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 |
|---|---|---|---|---|
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $5,175.00 | $6,900.00 | not published | 0 |
| Device intraute mirena HCPCS J7298 | $4,491.10 | $5,988.13 | $12,493.35 – $12,493.35 | 1 |
| Device sut capio slim opn HCPCS C2631 | $1,454.07 | $1,938.75 | not published | 0 |
| Device tiss remov myosure reach HCPCS C1782 | $1,070.85 | $1,427.80 | not published | 0 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $183.00 | $244.00 | $54.70 – $98.46 | 16 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $412.50 | $550.00 | $84.40 – $151.91 | 17 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $247.00 – $247.00 | 1 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $3,070.25 – $3,070.25 | 1 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $554.26 | $739.01 | $0.02 – $0.72 | 2 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $16.28 | $21.70 | $0.27 – $1.08 | 2 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $499.63 – $499.63 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $465.34 | $620.45 | $49.74 – $89.53 | 17 |
| Dextran 40 infusion HCPCS J7100 | $225.55 | $300.73 | $68.78 – $421.65 | 2 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $22.19 | $29.58 | $3.29 – $14.31 | 2 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $22.19 | $29.58 | $53.55 – $53.55 | 1 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $36.98 | $49.30 | $4.92 – $17.37 | 2 |
| Dextrose 5 % IV bolus HCPCS J7070 | $22.19 | $29.58 | $7.40 – $34.74 | 2 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $204.00 | $272.00 | $22.23 – $40.01 | 17 |
| Diabetes (HbA1c) Test CPT 83036 | $89.25 | $119.00 | $9.71 – $17.48 | 17 |
| Diab manage trn ind/group HCPCS G0109 | $57.75 | $77.00 | $15.40 – $27.71 | 16 |
| Diag bronchoscope/catheter CPT 31643 | $2,379.00 | $3,172.00 | $1,726.15 – $3,107.06 | 16 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $249.00 | $332.00 | $129.03 – $232.25 | 16 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $196.50 | $262.00 | not published | 0 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $164.25 | $219.00 | not published | 0 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $422.25 | $563.00 | $193.58 – $348.44 | 16 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $524.25 | $699.00 | $146.43 – $263.57 | 16 |
| Diagnostic Mammogram (one breast) CPT 77065 | $418.50 | $558.00 | $115.62 – $208.12 | 16 |
| Dialysis repeated eval CPT 90947 | $4,711.50 | $6,282.00 | $104.66 – $188.39 | 16 |
| Dialysis training incompl CPT 90993 | $1,392.00 | $1,856.00 | not published | 0 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $58.24 | $77.65 | $0.17 – $0.72 | 2 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $143.84 | $191.78 | $15.02 – $49.23 | 2 |
| Dicyclomine injection HCPCS J0500 | $310.41 | $413.88 | $28.40 – $224.73 | 2 |
| Diffusing capacity CPT 94729 | $211.50 | $282.00 | $58.56 – $105.40 | 16 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $472.14 | $629.51 | $9.74 – $84.69 | 2 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $17,050.66 | $22,734.21 | $5,166.99 – $12,093.52 | 17 |
| Digoxin total therapeutic drug level CPT 80162 | $104.25 | $139.00 | $13.28 – $23.90 | 17 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $297.86 | $397.14 | $236.27 – $381.06 | 2 |
| Dilate esophagus 1/mult pass CPT 43450 | $1,208.25 | $1,611.00 | $879.59 – $1,583.27 | 16 |
| Dilation of rectal stricture 45910 CPT 45910 | $1,146.00 | $1,528.00 | $1,160.50 – $2,088.91 | 16 |
| Dilator fascial 10fx20cm HCPCS C2627 | $291.87 | $389.16 | not published | 0 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $107.23 | $142.97 | not published | 0 |
| Dimenhydrinate injection HCPCS J1240 | $17.32 | $23.09 | $18.84 – $80.55 | 2 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $2,501.55 | $3,335.40 | $748.98 – $1,808.19 | 17 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $36.98 | $49.30 | $11.43 – $11.43 | 1 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $5.92 | $7.89 | $2.19 – $7.20 | 2 |
| Dipyridamole injection HCPCS J1245 | $64.49 | $85.98 | $9.40 – $33.48 | 2 |
| Disability dlco CPT 94727 | $207.75 | $277.00 | $209.40 – $376.92 | 16 |
| Disaccharidases CPT 82657 | $1,265.25 | $1,687.00 | $22.17 – $39.91 | 17 |
| Discography cerv/thor spine CPT 72285 | $2,062.50 | $2,750.00 | $1,893.75 – $3,408.76 | 17 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | $3,828.75 | $5,105.00 | $262.85 – $473.13 | 16 |
| Dmd dup/delet analysis CPT 81161 | $2,106.00 | $2,808.00 | $279.00 – $502.20 | 17 |
| Dmpk gene detc abnor allele CPT 81234 | $442.50 | $590.00 | $137.00 – $246.60 | 16 |
| Dna antibody native/double stranded CPT 86225 | $135.75 | $181.00 | $13.74 – $24.73 | 17 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $130.35 | $173.79 | $19.40 – $88.65 | 2 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $1,164.72 | $1,552.95 | $0.90 – $9.00 | 2 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $15.12 – $15.12 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $98.91 | $131.88 | $1.58 – $6.93 | 2 |
| Doppler echo complete CPT 93320 | $443.25 | $591.00 | $48.10 – $86.58 | 16 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $1,826.25 | $2,435.00 | not published | 0 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $591.00 | $788.00 | $209.40 – $376.92 | 16 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $358.50 | $478.00 | $129.03 – $232.25 | 16 |
| Dornase alfa non-comp unit HCPCS J7639 | $479.80 | $639.73 | $134.24 – $468.72 | 2 |
| Dornhoffer fixed part w/window HCPCS L8614 | $77,636.25 | $103,515.00 | $28,368.90 – $51,064.02 | 16 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $593.46 – $593.46 | 1 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $901.65 | $1,202.19 | $6.62 – $29.52 | 2 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $265.99 – $265.99 | 1 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $89.34 | $119.11 | not published | 0 |
| Dpyd gene common variants CPT 81232 | $354.00 | $472.00 | $174.81 – $314.66 | 17 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $684.00 | $912.00 | $686.75 – $1,236.14 | 16 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $681.00 | $908.00 | $686.75 – $1,236.14 | 16 |
| Drainage external ear complex 69005 CPT 69005 | $4,074.75 | $5,433.00 | $1,601.72 – $2,883.09 | 16 |
| Drainage external ear simple 69000 CPT 69000 | $709.50 | $946.00 | $686.75 – $1,236.14 | 16 |
| Drainage mouth roof lesion CPT 42000 | $235.50 | $314.00 | $229.70 – $413.45 | 16 |
| Drainage of eye CPT 65810 | $2,250.75 | $3,001.00 | $2,238.13 – $4,028.63 | 16 |
| Drainage of kidney lesion CPT 50390 | $2,676.00 | $3,568.00 | $686.75 – $1,236.14 | 16 |
| Drainage of mouth lesion CPT 41008 | $3,108.75 | $4,145.00 | $3,215.33 – $5,787.60 | 16 |
| Drainage of mouth lesion CPT 41017 | $3,288.75 | $4,385.00 | $3,215.33 – $5,787.60 | 16 |
| Drainage of nose lesion int 30000 CPT 30000 | $236.25 | $315.00 | $229.70 – $413.45 | 16 |
| Drainage of nose lesion sept 30020 CPT 30020 | $531.00 | $708.00 | $523.04 – $941.47 | 16 |
| Drain blood from under nail 11740 CPT 11740 | $435.00 | $580.00 | $129.03 – $232.25 | 16 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $3,169.50 | $4,226.00 | $1,601.72 – $2,883.09 | 16 |
| Drain cath image guided visceral pq CPT 49405 | $3,458.25 | $4,611.00 | $1,601.72 – $2,883.09 | 16 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $977.25 | $1,303.00 | $684.56 – $1,232.21 | 16 |
| Drain finger abscess;simple 26010 CPT 26010 | $190.50 | $254.00 | $194.58 – $350.24 | 16 |
| Drain lower leg lesion 27603 CPT 27603 | $3,269.25 | $4,359.00 | $2,816.99 – $5,070.59 | 16 |
| Drain neck/chest lesion 21501 CPT 21501 | $2,745.00 | $3,660.00 | $2,816.99 – $5,070.59 | 16 |
| Drain ovarn cyst abd CPT 58805 | $3,572.25 | $4,763.00 | $3,139.36 – $5,650.86 | 16 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $423.75 | $565.00 | $194.58 – $350.24 | 16 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $633.00 | $844.00 | $194.58 – $350.24 | 16 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $639.75 | $853.00 | $394.24 – $709.63 | 16 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $9,875.23 | $13,166.97 | $119.53 – $217.24 | 17 |
| Drng of eyelid abscess 67700 CPT 67700 | $747.00 | $996.00 | $307.82 – $554.08 | 16 |
| Drng of finger abscess comp 26011 CPT 26011 | $1,000.50 | $1,334.00 | $1,601.72 – $2,883.09 | 16 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | $3,624.75 | $4,833.00 | $3,139.36 – $5,650.86 | 16 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,580.25 | $2,107.00 | $1,601.72 – $2,883.09 | 16 |
| Drng salivary gland submax/subling 42310 CPT 42310 | $496.50 | $662.00 | $523.04 – $941.47 | 16 |
| Dronabinol 2.5mg oral HCPCS Q0167 | $1,907.03 | $2,542.70 | $4.06 – $7.29 | 2 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $13.05 – $13.05 | 1 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $1,956.48 | $2,608.64 | not published | 0 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $30.13 – $30.13 | 1 |
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.