Witham Memorial Hospital
Witham Memorial Hospital in Lebanon, IN publishes cash prices for 466 common procedures listed here, from its own machine-readable price file updated Oct 26, 2026. Compared with other hospitals in the state, its outpatient cash prices are above the Indiana median for 297 of 462 procedures and below it for 162. By typical cash price it ranks #74 of 84 Indiana hospitals and #13 of 16 hospitals in the Indianapolis, IN area, cheapest first. Select a procedure to compare it with other hospitals nearby.
2605 N Lebanon St Lebanon IN 46052 Collected Nov 2, 2026 Source price file Check a bill from this hospital (765) 485-8000
Acute care hospital Government-owned hospital Emergency department CMS star rating 4 of 5 CCN 150104 · CMS hospital register NPI 1699757401
Financial assistance
Public hospital: ask for its charity care or sliding-scale discount
Witham Memorial Hospital is government-owned (CMS register). The federal financial assistance rules for nonprofit hospitals do not always apply to public ones, but many public hospitals run charity care or sliding-scale discounts for uninsured and low-income patients. Ask the billing office for its financial assistance or charity care policy and application before you pay. Letters you can copy.
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Abdominal CT scan without and with contrast CPT 74170 CT scan of abdomen before and after contrast | $3,235.47 | $4,622.10 | $144.34–$11,555.25 | 138% above | 30% |
| Abdominal X-ray, 2 views CPT 74019 X-ray of abdomen, 2 views | $529.20 | $756.00 | $110.61–$1,890.00 | 96% above | 30% |
| Ankle X-ray, complete, 3 or more views CPT 73610 X-ray of ankle, minimum of 3 views | $484.37 | $691.95 | $17.51–$1,729.88 | 147% above | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ultrasound study of arm and leg arteries | $720.30 | $1,029.00 | $33.66–$2,572.50 | 97% above | 30% |
| Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT scan of arm without contrast | $1,972.01 | $2,817.15 | $97.76–$7,042.88 | 145% above | 30% |
| Barium swallow (esophagus X-ray with contrast) CPT 74220 Single contrast X-ray of esophagus | $565.95 | $808.50 | $48.47–$2,021.25 | 22% above | 30% |
| Bone scan, whole body (nuclear medicine) CPT 78306 Nuclear medicine study of bone and/or joint whole body | $2,040.36 | $2,914.80 | $147.39–$7,287.00 | 29% above | 30% |
| Breast ultrasound, complete, one breast CPT 76641 Complete ultrasound scan of 1 breast | $1,972.74 | $2,818.20 | $51.67–$7,045.50 | 355% above | 30% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 Limited ultrasound scan of 1 breast | $930.51 | $1,329.30 | $39.50–$3,323.25 | 187% above | 30% |
| CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT scan of blood vessels of abdomen and pelvis with contrast | $5,667.59 | $8,096.55 | $301.88–$20,241.38 | 200% above | 30% |
| CT angiography (CTA) of the head CPT 70496 CT scan of blood vessels of head with contrast | $3,638.25 | $5,197.50 | $185.58–$12,993.75 | 186% above | 30% |
| CT angiography (CTA) of the neck CPT 70498 CT scan of blood vessels of neck with contrast | $3,638.25 | $5,197.50 | $185.58–$12,993.75 | 199% above | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT scan of blood vessels of chest with contrast | $2,287.32 | $3,267.60 | $185.58–$8,169.00 | 80% above | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT scan of blood vessels and grafts of heart with contrast | $810.71 | $1,158.15 | $210.47–$2,895.38 | 3% below | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT scan of heart with evaluation of blood vessel calcium | $179.34 | $256.20 | $53.92–$640.50 | 4% below | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT scan of abdomen and pelvis without contrast | $3,527.27 | $5,038.95 | $89.84–$12,597.38 | 194% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $4,806.90 | $6,867.00 | $162.17–$17,167.50 | 179% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT scan of abdomen and pelvis before and after contrast | $6,466.53 | $9,237.90 | $192.64–$23,094.75 | 277% above | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT scan of abdomen with contrast | $2,404.92 | $3,435.60 | $122.78–$8,589.00 | 126% above | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT scan of abdomen without contrast | $1,765.47 | $2,522.10 | $65.81–$6,305.25 | 109% above | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT scan of face without contrast | $1,536.15 | $2,194.50 | $104.21–$5,486.25 | 84% above | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan head or brain without contrast | $1,678.01 | $2,397.15 | $56.64–$5,992.88 | 119% above | 30% |
| CT scan of the head with contrast CPT 70460 CT scan head or brain with contrast | $2,287.32 | $3,267.60 | $78.44–$8,169.00 | 168% above | 30% |
| CT scan of the head without and with contrast CPT 70470 CT scan of head or brain before and after contrast | $3,400.85 | $4,858.35 | $97.02–$12,145.88 | 226% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT scan of lower spine without contrast | $1,972.01 | $2,817.15 | $98.01–$7,042.88 | 123% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT scan of upper spine without contrast | $1,879.40 | $2,684.85 | $99.00–$6,712.13 | 126% above | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $2,404.92 | $3,435.60 | $123.28–$8,589.00 | 161% above | 30% |
| Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Ultrasound of both sides of head and neck blood flow | $241.08 | $344.40 | $97.43–$861.00 | 75% below | 30% |
| Chest CT scan without and with contrast CPT 71270 CT scan of chest before and after contrast | $3,235.47 | $4,622.10 | $153.25–$11,555.25 | 198% above | 30% |
| Chest X-ray, 2 views CPT 71046 X-ray of chest, 2 views | $346.92 | $495.60 | $62.12–$1,239.00 | 68% above | 30% |
| Chest X-ray, single view CPT 71045 X-ray of chest, 1 view | $281.51 | $402.15 | $62.12–$1,005.38 | 73% above | 30% |
| Collarbone (clavicle) X-ray, complete CPT 73000 X-ray of collar bone | $484.37 | $691.95 | $14.53–$1,729.88 | 152% above | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Complete ultrasound scan behind abdominal cavity | $905.52 | $1,293.60 | $67.05–$3,234.00 | 81% above | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA bone density measurement of hip, pelvis, spine | $897.44 | $1,282.05 | $26.92–$3,205.13 | 211% above | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA bone density measurement of forearm, finger, hand, or foot | $477.75 | $682.50 | $11.56–$1,706.25 | 229% above | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 Ultrasound scan of pregnant uterus with detailed fetal anatomic examination, single or first fetus | $1,368.57 | $1,955.10 | $62.59–$4,887.75 | 143% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT scan of chest without contrast | $1,678.01 | $2,397.15 | $97.76–$5,992.88 | 101% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT scan of chest with contrast | $2,286.59 | $3,266.55 | $123.28–$8,166.38 | 144% above | 30% |
| Diagnostic mammogram, both breasts CPT 77066 Diagnostic mammography of both breasts | $679.88 | $971.25 | $83.89–$2,428.13 | 56% above | 30% |
| Diagnostic mammogram, one breast CPT 77065 Diagnostic mammography of 1 breast | $470.40 | $672.00 | $65.56–$1,680.00 | 111% above | 30% |
| Duplex ultrasound of the leg arteries, both legs CPT 93925 Ultrasound of leg arteries or artery grafts | $2,226.32 | $3,180.45 | $97.43–$7,951.13 | 137% above | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 Ultrasound study of arm or leg veins with compression and maneuvers | $2,117.54 | $3,025.05 | $189.62–$7,562.63 | 62% above | 30% |
| Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function | $2,382.14 | $3,403.05 | $578.11–$8,507.63 | 44% above | 30% |
| Elbow X-ray, 2 views CPT 73070 X-ray of elbow, 2 views | $463.05 | $661.50 | $14.28–$1,653.75 | 180% above | 30% |
| Elbow X-ray, complete, 3 or more views CPT 73080 X-ray of elbow, minimum of 3 views | $463.05 | $661.50 | $17.51–$1,653.75 | 81% above | 30% |
| Eye socket (orbit) CT scan without contrast CPT 70480 CT scan of cranial cavity without contrast | $1,448.69 | $2,069.55 | $110.61–$5,173.88 | 70% above | 30% |
| Facial bones X-ray, complete, 3 or more views CPT 70150 X-ray of face bones, minimum of 3 views | $463.05 | $661.50 | $20.97–$1,653.75 | 70% above | 30% |
| Forearm X-ray (radius and ulna), 2 views CPT 73090 X-ray of forearm, 2 views | $484.37 | $691.95 | $13.79–$1,729.88 | 163% above | 30% |
| HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nuclear medicine study of liver and bile duct system | $3,674.27 | $5,248.95 | $208.08–$13,122.38 | 179% above | 30% |
| Hand X-ray, 2 views CPT 73120 X-ray of hand, 2 views | $271.95 | $388.50 | $13.54–$971.25 | 58% above | 30% |
| Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 X-ray of heel, minimum of 2 views | $418.95 | $598.50 | $14.28–$1,496.25 | 96% above | 30% |
| Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Sleep study including heart rate, breathing, airflow, and effort | $56.60 | $80.85 | $50.13–$434.05 | 86% below | 30% |
| In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Sleep study in sleep lab with continuous airway pressure (6 years or older) | $5,553.66 | $7,933.80 | $908.56–$19,834.50 | 71% above | 30% |
| Knee X-ray, 3 views CPT 73562 X-ray of knee, 3 views | $463.05 | $661.50 | $19.24–$1,653.75 | 102% above | 30% |
| Knee X-ray, complete, 4 or more views CPT 73564 X-ray of knee, 4 or more views | $553.46 | $790.65 | $22.21–$1,976.63 | 112% above | 30% |
| Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT scan of leg without contrast | $1,536.15 | $2,194.50 | $97.76–$5,486.25 | 96% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Limited ultrasound scan of abdomen | $993.72 | $1,419.60 | $55.41–$3,549.00 | 118% above | 30% |
| Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Limited ultrasound scan of joint or other extremity structure except blood vessels | $657.09 | $938.70 | $7.60–$2,346.75 | 117% above | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Low dose CT scan of chest for lung cancer screening | $235.94 | $337.05 | $80.90–$842.63 | 24% above | 30% |
| Lower leg X-ray (tibia and fibula), 2 views CPT 73590 X-ray of lower leg, 2 views | $463.05 | $661.50 | $13.29–$1,653.75 | 133% above | 30% |
| MR angiography (MRA) of the head without contrast CPT 70544 MRI scan of blood vessels of head without contrast | $2,648.94 | $3,784.20 | $240.45–$9,460.50 | 137% above | 30% |
| MRI of both breasts, without and then with contrast dye CPT 77049 MRI scan of both breasts | $1,770.62 | $2,529.45 | $317.99–$6,323.63 | 330% above | 30% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI scan of leg joint without contrast | $2,617.34 | $3,739.05 | $129.47–$9,347.63 | 154% above | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI scan of leg joint before and after contrast | $3,300.15 | $4,714.50 | $262.99–$11,786.25 | 128% above | 30% |
| MRI of the abdomen without contrast CPT 74181 MRI scan of abdomen without contrast | $2,189.57 | $3,127.95 | $183.97–$7,819.88 | 105% above | 30% |
| MRI of the abdomen, without and then with contrast dye CPT 74183 MRI scan of abdomen before and after contrast | $3,017.91 | $4,311.30 | $283.55–$10,778.25 | 91% above | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI scan of brain without contrast | $2,374.79 | $3,392.55 | $119.07–$8,481.38 | 134% above | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI scan of brain before and after contrast | $3,479.49 | $4,970.70 | $193.88–$12,426.75 | 166% above | 30% |
| MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal without contrast | $2,496.06 | $3,565.80 | $117.33–$8,914.50 | 146% above | 30% |
| MRI of the lower back, without and then with contrast dye CPT 72158 MRI scan of lower spinal canal before and after contrast | $3,479.49 | $4,970.70 | $192.89–$12,426.75 | 138% above | 30% |
| MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI scan of middle spinal canal without contrast | $2,189.57 | $3,127.95 | $117.33–$7,819.88 | 118% above | 30% |
| MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI scan of upper spinal canal before and after contrast | $3,651.48 | $5,216.40 | $194.13–$13,041.00 | 149% above | 30% |
| MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI scan of upper spinal canal without contrast | $2,617.34 | $3,739.05 | $117.33–$9,347.63 | 151% above | 30% |
| MRI of the pelvis without and with contrast CPT 72197 MRI scan of pelvis before and after contrast | $1,764.74 | $2,521.05 | $282.31–$6,302.63 | 21% above | 30% |
| MRI of the pelvis, no contrast dye CPT 72195 MRI scan of pelvis without contrast | $2,374.79 | $3,392.55 | $211.96–$8,481.38 | 126% above | 30% |
| MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI scan of arm joint without contrast | $2,617.34 | $3,739.05 | $129.22–$9,347.63 | 146% above | 30% |
| Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-ray of upper spine, 4-5 views | $905.52 | $1,293.60 | $22.95–$3,234.00 | 160% above | 30% |
| Neck soft tissue CT scan with contrast CPT 70491 CT scan of soft tissue of neck with contrast | $2,287.32 | $3,267.60 | $122.78–$8,169.00 | 134% above | 30% |
| Neck soft tissue CT scan without contrast CPT 70490 CT scan of soft tissue of neck without contrast | $1,765.47 | $2,522.10 | $97.76–$6,305.25 | 112% above | 30% |
| Neck soft tissue X-ray CPT 70360 X-ray of soft tissue of neck | $330.02 | $471.45 | $14.53–$1,178.63 | 91% above | 30% |
| Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear medicine studies of heart muscle at rest and with stress and SPECT | $5,314.05 | $7,591.50 | $280.83–$18,978.75 | 38% above | 30% |
| PET/CT scan from the base of the skull to mid-thigh CPT 78815 Nuclear medicine study from skull base to mid-thigh with CT scan | $3,258.26 | $4,654.65 | $777.75–$11,636.63 | 20% below | 30% |
| Pelvic CT scan without contrast CPT 72192 CT scan of pelvis without contrast | $1,765.47 | $2,522.10 | $67.30–$6,305.25 | 112% above | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Limited ultrasound scan of pelvis | $1,114.26 | $1,591.80 | $24.19–$3,979.50 | 212% above | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 Complete ultrasound scan of pelvis | $1,114.26 | $1,591.80 | $62.84–$3,979.50 | 140% above | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus | $740.15 | $1,057.35 | $67.54–$2,643.38 | 34% above | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus | $740.15 | $1,057.35 | $53.92–$2,643.38 | 44% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Limited ultrasound of pregnant uterus | $366.77 | $523.95 | $40.54–$1,309.88 | 4% below | 30% |
| Rib X-ray, one side, 2 views CPT 71100 X-ray of ribs on side of body, 2 views | $463.05 | $661.50 | $15.28–$1,653.75 | 126% above | 30% |
| Rib X-ray, one side, with a chest view, 3 or more views CPT 71101 X-ray of ribs on side of body, minimum of 3 views | $234.47 | $334.95 | $18.74–$837.38 | 4% below | 30% |
| Screening mammogram, both breasts CPT 77067 Screening mammography | $138.18 | $197.40 | $69.28–$493.50 | 45% below | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-ray of shoulder, minimum of 2 views | $610.05 | $871.50 | $14.78–$2,178.75 | 192% above | 30% |
| Sinus X-ray, complete, 3 or more views CPT 70220 X-ray of paranasal sinus, minimum of 3 views | $378.53 | $540.75 | $18.50–$1,351.88 | 33% above | 30% |
| Skull X-ray, fewer than 4 views CPT 70250 X-ray of skull, 1-3 views | $466.73 | $666.75 | $17.51–$1,666.88 | 100% above | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep study in sleep lab (6 years or older) | $4,760.60 | $6,800.85 | $908.56–$17,002.13 | 80% above | 30% |
| Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Ultrasound of heart with continuous electrocardiogram (ECG) during rest, exercise and/or drug induced stress with review and report | $2,978.22 | $4,254.60 | $578.11–$10,636.50 | 66% above | 30% |
| Swallow study (modified barium swallow, video X-ray) CPT 74230 Imaging for evaluation of swallowing function | $565.95 | $808.50 | $45.99–$2,021.25 | 56% above | 30% |
| Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-ray of thigh bone, minimum 2 views | $563.01 | $804.30 | $15.77–$2,010.75 | 181% above | 30% |
| Thoracic spine (mid back) CT scan without contrast CPT 72128 CT scan of middle spine without contrast | $1,536.15 | $2,194.50 | $98.51–$5,486.25 | 81% above | 30% |
| Toe X-ray, 2 or more views CPT 73660 X-ray of toe, minimum of 2 views | $202.86 | $289.80 | $16.76–$724.50 | 32% above | 30% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina | $524.79 | $749.70 | $64.08–$1,874.25 | 29% above | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 Vaginal ultrasound of pregnant uterus | $219.77 | $313.95 | $44.51–$784.88 | 41% below | 30% |
| Ultrasound of the abdomen, complete CPT 76700 Complete ultrasound scan of abdomen | $1,114.26 | $1,591.80 | $70.27–$3,979.50 | 113% above | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 Ultrasound scan of scrotum | $1,062.81 | $1,518.30 | $29.15–$3,795.75 | 151% above | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound scan of head and neck soft tissue | $1,164.24 | $1,663.20 | $65.56–$4,158.00 | 173% above | 30% |
| Upper arm X-ray (humerus), 2 views CPT 73060 X-ray of upper arm, minimum of 2 views | $438.80 | $626.85 | $14.28–$1,567.13 | 129% above | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 Ultrasound study of one arm or leg veins with compression and maneuvers | $1,057.67 | $1,510.95 | $110.61–$3,777.38 | 67% above | 30% |
| Wrist X-ray, 2 views CPT 73100 X-ray of wrist, 2 views | $240.35 | $343.35 | $15.77–$858.38 | 54% above | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-ray of wrist, minimum of 3 views | $463.05 | $661.50 | $20.48–$1,653.75 | 82% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-ray of hip, 2-3 views | $563.01 | $804.30 | $20.73–$2,010.75 | 112% above | 30% |
| X-ray of the abdomen, 1 view CPT 74018 X-ray of abdomen, 1 view | $397.64 | $568.05 | $62.12–$1,420.13 | 83% above | 30% |
| X-ray of the ankle, 2 views CPT 73600 X-ray of ankle, 2 views | $301.35 | $430.50 | $14.28–$1,076.25 | 88% above | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-ray of finger, minimum of 2 views | $463.05 | $661.50 | $18.50–$1,653.75 | 191% above | 30% |
| X-ray of the foot, 2 views CPT 73620 X-ray of foot, 2 views | $202.86 | $289.80 | $13.79–$724.50 | 24% above | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-ray of foot, minimum of 3 views | $484.37 | $691.95 | $16.27–$1,729.88 | 140% above | 30% |
| X-ray of the hand, 3 or more views CPT 73130 X-ray of hand, minimum of 3 views | $500.54 | $715.05 | $17.01–$1,787.63 | 148% above | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-ray of knee, 1-2 views | $376.32 | $537.60 | $15.03–$1,344.00 | 80% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-ray of lower and sacral spine, 2-3 views | $427.77 | $611.10 | $17.01–$1,527.75 | 70% above | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 X-ray of lower and sacral spine, minimum of 4 views | $862.16 | $1,231.65 | $23.45–$3,079.13 | 149% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-ray of middle spine, 2 views | $288.86 | $412.65 | $15.77–$1,031.63 | 24% above | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-ray of nose bones, minimum of 3 views | $463.05 | $661.50 | $17.75–$1,653.75 | 129% above | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-ray of upper spine, 2-3 views | $747.50 | $1,067.85 | $17.01–$2,669.63 | 199% above | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-ray of pelvis, 1-2 views | $438.80 | $626.85 | $13.79–$1,567.13 | 123% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-ray of sacrum and tailbone, minimum of 2 views | $529.20 | $756.00 | $14.28–$1,890.00 | 142% above | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) level | $628.43 | $897.75 | $38.62–$2,244.38 | 153% above | 30% |
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 Liver enzyme (SGPT), level | $94.08 | $134.40 | $5.30–$336.00 | 242% above | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 Liver enzyme (SGOT), level | $94.08 | $134.40 | $5.18–$336.00 | 224% above | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel | $314.58 | $449.40 | $47.63–$1,123.50 | at median | 30% |
| Albumin blood test CPT 82040 Albumin (protein) level | $75.71 | $108.15 | $4.95–$270.38 | 232% above | 30% |
| Aldosterone blood test CPT 82088 Aldosterone hormone level | $731.33 | $1,044.75 | $40.75–$2,611.88 | 255% above | 30% |
| Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase (enzyme) level, alkaline | $92.61 | $132.30 | $5.18–$330.75 | 189% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each | $55.86 | $79.80 | $5.22–$199.50 | 191% above | 30% |
| Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP) level, serum | $432.18 | $617.40 | $16.77–$1,543.50 | 324% above | 30% |
| Ammonia blood test CPT 82140 Ammonia level | $191.84 | $274.05 | $14.57–$685.13 | 60% above | 30% |
| Amylase blood test CPT 82150 Amylase (enzyme) level | $177.87 | $254.10 | $6.48–$635.25 | 243% above | 30% |
| Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Measurement of antibody for rheumatoid arthritis assessment | $145.53 | $207.90 | $12.95–$519.75 | 176% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 Screening test for autoimmune disorder | $284.45 | $406.35 | $12.09–$1,015.88 | 375% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide (heart and blood vessel protein) level | $182.28 | $260.40 | $39.26–$651.00 | 7% above | 30% |
| Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial culture, any other source except urine, blood or stool, aerobic | $195.51 | $279.30 | $8.62–$698.25 | 109% above | 30% |
| Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) | $54.39 | $77.70 | $8.46–$194.25 | 31% below | 30% |
| Bilirubin blood test, total CPT 82247 Bilirubin level, total | $113.19 | $161.70 | $5.02–$404.25 | 227% above | 30% |
| Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity | $252.84 | $361.20 | $55.13–$903.00 | 2% below | 30% |
| Blood culture for bacteria CPT 87040 Bacterial blood culture | $182.28 | $260.40 | $10.32–$651.00 | 40% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample | $44.10 | $63.00 | $9.09–$157.50 | 166% above | 30% |
| Blood glucose (sugar) test CPT 82947 Blood glucose (sugar) level | $72.03 | $102.90 | $3.93–$257.25 | 171% above | 30% |
| Blood lead test CPT 83655 Lead level | $195.51 | $279.30 | $12.11–$698.25 | 174% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Gonadotropin (reproductive hormone) analysis | $141.86 | $202.65 | $7.52–$506.63 | 95% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood group typing (ABO) | $48.51 | $69.30 | $2.99–$173.25 | 1% below | 30% |
| Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen level to assess kidney function, quantitative | $75.71 | $108.15 | $3.95–$270.38 | 220% above | 30% |
| C-peptide blood test CPT 84681 C-peptide (protein) level | $418.95 | $598.50 | $20.81–$1,496.25 | 205% above | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Measurement C-reactive protein for detection of infection or inflammation | $145.53 | $207.90 | $5.18–$519.75 | 111% above | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique | $147.00 | $210.00 | $37.27–$525.00 | 11% above | 30% |
| CA 19-9 blood test (tumor marker) CPT 86301 Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9 | $232.26 | $331.80 | $20.81–$829.50 | 60% above | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 Immunologic analysis for detection of tumor antigen, quantitative; CA 125 | $377.06 | $538.65 | $20.81–$1,346.63 | 131% above | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen | $152.88 | $218.40 | $51.31–$546.00 | 45% above | 30% |
| Calcium blood test, total CPT 82310 Calcium level, total | $111.72 | $159.60 | $5.16–$399.00 | 322% above | 30% |
| Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) protein level | $454.97 | $649.95 | $18.96–$1,624.88 | 277% above | 30% |
| Chickenpox (varicella) immunity blood test CPT 86787 Analysis for antibody to varicella-zoster virus (chicken pox) | $285.18 | $407.40 | $12.88–$1,018.50 | 192% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique | $190.37 | $271.95 | $35.09–$679.88 | 96% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $63.95 | $91.35 | $13.39–$228.38 | 39% below | 30% |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $50.72 | $72.45 | $7.77–$181.13 | 23% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $132.30 | $189.00 | $6.47–$472.50 | 348% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $66.15 | $94.50 | $10.56–$236.25 | 25% below | 30% |
| Cortisol blood test, total CPT 82533 Cortisol (hormone) measurement, total | $416.75 | $595.35 | $16.30–$1,488.38 | 342% above | 30% |
| Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (cardiac enzyme) level, total | $192.57 | $275.10 | $6.51–$687.75 | 396% above | 30% |
| Creatinine blood test CPT 82565 Blood creatinine level | $75.71 | $108.15 | $5.12–$270.38 | 163% above | 30% |
| Cytomegalovirus (CMV) antibody test CPT 86644 Analysis for antibody to Cytomegalovirus (CMV) | $457.17 | $653.10 | $14.39–$1,632.75 | 474% above | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 Coagulation function measurement, D-dimer; quantitative | $402.05 | $574.35 | $10.18–$1,435.88 | 230% above | 30% |
| DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (DHEA-S) hormone level | $449.09 | $641.55 | $22.23–$1,603.88 | 206% above | 30% |
| Drug screen by lab instrument (any number of drug classes) CPT 80307 Testing for presence of drug, by chemistry analyzers | $467.46 | $667.80 | $62.14–$1,669.50 | 309% above | 30% |
| Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) | $118.34 | $169.05 | $7.01–$422.63 | 84% above | 30% |
| Epstein-Barr virus (EBV) antibody test CPT 86665 Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid | $347.66 | $496.65 | $18.14–$1,241.63 | 327% above | 30% |
| Estradiol blood test CPT 82670 Measurement of total estradiol (hormone) | $234.47 | $334.95 | $27.94–$837.38 | 83% above | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level | $463.79 | $662.55 | $18.58–$1,656.38 | 263% above | 30% |
| Fecal calprotectin (stool inflammation test) CPT 83993 Stool calprotectin (protein) level | $98.49 | $140.70 | $19.63–$351.75 | 46% below | 30% |
| Ferritin blood test (iron stores) CPT 82728 Ferritin (blood protein) level | $78.65 | $112.35 | $13.63–$280.88 | 1% below | 30% |
| Fibrinogen blood test CPT 85384 Fibrinogen (factor 1) activity measurement | $113.93 | $162.75 | $9.72–$406.88 | 90% above | 30% |
| Folate (folic acid) blood test CPT 82746 Folic acid level, serum | $284.45 | $406.35 | $14.70–$1,015.88 | 271% above | 30% |
| Free T3 thyroid hormone test CPT 84481 Thyroid hormone, T3 measurement, free | $263.13 | $375.90 | $16.94–$939.75 | 99% above | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (thyroid chemical), free | $74.24 | $106.05 | $9.02–$265.13 | 8% below | 30% |
| Free testosterone test CPT 84402 Testosterone (hormone) level, free | $336.70 | $481.00 | $25.47–$1,202.50 | 303% above | 30% |
| Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase (liver enzyme) level | $186.69 | $266.70 | $7.20–$666.75 | 474% above | 30% |
| General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel | $186.90 | $267.00 | $65.12–$667.50 | 39% below | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Blood glucose (sugar) level after receiving dose of glucose | $76.44 | $109.20 | $4.75–$273.00 | 86% above | 30% |
| Glucose tolerance test, 3 samples CPT 82951 Blood glucose (sugar) tolerance test, 3 specimens | $178.61 | $255.15 | $12.87–$637.88 | 142% above | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique | $190.37 | $271.95 | $35.09–$679.88 | 96% above | 30% |
| H. pylori antibody blood test CPT 86677 Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria) | $175.67 | $250.95 | $16.85–$627.38 | 82% above | 30% |
| H. pylori stool antigen test CPT 87338 Detection test by immunoassay technique for Helicobacter pylori (GI tract bacteria) in stool | $180.08 | $257.25 | $14.38–$643.13 | 37% above | 30% |
| HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification | $353.54 | $505.05 | $85.10–$1,262.63 | at median | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 Analysis for antibody to HIV-1 and HIV-2 virus | $144.80 | $206.85 | $13.71–$517.13 | 141% above | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 antibodies | $338.10 | $483.00 | $24.08–$1,207.50 | 467% above | 30% |
| HPV test for high-risk types, one combined (pooled) result CPT 87624 Detection test by nucleic acid for Human Papillomavirus (HPV), high-risk types | $180.08 | $257.25 | $35.09–$643.13 | 72% above | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C level | $66.89 | $95.55 | $9.71–$238.88 | 2% above | 30% |
| Hemoglobin blood test CPT 85018 Blood count, hemoglobin | $58.07 | $82.95 | $2.37–$207.38 | 216% above | 30% |
| Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody measurement | $41.16 | $58.80 | $12.05–$147.00 | 38% below | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody measurement | $219.77 | $313.95 | $10.74–$784.88 | 236% above | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen | $194.04 | $277.20 | $10.33–$693.00 | 218% above | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody measurement | $282.98 | $404.25 | $14.27–$1,010.63 | 184% above | 30% |
| Hepatitis C viral load (HCV RNA) test CPT 87522 Detection test by nucleic acid for Hepatitis C virus, quantification | $689.43 | $984.90 | $42.84–$2,462.25 | 208% above | 30% |
| Herpes blood test, HSV-1 antibody CPT 86695 Analysis for antibody to Herpes simplex virus, type 1 | $187.43 | $267.75 | $13.19–$669.38 | 270% above | 30% |
| Herpes blood test, HSV-2 antibody CPT 86696 Analysis for antibody to Herpes simplex virus, type 2 | $196.25 | $280.35 | $19.35–$700.88 | 170% above | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 Measurement C-reactive protein for detection of infection or inflammation, high sensitivity | $145.53 | $207.90 | $12.95–$519.75 | 97% above | 30% |
| Homocysteine blood test CPT 83090 Homocysteine (amino acid) level | $501.27 | $716.10 | $17.92–$1,790.25 | 286% above | 30% |
| Insulin blood test CPT 83525 Insulin measurement, total | $242.55 | $346.50 | $11.43–$866.25 | 239% above | 30% |
| Iron blood test (serum iron) CPT 83540 Iron level | $37.49 | $53.55 | $6.47–$133.88 | 22% below | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity | $55.86 | $79.80 | $8.74–$199.50 | 26% above | 30% |
| Kidney function blood test panel CPT 80069 Kidney function blood test panel | $194.04 | $277.20 | $8.68–$693.00 | 92% above | 30% |
| LH (luteinizing hormone) test CPT 83002 Gonadotropin, luteinizing (reproductive hormone) level | $278.57 | $397.95 | $18.52–$994.88 | 96% above | 30% |
| Lactate (lactic acid) blood test CPT 83605 Lactic acid level | $221.97 | $317.10 | $11.57–$792.75 | 147% above | 30% |
| Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate dehydrogenase (enzyme) level | $130.10 | $185.85 | $6.04–$464.63 | 204% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 Lipase (fat enzyme) level | $161.70 | $231.00 | $6.89–$577.50 | 82% above | 30% |
| Liver function blood test panel CPT 80076 Liver function blood test panel | $61.01 | $87.15 | $8.17–$217.88 | 35% below | 30% |
| Lyme disease antibody test CPT 86618 Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria) | $449.09 | $641.55 | $17.03–$1,603.88 | 265% above | 30% |
| Magnesium blood test CPT 83735 Magnesium level | $119.81 | $171.15 | $6.70–$427.88 | 152% above | 30% |
| Measles (rubeola) antibody test CPT 86765 Analysis for antibody to Rubeola (measles virus) | $266.07 | $380.10 | $12.88–$950.25 | 239% above | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 Screening test for mononucleosis (mono) | $123.48 | $176.40 | $5.18–$441.00 | 59% above | 30% |
| Mumps immunity blood test CPT 86735 Analysis for antibody to mumps virus | $442.47 | $632.10 | $13.05–$1,580.25 | 480% above | 30% |
| Obstetric blood test panel CPT 80055 Obstetric blood test panel | $420.42 | $600.60 | $47.81–$1,501.50 | 30% above | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free | $310.91 | $444.15 | $18.39–$1,110.38 | 347% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total | $91.14 | $130.20 | $18.39–$325.50 | 14% above | 30% |
| Pap test (liquid-based, automated screening with review) CPT 88175 Pap test, automated thin layer preparation; automated system and manual rescreening | $133.77 | $191.10 | $26.61–$477.75 | 61% above | 30% |
| Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Pap test, manual screening | $99.23 | $141.75 | $20.26–$354.38 | 42% above | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) level | $488.04 | $697.20 | $41.28–$1,743.00 | 153% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood | $141.86 | $202.65 | $6.01–$506.63 | 184% above | 30% |
| Phosphorus (phosphate) blood test CPT 84100 Phosphate level | $118.34 | $169.05 | $4.74–$422.63 | 313% above | 30% |
| Potassium blood test CPT 84132 Blood potassium level | $68.36 | $97.65 | $4.76–$244.13 | 139% above | 30% |
| Progesterone blood test CPT 84144 Progesterone (reproductive hormone) level | $325.61 | $465.15 | $20.86–$1,162.88 | 137% above | 30% |
| Prolactin blood test CPT 84146 Prolactin (milk producing hormone) level | $266.07 | $380.10 | $19.38–$950.25 | 164% above | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $87.47 | $124.95 | $4.29–$312.38 | 230% above | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Testing for presence of drug, read by direct observation | $27.93 | $39.90 | $12.60–$99.75 | 72% below | 30% |
| Rapid flu test (influenza antigen) CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus | $36.75 | $52.50 | $16.55–$131.25 | 30% below | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep) | $99.23 | $141.75 | $16.53–$354.38 | 28% above | 30% |
| Renin blood test CPT 84244 Renin (kidney enzyme) level | $420.42 | $600.60 | $21.99–$1,501.50 | 279% above | 30% |
| Rh blood typing CPT 86901 Blood typing for Rh (D) antigen | $51.45 | $73.50 | $2.99–$183.75 | 33% above | 30% |
| Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor level | $113.19 | $161.70 | $5.67–$404.25 | 132% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 Analysis for antibody to Rubella (German measles virus) | $169.79 | $242.55 | $14.39–$606.38 | 155% above | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Red blood cell sedimentation rate, to detect inflammation, automated | $61.01 | $87.15 | $2.70–$217.88 | 57% above | 30% |
| Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen evaluation volume, sperm count, motility and analysis | $252.84 | $361.20 | $12.31–$903.00 | 131% above | 30% |
| Sodium blood test CPT 84295 Blood sodium level | $68.36 | $97.65 | $4.81–$244.13 | 87% above | 30% |
| Stool ova and parasites exam CPT 87177 Smear for parasites | $326.34 | $466.20 | $8.90–$1,165.50 | 573% above | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool analysis for blood to screen for colon tumors | $16.91 | $24.15 | $4.38–$60.38 | 53% below | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay | $61.01 | $87.15 | $15.92–$217.88 | 18% above | 30% |
| Syphilis antibody test (Treponema pallidum) CPT 86780 Analysis for antibody, Treponema pallidum | $241.08 | $344.40 | $13.24–$861.00 | 257% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis detection test | $118.34 | $169.05 | $4.27–$422.63 | 190% above | 30% |
| TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, gamma interferon | $282.98 | $404.25 | $61.98–$1,010.63 | 91% above | 30% |
| Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone (hormone) level, total | $99.96 | $142.80 | $25.81–$357.00 | 16% below | 30% |
| Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (autoantibody) measurement | $416.75 | $595.35 | $14.55–$1,488.38 | 350% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $79.38 | $113.40 | $16.80–$283.50 | 3% below | 30% |
| Total IgE blood test CPT 82785 IgE (immune system protein) level | $55.86 | $79.80 | $16.46–$199.50 | 26% below | 30% |
| Total cholesterol blood test CPT 82465 Cholesterol level | $119.81 | $171.15 | $4.35–$427.88 | 291% above | 30% |
| Total thyroxine (T4) blood test CPT 84436 Thyroxine (thyroid chemical), total | $117.60 | $168.00 | $6.87–$420.00 | 148% above | 30% |
| Total triiodothyronine (T3) blood test CPT 84480 Thyroid hormone, T3 measurement, total | $311.64 | $445.20 | $14.18–$1,113.00 | 158% above | 30% |
| Transferrin blood test CPT 84466 Transferrin (iron binding protein) level | $174.93 | $249.90 | $12.76–$624.75 | 106% above | 30% |
| Trichomonas test (NAAT) CPT 87661 Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique | $111.72 | $159.60 | $35.09–$399.00 | 18% above | 30% |
| Triglycerides blood test CPT 84478 Triglycerides level | $137.45 | $196.35 | $5.74–$490.88 | 284% above | 30% |
| Troponin test, quantitative CPT 84484 Troponin (protein) analysis, quantitative | $307.97 | $439.95 | $12.47–$1,099.88 | 154% above | 30% |
| Uric acid blood test CPT 84550 Uric acid level, blood | $113.93 | $162.75 | $4.52–$406.88 | 137% above | 30% |
| Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated | $117.60 | $168.00 | $3.17–$420.00 | 180% above | 30% |
| Urinalysis with microscope exam, manual CPT 81000 Manual urinalysis test with examination using microscope, non-automated | $8.82 | $12.60 | $4.02–$31.50 | 67% below | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test | $119.81 | $171.15 | $2.25–$427.88 | 389% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test | $19.85 | $28.35 | $3.48–$70.88 | 27% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 Bacterial colony count, urine | $81.59 | $116.55 | $8.07–$291.38 | 87% above | 30% |
| Urine microalbumin (albumin) test CPT 82043 Urine microalbumin (protein) level | $35.28 | $50.40 | $5.78–$126.00 | 2% above | 30% |
| Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test | $19.11 | $27.30 | $8.61–$68.25 | 64% below | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (vitamin B-12) level | $93.35 | $133.35 | $15.08–$333.38 | 27% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D-3 level | $193.31 | $276.15 | $29.60–$690.38 | 43% above | 30% |
| Vitamin D, 1,25-dihydroxy blood test CPT 82652 Dihydroxyvitamin D, 1, 25 level | $429.98 | $614.25 | $38.50–$1,535.63 | 141% above | 30% |
| Zinc blood test CPT 84630 Zinc level | $269.75 | $385.35 | $11.39–$963.38 | 226% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (reproductive hormone) level | $232.26 | $331.80 | $15.05–$829.50 | 191% above | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Adenoid removal (adenoidectomy), child under 12 CPT 42830 Primary removal of adenoids (younger than 12 years) | $401.31 | $573.30 | $355.45–$6,664.80 | 91% below | 30% |
| Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Fusion of upper spine bone with removal of disc and release of spinal cord or nerve, 1 disc | $27,340.53 | $39,057.90 | $13,583.50–$97,644.75 | at median | 30% |
| Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 Removal of ruptured infected appendix | $1,968.33 | $2,811.90 | $745.05–$7,029.75 | — | 30% |
| Appendectomy, open surgery CPT 44950 Removal of appendix | $1,553.79 | $2,219.70 | $1,376.21–$13,013.80 | 77% below | 30% |
| Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Repair of anterior cruciate ligament of knee using an endoscope | $1,701.53 | $2,430.75 | $1,507.07–$14,586.59 | 91% below | 30% |
| Arthroscopic rotator cuff repair of the shoulder CPT 29827 Repair of shoulder rotator cuff using an endoscope | $1,489.85 | $2,128.35 | $1,319.58–$14,586.59 | 91% below | 30% |
| Balloon dilation of the maxillary sinus opening, one side CPT 31295 Dilation of nasal sinus using an endoscope | $2,199.86 | $3,142.65 | $1,948.44–$14,187.03 | at median | 30% |
| Botox injections for chronic migraine CPT 64615 Injection of chemical for paralysis of facial and neck nerve muscles on both sides of face | $373.38 | $533.40 | $324.76–$1,333.50 | 42% below | 30% |
| Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Biopsy of breast and placement of locating device using X-ray with needle, first growth | $5,334.63 | $7,620.90 | $702.08–$19,052.25 | 113% above | 30% |
| Bunion correction with removal of part of the big toe joint CPT 28292 Correction of bunion | $1,501.61 | $2,145.15 | $1,329.99–$6,577.44 | 73% below | 30% |
| Cardiac catheterization with coronary angiogram one side CPT 93458 Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist | $11,884.22 | $16,977.45 | $3,430.00–$42,443.63 | 20% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat | $1,863.96 | $2,662.80 | $699.29–$6,657.00 | 33% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat | $1,869.11 | $2,670.15 | $699.29–$6,675.38 | 33% above | 30% |
| Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 External shock to heart to regulate heart beat | $1,869.11 | $2,670.15 | $699.29–$6,675.38 | — | 30% |
| Carpal tunnel release, open surgery CPT 64721 Release and/or relocation of hand nerve | $840.11 | $1,200.15 | $744.09–$3,925.40 | 82% below | 30% |
| Cervical biopsy CPT 57500 Biopsy of cervix or removal of growth | $1,013.57 | $1,447.95 | $897.73–$3,619.88 | 25% below | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Cesarean delivery with care before and after delivery | $2,560.74 | $3,658.20 | $2,201.39–$9,145.50 | — | 30% |
| Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Removal of foreskin (older than 28 days) | $218.30 | $311.85 | $193.35–$4,202.14 | 96% below | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Removal of foreskin using clamp or device | $337.37 | $481.95 | $298.81–$4,202.14 | 53% below | 30% |
| Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical snare | $1,040.20 | $1,486.00 | $921.32–$3,715.00 | 66% below | 30% |
| Colonoscopy with tissue sample CPT 45380 Biopsy of large bowel using a flexible endoscope | $1,026.80 | $1,466.85 | $909.45–$3,667.13 | 65% below | 30% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using a flexible endoscope | $341.04 | $487.20 | $302.06–$1,869.42 | 83% below | 30% |
| Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Biopsy and scraping of cervix using an endoscope | $404.25 | $577.50 | $322.41–$1,443.75 | 83% below | 30% |
| Coronary stent placement, one artery CPT 92928 Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch | $13,324.08 | $19,034.40 | $5,514.02–$47,586.00 | 15% below | 30% |
| Cystoscopy with ureteral stent placement CPT 52332 Insertion of stent in ureter using an endoscope | $487.31 | $696.15 | $431.61–$7,085.99 | 93% below | 30% |
| Cystoscopy, diagnostic look inside the bladder and urethra CPT 52000 Diagnostic exam of bladder and urethra using an endoscope | $205.80 | $294.00 | $182.28–$1,401.72 | 92% below | 30% |
| D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation and scraping of uterus | $542.43 | $774.90 | $480.44–$6,507.33 | 95% below | 30% |
| Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction of precancer skin growth, 1 growth | $252.11 | $360.15 | $212.27–$900.38 | 35% above | 30% |
| Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Incision of eardrum with placement of eardrum tube under general anesthesia | $317.52 | $453.60 | $281.23–$3,119.02 | 95% below | 30% |
| Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal of impacted ear wax by washing | $77.18 | $110.25 | $62.41–$275.63 | 56% below | 30% |
| Earwax removal with instruments, one ear CPT 69210 Removal of impacted ear wax | $77.18 | $110.25 | $62.41–$275.63 | 52% below | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of lining of uterus | $251.37 | $359.10 | $213.90–$897.75 | 12% below | 30% |
| Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Removal of nasal sinus using an endoscope | $2,221.17 | $3,173.10 | $1,967.32–$14,187.03 | 87% below | 30% |
| Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Exploration of nasal sinus using an endoscope | $1,647.14 | $2,353.05 | $1,458.89–$14,187.03 | 86% below | 30% |
| Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Incision of nasal sinus using an endoscope | $1,384.01 | $1,977.15 | $1,225.83–$7,494.80 | 84% below | 30% |
| Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Removal of nasal sinus tissue using an endoscope | $1,614.80 | $2,306.85 | $1,430.25–$14,187.03 | 83% below | 30% |
| Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance | $314.58 | $449.40 | $278.63–$1,418.98 | 70% below | 30% |
| Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection of lower or sacral spine facet joint using imaging guidance, single level | $1,070.90 | $1,529.85 | $935.78–$3,824.63 | 7% below | 30% |
| First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Initial repair of sliding hernia of abdomen, 3-10 cm in length | $575.51 | $822.15 | $509.73–$13,013.80 | 97% below | 30% |
| First repair of a front abdominal hernia larger than 10 cm CPT 49595 Initial repair of sliding hernia of abdomen, more than 10 cm in length | $773.96 | $1,105.65 | $685.50–$13,013.80 | 97% below | 30% |
| First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Initial repair of sliding hernia of abdomen, less than 3 cm in length | $343.25 | $490.35 | $304.02–$7,197.39 | 96% below | 30% |
| Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic exam of lower portion of large bowel using a flexible endoscope | $257.25 | $367.50 | $227.85–$1,869.42 | 88% below | 30% |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $2,278.50 | $3,255.00 | $2,018.10–$12,152.84 | 86% below | 30% |
| Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope | $2,745.96 | $3,922.80 | $2,432.14–$12,152.84 | 84% below | 30% |
| Gallbladder removal, open surgery through a larger incision CPT 47600 Removal of gallbladder | $2,486.51 | $3,552.15 | $914.09–$8,880.38 | — | 30% |
| Hemorrhoidectomy (internal and external), one area CPT 46255 Removal of single external and internal hemorrhoid group | $1,773.56 | $2,533.65 | $1,570.86–$6,334.13 | 69% below | 30% |
| Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Insertion of tube and introduction of contrast for X-ray of uterus and fallopian tubes | $411.60 | $588.00 | $48.34–$1,470.00 | 43% above | 30% |
| Hysteroscopy with endometrial ablation CPT 58563 Exam of uterus with destruction of lining of uterus using an endoscope | $3,066.42 | $4,380.60 | $2,715.97–$10,951.50 | 63% below | 30% |
| Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Biopsy of lining of uterus and/or removal of polyp using an endoscope | $826.14 | $1,180.20 | $731.72–$6,507.33 | 88% below | 30% |
| IUD insertion (the device itself billed separately) CPT 58300 Insertion of IUD for pregnancy prevention | $401.31 | $573.30 | $355.45–$1,433.25 | 93% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess | $384.41 | $549.15 | $212.27–$1,372.88 | 17% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess | $385.14 | $550.20 | $212.27–$1,375.50 | 17% below | 30% |
| Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Simple or single drainage of skin abscess | $385.14 | $550.20 | $212.27–$1,375.50 | — | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia (5 years or older) | $1,452.36 | $2,074.80 | $1,286.38–$7,197.39 | 83% below | 30% |
| Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament | $373.38 | $533.40 | $324.76–$1,333.50 | 30% below | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration and/or injection of fluid from large joint | $373.38 | $533.40 | $324.76–$1,333.50 | 10% below | 30% |
| Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion of drug delivery implant into tissue | $297.68 | $425.25 | $140.77–$1,063.13 | 84% below | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint | $373.38 | $533.40 | $324.76–$1,333.50 | 13% below | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint | $373.38 | $533.40 | $324.76–$1,333.50 | 27% above | 30% |
| Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Repair of inside or outside knee joint cartilage using an endoscope | $1,062.81 | $1,518.30 | $941.35–$6,577.44 | 92% below | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of knee cartilage using an endoscope | $1,081.92 | $1,545.60 | $958.27–$6,577.44 | 87% below | 30% |
| Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Removal of both knee cartilages using an endoscope | $1,176.74 | $1,681.05 | $1,042.25–$6,577.44 | 85% below | 30% |
| Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Removal or shaving of knee joint cartilage using an endoscope | $1,300.95 | $1,858.50 | $1,152.27–$6,577.44 | 88% below | 30% |
| Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Removal of appendix using an endoscope | $1,051.05 | $1,501.50 | $930.93–$12,152.84 | 93% below | 30% |
| Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Removal of uterus through abdomen using an endoscope, 250.0 g or less | $847.46 | $1,210.65 | $750.60–$21,368.35 | 96% below | 30% |
| Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Removal of uterus, tubes, and/or ovaries through abdomen using an endoscope, 250.0 g or less | $1,589.07 | $2,270.10 | $1,407.46–$21,368.35 | 93% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Repair of groin hernia using an endoscope | $929.04 | $1,327.20 | $822.86–$12,152.84 | 94% below | 30% |
| Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Repair of recurrent groin hernia using an endoscope | $1,031.94 | $1,474.20 | $914.00–$12,152.84 | 94% below | 30% |
| Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Removal of ovaries and/or tubes using an endoscope | $1,715.49 | $2,450.70 | $1,519.43–$12,152.84 | 89% below | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less | $374.12 | $534.45 | $331.36–$1,336.13 | 48% below | 30% |
| Left heart catheterization, diagnostic one side CPT 93452 Insertion of tube in left heart chambers for diagnosis with review by radiologist | $11,884.22 | $16,977.45 | $3,430.00–$42,443.63 | 53% above | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance | $310.91 | $444.15 | $275.37–$1,418.98 | 76% below | 30% |
| Lumpectomy (partial mastectomy) CPT 19301 Partial removal of breast | $742.35 | $1,060.50 | $657.51–$7,870.88 | 91% below | 30% |
| Mastectomy (total removal of the breast) CPT 19303 Simple complete removal of breast | $1,955.10 | $2,793.00 | $1,731.66–$13,348.18 | 89% below | 30% |
| Miscarriage treatment with D&C, first trimester CPT 59820 Treatment of miscarriage during first trimester | $674.73 | $963.90 | $597.62–$6,507.33 | 84% below | 30% |
| Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less | $1,027.53 | $1,467.90 | $749.21–$3,669.75 | 54% below | 30% |
| Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less | $260.93 | $372.75 | $231.11–$1,423.50 | 65% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $341.78 | $488.25 | $212.27–$1,220.63 | 14% below | 30% |
| Nail removal (partial or complete), one nail CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $365.30 | $521.85 | $212.27–$1,304.63 | 8% below | 30% |
| Nail removal (partial or complete), one nail inpatient CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail | $341.78 | $488.25 | $212.27–$1,220.63 | — | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $373.38 | $533.40 | $324.76–$1,333.50 | 38% below | 30% |
| Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $1,044.44 | $1,492.05 | $324.76–$3,730.13 | 73% above | 30% |
| Occipital nerve block (injection for headaches) inpatient CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve | $1,044.44 | $1,492.05 | $324.76–$3,730.13 | — | 30% |
| Pacemaker implant (dual chamber) CPT 33208 Insertion of pacemaker and upper and lower heart chamber electrode | $21,613.41 | $30,876.30 | $11,058.30–$77,190.75 | 79% above | 30% |
| Paracentesis with imaging guidance CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance | $1,251.71 | $1,788.15 | $412.39–$4,470.38 | 10% below | 30% |
| Paracentesis with imaging guidance CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance | $2,753.31 | $3,933.30 | $412.39–$9,833.25 | 99% above | 30% |
| Paracentesis with imaging guidance inpatient CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance | $1,251.71 | $1,788.15 | $412.39–$4,470.38 | — | 30% |
| Partial knee replacement (one compartment) CPT 27446 Replacement of knee joint on side of knee | $2,160.17 | $3,085.95 | $1,913.29–$25,808.65 | 91% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail | $612.99 | $875.70 | $430.10–$2,189.25 | 12% below | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail | $1,155.42 | $1,650.60 | $430.10–$4,126.50 | 66% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent removal fingernail or toenail | $612.99 | $875.70 | $430.10–$2,189.25 | — | 30% |
| Prostate biopsy CPT 55700 Biopsy of prostate gland | $277.90 | $397.00 | $246.14–$992.50 | 92% below | 30% |
| Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint | $784.25 | $1,120.35 | $694.62–$3,925.40 | 76% below | 30% |
| Removal of a breast lump, open surgery CPT 19120 Removal of growth and tissue of breast, duct, or nipple | $817.32 | $1,167.60 | $723.91–$7,870.88 | 84% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $447.62 | $639.45 | $396.46–$1,598.63 | 27% below | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $502.74 | $718.20 | $430.10–$1,795.50 | 18% below | 30% |
| Removal of a foreign object under the skin, simple inpatient CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple | $447.62 | $639.45 | $396.46–$1,598.63 | — | 30% |
| Removal of one lobe of the thyroid (lobectomy) CPT 60220 Removal of thyroid lobe on side of neck | $718.83 | $1,026.90 | $636.68–$12,152.84 | 93% below | 30% |
| Septoplasty to straighten the nasal septum CPT 30520 Reshaping of nasal cartilage | $1,763.27 | $2,518.95 | $1,561.75–$6,664.80 | 82% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 Application of nonmoveable forearm to hand splint | $160.97 | $229.95 | $140.77–$574.88 | 11% below | 30% |
| Short leg cast (below the knee) CPT 29405 Application of short leg cast | $655.62 | $936.60 | $295.92–$2,341.50 | 73% above | 30% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint from calf to foot | $198.45 | $283.50 | $171.93–$708.75 | 18% below | 30% |
| Short leg splint (calf to foot) CPT 29515 Application of short leg splint from calf to foot | $249.20 | $356.00 | $171.93–$971.25 | 3% above | 30% |
| Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint from calf to foot | $198.45 | $283.50 | $171.93–$708.75 | — | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Shaving of part of shoulder bone and repair of ligament using an endoscope | $361.62 | $516.60 | $135.46–$1,291.50 | 98% below | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less | $252.11 | $360.15 | $212.27–$900.38 | 42% below | 30% |
| Skin biopsy, punch, one lesion CPT 11104 Punch biopsy, first skin growth | $502.74 | $718.20 | $430.10–$1,795.50 | 11% above | 30% |
| Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Removal of cancer skin growth of body, arms, or legs, 0.5 cm or less | $887.15 | $1,267.35 | $749.21–$3,168.38 | 83% above | 30% |
| Skin tag removal, up to 15 tags CPT 11200 Removal of skin tag, 1-15 skin tags | $397.64 | $568.05 | $212.27–$1,420.13 | 40% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $155.09 | $221.55 | $137.36–$1,418.98 | 85% below | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $1,608.18 | $2,297.40 | $746.83–$5,743.50 | 57% above | 30% |
| Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test | $1,608.18 | $2,297.40 | $746.83–$5,743.50 | — | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm | $252.11 | $360.15 | $212.27–$900.38 | 37% below | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less | $458.64 | $655.20 | $212.27–$1,638.00 | 6% above | 30% |
| TURP (transurethral resection of the prostate) CPT 52601 Removal of prostate gland using an electrocautery knife through urethra with control of bleeding using an endoscope | $799.68 | $1,142.40 | $708.29–$10,778.38 | 95% below | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 Biopsy of related skin growth, first growth | $252.11 | $360.15 | $223.29–$900.38 | 38% below | 30% |
| Thoracentesis with imaging guidance CPT 32555 Aspiration of fluid from chest cavity using imaging guidance | $5,203.80 | $7,434.00 | $412.39–$18,585.00 | 375% above | 30% |
| Tonsil and adenoid removal, age 12 or older CPT 42821 Removal of tonsils and adenoid glands (12 years or older) | $715.16 | $1,021.65 | $633.42–$6,664.80 | 89% below | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands (younger than 12 years) | $662.24 | $946.05 | $586.55–$11,900.16 | 89% below | 30% |
| Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Removal of tonsils (12 years or older) | $687.96 | $982.80 | $609.34–$6,664.80 | 88% below | 30% |
| Tonsil removal (tonsillectomy) only, child under 12 CPT 42825 Removal of tonsils (younger than 12 years) | $605.64 | $865.20 | $536.42–$11,900.16 | 93% below | 30% |
| Total hip replacement CPT 27130 Replacement of thigh bone and hip joint with prosthesis | $2,654.09 | $3,791.55 | $2,350.76–$25,808.65 | 91% below | 30% |
| Total knee replacement CPT 27447 Replacement of knee joint, both sides of knee | $2,387.28 | $3,410.40 | $2,114.45–$25,808.65 | 91% below | 30% |
| Total shoulder replacement CPT 23472 Prosthetic repair of shoulder joint, total shoulder | $3,637.52 | $5,196.45 | $3,221.80–$35,246.90 | 90% below | 30% |
| Total thyroid removal (thyroidectomy) CPT 60240 Removal of thyroid | $1,902.18 | $2,717.40 | $1,684.79–$12,152.84 | 87% below | 30% |
| Trigger finger release surgery CPT 26055 Incision of tendon covering of finger | $305.03 | $435.75 | $270.17–$3,232.41 | 93% below | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles | $669.59 | $956.55 | $324.76–$2,391.38 | 18% above | 30% |
| Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles | $671.79 | $959.70 | $324.76–$2,399.25 | 18% above | 30% |
| Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Injection of trigger points, 1-2 muscles | $671.79 | $959.70 | $324.76–$2,399.25 | — | 30% |
| Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Destruction of fallopian tubes using an endoscope | $1,291.40 | $1,844.85 | $1,143.81–$12,152.84 | 91% below | 30% |
| Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Biopsy of breast and placement of locating device using ultrasound, first growth | $5,316.99 | $7,595.70 | $702.08–$18,989.25 | 129% above | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $654.15 | $934.50 | $579.39–$2,336.25 | 78% below | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 Injection of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $141.12 | $201.60 | $124.99–$1,823.24 | 96% below | 30% |
| Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare | $203.60 | $290.85 | $180.33–$3,857.42 | 95% below | 30% |
| Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Insertion of guide wire with dilation of esophagus using a flexible endoscope | $169.05 | $241.50 | $149.73–$1,823.24 | 94% below | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope | $566.69 | $809.55 | $501.92–$2,023.88 | 76% below | 30% |
| Ureteroscopy with laser stone breaking (lithotripsy) CPT 52353 Crushing of stone of ureter using an endoscope | $433.65 | $619.50 | $384.09–$10,778.38 | 96% below | 30% |
| Ureteroscopy with laser stone breaking and stent placement CPT 52356 Crushing of stone of ureter with insertion of stent using an endoscope | $463.05 | $661.50 | $410.13–$10,778.38 | 97% below | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Vaginal delivery with care before and after delivery | $2,195.45 | $3,136.35 | $1,944.54–$7,840.88 | — | 30% |
| Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of sperm duct | $607.85 | $868.35 | $538.38–$4,202.14 | 88% below | 30% |
| Wart removal, up to 14 warts CPT 17110 Destruction of skin growth, 1-14 growths | $252.11 | $360.15 | $212.27–$900.38 | 15% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Removal of skin and tissue, 20.0 sq cm or less | $466.73 | $666.75 | $413.39–$1,666.88 | 40% below | 30% |
| Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treatment of broken forearm bone on thumb side of wrist, above wrist, with placement of stabilizing device | $1,192.17 | $1,703.10 | $1,055.92–$14,586.59 | 88% below | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 Transfusion of blood or blood products | $829.08 | $1,184.40 | $466.77–$2,961.00 | 8% below | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment for airway obstruction or sputum production | $112.46 | $160.65 | $99.60–$440.19 | at median | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 Administration of chemotherapy into vein, 1 hour or less | $981.96 | $1,402.80 | $83.23–$3,507.00 | 45% above | 30% |
| Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive hearing and speech recognition test | $224.70 | $321.00 | $136.14–$874.13 | 16% above | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes | $1,760.33 | $2,514.75 | $873.95–$6,286.88 | 17% below | 30% |
| Critical care, first 30 to 74 minutes inpatient CPT 99291 Critical care, first 30-74 minutes | $1,760.33 | $2,514.75 | $873.95–$6,286.88 | — | 30% |
| EEG (brain wave test), awake and drowsy, routine CPT 95816 Measurement of brain wave activity (EEG), awake and drowsy | $1,234.07 | $1,762.95 | $228.45–$4,407.38 | 80% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing | $320.46 | $457.80 | $62.41–$1,144.50 | 59% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional | $281.51 | $402.15 | $89.22–$1,005.38 | 29% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency department visit for problem that may not require health care professional | $281.51 | $402.15 | $89.22–$1,005.38 | — | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making | $451.29 | $644.70 | $162.45–$1,611.75 | 8% above | 30% |
| Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency department visit with straightforward medical decision making | $451.29 | $644.70 | $162.45–$1,611.75 | — | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making | $904.05 | $1,291.50 | $288.81–$3,228.75 | 16% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency department visit with low level of medical decision making | $904.05 | $1,291.50 | $288.81–$3,228.75 | — | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making | $1,552.32 | $2,217.60 | $441.47–$5,544.00 | 31% above | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency department visit with moderate level of medical decision making | $1,552.32 | $2,217.60 | $441.47–$5,544.00 | — | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making | $2,211.62 | $3,159.45 | $630.08–$7,898.63 | 26% above | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency department visit with high level of medical decision making | $2,211.62 | $3,159.45 | $630.08–$7,898.63 | — | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG) | $1,257.59 | $1,796.55 | $228.45–$4,491.38 | 65% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes | $257.99 | $368.55 | $225.04–$921.38 | 30% below | 30% |
| IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | $268.28 | $383.25 | $225.04–$958.13 | 34% below | 30% |
| IV push of a medicine, first drug CPT 96374 Injection of drug or substance into vein | $274.89 | $392.70 | $225.04–$981.75 | 30% above | 30% |
| IV push of a medicine, first drug CPT 96374 Injection of drug or substance into vein | $275.63 | $393.75 | $225.04–$984.38 | 30% above | 30% |
| IV push of a medicine, first drug inpatient CPT 96374 Injection of drug or substance into vein | $275.63 | $393.75 | $225.04–$984.38 | — | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle | $131.57 | $187.95 | $76.18–$469.88 | 25% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle | $131.57 | $187.95 | $76.18–$469.88 | 25% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection of drug or substance under skin or into muscle | $131.57 | $187.95 | $76.18–$469.88 | — | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $145.60 | $208.00 | $31.42–$569.63 | 92% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $324.87 | $464.10 | $67.80–$1,160.25 | 96% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $418.95 | $598.50 | $111.17–$1,496.25 | 122% above | 30% |
| New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | $549.78 | $785.40 | $151.85–$1,963.50 | 117% above | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more | $245.49 | $350.70 | $39.32–$876.75 | 75% above | 30% |
| Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Therapy procedure for nutrition management, each 15 minutes | $113.93 | $162.75 | $25.61–$406.88 | 233% above | 30% |
| Occupational therapy evaluation, low complexity CPT 97165 Evaluation for occupational therapy, typically 30 minutes | $187.60 | $268.00 | $96.81–$732.38 | 18% above | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Evaluation for physical therapy, typically 45 minutes | $576.98 | $824.25 | $94.33–$2,060.63 | 147% above | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Evaluation for physical therapy, typically 20 minutes | $187.60 | $268.00 | $94.33–$732.38 | 31% above | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Evaluation for physical therapy, typically 30 minutes | $357.70 | $511.00 | $94.33–$1,391.25 | 92% above | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Therapy procedure using manual technique, each 15 minutes | $141.40 | $202.00 | $26.60–$553.88 | 65% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $141.40 | $202.00 | $27.89–$553.88 | 87% above | 30% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventive medicine evaluation (18-39 years) | $132.30 | $189.00 | $117.18–$472.50 | 7% below | 30% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventive medicine evaluation (40-64 years) | $132.30 | $189.00 | $117.18–$472.50 | 16% below | 30% |
| Preventive checkup, new patient aged 65 or older CPT 99387 Initial new patient preventive medicine evaluation (65 years or older) | $132.30 | $189.00 | $117.18–$472.50 | 35% below | 30% |
| Preventive checkup, returning patient aged 18–39 CPT 99395 Established patient periodic preventive medicine examination (18-39 years) | $132.30 | $189.00 | $117.18–$472.50 | 21% above | 30% |
| Preventive checkup, returning patient aged 40–64 CPT 99396 Established patient periodic preventive medicine examination (40-64 years) | $132.30 | $189.00 | $117.18–$472.50 | 13% above | 30% |
| Preventive checkup, returning patient aged 65 or older CPT 99397 Established patient periodic preventive medicine examination (65 year old or older) | $132.30 | $189.00 | $117.18–$472.50 | 5% below | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | $420.42 | $600.60 | $120.15–$1,501.50 | 179% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more | $283.71 | $405.30 | $55.10–$1,013.25 | 223% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $324.87 | $464.10 | $80.95–$1,160.25 | 193% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $245.49 | $350.70 | $29.62–$876.75 | 376% above | 30% |
| Speech and language evaluation CPT 92523 Evaluation of speech sound production with evaluation of language comprehension and expression | $204.33 | $291.90 | $165.54–$729.75 | at median | 30% |
| Speech therapy session, individual CPT 92507 Treatment of speech, language, voice, communication, and/or hearing processing disorder | $141.40 | $202.00 | $73.62–$553.88 | 3% below | 30% |
| Spirometry (breathing test) CPT 94010 Test to measure expiratory airflow and volume | $371.91 | $531.30 | $228.45–$1,328.25 | 52% above | 30% |
| Spirometry before and after a bronchodilator CPT 94060 Test to measure expiratory airflow and volume changes before and after medication administration | $984.17 | $1,405.95 | $394.81–$3,514.88 | 81% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 Therapy procedure using functional activities | $155.09 | $221.55 | $33.44–$553.88 | 105% above | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Drawing of blood for a medical problem | $345.45 | $493.50 | $105.04–$1,233.75 | 64% above | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Indiana | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 Influenza vaccine, inactivated | $68.36 | $97.65 | $60.54–$244.13 | 17% above | 30% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | $155.09 | $221.55 | $137.36–$553.88 | 54% below | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella vaccine | $138.18 | $197.40 | $122.39–$493.50 | 66% below | 30% |
| DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b vaccine | $284.45 | $406.35 | $122.13–$1,015.88 | 15% above | 30% |
| Flu shot, recombinant, egg-free (Flublok) CPT 90673 Influenza vaccine, trivalent derived from recombinant DNA | $33.81 | $48.30 | $29.95–$120.75 | 40% below | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza vaccine, trivalent, split virus, preservative-free, 0.5 mL dosage | $91.61 | $130.88 | $81.14–$327.19 | 135% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent | $150.68 | $215.25 | $133.46–$538.13 | 76% below | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) CPT 90636 Hepatitis A and hepatitis B vaccine | $108.78 | $155.40 | $96.35–$388.50 | 54% below | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A vaccine adult dosage | $99.96 | $142.80 | $88.54–$357.00 | 41% below | 30% |
| Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A vaccine pediatric or adolescent dosage | $62.48 | $89.25 | $55.34–$223.13 | 27% below | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine, adult dosage (3 dose schedule) | $101.43 | $144.90 | $89.84–$362.25 | 42% below | 30% |
| Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 Hepatitis B vaccine, pediatric or adolescent dosage (3 dose schedule) | $87.47 | $124.95 | $77.47–$312.38 | 19% above | 30% |
| Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophilus influenzae type b vaccine, PRP-T conjugate | $70.56 | $100.80 | $62.50–$252.00 | 45% above | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older CPT 90662 Influenza vaccine split virus, preservative free | $90.41 | $129.15 | $80.07–$322.88 | 50% below | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 Measles, mumps, and rubella vaccine | $133.04 | $190.05 | $117.83–$475.13 | 48% below | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal vaccine, serogroups A, C, W, Y, diphtheria toxoid carrier vaccine | $138.18 | $197.40 | $102.50–$493.50 | 61% below | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B | $193.31 | $276.15 | $171.21–$690.38 | 50% below | 30% |
| Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal vaccine, 13-valent | $216.83 | $309.75 | $192.05–$774.38 | 54% below | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use | $964.77 | $1,378.24 | $287.54–$3,445.60 | 54% above | 30% |
| Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use | $260.19 | $371.70 | $230.45–$929.25 | 36% below | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal vaccine, 23-valent | $109.52 | $156.45 | $97.00–$391.13 | 53% below | 30% |
| RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use | $276.36 | $394.80 | $244.78–$987.00 | 54% below | 30% |
| RSV vaccine with adjuvant (Arexvy), one dose for older adults CPT 90679 Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use | $276.36 | $394.80 | $244.78–$987.00 | 64% below | 30% |
| Rabies vaccine, one dose CPT 90675 Rabies vaccine for injection into muscle | $638.72 | $912.45 | $313.68–$2,281.13 | 20% below | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingles vaccine for injection into muscle | $204.33 | $291.90 | $180.98–$729.75 | 48% below | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Diphtheria and tetanus vaccine (7 years or older) | $74.24 | $106.05 | $65.75–$265.13 | 35% below | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older) | $144.80 | $206.85 | $128.25–$517.13 | 18% above | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of vaccine | $110.99 | $158.55 | $76.18–$396.38 | 80% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration of vaccine, each additional vaccine | $59.54 | $85.05 | $15.08–$212.63 | 50% above | 30% |
Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More
Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.
Off list How much lower the cash price is than the list price.
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.
Source file: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWithamHospital&type=CDMWithoutLabel&fileType=CSV