Unlisted pathology test

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR PENTOXIFLLINE STIM SPERM

Medcost pricing summary

Low

$45

Average

$202

Median

$104

High

$3.4k

Medcost rate distribution

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31 hospital rates

#		Plans
1	Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient	1	$49	$49	—	—	—	$49 – $49
2	Brunswick Community Hospital, LLC Bolivia, NC fee schedule · outpatient	2	$131	$131	$7	5%	—	$123 – $138
3	Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · inpatientfrom % of charges	1	$3.6k	$3.6k	—	—	—	$3.6k – $3.6k
4	Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges	1	$3.3k	$3.3k	—	—	—	$3.3k – $3.3k
5	Forsyth Memorial Hospital, Inc. Clemmons, NC fee schedule · outpatient	2	$147	$147	$7	5%	—	$139 – $154
6	Forsyth Memorial Hospital, Inc. Winston-Salem, NC fee schedule · outpatient	2	$147	$147	$7	5%	—	$139 – $154
7	Forsyth Memorial Hospital, Inc. Kernersville, NC fee schedule · outpatient	2	$147	$147	$7	5%	—	$139 – $154
8	Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges	1	$88	$88	$7	8%	—	$81 – $95
9	Medical Park Hospital LLC Winston-Salem, NC fee schedule · outpatient	2	$147	$147	$7	5%	—	$139 – $154
10	Novant Health Ballantyne Medical Center LLC Charlotte, NC fee schedule · outpatient	2	$120	$120	$3	3%	—	$116 – $123
11	Novant Health Matthews Medical Center LLC Matthews, NC fee schedule · outpatient	2	$120	$120	$3	3%	—	$116 – $123
12	Novant Health Mint Hill Medical Center, LLC Charlotte, NC fee schedule · outpatient	2	$120	$120	$3	3%	—	$116 – $123
13	Novant Health Rowan Medical Center LLC Salisbury, NC fee schedule · outpatient	2	$121	$121	$3	3%	—	$118 – $125
14	Novant Health Thomasville Medical Center, LLC Thomasville, NC fee schedule · outpatient	2	$147	$147	$7	5%	—	$139 – $154
15	PRISMA HEALTH BAPTIST COLUMBIA HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
16	PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
17	PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
18	PRISMA HEALTH BLOUNT MEMORIAL HOSPITAL MARYVILLE, TN percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
19	PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
20	PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
21	PRISMA HEALTH HILLCREST HOSPITAL SIMPSONVILLE, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
22	PRISMA HEALTH LAURENS COUNTY HOSPITAL CLINTON, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
23	PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
24	PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47
25	PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges	2	$45	$45	$3	6%	—	$42 – $47

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CPT 89240