Witham Memorial Hospital
Witham Memorial Hospital in Lebanon, IN publishes cash prices for 57 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
2605 N Lebanon St Lebanon IN 46052 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| 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 | 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 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast | $2,404.92 | $3,435.60 | 30% |
| Diagnostic mammogram, both breasts CPT 77066 Diagnostic mammography of both breasts | $679.88 | $971.25 | 30% |
| Diagnostic mammogram, one breast CPT 77065 Diagnostic mammography of 1 breast | $470.40 | $672.00 | 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 | 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 | 30% |
| MRI of the brain, no contrast dye CPT 70551 MRI scan of brain without contrast | $2,374.79 | $3,392.55 | 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 | 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 | 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 | 30% |
| Screening mammogram, both breasts CPT 77067 Screening mammography | $138.18 | $197.40 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep study in sleep lab (6 years or older) | $4,760.60 | $6,800.85 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina | $524.79 | $749.70 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 Complete ultrasound scan of abdomen | $1,114.26 | $1,591.80 | 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 | 30% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total) | $54.39 | $77.70 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $63.95 | $91.35 | 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 | 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 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals | $66.15 | $94.50 | 30% |
| Kidney function blood test panel CPT 80069 Kidney function blood test panel | $194.04 | $277.20 | 30% |
| Liver function blood test panel CPT 80076 Liver function blood test panel | $61.01 | $87.15 | 30% |
| Obstetric blood test panel CPT 80055 Obstetric blood test panel | $420.42 | $600.60 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free | $310.91 | $444.15 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total | $91.14 | $130.20 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood | $141.86 | $202.65 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $87.47 | $124.95 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $79.38 | $113.40 | 30% |
| Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated | $117.60 | $168.00 | 30% |
| Urinalysis with microscope exam, manual CPT 81000 Manual urinalysis test with examination using microscope, non-automated | $8.82 | $12.60 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test | $119.81 | $171.15 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test | $19.85 | $28.35 | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cesarean delivery, including prenatal and postpartum care CPT 59510 Cesarean delivery with care before and after delivery | $2,560.74 | $3,658.20 | 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 | 30% |
| Colonoscopy with tissue sample CPT 45380 Biopsy of large bowel using a flexible endoscope | $1,026.80 | $1,466.85 | 30% |
| Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using a flexible endoscope | $341.04 | $487.20 | 30% |
| Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope | $2,278.50 | $3,255.00 | 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 | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 Removal of knee cartilage using an endoscope | $1,081.92 | $1,545.60 | 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 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance | $310.91 | $444.15 | 30% |
| Prostate biopsy CPT 55700 Biopsy of prostate gland | $277.90 | $397.00 | 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 | 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 | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands (younger than 12 years) | $662.24 | $946.05 | 30% |
| Total hip replacement CPT 27130 Replacement of thigh bone and hip joint with prosthesis | $2,654.09 | $3,791.55 | 30% |
| Total knee replacement CPT 27447 Replacement of knee joint, both sides of knee | $2,387.28 | $3,410.40 | 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 | 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 | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 Vaginal delivery with care before and after delivery | $2,195.45 | $3,136.35 | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| 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 | 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 | 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 | 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 | 30% |
| Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventive medicine evaluation (18-39 years) | $132.30 | $189.00 | 30% |
| Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventive medicine evaluation (40-64 years) | $132.30 | $189.00 | 30% |
Source file: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWithamHospital&type=CDMWithoutLabel&fileType=CSV