▸ Hospital · OH · CCN 361309

Henry County Hospital, Inc

11600 STATE ROUTE 424, NAPOLEON, OH, 43545-

25 bedsCritical Access Hospitals2

Compliance grade

86/100

Procedures tracked

130

of 209 target codes

Payers

with negotiated rates

Rates published

956

last crawl 2026-05-24

▸ Compare with other hospitals All OH hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://www.henrycountyhospital.org/documents/344477047_henry-county-hospital_standardcharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
emergency
ED visit level 1	CPT	99281	0	$230	$172.5	—	—	—
ED visit level 2	CPT	99282	0	$410	$307.5	—	—	—
ED visit level 3	CPT	99283	0	$715	$536.25	—	—	—
ED visit level 4	CPT	99284	0	$1,105	$828.75	—	—	—
ED visit level 5	CPT	99285	0	$1,590	$1,192.5	—	—	—
Critical care, first hour	CPT	99291	0	$2,180	$1,635	—	—	—
imaging
CT head without contrast	CPT	70450	0	$1,200	$900	—	—	—
CT head with contrast	CPT	70460	0	$1,735	$1,301.25	—	—	—
CT head with and without contrast	CPT	70470	0	$3,470	$2,602.5	—	—	—
CT neck with contrast	CPT	70491	0	$1,735	$1,301.25	—	—	—
MRI brain without contrast	CPT	70551	0	$2,660	$1,995	—	—	—
MRI brain with contrast	CPT	70552	0	$3,930	$2,947.5	—	—	—
MRI brain with and without contrast	CPT	70553	0	$3,930	$2,947.5	—	—	—
Chest X-ray single view	CPT	71045	0	$175	$131.25	—	—	—
Chest X-ray 2 views	CPT	71046	0	$255	$191.25	—	—	—
Chest X-ray 3 views	CPT	71047	0	$175	$131.25	—	—	—
CT chest without contrast	CPT	71250	0	$1,400	$1,050	—	—	—
CT chest with contrast	CPT	71260	0	$2,135	$1,601.25	—	—	—
CT chest with and without contrast	CPT	71270	0	$4,270	$3,202.5	—	—	—
MRI chest without contrast	CPT	71550	0	$2,600	$1,950	—	—	—
MRI chest with contrast	CPT	71551	0	$3,200	$2,400	—	—	—
MRI chest with and without contrast	CPT	71552	0	$3,840	$2,880	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$400	$300	—	—	—
CT cervical spine without contrast	CPT	72125	0	$1,275	$956.25	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$1,275	$956.25	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$1,275	$956.25	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$2,660	$1,995	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$2,660	$1,995	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$2,660	$1,995	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$3,930	$2,947.5	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$3,930	$2,947.5	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$3,345	$2,508.75	—	—	—
CT pelvis without contrast	CPT	72192	0	$1,275	$956.25	—	—	—
CT pelvis with contrast	CPT	72193	0	$2,135	$1,601.25	—	—	—
Shoulder X-ray	CPT	73030	0	$415	$311.25	—	—	—
Humerus X-ray	CPT	73060	0	$415	$311.25	—	—	—
Hand X-ray 3 views	CPT	73130	0	$415	$311.25	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$3,250	$2,437.5	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$4,800	$3,600	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$415	$311.25	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$415	$311.25	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$3,250	$2,437.5	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$4,800	$3,600	—	—	—
CT abdomen without contrast	CPT	74150	0	$1,275	$956.25	—	—	—
CT abdomen with contrast	CPT	74160	0	$2,135	$1,601.25	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$4,270	$3,202.5	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$2,900	$2,175	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$3,300	$2,475	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$8,570	$6,427.5	—	—	—
MRI abdomen without contrast	CPT	74181	0	$2,600	$1,950	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$3,840	$2,880	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$800	$600	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$800	$600	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$800	$600	—	—	—
Obstetric ultrasound first trimester	CPT	76801	0	$800	$600	—	—	—
Obstetric ultrasound after first trimester	CPT	76805	0	$800	$600	—	—	—
Transvaginal ultrasound	CPT	76830	0	$800	$600	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$800	$600	—	—	—
Scrotal ultrasound	CPT	76870	0	$800	$600	—	—	—
Diagnostic mammography unilateral	CPT	77065	0	$260	$195	—	—	—
Diagnostic mammography bilateral	CPT	77066	0	$400	$300	—	—	—
Screening mammography bilateral	CPT	77067	0	$300	$225	—	—	—
EKG complete	CPT	93000	0	$33	$24.75	—	—	—
EKG tracing only	CPT	93005	0	$170	$127.5	—	—	—
EKG interpretation only	CPT	93010	0	$4	$3	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$2,465	$1,848.75	—	—	—
Stress echocardiogram	CPT	93350	0	$2,465	$1,848.75	—	—	—
inpatient
Initial hospital care, low complexity	CPT	99221	0	$195	$146.25	—	—	—
Initial hospital care, moderate complexity	CPT	99222	0	$307	$230.25	—	—	—
Initial hospital care, high complexity	CPT	99223	0	$409	$306.75	—	—	—
Hospital discharge, <30 min	CPT	99238	0	$190	$142.5	—	—	—
Hospital discharge, >30 min	CPT	99239	0	$269	$201.75	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$80	$60	—	—	—
Electrolyte panel	CPT	80051	0	$65	$48.75	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$100	$75	—	—	—
Lipid panel	CPT	80061	0	$130	$97.5	—	—	—
Renal function panel	CPT	80069	0	$85	$63.75	—	—	—
Hepatic function panel	CPT	80076	0	$80	$60	—	—	—
Urinalysis non-automated	CPT	81002	0	$60	$45	—	—	—
Urinalysis automated	CPT	81003	0	$35	$26.25	—	—	—
Glucose quantitative	CPT	82947	0	$40	$30	—	—	—
Hemoglobin A1c	CPT	83036	0	$95	$71.25	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$160	$120	—	—	—
Complete blood count with automated differential	CPT	85025	0	$65	$48.75	—	—	—
Complete blood count without differential	CPT	85027	0	$55	$41.25	—	—	—
Urine culture bacterial	CPT	87086	0	$50	$37.5	—	—	—
Urine culture identification	CPT	87088	0	$50	$37.5	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$125	$93.75	—	—	—
maternity
Fetal non-stress test	CPT	59025	0	$1,575	$1,181.25	—	—	—
Routine obstetric care including vaginal delivery	CPT	59400	0	$5,730	$4,297.5	—	—	—
Vaginal delivery only	CPT	59409	0	$1,909	$1,431.75	—	—	—
Vaginal delivery with postpartum	CPT	59410	0	$2,579	$1,934.25	—	—	—
Routine obstetric care with C-section	CPT	59510	0	$6,376	$4,782	—	—	—
C-section delivery only	CPT	59514	0	$2,168	$1,626	—	—	—
C-section with postpartum	CPT	59515	0	$3,200	$2,400	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$90	$67.5	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$140	$105	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$165	$123.75	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$215	$161.25	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$65	$48.75	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$90	$67.5	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$140	$105	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$165	$123.75	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$215	$161.25	—	—	—
preventive
Upper GI endoscopy diagnostic	CPT	43235	0	$287	$215.25	—	—	—
Upper GI endoscopy with biopsy	CPT	43239	0	$322	$241.5	—	—	—
Sigmoidoscopy diagnostic	CPT	45330	0	$133	$99.75	—	—	—
Sigmoidoscopy with biopsy	CPT	45331	0	$170	$127.5	—	—	—
Colonoscopy diagnostic	CPT	45378	0	$431	$323.25	—	—	—
Colonoscopy with biopsy	CPT	45380	0	$469	$351.75	—	—	—
Colonoscopy with polyp removal	CPT	45385	0	$592	$444	—	—	—
surgery
Total shoulder arthroplasty	CPT	23472	0	$3,424	$2,568	—	—	—
Hip hemiarthroplasty	CPT	27125	0	$2,688	$2,016	—	—	—
Total hip replacement	CPT	27130	0	$3,048	$2,286	—	—	—
Total knee replacement	CPT	27447	0	$3,045	$2,283.75	—	—	—
Knee revision arthroplasty single component	CPT	27486	0	$3,333	$2,499.75	—	—	—
Knee revision arthroplasty all components	CPT	27487	0	$4,154	$3,115.5	—	—	—
Shoulder arthroscopy with decompression	CPT	29826	0	$407	$305.25	—	—	—
Shoulder arthroscopy with rotator cuff repair	CPT	29827	0	$2,534	$1,900.5	—	—	—
Knee arthroscopy with meniscectomy	CPT	29881	0	$1,290	$967.5	—	—	—
ACL reconstruction	CPT	29888	0	$2,310	$1,732.5	—	—	—
Open appendectomy	CPT	44950	0	$1,532	$1,149	—	—	—
Laparoscopic appendectomy	CPT	44970	0	$1,438	$1,078.5	—	—	—
Laparoscopic cholecystectomy	CPT	47562	0	$1,579	$1,184.25	—	—	—
Lap cholecystectomy with cholangiography	CPT	47563	0	$1,718	$1,288.5	—	—	—
Lap inguinal hernia repair	CPT	49650	0	$1,035	$776.25	—	—	—
Total abdominal hysterectomy	CPT	58150	0	$2,415	$1,811.25	—	—	—
Lap-assisted vaginal hysterectomy	CPT	58550	0	$2,093	$1,569.75	—	—	—
Lap-assisted vaginal hysterectomy >250g	CPT	58552	0	$2,328	$1,746	—	—	—
Lap salpingo-oophorectomy	CPT	58661	0	$1,548	$1,161	—	—	—