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Adena Pike Medical Center

100 Dawn Lane, Waverly, OH 45690 · (740) 947-2186

Critical Access HospitalsVoluntary non-profit - Private

Price file

Prices published

File dated 2026-08-19

2,970 price rows for 69 procedures

Published prices

cash · negotiated range · list
Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines

$20
cash
$2,016
cash
CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines

$764
cash
CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines

$1,008
cash
—
cash
—
cash
—
cash
Chlamydia test (DNA)

CPT 87491 · lowest of 4 lines

$96
cash
Colonoscopy (diagnostic)

CPT 45378 · lowest of 2 lines

$2,990
cash
Colonoscopy with biopsy

CPT 45380 · lowest of 2 lines

$3,336
cash
Colonoscopy with polyp removal

CPT 45385 · lowest of 2 lines

$3,220
cash
Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines

$21
cash
Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines

$29
cash
Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 2 lines

$375
cash
—
cash
$107
cash
Family psychotherapy with the patient

CPT 90847 · lowest of 2 lines

$281
cash
Family psychotherapy without the patient

CPT 90846 · lowest of 2 lines

$197
cash
—
cash
Gonorrhea test (DNA)

CPT 87591 · lowest of 4 lines

$96
cash
Group psychotherapy

CPT 90853 · lowest of 2 lines

$191
cash
—
cash
—
cash
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cash
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cash
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cash
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cash
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cash
Lipid panel (cholesterol test)

CPT 80061 · lowest of 4 lines

$35
cash
Liver function panel

CPT 80076 · lowest of 2 lines

$17
cash
MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines

$1,495
cash
$2,116
cash
$1,144
cash
MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines

$1,151
cash
—
cash
$5,549
cash
New patient office visit (about 30 minutes)

CPT 99203 · lowest of 2 lines

$95
cash
New patient office visit (about 45 minutes)

CPT 99204 · lowest of 2 lines

$115
cash
New patient office visit (about 60 minutes)

CPT 99205 · lowest of 2 lines

$129
cash
PSA test (prostate)

CPT 84153 · lowest of 4 lines

$44
cash
$16
cash
$112
cash
Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines

$178
cash
—
cash
—
cash
—
cash
—
cash
Prothrombin time (blood clotting test)

CPT 85610 · lowest of 4 lines

$11
cash
Psychotherapy, 30 minutes

CPT 90832 · lowest of 2 lines

$281
cash
Psychotherapy, 45 minutes

CPT 90834 · lowest of 2 lines

$281
cash
Psychotherapy, 60 minutes

CPT 90837 · lowest of 2 lines

$281
cash
—
cash
Screening mammogram (both breasts)

CPT 77067 · lowest of 2 lines

$144
cash
—
cash
Sleep study (overnight, attended)

CPT 95810 · lowest of 2 lines

$2,698
cash
—
cash
$1,636
cash
$2,336
cash
TSH test (thyroid)

CPT 84443 · lowest of 4 lines

$40
cash
—
cash
Transvaginal ultrasound

CPT 76830 · lowest of 2 lines

$409
cash
Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines

$409
cash
Upper endoscopy (EGD)

CPT 43235 · lowest of 2 lines

$2,595
cash
Upper endoscopy with biopsy

CPT 43239 · lowest of 2 lines

$2,883
cash
Urinalysis with microscope

CPT 81001 · lowest of 2 lines

$9
cash
—
cash
—
cash
—
cash
X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines

$304
cash

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.