Summit County Physician / Clinic Costs

Location Service Description Plain English Description Procedure Description Procedure Code Self Pay Rate Payment Method
Summit County Surgery Debridement subcutaneous (under the skin) tissue - first 20 sq cm Debridement, Subsequesnt Tissue 20 Sq Cm/ 11042 $106.32 Per Service
Summit County Surgery Insertion of drug implant device Insertion of Drug Implant Device 11981 $238.77 Per Service
Summit County Surgery Tissue Transfer - additional 30 square cm Tissue Transfer Additional 30 Square Cm 14302 $392.47 Per Service
Summit County Surgery Descuction of up to 14 benign lesions Destruction of benign Lesion 1-14 17110 $191.85 Per Service
Summit County Surgery Breast biopsy with placement of clip/metallic pellet - with ultrasound guidance Biopsy Breast 1st Lesion Ultrasound Imaging 19083 $301.26 Per Service
Summit County Surgery Large oint aspiration or injection (shoulder, knee, hip) without ultraound Drain/Inj Joint/Bursa W/O Ultrasound 20610 $109.50 Per Service
Summit County Surgery Large joint aspiration or injection (shoulder, knee, hip) with ultrasound Drain/Inj Joint/Bursa W/Ultrasound 20611 $162.65 Per Service
Summit County Surgery Insertion of mechanical disk spacer during spine surgery Insertion of Biomechanical Device 22853 $481.66 Per Service
Summit County Surgery Reduction of shoulder dislocation Treat Shoulder Dislocation 23650 $495.88 Per Service
Summit County Surgery Nonsurgical treatment of radius fracture at the wrist including ulna Treat Fracture Radius/Ulna 25600 $563.08 Per Service
Summit County Surgery Total Hip Arthroplasty (THA) Total Hip Arthroplasty 27130 $2,445.94 Per Service
Summit County Surgery Total Knee Arthroplasty (TKA) Total Knee Arthroplasty 27447 $2,485.50 Per Service
Summit County Surgery Arthroscopic shoulder surgery - decompression/repair of acromion/ligament release Shoulder Arthroscopy/Surgery 29826 $310.68 Per Service
Summit County Surgery Arthroscopic Cartilage Removal Knee Arthroscopy/Surgery 29881 $954.99 Per Service
Summit County Surgery Arthroscopic ACL Repair Knee Arthroscopy/Surgery 29888 $1,732.92 Per Service
Summit County Surgery Removal of inferior nasal turbinate Resect Inferior Turbinate 30140 $778.32 Per Service
Summit County Surgery Repair Of Nasal Septum Repair Of Nasal Septum 30520 $1,099.29 Per Service
Summit County Surgery Diagnostic scope of the nose - unilateral or bilateral Nasal Endoscopy Dx 31231 $357.01 Per Service
Summit County Surgery Sinus or Nasal surgery with biopsy or removal of polyps Nasal/Sinus Endoscopy Surg 31237 $465.50 Per Service
Summit County Surgery Scope of Larynx (voice box) Diagnostic Laryngoscopy 31575 $202.03 Per Service
Summit County Surgery Routine Venipuncture Routine Venipuncture 36415 $5.15 Per Service
Summit County Surgery Esophagus/Stomach/Intestine (EDG) with biopsy single/multiple Esophagus Biopsy Single/Multiple 43239 $278.39 Per Service
Summit County Surgery Diagnostic Colonoscopy Diagnostic Colonoscopy 45378 $375.18 Per Service
Summit County Surgery Colonoscopy with biopsy Colonoscopy And Biopsy 45380 $443.30 Per Service
Summit County Surgery Colonoscopy with lesion/polyp removal Colonoscopy W/Lesion Removal 45385 $530.21 Per Service
Summit County Surgery Diagnostic exam of the anus using an endoscope Diagnostic Anoscopy Specimen 46600 $153.80 Per Service
Summit County Surgery Circumcision - Clamp Circumcision W/Regional Block 54150 $172.89 Per Service
Summit County Surgery Cervical biopsy with scope Bx/Curett Of Cervix W/Scope 57454 $270.30 Per Service
Summit County Surgery Biopsy of Uterine Lining Biopsy Of Uterus Lining 58100 $193.06 Per Service
Summit County Surgery Insertion of an Intrauterine Device (IUD) Insert Intrauterine Device 58300 $123.49 Per Service
Summit County Surgery Removal of an Intrauterine Device (IUD) Remove Intrauterine Device 58301 $168.30 Per Service
Summit County Surgery Laparoscopic total hysterectomy for a uterus of 250g or less Tlh W/T/O 250 G Or Less 58571 $1,629.00 Per Service
Summit County Surgery Fetal Non Stress Test Fetal Non-Stress Test 59025 $84.05 Per Service
Summit County Surgery Routine Vaginal Delivery Package - includes:
• Up to 13 prenatal visits (after initial visit)
• Routine prenatal urinalysis tests
• Labor, delivery
• Uncomplicated postpartum care
Obstetrical Care 59400 $3,702.35 Per Service
Summit County Surgery Physician charges of antepartum care only Antepartum Care Only 59426 $1,443.96 Per Service
Summit County Surgery C-Section Delivery Package - includes:
• Up to 13 prenatal visits (after initial visit)
• Routine prenatal urinalysis tests
• Labor, delivery
• Uncomplicated postpartum care
Cesarean Delivery 59510 $4,100.39 Per Service
Summit County Surgery C-Section - Delivery Only Cesarean Delivery Only 59514 $1,636.43 Per Service
Summit County Surgery Spinal injection - epidural with imaging - Lumbar/Sacrum single level Injection transforminal Epidural Lumbar/Sacral 64483 $197.64 Per Service
Summit County Surgery Spinal Facet Injection with imaging - Lumbar/Sacrum single level Injection Paravertebral Facet Joint L/S 1 Lev 64493 $162.23 Per Service
Summit County Surgery Bilateral Chemodenervation of Muscle(s) (eg: Botox for Migraines) Chemodenervation of Muscle(s) for Migraine 64615 $253.68 Per Service
Summit County Radiology Chest X-Ray - 2 view Chest X-Ray 2 view Frontal&Lateral 71020 $50.50 Per Service
Summit County Radiology X-Ray of Shoulder - complete X-Ray Exam Of Shoulder 73030 $52.50 Per Service
Summit County Radiology X-Ray of Wrist - complete X-Ray Exam Of Wrist 73110 $64.00 Per Service
Summit County Radiology X-Ray of Knee - 3 views X-Ray Exam Of Knee 3 73562 $64.50 Per Service
Summit County Radiology X-Ray of Ankle - complete X-Ray Exam Of Ankle 73610 $57.00 Per Service
Summit County Radiology X-Ray of foot - complete X-Ray Exam Of Foot 73630 $52.50 Per Service
Summit County Radiology Ultrasound Breast Limited - Unilateral Ultrasound Breast Limited 76642 $157.65 Per Service
Summit County Radiology OB Ultrasound first trimester - Single Fetus OB Ultrasound 76801 $224.78 Per Service
Summit County Radiology OB Ultrasound after first trimester - Single Fetus Ob Ultrasound >/= 14 Wks Single Fetus 76805 $258.50 Per Service
Summit County Radiology OB Ultrasound Follow-Up Per Fetus OB Ultrasound Follow-Up Per Fetus 76816 $208.10 Per Service
Summit County Radiology Transvaginal ultrasound - obstetric Transvaginal Ultrasound Obstetric 76817 $177.00 Per Service
Summit County Radiology Transvaginal ultrasound - not obstetric Transvaginal Ultrasound Non-Ob 76830 $222.45 Per Service
Summit County Radiology 3D screening breast mammography - bilateral Breast Tomosynthesis Biopsy 77063 $98.44 Per Service
Summit County Radiology Screening Mammogram - Bilateral Screening Mamm Bilat Incl Cad When Perf 77067 $239.22 Per Service
Summit County Lab Path Automated Urinalysis without microscopy Urinalysis Auto W/O Scope 81003 $5.50 Per Service
Summit County Lab Path Influenze A or B Test Influenza Assay W/Optic 87804 $29.13 Per Service
Summit County Lab Path Strep A Test Strep A Assay W/Optic 87880 $29.13 Per Service
Summit County Medicine Immunization admistration with counseling - ages of 0-18 Im Admin 1St/Only Component 90460 $43.31 Per Service
Summit County Medicine Immunization administration with counseling - additional vaccines - ages of 0-18 Im Admin Each Addl Component 90461 $21.87 Per Service
Summit County Medicine Immunization administration - initial vaccine Immunization Admin 90471 $43.05 Per Service
Summit County Medicine Immunization administration - additional administration Immunization Admin Each Add 90472 $21.35 Per Service
Summit County Medicine HPV Vaccine Vaccine 2/3 Dose Im 90651 $172.00 Per Service
Summit County Medicine Pneumonia 13 Vaccine Pcv13 Vaccine Im 90670 $262.34 Per Service
Summit County Medicine Flu Vaccine - preservative free Flu Vacinne 0.5 Ml Intramuscular 90686 $31.52 Per Service
Summit County Medicine Flu Vaccine Flu Vaccine Split 0.5 Ml Intramuscular 90688 $31.50 Per Service
Summit County Medicine Tetanus Diptheria Vaccine administered to individuals 7 years or older Tetanus Diptheria Vaccine 7 Yrs/> Intramuscular 90715 $53.00 Per Service
Summit County Medicine Psychotherapy Evalutation - 30 Minutes Psychotherapy Evalutation with E/M 30 Min 90833 $114.16 Per Service
Summit County Medicine Psychotherapy Evaluation - 45 Minutes Psychotherapy Evaluation with E/M 45 Minutes 90834 $148.69 Per Service
Summit County Medicine Electroconvulsive Therapy Electroconvulsive Therapy 90870 $189.71 Per Service
Summit County Medicine Comprehensive Hearing Test Comprehensive Hearing Test 92557 $66.77 Per Service
Summit County Medicine Electrocardiogram (EKG) Complete Electrocardiogram Complete 93000 $30.99 Per Service
Summit County Medicine Electrocardiogram (EKG) Report Electrocardiogram Report 93010 $14.80 Per Service
Summit County Medicine Echocardiogram with Doppler Study Transthoracic Echo w/Doppler Complete 93306 $386.64 Per Service
Summit County Medicine Heart Stress Test Complete Stress Test Complete 93351 $457.77 Per Service
Summit County Medicine Heart Angiogram including Left Heart Catherization L Hrt Artery/Ventricle Angio 93458 $1,820.00 Per Service
Summit County Medicine Abdominal/Pelvic ultrasound study -arteries/veins - Limited Vascular Study 93976 $295.00 Per Service
Summit County Medicine Therapeutic Exercises, each 15 minutes Therapeutic Exercises 97110 $54.87 Per Service
Summit County Medicine Manual therapy for 1 or more regions, each 15 minutes Manual Therapy 1/> Regions 97140 $51.13 Per Service
Summit County Medicine Physical therapy evaluation - low complexity (about 20 Minutes) Physical therapy Evaluation Low Complex 20 Min 97161 $142.84 Per Service
Summit County Evaluation and Mgmt Level 2 office visit for a new patient Office/Outpatient Visit New Patient 99202 $127.86 Per Service
Summit County Evaluation and Mgmt Level 3 office visit for a new patient Office/Outpatient Visit New Patient 99203 $185.29 Per Service
Summit County Evaluation and Mgmt Level 4 office visit for a new patient Office/Outpatient Visit New Patient 99204 $283.30 Per Service
Summit County Evaluation and Mgmt Level 5 office visit for a new patient Office/Outpatient Visit New Patient 99205 $352.93 Per Service
Summit County Evaluation and Mgmt Level 2 office visit for an established patient Office/Outpatient Visit Established Patient 99212 $74.98 Per Service
Summit County Evaluation and Mgmt Level 3 office visit for an established patient Office/Outpatient Visit Established Patient 99213 $124.78 Per Service
Summit County Evaluation and Mgmt Level 4 office visit for an established patient Office/Outpatient Visit Established Patient 99214 $184.17 Per Service
Summit County Evaluation and Mgmt Level 5 office visit for an established patient Office/Outpatient Visit Established Patient 99215 $247.07 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a newpatient less than one year old Init Preventative E/M New Patient Infant 99381 $190.10 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a new patient between the ages 1-4 Init Preventative E/M New Patient 1-4 Yrs 99382 $198.38 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a new patient between the ages 5-11 Previous Visit New Age 5-11 99383 $206.32 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a new patient between the ages 12-17 Previous Visit New Age 12-17 99384 $232.77 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a new patient between the ages 18-39 Prev Visit New Patient Age 18-39 99385 $226.26 Per Service
Summit County Evaluation and Mgmt Initial preventative visit for a new patient between the ages 40-64 Prev Visit New Patient Age 40-64 99386 $261.85 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established infant patient less than one year old Preventive Visit Reevaluation Established Pat Infant 99391 $170.14 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patient between the ages of 1-4 Preventive Visit Established Patient Age 1-4 99392 $181.90 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patient between the ages of 5-11 Preventive Med Visit Established Pateint Age 5-11 99393 $181.29 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patient between the ages of 12-17 Preventive Visit Established Patient Age 12-17 99394 $198.38 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patient between the ages of 18-39 Prev Visit Established Patient Age 18-39 99395 $202.64 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patient between the ages of 40-64 Prev Visit Est Age 40-64 99396 $216.19 Per Service
Summit County Evaluation and Mgmt Preventive visit for an established patients ages 65 and over Established Patient Reevaluation65+ Yr 99397 $233.11 Per Service

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Our goal is to provide meaningful and reliable information to help you understand prices in advance of your visit. We have put together the top outpatient visits and procedure costs by region for self-pay individuals to give you an estimate of the expected pricing for commonly provided health care services at a Centura Health practice or clinic.

Actual prices on the final bill may vary from this information based on the provider providing the services, the patient’s medical condition, unknown circumstances or complications, final diagnosis, and recommended treatment ordered.  Please be advised that while Centura Health attempts to estimate the prices of care as accurately as possible, there may be significant variations between the prices listed and the actual price reflected on your final bill.

These are physician fees only. You may incur other charges from the entity where services were rendered. 

If you do not see the procedure or service you are looking for, or wish to receive a customized estimate on a specific procedure, please request a custom estimate.