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 |
|---|---|---|---|---|
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $1,050.00 | $1,400.00 | $394.24 – $709.63 | 16 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $1,311.75 | $1,749.00 | $394.24 – $709.63 | 16 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $1,149.75 | $1,533.00 | $394.24 – $709.63 | 16 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $1,097.25 | $1,463.00 | $394.24 – $709.63 | 16 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $135.00 | $180.00 | $194.58 – $350.24 | 16 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $142.50 | $190.00 | $194.58 – $350.24 | 16 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $135.00 | $180.00 | $194.58 – $350.24 | 16 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $159.00 | $212.00 | $194.58 – $350.24 | 16 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $159.00 | $212.00 | $194.58 – $350.24 | 16 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,692.00 | $2,256.00 | $209.40 – $376.92 | 16 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $2,091.75 | $2,789.00 | $832.81 – $1,499.05 | 16 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $229.50 | $306.00 | $45.64 – $82.16 | 16 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $316.50 | $422.00 | $98.01 – $176.42 | 16 |
| Ghs strapping shoulder - 29240 CPT 29240 | $257.25 | $343.00 | $129.03 – $232.25 | 16 |
| Ghs st - re-eval for alt comm CPT 92597 | $410.25 | $547.00 | $68.59 – $123.47 | 16 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $606.75 | $809.00 | $716.75 – $1,290.15 | 16 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $894.00 | $1,192.00 | $394.24 – $709.63 | 16 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $403.50 | $538.00 | $239.22 – $430.59 | 16 |
| Ghs urine, porphyrins quant CPT 84120 | $447.00 | $596.00 | $14.71 – $26.48 | 17 |
| Ghs vaginal delivery only CPT 59409 | $773.25 | $1,031.00 | $3,139.36 – $5,650.86 | 16 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $2,699.25 | $3,599.00 | $361.89 – $651.40 | 16 |
| Giardia lamblia antibody CPT 86674 | $114.00 | $152.00 | $14.72 – $26.50 | 17 |
| Gi inhouse confirmation CPT 87045 | $70.50 | $94.00 | $9.44 – $16.99 | 17 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,582.50 | $2,110.00 | $879.59 – $1,583.27 | 16 |
| Glassia injection HCPCS J0257 | $2,551.28 | $3,401.70 | $5.66 – $13.90 | 17 |
| Glove finger flexion right lg xl HCPCS L3912 | $36.75 | $49.00 | $142.19 – $255.94 | 16 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $476.55 – $476.55 | 1 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $509.06 | $678.74 | $135.00 – $243.00 | 16 |
| Glucagon plasma - sendout CPT 82943 | $52.50 | $70.00 | $14.29 – $25.72 | 17 |
| Glucose 1 hr post dose CPT 82950 | $86.25 | $115.00 | $4.75 – $8.55 | 17 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $57.75 | $77.00 | $6.05 – $10.89 | 17 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $30.00 | $40.00 | $3.28 – $5.90 | 17 |
| Glucose blood quantitative CPT 82947 | $45.00 | $60.00 | $3.93 – $7.07 | 17 |
| Glucose body fluid CPT 82945 | $59.25 | $79.00 | $3.93 – $7.07 | 17 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $147.00 | $196.00 | $12.87 – $23.17 | 17 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $44.25 | $59.00 | $3.92 – $7.06 | 17 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $102.50 | $136.66 | $5.58 – $5.58 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $7,166.65 | $9,555.53 | $11.29 – $26.82 | 17 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $147.00 | $196.00 | $18.58 – $33.44 | 17 |
| Gonadotropin hormone panel CPT 80426 | $973.50 | $1,298.00 | $148.41 – $267.14 | 17 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $96.75 | $129.00 | $18.52 – $33.34 | 17 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $11,433.78 | $15,245.04 | $1,786.92 – $5,481.09 | 2 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $3,026.25 | $4,035.00 | $73.75 – $217.24 | 17 |
| Graft axiofill 1000mg HCPCS J3590 | $675,000.00 | $900,000.00 | not published | 0 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $2,897.51 – $2,897.51 | 1 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $17,736.75 | $23,649.00 | $120.69 – $217.24 | 17 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $31,488.75 | $41,985.00 | $120.69 – $217.24 | 16 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $27,652.41 | $36,869.88 | not published | 0 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $78,750.00 | $105,000.00 | not published | 0 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $29,670.10 | $39,560.13 | $120.69 – $217.24 | 17 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $6,187.50 | $8,250.00 | $120.69 – $239.85 | 17 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $6,075.00 | $8,100.00 | $120.69 – $331.44 | 17 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $7,746.75 | $10,329.00 | $118.90 – $217.24 | 17 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $394.48 – $394.48 | 1 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $66,548.25 | $88,731.00 | $120.69 – $217.24 | 16 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $2,227.50 | $2,970.00 | $120.69 – $217.24 | 17 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $99,296.10 | $132,394.80 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $6,187.50 | $8,250.00 | not published | 0 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.54 – $0.54 | 1 |
| Great toe with reduction 28495 CPT 28495 | $581.25 | $775.00 | $239.22 – $430.59 | 16 |
| Growth hormone panel CPT 80428 | $135.75 | $181.00 | $66.70 – $120.06 | 17 |
| Growth hormone panel CPT 80430 | $261.75 | $349.00 | $129.33 – $232.79 | 17 |
| Growth stimulation gene 2 CPT 83006 | $1,637.25 | $2,183.00 | $75.60 – $136.08 | 17 |
| G-tube reposition CPT 43761 | $865.50 | $1,154.00 | $242.30 – $436.15 | 16 |
| Gu dilat ureter/urethra s&i CPT 74485 | $1,476.75 | $1,969.00 | $2,027.25 – $3,649.06 | 17 |
| Guided cath fluid drainage 10030 CPT 10030 | $2,959.50 | $3,946.00 | $686.75 – $1,236.14 | 16 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $2,108.25 | $2,811.00 | $817.79 – $1,472.02 | 16 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $20,413.63 | $27,218.17 | not published | 0 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $3,593.25 | $4,791.00 | not published | 0 |
| Gw stiffened micro access kit HCPCS C1894 | $101,250.00 | $135,000.00 | not published | 0 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $120.02 | $160.02 | $11.39 – $79.02 | 2 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $8.58 | $11.44 | $2.02 – $12.78 | 2 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $114.00 | $152.00 | $26.59 – $47.87 | 16 |
| Hand X-ray CPT 73130 | $236.25 | $315.00 | $84.40 – $151.91 | 17 |
| Hand X-ray (2 views, both hands) CPT 73120 | $213.75 | $285.00 | $101.39 – $182.50 | 17 |
| Haptoglobin quantitative CPT 83010 | $83.25 | $111.00 | $12.58 – $22.64 | 17 |
| Hast w/i&r phys/qhp CPT 94452 | $351.00 | $468.00 | $129.03 – $232.25 | 16 |
| Hast w/oxygen titrate CPT 94453 | $422.25 | $563.00 | $129.03 – $232.25 | 16 |
| Hba1/hba2 full gene sequence CPT 81259 | $1,051.50 | $1,402.00 | $600.00 – $1,080.00 | 17 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $743.25 | $991.00 | $202.40 – $364.32 | 17 |
| Hbot, full body chamber, 30m HCPCS G0277 | $615.75 | $821.00 | $133.45 – $240.22 | 16 |
| Hcg qualitative CPT 84703 | $60.75 | $81.00 | $7.52 – $13.54 | 17 |
| Hcg quantitative CPT 84702 | $145.50 | $194.00 | $15.05 – $27.09 | 17 |
| Hc nm fusion spect CT unlisted CPT 78999 | $680.25 | $907.00 | $387.70 – $697.86 | 17 |
| Hc nm kidney imaging with flow CPT 78701 | $638.25 | $851.00 | $387.70 – $697.86 | 17 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | $471.75 | $629.00 | $526.57 – $1,694.37 | 17 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | $2,528.25 | $3,371.00 | $1,255.55 – $2,259.99 | 16 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | $2,175.00 | $2,900.00 | $114.72 – $206.49 | 16 |
| Head CT scan (with and without contrast) CPT 70470 | $1,720.50 | $2,294.00 | $170.10 – $306.19 | 16 |
| Head CT scan (with contrast) CPT 70460 | $1,833.75 | $2,445.00 | $170.10 – $306.19 | 16 |
| Head CT scan (without contrast) CPT 70450 | $1,557.00 | $2,076.00 | $101.39 – $182.50 | 16 |
| Heart first pass add-on CPT 78496 | $522.00 | $696.00 | $40.25 – $72.45 | 16 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $216.00 | $288.00 | $84.40 – $151.91 | 17 |
| Helicoll, per square cm HCPCS Q4164 | not published | not published | $3,994.00 – $3,994.00 | 1 |
| Hematocrit CPT 85014 | $33.00 | $44.00 | $2.37 – $4.27 | 17 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $41,382.91 | $55,177.21 | $35.31 – $83.15 | 17 |
| Hemodialysis repeated eval CPT 90937 | $2,004.00 | $2,672.00 | $87.21 – $156.98 | 16 |
| Hemoglobin CPT 85018 | $28.50 | $38.00 | $2.37 – $4.27 | 17 |
| Hemoglobin fetal qualitative CPT 83033 | $43.50 | $58.00 | $8.00 – $14.40 | 17 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $132.75 | $177.00 | $8.20 – $14.76 | 17 |
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.