University Hospitals Samaritan Medical Center
1025 Center St, Ashland, OH · University Hospitals · · NPI 1902882939
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Cyclosporine 2 hour CPT 80158 | $96.00 | $128.00 | $18.05 – $32.49 | 17 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $470.55 | $627.40 | $1.85 – $7.56 | 2 |
| Cyclosporine oral 100 mg HCPCS J7502 | $2,865.39 | $3,820.51 | $5.01 – $20.34 | 2 |
| Cygnus matrix, per sq cm HCPCS Q4199 | not published | not published | $317.03 – $317.03 | 1 |
| Cygnus, per sq cm HCPCS Q4170 | not published | not published | $101.13 – $101.13 | 1 |
| Cylinder pump set 20cm titan zero angl HCPCS C1813 | $42,849.57 | $57,132.75 | not published | 0 |
| Cyp2c19 gene com variants CPT 81225 | $613.50 | $818.00 | $291.36 – $524.45 | 17 |
| Cyp2c9 gene com variants CPT 81227 | $368.25 | $491.00 | $174.81 – $314.66 | 17 |
| Cyp2d6 gene com variants CPT 81226 | $949.50 | $1,266.00 | $450.91 – $811.64 | 17 |
| Cyp3a4 gene common variants CPT 81230 | $328.50 | $438.00 | $174.81 – $314.66 | 17 |
| Cyp3a5 gene common variants CPT 81231 | $328.50 | $438.00 | $174.81 – $314.66 | 17 |
| Cystatin c CPT 82610 | $61.50 | $82.00 | $18.52 – $33.34 | 17 |
| Cystic fibrosis cftr CPT 81223 | $6,271.50 | $8,362.00 | $499.00 – $898.20 | 17 |
| Cystine urine quantitative CPT 82131 | $171.75 | $229.00 | $22.98 – $41.36 | 17 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $633.00 | $844.00 | $338.34 – $609.01 | 17 |
| Cystoscopy and treatment CPT 52310 | $1,579.50 | $2,106.00 | $2,027.25 – $3,649.06 | 16 |
| Cystoscopy (Bladder Scope) CPT 52000 | $2,335.50 | $3,114.00 | $676.24 – $1,217.23 | 16 |
| Cystoscopy chemodenervation CPT 52287 | $322.50 | $430.00 | $2,027.25 – $3,649.06 | 16 |
| Cystoscopy & ureter catheter CPT 52005 | $1,997.25 | $2,663.00 | $2,027.25 – $3,649.06 | 16 |
| Cysto/uretero w/lithotripsy CPT 52356 | $17,490.00 | $23,320.00 | $5,199.87 – $9,359.77 | 16 |
| Cystouretero w/lithotripsy CPT 52353 | $11,789.25 | $15,719.00 | $5,199.87 – $9,359.77 | 16 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | $64.71 | $86.28 | $1.95 – $8.73 | 2 |
| Cytogenetics 25-99 CPT 88274 | $188.25 | $251.00 | $42.38 – $76.28 | 17 |
| Cytog genom-wid alys hem mal CPT 81195 | $2,368.50 | $3,158.00 | $1,863.22 – $3,353.80 | 16 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $100.50 | $134.00 | $14.39 – $25.90 | 17 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $113.25 | $151.00 | $16.85 – $30.33 | 17 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | $6,333.64 | $8,444.85 | $1,808.61 – $4,404.18 | 17 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $240.75 | $321.00 | $50.54 – $90.97 | 16 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $153.00 | $204.00 | $26.61 – $47.90 | 17 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $195.75 | $261.00 | $20.26 – $36.47 | 17 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $67.50 | $90.00 | $36.22 – $65.20 | 16 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $111.00 | $148.00 | $36.22 – $65.20 | 16 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $141.00 | $188.00 | $165.22 – $297.40 | 16 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $163.50 | $218.00 | $50.54 – $90.97 | 16 |
| Cytopath smear other source CPT 88160 | $82.50 | $110.00 | $28.05 – $50.49 | 16 |
| Cytopath tbs c/v manual CPT 88164 | $168.75 | $225.00 | $16.55 – $33.37 | 17 |
| Cytotoxic antibody screening CPT 86808 | $363.75 | $485.00 | $29.68 – $53.42 | 17 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $907.50 | $1,210.00 | $165.22 – $297.40 | 16 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $53.55 | $71.39 | $9.27 – $33.57 | 2 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | $10,014.84 | $13,353.11 | $337.67 – $737.31 | 17 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | $6,061.91 | $8,082.54 | $15.00 – $37.85 | 17 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $43.91 – $43.91 | 1 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | not published | not published | $0.07 – $0.07 | 1 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $38,894.03 | $51,858.70 | $55.03 – $133.04 | 17 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $5,546.48 | $7,395.30 | $3.07 – $7.28 | 17 |
| Darbepoetin alfa, esrd use HCPCS J0882 | not published | not published | $7.28 – $7.28 | 1 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | $38,568.63 | $51,424.83 | $261.20 – $620.89 | 17 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | $300.73 | $400.97 | $48.10 – $321.03 | 2 |
| D&c after delivery 59160 CPT 59160 | $792.00 | $1,056.00 | $3,139.36 – $5,650.86 | 16 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | $358.50 | $478.00 | $3,139.36 – $5,650.86 | 16 |
| Dch glucoscan CPT 82948 | $19.50 | $26.00 | $5.04 – $9.07 | 17 |
| Dch pulmonary stress test CPT 94621 | $1,923.75 | $2,565.00 | $361.89 – $651.40 | 16 |
| Dch validity tests CPT 81002 | $18.00 | $24.00 | $3.48 – $6.26 | 17 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | $1,809.00 | $2,412.00 | $1,893.75 – $3,408.76 | 16 |
| Deamidated gliadin antibody iga CPT 86258 | $30.00 | $40.00 | $12.05 – $21.69 | 16 |
| Debridement (>20 cm) charge pt CPT 97598 | $319.50 | $426.00 | $45.22 – $81.40 | 16 |
| Debridement bone <= 20 sq cm CPT 11044 | $3,915.75 | $5,221.00 | $1,601.72 – $2,883.09 | 16 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $915.75 | $1,221.00 | $73.34 – $132.02 | 16 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $2,160.00 | $2,880.00 | $123.63 – $222.54 | 16 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $778.50 | $1,038.00 | $394.24 – $709.63 | 16 |
| Debride nail1-5 11720 CPT 11720 | $222.75 | $297.00 | $57.21 – $102.98 | 16 |
| Debride nail6 or more 11721 CPT 11721 | $308.25 | $411.00 | $57.21 – $102.98 | 16 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $798.75 | $1,065.00 | $39.76 – $71.58 | 16 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $997.50 | $1,330.00 | $716.75 – $1,290.15 | 16 |
| Decalcification CPT 88311 | $35.25 | $47.00 | $18.72 – $33.70 | 16 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $634.17 | $845.55 | $3.87 – $15.21 | 2 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $609.75 | $813.00 | $320.33 – $576.59 | 16 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | $102.84 | $137.12 | $21.93 – $77.40 | 2 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $3,396.16 | $4,528.21 | $4.46 – $10.59 | 17 |
| Delivery of placenta 59414 CPT 59414 | $924.75 | $1,233.00 | $3,139.36 – $5,650.86 | 16 |
| Delivery transcath fxtn dvc to endogrft w/s&i CPT 34712 | $6,758.25 | $9,011.00 | $585.43 – $1,053.78 | 16 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $196.50 | $262.00 | $212.36 – $382.26 | 16 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $12,371.55 | $16,495.39 | $29.51 – $71.15 | 17 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $168.00 | $224.00 | $129.03 – $232.25 | 16 |
| Depo-estradiol cypionate inj HCPCS J1000 | not published | not published | $114.18 – $114.18 | 1 |
| Derma-gide, 1 sq cm HCPCS Q4203 | not published | not published | $2,120.89 – $2,120.89 | 1 |
| Dermagraft HCPCS Q4106 | $100.50 | $134.00 | $109.38 – $404.46 | 2 |
| Dermapure 1 square cm HCPCS Q4152 | $5,197.50 | $6,930.00 | $110.50 – $217.24 | 17 |
| Dermavest, plurivest sq cm HCPCS Q4153 | not published | not published | $264.33 – $264.33 | 1 |
| Derm-maxx, per sq cm HCPCS Q4238 | $7,762.50 | $10,350.00 | $120.69 – $4,198.75 | 17 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $172.46 | $229.94 | $9.47 – $56.97 | 2 |
| Desoxycorticosterone CPT 82633 | $84.00 | $112.00 | $30.98 – $55.76 | 17 |
| Des thora aorta rpr without left sub art 33881 CPT 33881 | $6,309.00 | $8,412.00 | $1,068.08 – $1,922.55 | 16 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $1,967.25 | $2,623.00 | $1,893.75 – $3,408.76 | 16 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $1,535.25 | $2,047.00 | $247.48 – $445.46 | 16 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $199.50 | $266.00 | $194.58 – $350.24 | 16 |
| Destroy vulva lesion simple 56501 CPT 56501 | $3,215.25 | $4,287.00 | $2,000.97 – $3,601.74 | 16 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $228.00 | $304.00 | $194.58 – $350.24 | 16 |
| Destruction 2-14 lesions 17003 CPT 17003 | $83.25 | $111.00 | $5.91 – $10.64 | 16 |
| Destruction anal lesion(s) CPT 46910 | $1,783.50 | $2,378.00 | $2,000.97 – $3,601.74 | 16 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | $468.00 | $624.00 | $394.24 – $709.63 | 16 |
| Destruction benign lesions < 14 lesions CPT 17110 | $268.50 | $358.00 | $194.58 – $350.24 | 16 |
| Destruction by injection tx of nerve 64630 CPT 64630 | $2,203.50 | $2,938.00 | $857.76 – $1,543.97 | 16 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $1,463.25 | $1,951.00 | $233.26 – $419.87 | 16 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $2,343.75 | $3,125.00 | $1,893.75 – $3,408.76 | 16 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $1,170.00 | $1,560.00 | $394.24 – $709.63 | 16 |
| Detect agnt mult dna direc CPT 87800 | $115.50 | $154.00 | $43.67 – $78.61 | 17 |
| Determine refractive state CPT 92015 | $18.00 | $24.00 | $18.52 – $33.34 | 16 |
| Devel tst phys/qhp 1st hr CPT 96112 | $439.50 | $586.00 | $124.79 – $224.62 | 16 |
| Device ablt adv novasure HCPCS C1886 | $11,239.88 | $14,986.50 | not published | 0 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.