injection to check the fallopian tubes: from $417.60 to $417.60, with a median of $417.60. Across Ohio, the median is $381.60 at 107 hospitals.

Cash prices at 1 facility for code 58340, as an outpatient — the setting a self-pay patient normally buys. Collected Sep 29, 2026; the hospital files themselves were last updated between Apr 1, 2026 and Apr 1, 2026.

Lowest$417.60Mary Rutan Hospital
Median$417.60half pay less
Highest$417.60in this market
Difference1.0×highest vs lowest

Hospitals, cheapest first

HospitalCash price List priceInsurers payOff listFile date
Mary Rutan Hospital Bellefontaine, OH · (937) 651-3257 Inj For Hystero $417.60 $522.00 — 20% Apr 1, 2026
source file

Outpatient: lowest $417.60, median $417.60, highest $417.60.

As an inpatient, the same code is billed by 1 facility here, median $417.60. Inpatient and outpatient prices are not comparable and are kept on separate pages: the inpatient charge covers admission, not the same purchase.

What it is

An HSG is an X-ray test that checks whether the fallopian tubes are open and the uterus has a normal shape. Dye is injected through the cervix while X-rays are taken.

What the price covers

The price covers the injection. The X-ray imaging is usually billed separately.