Hospital Indianapolis-Carmel-Greenwood, IN

Franciscan St Francis Health - Carmel

Listed in its price file as “FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL”.

Franciscan St Francis Health - Carmel in Carmel, IN publishes cash prices for 368 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Indiana median for 321 of 362 procedures and above it for 35. By typical cash price it ranks #8 of 84 Indiana hospitals and #1 of 16 hospitals in the Indianapolis, IN area, cheapest first. Select a procedure to compare it with other hospitals nearby.

12188 B N MERIDIAN ST CARMEL, IN 46032 Collected Sep 27, 2026 Source price file Check a bill from this hospital (317) 528-5000

Acute care hospital Nonprofit hospital Emergency department CMS star rating 4 of 5 CCN 150162 · CMS hospital register NPI 1386749893

Financial assistance

Nonprofit hospital: it must offer free or discounted care to patients who qualify. How to apply

Franciscan St Francis Health - Carmel is a nonprofit hospital in the CMS register. Under section 501(r) of the federal tax code it must have a written Financial Assistance Policy with a free application, publish both on its website, and charge patients who qualify no more than the amounts generally billed to insured patients for emergency and other medically necessary care. Who qualifies depends on household income; the policy states the limits.

You can apply up to 240 days after the first bill. Before collection actions such as credit reporting or a lawsuit, the hospital must tell you about the policy and wait at least 120 days after that bill. Ask the billing office for the policy and the application before you pay, or search the hospital's website for “financial assistance”. Letters you can copy.

Source: IRS, section 501(r) requirements for nonprofit hospitals.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abd; W/WO Cont	$622.78	$2,696.00	$180.22–$2,426.40	49% below	77%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abd; W/WO Cont	$622.78	$2,696.00	$180.22–$2,426.40	—	77%
Abdominal X-ray, 2 views CPT 74019 X-Ray Exam Abdomen 2 Views	$185.96	$805.00	$110.61–$724.50	31% below	77%
Abdominal X-ray, 2 views inpatient CPT 74019 X-Ray Exam Abdomen 2 Views	$185.96	$805.00	$110.61–$724.50	—	77%
Ankle X-ray, complete, 3 or more views CPT 73610 Rad Exam Ankl; Compl 3 Vw Min	$185.96	$805.00	$68.29–$1,449.00	5% below	77%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Rad Exam Ankl; Compl 3 Vw Min	$185.96	$805.00	$68.29–$1,449.00	—	77%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Noninvasive Phys Study Uea/Lea Sngl/Bilat	$252.71	$1,094.00	$131.27–$984.60	—	77%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Noninvasive Phys Study Uea/Lea Sngl/Bilat	$252.71	$1,094.00	$131.27–$984.60	—	77%
Arm CT scan without contrast (shoulder to hand, any part) CPT 73200 CT Upper Extrmty; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	49% below	77%
Arm CT scan without contrast (shoulder to hand, any part) inpatient CPT 73200 CT Upper Extrmty; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Rad Exam; Esophagus Sngl Contrast Study	$291.52	$1,262.00	$185.58–$1,135.80	37% below	77%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Rad Exam; Esophagus Sngl Contrast Study	$291.52	$1,262.00	$185.58–$1,135.80	—	77%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Imaging; Whole Body	$1,077.85	$4,666.00	$428.40–$4,199.40	27% below	77%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Imaging; Whole Body	$1,077.85	$4,666.00	$428.40–$4,199.40	—	77%
Breast ultrasound, complete, one breast CPT 76641 Ultrasound Breast Complete Unil Hcode	$117.35	$508.00	$110.61–$480.96	73% below	77%
Breast ultrasound, complete, one breast inpatient CPT 76641 Ultrasound Breast Complete Unil Hcode	$117.35	$508.00	$110.61–$480.96	—	77%
Breast ultrasound, limited (one breast or one area) CPT 76642 ED Bedside US Breast Limited	$141.60	$613.00	$89.96–$551.70	56% below	77%
Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound Breast Limited Hcode	$171.86	$744.00	$89.96–$669.60	47% below	77%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 ED Bedside US Breast Limited	$141.60	$613.00	$89.96–$551.70	—	77%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound Breast Limited Hcode	$171.86	$744.00	$89.96–$669.60	—	77%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT Angio Abd&Pelv W/O&W/Dye	$622.78	$2,696.00	$369.11–$2,426.40	67% below	77%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CT Angio Abd&Pelv W/O&W/Dye	$622.78	$2,696.00	$369.11–$2,426.40	—	77%
CT angiography (CTA) of the head CPT 70496 CT Angio Hd W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	26% below	77%
CT angiography (CTA) of the head inpatient CPT 70496 CT Angio Hd W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	—	77%
CT angiography (CTA) of the neck CPT 70498 CT Angio Nk W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	22% below	77%
CT angiography (CTA) of the neck inpatient CPT 70498 CT Angio Nk W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	—	77%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest; W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	28% below	77%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest; W/WO Cont	$892.82	$3,865.00	$185.58–$3,478.50	—	77%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angio Hrt W/Cont & 3d	$257.33	$1,114.00	$369.11–$1,684.00	69% below	77%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angio Hrt W/Cont & 3d	$257.33	$1,114.00	$369.11–$1,684.00	—	77%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd & Pelvis W/O Contrast	$632.48	$2,738.00	$252.44–$2,464.20	46% below	77%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd & Pelvis W/O Contrast	$632.48	$2,738.00	$252.44–$2,464.20	—	77%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd & Pelvis W/Contrast	$781.01	$3,381.00	$369.11–$3,042.90	55% below	77%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd & Pelvis W/Contrast	$781.01	$3,381.00	$369.11–$3,042.90	—	77%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT-Abd/Pelvis WO/W Contrast	$899.75	$3,895.00	$369.11–$3,505.50	47% below	77%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT-Abd/Pelvis WO/W Contrast	$899.75	$3,895.00	$369.11–$3,505.50	—	77%
CT scan of the abdomen with contrast CPT 74160 CT Abd; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	49% below	77%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abd; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	—	77%
CT scan of the abdomen without contrast CPT 74150 CT Abd; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	49% below	77%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abd; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Area; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	49% below	77%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial Area; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
CT scan of the head or brain, no contrast dye CPT 70450 CT Hd/Brain; W/O Cont	$297.53	$1,288.00	$110.61–$1,684.00	60% below	77%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Hd/Brain; W/O Cont	$297.53	$1,288.00	$110.61–$1,684.00	—	77%
CT scan of the head with contrast CPT 70460 CT Hd/Brain; W/Cont	$605.45	$2,621.00	$185.58–$2,358.90	27% below	77%
CT scan of the head with contrast inpatient CPT 70460 CT Hd/Brain; W/Cont	$605.45	$2,621.00	$185.58–$2,358.90	—	77%
CT scan of the head without and with contrast CPT 70470 CT Hd/Brain; W/WO Cont	$448.60	$1,942.00	$185.58–$1,747.80	56% below	77%
CT scan of the head without and with contrast inpatient CPT 70470 CT Hd/Brain; W/WO Cont	$448.60	$1,942.00	$185.58–$1,747.80	—	77%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumb Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	54% below	77%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumb Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cerv Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	49% below	77%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cerv Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelv; W/Cont	$264.03	$1,143.00	$185.58–$1,684.00	71% below	77%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelv; W/Cont	$264.03	$1,143.00	$185.58–$1,684.00	—	77%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CARotid DPLX SCAN; COMPL BILAT STUDY	$808.27	$3,499.00	$252.44–$3,149.10	—	77%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CARotid DPLX SCAN; COMPL BILAT STUDY	$808.27	$3,499.00	$252.44–$3,149.10	—	77%
Chest CT scan without and with contrast CPT 71270 CT Chest; W/WO Cont	$622.78	$2,696.00	$185.58–$2,426.40	41% below	77%
Chest CT scan without and with contrast inpatient CPT 71270 CT Chest; W/WO Cont	$622.78	$2,696.00	$185.58–$2,426.40	—	77%
Chest X-ray, 2 views CPT 71046 X-Ray Exam Chest 2 Views	$133.52	$578.00	$92.07–$520.20	35% below	77%
Chest X-ray, 2 views inpatient CPT 71046 X-Ray Exam Chest 2 Views	$133.52	$578.00	$92.07–$520.20	—	77%
Chest X-ray, single view CPT 71045 Xray Exam Babyscan Chest 1 View	$50.13	$217.00	$92.07–$390.96	69% below	77%
Chest X-ray, single view CPT 71045 X-Ray Exam Chest 1 View	$115.27	$499.00	$92.07–$449.10	29% below	77%
Chest X-ray, single view inpatient CPT 71045 Xray Exam Babyscan Chest 1 View	$50.13	$217.00	$92.07–$390.96	—	77%
Chest X-ray, single view inpatient CPT 71045 X-Ray Exam Chest 1 View	$115.27	$499.00	$92.07–$449.10	—	77%
Collarbone (clavicle) X-ray, complete CPT 73000 Rad Exam; Clavicle Compl	$142.76	$618.00	$56.67–$556.20	26% below	77%
Collarbone (clavicle) X-ray, complete inpatient CPT 73000 Rad Exam; Clavicle Compl	$142.76	$618.00	$56.67–$556.20	—	77%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal W/Image; Compl	$282.98	$1,225.00	$110.61–$1,102.50	44% below	77%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal W/Image; Compl	$282.98	$1,225.00	$110.61–$1,102.50	—	77%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA Bone Density Study; Axial Skeleton	$148.76	$644.00	$104.99–$579.60	48% below	77%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA Bone Density Study; Axial Skeleton	$148.76	$644.00	$104.99–$579.60	—	77%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA Bn Density Study; Appendicular Skeleton	$56.13	$243.00	$45.08–$390.96	61% below	77%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA Bn Density Study; Appendicular Skeleton	$56.13	$243.00	$45.08–$390.96	—	77%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Preg Uterus Detailed; 1st Gestation	$631.55	$2,734.00	$244.10–$2,460.60	17% above	77%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Preg Uterus Detailed; 1st Gestation	$631.55	$2,734.00	$244.10–$2,460.60	—	77%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	49% below	77%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	42% below	77%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	—	77%
Diagnostic mammogram, both breasts both sides CPT 77066 Dx Mammo Incl Cad Bi	$149.00	$645.00	$102.19–$580.50	—	77%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Dx Mammo Incl Cad Bi	$149.00	$645.00	$102.19–$580.50	—	77%
Diagnostic mammogram, one breast CPT 77065 Dx Mammo Incl Cad Uni	$125.20	$542.00	$79.74–$487.80	44% below	77%
Diagnostic mammogram, one breast inpatient CPT 77065 Dx Mammo Incl Cad Uni	$125.20	$542.00	$79.74–$487.80	—	77%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Dplx Scan of Lea or Graft; Compl Bilat Study	$1,010.39	$4,374.00	$252.44–$3,936.60	—	77%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Dplx Scan of Lea or Graft; Compl Bilat Study	$1,010.39	$4,374.00	$252.44–$3,936.60	—	77%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dplx Scan Ext Veins; Compl Bilat Study	$1,010.39	$4,374.00	$255.69–$3,936.60	—	77%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Dplx Scan Ext Veins; Compl Bilat Study	$1,010.39	$4,374.00	$255.69–$3,936.60	—	77%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Tte W/Doppler and Color Flow	$797.18	$3,451.00	$564.85–$3,105.90	52% below	77%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Tte W/Doppler and Color Flow	$797.18	$3,451.00	$564.85–$3,105.90	—	77%
Elbow X-ray, 2 views CPT 73070 Rad Exam Elbow; 2 Vw	$155.00	$671.00	$55.69–$603.90	6% below	77%
Elbow X-ray, 2 views inpatient CPT 73070 Rad Exam Elbow; 2 Vw	$155.00	$671.00	$55.69–$603.90	—	77%
Elbow X-ray, complete, 3 or more views CPT 73080 Rad Exam Elbow; Complete 3 Vw Min	$201.43	$872.00	$68.29–$784.80	17% below	77%
Elbow X-ray, complete, 3 or more views inpatient CPT 73080 Rad Exam Elbow; Complete 3 Vw Min	$201.43	$872.00	$68.29–$784.80	—	77%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Orbitsellapost/Mid/Inner Ear; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	50% below	77%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Orbitsellapost/Mid/Inner Ear; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
Facial bones X-ray, complete, 3 or more views CPT 70150 Rad Exam Facial Bns; Compl 3 Vw Min	$340.49	$1,474.00	$81.78–$1,326.60	25% above	77%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 Rad Exam Facial Bns; Compl 3 Vw Min	$340.49	$1,474.00	$81.78–$1,326.60	—	77%
Forearm X-ray (radius and ulna), 2 views CPT 73090 Rad Exam; Fa 2 Vw	$161.47	$699.00	$53.78–$629.10	12% below	77%
Forearm X-ray (radius and ulna), 2 views inpatient CPT 73090 Rad Exam; Fa 2 Vw	$161.47	$699.00	$53.78–$629.10	—	77%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary System Imaging	$1,044.12	$4,520.00	$428.40–$4,068.00	21% below	77%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary System Imaging	$1,044.12	$4,520.00	$428.40–$4,068.00	—	77%
Hand X-ray, 2 views CPT 73120 Rad Exam Hnd; 2 Vw	$152.23	$659.00	$43.06–$1,186.20	11% below	77%
Hand X-ray, 2 views inpatient CPT 73120 Rad Exam Hnd; 2 Vw	$152.23	$659.00	$43.06–$1,186.20	—	77%
Heel bone (calcaneus) X-ray, 2 or more views CPT 73650 Rad Exam; Calcaneus 2 Vw Min	$192.42	$833.00	$19.05–$1,499.40	9% below	77%
Heel bone (calcaneus) X-ray, 2 or more views inpatient CPT 73650 Rad Exam; Calcaneus 2 Vw Min	$192.42	$833.00	$19.05–$1,499.40	—	77%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Test/Type 3 Porta	$476.55	$2,063.00	$223.21–$1,856.70	16% above	77%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Home Sleep Test/Type 3 Porta	$476.55	$2,063.00	$223.21–$1,856.70	—	77%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Pss W 4/> P W Cpap/Bipap	$1,356.20	$5,871.00	$780.39–$5,283.90	59% below	77%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Pss W 4/> P W Cpap/Bipap	$1,356.20	$5,871.00	$780.39–$5,283.90	—	77%
Knee X-ray, 3 views CPT 73562 Rad Exam Knee; 3 Vw	$182.95	$792.00	$75.04–$1,425.60	20% below	77%
Knee X-ray, 3 views inpatient CPT 73562 Rad Exam Knee; 3 Vw	$182.95	$792.00	$75.04–$1,425.60	—	77%
Knee X-ray, complete, 4 or more views CPT 73564 Rad Exam Knee; Compl 4 Vw Min	$226.61	$981.00	$86.62–$1,765.80	13% below	77%
Knee X-ray, complete, 4 or more views inpatient CPT 73564 Rad Exam Knee; Compl 4 Vw Min	$226.61	$981.00	$86.62–$1,765.80	—	77%
Leg CT scan without contrast (hip to foot, any part) CPT 73700 CT Lower Extrmty; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	48% below	77%
Leg CT scan without contrast (hip to foot, any part) inpatient CPT 73700 CT Lower Extrmty; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Bedside US Echo Exam of Abdomen Limited	$231.92	$1,004.00	$110.61–$903.60	44% below	77%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abd W/Image; Ltd	$231.92	$1,004.00	$110.61–$903.60	44% below	77%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Bedside US Echo Exam of Abdomen Limited	$231.92	$1,004.00	$110.61–$903.60	—	77%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abd W/Image; Ltd	$231.92	$1,004.00	$110.61–$903.60	—	77%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Bedside US Lmtd Jt/Nonvasc Xtr Strux	$276.97	$1,199.00	$29.64–$1,079.10	8% below	77%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 US Xtr Non-Vasc Lmtd	$276.97	$1,199.00	$29.64–$1,079.10	8% below	77%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 Bedside US Lmtd Jt/Nonvasc Xtr Strux	$276.97	$1,199.00	$29.64–$1,079.10	—	77%
Limited ultrasound of an arm or leg (non-vascular) inpatient CPT 76882 US Xtr Non-Vasc Lmtd	$276.97	$1,199.00	$29.64–$1,079.10	—	77%
Lower leg X-ray (tibia and fibula), 2 views CPT 73590 Rad Exam; Tibia and Fibula 2 Vw	$155.00	$671.00	$51.83–$603.90	22% below	77%
Lower leg X-ray (tibia and fibula), 2 views inpatient CPT 73590 Rad Exam; Tibia and Fibula 2 Vw	$155.00	$671.00	$51.83–$603.90	—	77%
MR angiography (MRA) of the head without contrast CPT 70544 Mra Head; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	32% below	77%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 Mra Head; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	—	77%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI Breast WO/With Contrast W/Cad Bil	$305.84	$1,324.00	$369.11–$2,817.00	26% below	77%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Breast WO/With Contrast W/Cad Bil	$305.84	$1,324.00	$369.11–$2,817.00	—	77%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Lower Extremity Jnt; W/O Contrast	$574.27	$2,486.00	$252.44–$2,817.00	43% below	77%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Lower Extremity Jnt; W/O Contrast	$574.27	$2,486.00	$252.44–$2,817.00	—	77%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Lower Extremity Jnt; W&W/O Contrast	$532.46	$2,305.00	$369.11–$2,817.00	61% below	77%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI Lower Extremity Jnt; W&W/O Contrast	$532.46	$2,305.00	$369.11–$2,817.00	—	77%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	29% below	77%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	—	77%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	42% below	77%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	—	77%
MRI of the brain, no contrast dye CPT 70551 MRI Brain; W/O Contrast	$551.86	$2,389.00	$252.44–$2,817.00	45% below	77%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain; W/O Contrast	$551.86	$2,389.00	$252.44–$2,817.00	—	77%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain; W&W/O Contrast	$756.06	$3,273.00	$360.64–$2,945.70	41% below	77%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain; W&W/O Contrast	$756.06	$3,273.00	$360.64–$2,945.70	—	77%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar; W/O Contrast	$552.78	$2,393.00	$246.65–$2,817.00	45% below	77%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar; W/O Contrast	$552.78	$2,393.00	$246.65–$2,817.00	—	77%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar; W&W/O Contrast	$779.39	$3,374.00	$373.86–$3,036.60	44% below	77%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar; W&W/O Contrast	$779.39	$3,374.00	$373.86–$3,036.60	—	77%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic; W/O Contrast	$757.91	$3,281.00	$255.69–$2,952.90	26% below	77%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic; W/O Contrast	$757.91	$3,281.00	$255.69–$2,952.90	—	77%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	38% below	77%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	—	77%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	26% below	77%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	—	77%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	37% below	77%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis; W&W/O Contrast	$865.79	$3,748.00	$369.11–$3,373.20	—	77%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	26% below	77%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis; W/O Contrast	$757.91	$3,281.00	$252.44–$2,952.90	—	77%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Upper Extremity Jnt; W/O Contrast	$757.91	$3,281.00	$246.65–$2,952.90	26% below	77%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Upper Extremity Jnt; W/O Contrast	$757.91	$3,281.00	$246.65–$2,952.90	—	77%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 Rad Exam Cerv Spine; 4 Vw Min	$251.10	$1,087.00	$38.87–$978.30	28% below	77%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 Rad Exam Cerv Spine; 4 Vw Min	$251.10	$1,087.00	$38.87–$978.30	—	77%
Neck soft tissue CT scan with contrast CPT 70491 CT Soft Tiss Nk; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	45% below	77%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Soft Tiss Nk; W/Cont	$514.21	$2,226.00	$185.58–$2,003.40	—	77%
Neck soft tissue CT scan without contrast CPT 70490 CT Soft Tiss Nk; W/O Cont	$405.87	$1,757.00	$108.07–$1,684.00	49% below	77%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Soft Tiss Nk; W/O Cont	$405.87	$1,757.00	$108.07–$1,684.00	—	77%
Neck soft tissue X-ray CPT 70360 Rad Exam; Neck Soft Tiss	$152.23	$659.00	$56.67–$593.10	12% below	77%
Neck soft tissue X-ray inpatient CPT 70360 Rad Exam; Neck Soft Tiss	$152.23	$659.00	$56.67–$593.10	—	77%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial W/Spect; Multiple Studies	$2,693.92	$11,662.00	$1,095.24–$10,495.80	29% below	77%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial W/Spect; Multiple Studies	$2,693.92	$11,662.00	$1,095.24–$10,495.80	—	77%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet W/CT; Skull Base to Mid-Thigh	$3,607.99	$15,619.00	$1,512.90–$14,057.10	13% below	77%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet W/CT; Skull Base to Mid-Thigh	$3,607.99	$15,619.00	$1,512.90–$14,057.10	—	77%
Pelvic CT scan without contrast CPT 72192 CT Pelv W/O Cont	$315.08	$1,364.00	$110.61–$1,684.00	60% below	77%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelv W/O Cont	$315.08	$1,364.00	$110.61–$1,684.00	—	77%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Exam Pelvic Limited	$270.73	$1,172.00	$94.34–$1,054.80	20% below	77%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Bedside US Exam Pelvic Limited	$270.73	$1,172.00	$94.34–$1,054.80	20% below	77%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Bedside US Exam Pelvic Limited	$270.73	$1,172.00	$94.34–$1,054.80	—	77%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Exam Pelvic Limited	$270.73	$1,172.00	$94.34–$1,054.80	—	77%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelv; Compl	$249.94	$1,082.00	$110.61–$973.80	45% below	77%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelv; Compl	$249.94	$1,082.00	$110.61–$973.80	—	77%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uterus >14wk; 1st Gest	$637.56	$2,760.00	$108.07–$2,484.00	16% above	77%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Preg Uterus >14wk; 1st Gest	$637.56	$2,760.00	$108.07–$2,484.00	—	77%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Preg Uter <14wk; 1st Gest	$601.52	$2,604.00	$110.61–$2,343.60	17% above	77%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Preg Uter <14wk; 1st Gest	$601.52	$2,604.00	$110.61–$2,343.60	—	77%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Bedside US Preg Uterus Limited 1+ Fetus(S)	$451.14	$1,953.00	$110.61–$1,757.70	23% above	77%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Preg Uter Ltd	$451.14	$1,953.00	$110.61–$1,757.70	23% above	77%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Bedside US Preg Uterus Limited 1+ Fetus(S)	$451.14	$1,953.00	$110.61–$1,757.70	—	77%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Preg Uter Ltd	$451.14	$1,953.00	$110.61–$1,757.70	—	77%
Rib X-ray, one side, 2 views CPT 71100 Rad Exam Ribs Unilatl; 2 Vw	$120.81	$523.00	$59.59–$470.70	41% below	77%
Rib X-ray, one side, 2 views inpatient CPT 71100 Rad Exam Ribs Unilatl; 2 Vw	$120.81	$523.00	$59.59–$470.70	—	77%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 Rad Exam Ribs Unilat; W/Pa Cxr 3 Vw Min	$167.71	$726.00	$73.09–$653.40	31% below	77%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 Rad Exam Ribs Unilat; W/Pa Cxr 3 Vw Min	$167.71	$726.00	$73.09–$653.40	—	77%
Screening mammogram, both breasts both sides CPT 77067 Scr Mammo Bi Incl Cad	$155.23	$672.00	$84.38–$604.80	—	77%
Screening mammogram, both breasts inpatient both sides CPT 77067 Scr Mammo Bi Incl Cad	$155.23	$672.00	$84.38–$604.80	—	77%
Shoulder X-ray, complete, 2 or more views CPT 73030 Rad Exam Shldr; Compl 2 Vw Min	$176.95	$766.00	$57.64–$1,378.80	15% below	77%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Rad Exam Shldr; Compl 2 Vw Min	$176.95	$766.00	$57.64–$1,378.80	—	77%
Sinus X-ray, complete, 3 or more views CPT 70220 Rad Exam Sinuses Compl 3 Vw Min	$185.96	$805.00	$72.15–$724.50	34% below	77%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 Rad Exam Sinuses Compl 3 Vw Min	$185.96	$805.00	$72.15–$724.50	—	77%
Skull X-ray, fewer than 4 views CPT 70250 Rad Exam Skull; <4 Vw	$229.38	$993.00	$68.29–$893.70	1% below	77%
Skull X-ray, fewer than 4 views inpatient CPT 70250 Rad Exam Skull; <4 Vw	$229.38	$993.00	$68.29–$893.70	—	77%
Sleep study in a lab (polysomnography) CPT 95810 Pss W 4/> Param W Tech	$1,254.10	$5,429.00	$780.39–$4,886.10	54% below	77%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Pss W 4/> Param W Tech	$1,254.10	$5,429.00	$780.39–$4,886.10	—	77%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Tte Complete	$1,134.90	$4,913.00	$578.11–$4,421.70	37% below	77%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress Tte Complete	$1,134.90	$4,913.00	$578.11–$4,421.70	—	77%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Swallowing Function W/Video Contrast Study	$247.63	$1,072.00	$179.36–$964.80	26% below	77%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Swallowing Function W/Video Contrast Study	$247.63	$1,072.00	$179.36–$964.80	—	77%
Thigh bone (femur) X-ray, 2 or more views CPT 73552 X-Ray Exam of Femur 2/> Views	$185.96	$805.00	$61.50–$724.50	7% below	77%
Thigh bone (femur) X-ray, 2 or more views inpatient CPT 73552 X-Ray Exam of Femur 2/> Views	$185.96	$805.00	$61.50–$724.50	—	77%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Thor Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	51% below	77%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Thor Spin; W/O Cont	$405.87	$1,757.00	$110.61–$1,684.00	—	77%
Toe X-ray, 2 or more views CPT 73660 Rad Exam; Toe(S) 2 Vw Min	$142.76	$618.00	$65.36–$556.20	4% below	77%
Toe X-ray, 2 or more views inpatient CPT 73660 Rad Exam; Toe(S) 2 Vw Min	$142.76	$618.00	$65.36–$556.20	—	77%
Transvaginal pelvic ultrasound CPT 76830 US Transvag	$136.52	$591.00	$110.61–$531.90	65% below	77%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvag	$136.52	$591.00	$110.61–$531.90	—	77%
Transvaginal ultrasound during pregnancy CPT 76817 US Preg Uter Transvag	$147.84	$640.00	$108.07–$576.00	60% below	77%
Transvaginal ultrasound during pregnancy CPT 76817 ED Bedside US Preg Uterus Transvaginal	$147.84	$640.00	$108.07–$576.00	60% below	77%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ED Bedside US Preg Uterus Transvaginal	$147.84	$640.00	$108.07–$576.00	—	77%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Preg Uter Transvag	$147.84	$640.00	$108.07–$576.00	—	77%
Ultrasound of the abdomen, complete CPT 76700 US Abd W/Image Doc; Compl	$189.42	$820.00	$110.61–$738.00	64% below	77%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abd W/Image Doc; Compl	$189.42	$820.00	$110.61–$738.00	—	77%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum and Contents	$390.85	$1,692.00	$110.61–$1,522.80	8% below	77%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum	$390.85	$1,692.00	$110.61–$1,522.80	8% below	77%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum and Contents	$390.85	$1,692.00	$110.61–$1,522.80	—	77%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Scrotum	$390.85	$1,692.00	$110.61–$1,522.80	—	77%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Bedside US Exam of Head and Neck	$243.94	$1,056.00	$110.61–$950.40	43% below	77%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Sft Tissue Head/Neck W/Image	$243.94	$1,056.00	$110.61–$950.40	43% below	77%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Sft Tissue Head/Neck W/Image	$243.94	$1,056.00	$110.61–$950.40	—	77%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Bedside US Exam of Head and Neck	$243.94	$1,056.00	$110.61–$950.40	—	77%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Rad Exam Upper GI Sngl Contrast Study	$291.52	$1,262.00	$185.58–$1,135.80	44% below	77%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Rad Exam Upper GI Sngl Contrast Study	$291.52	$1,262.00	$185.58–$1,135.80	—	77%
Upper arm X-ray (humerus), 2 views CPT 73060 Rad Exam; Humerus 2 Vw Min	$158.00	$684.00	$55.69–$615.60	18% below	77%
Upper arm X-ray (humerus), 2 views inpatient CPT 73060 Rad Exam; Humerus 2 Vw Min	$158.00	$684.00	$55.69–$615.60	—	77%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Duplx Scan of Ext Veins; Unilat or Ltd Study	$707.32	$3,062.00	$110.61–$2,755.80	11% above	77%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Bedside Duplx Scan of Ext Veins; Unilat or Ltd	$707.32	$3,062.00	$110.61–$2,755.80	11% above	77%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Bedside Duplx Scan of Ext Veins; Unilat or Ltd	$707.32	$3,062.00	$110.61–$2,755.80	—	77%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 Duplx Scan of Ext Veins; Unilat or Ltd Study	$707.32	$3,062.00	$110.61–$2,755.80	—	77%
Wrist X-ray, 2 views CPT 73100 Rad Exam Wrist; 2 Vw	$155.00	$671.00	$61.50–$603.90	1% below	77%
Wrist X-ray, 2 views inpatient CPT 73100 Rad Exam Wrist; 2 Vw	$155.00	$671.00	$61.50–$603.90	—	77%
Wrist X-ray, complete, 3 or more views CPT 73110 Rad Exam Wrist; Compl 3 Vw Min	$167.71	$726.00	$79.87–$1,306.80	34% below	77%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Rad Exam Wrist; Compl 3 Vw Min	$167.71	$726.00	$79.87–$1,306.80	—	77%
X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-Ray Exam Hip Uni, W/Pelvis When Performed, 2-3 V	$145.76	$631.00	$80.85–$567.90	45% below	77%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient CPT 73502 X-Ray Exam Hip Uni, W/Pelvis When Performed, 2-3 V	$145.76	$631.00	$80.85–$567.90	—	77%
X-ray of the abdomen, 1 view CPT 74018 Xray Exam Babyscan Abdomen 1 View	$50.13	$217.00	$92.07–$390.96	78% below	77%
X-ray of the abdomen, 1 view CPT 74018 X-Ray Exam Abdomen 1 View	$86.63	$375.00	$92.07–$390.96	61% below	77%
X-ray of the abdomen, 1 view inpatient CPT 74018 Xray Exam Babyscan Abdomen 1 View	$50.13	$217.00	$92.07–$390.96	—	77%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-Ray Exam Abdomen 1 View	$86.63	$375.00	$92.07–$390.96	—	77%
X-ray of the ankle, 2 views CPT 73600 Rad Exam Ankl; 2 Vw	$148.76	$644.00	$55.69–$579.60	7% below	77%
X-ray of the ankle, 2 views inpatient CPT 73600 Rad Exam Ankl; 2 Vw	$148.76	$644.00	$55.69–$579.60	—	77%
X-ray of the finger(s), 2 or more views CPT 73140 Rad Exam Fngr(S); 2 Vw Min	$139.52	$604.00	$72.15–$543.60	9% below	77%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Rad Exam Fngr(S); 2 Vw Min	$139.52	$604.00	$72.15–$543.60	—	77%
X-ray of the foot, 2 views CPT 73620 Rad Exam Ft; 2 Vw	$158.00	$684.00	$53.78–$615.60	4% below	77%
X-ray of the foot, 2 views inpatient CPT 73620 Rad Exam Ft; 2 Vw	$158.00	$684.00	$53.78–$615.60	—	77%
X-ray of the foot, complete, 3 or more views CPT 73630 Rad Exam Ft; Compl 3 Vw Min	$170.25	$737.00	$63.45–$1,326.60	16% below	77%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Rad Exam Ft; Compl 3 Vw Min	$170.25	$737.00	$63.45–$1,326.60	—	77%
X-ray of the hand, 3 or more views CPT 73130 Rad Exam Hnd; 3 Vw Min	$182.95	$792.00	$66.34–$1,425.60	9% below	77%
X-ray of the hand, 3 or more views inpatient CPT 73130 Rad Exam Hnd; 3 Vw Min	$182.95	$792.00	$66.34–$1,425.60	—	77%
X-ray of the knee, 1 or 2 views CPT 73560 Rad Exam Knee; 1/2 Vw	$164.47	$712.00	$58.62–$1,281.60	21% below	77%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Rad Exam Knee; 1/2 Vw	$164.47	$712.00	$58.62–$1,281.60	—	77%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Rad Exam Spine Lumbosacral;2/3 Vw	$139.76	$605.00	$66.34–$544.50	44% below	77%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Rad Exam Spine Lumbosacral;2/3 Vw	$139.76	$605.00	$66.34–$544.50	—	77%
X-ray of the lower back, 4 or more views CPT 72110 Rad Exam Spine Lumbosacral; 4vw Min	$171.86	$744.00	$91.46–$669.60	50% below	77%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Rad Exam Spine Lumbosacral; 4vw Min	$171.86	$744.00	$91.46–$669.60	—	77%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Rad Exam Spine; Thor 2 Vw	$173.71	$752.00	$61.50–$676.80	25% below	77%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Rad Exam Spine; Thor 2 Vw	$173.71	$752.00	$61.50–$676.80	—	77%
X-ray of the nasal bones, 3 or more views CPT 70160 Rad Exam Nasal Bns; Compl 3 Vw Min	$207.90	$900.00	$69.23–$810.00	3% above	77%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Rad Exam Nasal Bns; Compl 3 Vw Min	$207.90	$900.00	$69.23–$810.00	—	77%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Rad Exam Cerv Spine; 2/3 Vw	$235.85	$1,021.00	$66.34–$918.90	6% below	77%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Rad Exam Cerv Spine; 2/3 Vw	$235.85	$1,021.00	$66.34–$918.90	—	77%
X-ray of the pelvis, 1 or 2 views CPT 72170 Rad Exam Pel; 1/2 Vw	$158.00	$684.00	$53.78–$615.60	20% below	77%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Rad Exam Pel; 1/2 Vw	$158.00	$684.00	$53.78–$615.60	—	77%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Rad Exam Sacrum/Coccyx 2 Vw Min	$155.00	$671.00	$55.69–$603.90	29% below	77%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Rad Exam Sacrum/Coccyx 2 Vw Min	$155.00	$671.00	$55.69–$603.90	—	77%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone	$150.15	$650.00	$30.51–$585.00	35% below	77%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone	$150.15	$650.00	$30.51–$585.00	—	77%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; Alanine Amino	$22.87	$99.00	$4.19–$89.10	17% below	77%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Transferase; Alanine Amino	$22.87	$99.00	$4.19–$89.10	—	77%
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast or Sgot	$22.87	$99.00	$4.09–$89.10	21% below	77%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Ast or Sgot	$22.87	$99.00	$4.09–$89.10	—	77%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$197.97	$857.00	$37.63–$771.30	37% below	77%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$197.97	$857.00	$37.63–$771.30	—	77%
Albumin blood test CPT 82040 Assay of Serum Albumin 062	$13.40	$58.00	$3.91–$52.20	41% below	77%
Albumin blood test CPT 82040 Assay of Serum Albumin 064	$15.48	$67.00	$3.91–$60.30	32% below	77%
Albumin blood test inpatient CPT 82040 Assay of Serum Albumin 062	$13.40	$58.00	$3.91–$52.20	—	77%
Albumin blood test inpatient CPT 82040 Assay of Serum Albumin 064	$15.48	$67.00	$3.91–$60.30	—	77%
Aldosterone blood test CPT 82088 Aldosterone 071	$159.62	$691.00	$32.19–$621.90	22% below	77%
Aldosterone blood test inpatient CPT 82088 Aldosterone 071	$159.62	$691.00	$32.19–$621.90	—	77%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaine Phosphatase	$25.64	$111.00	$4.09–$99.90	20% below	77%
Alkaline phosphatase (ALP) blood test CPT 84075 Alkaline Phosphatase	$25.64	$111.00	$4.09–$99.90	20% below	77%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaine Phosphatase	$25.64	$111.00	$4.09–$99.90	—	77%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 Alkaline Phosphatase	$25.64	$111.00	$4.09–$99.90	—	77%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg Sp Ige; Quan or Semiquan 493	$10.16	$44.00	$4.12–$39.60	47% below	77%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg Sp Ige; Quan or Semiquan 493	$10.16	$44.00	$4.12–$39.60	—	77%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-Fetoprotein; Serum 075	$66.99	$290.00	$13.25–$261.00	34% below	77%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-Fetoprotein; Serum 075	$66.99	$290.00	$13.25–$261.00	—	77%
Ammonia blood test CPT 82140 Ammonia	$54.52	$236.00	$11.51–$212.40	54% below	77%
Ammonia blood test inpatient CPT 82140 Ammonia	$54.52	$236.00	$11.51–$212.40	—	77%
Amylase blood test CPT 82150 Amylase 087	$54.52	$236.00	$5.12–$212.40	5% above	77%
Amylase blood test CPT 82150 Amylase 088	$54.52	$236.00	$5.12–$212.40	5% above	77%
Amylase blood test inpatient CPT 82150 Amylase 088	$54.52	$236.00	$5.12–$212.40	—	77%
Amylase blood test inpatient CPT 82150 Amylase 087	$54.52	$236.00	$5.12–$212.40	—	77%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibody	$48.05	$208.00	$10.23–$187.20	8% below	77%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibody	$48.05	$208.00	$10.23–$187.20	—	77%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (Ana);	$22.87	$99.00	$9.55–$89.10	64% below	77%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (Ana);	$22.87	$99.00	$9.55–$89.10	—	77%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic Peptide	$95.63	$414.00	$31.02–$372.60	44% below	77%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Natriuretic Peptide	$95.63	$414.00	$31.02–$372.60	—	77%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture - Othr Source 671	$41.58	$180.00	$6.81–$162.00	55% below	77%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial Culture - Othr Source 675	$41.58	$180.00	$6.81–$162.00	55% below	77%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture - Othr Source 671	$41.58	$180.00	$6.81–$162.00	—	77%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 Bacterial Culture - Othr Source 675	$41.58	$180.00	$6.81–$162.00	—	77%
Basic metabolic panel (blood test) CPT 80048 Bmp (Calcium Total)	$35.81	$155.00	$6.68–$139.50	54% below	77%
Basic metabolic panel (blood test) one side CPT 80048 Metabolic Panel Total Ca-Rt	$35.81	$155.00	$6.68–$139.50	54% below	77%
Basic metabolic panel (blood test) inpatient CPT 80048 Bmp (Calcium Total)	$35.81	$155.00	$6.68–$139.50	—	77%
Basic metabolic panel (blood test) inpatient one side CPT 80048 Metabolic Panel Total Ca-Rt	$35.81	$155.00	$6.68–$139.50	—	77%
Bilirubin blood test, total CPT 82247 Bilirubin Total 102	$25.64	$111.00	$3.97–$99.90	26% below	77%
Bilirubin blood test, total inpatient CPT 82247 Bilirubin Total 102	$25.64	$111.00	$3.97–$99.90	—	77%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Tissue Exam by Pathologist 009	$318.55	$1,379.00	$55.13–$1,241.10	23% above	77%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Tissue Exam by Pathologist 009	$318.55	$1,379.00	$55.13–$1,241.10	—	77%
Blood culture for bacteria CPT 87040 Aerob Bacterial Bld Culture	$60.98	$264.00	$8.15–$237.60	53% below	77%
Blood culture for bacteria inpatient CPT 87040 Aerob Bacterial Bld Culture	$60.98	$264.00	$8.15–$237.60	—	77%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$8.32	$36.00	$4.50–$38.57	50% below	77%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Pace Venipuncture	$8.32	$36.00	$4.50–$38.57	50% below	77%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$8.32	$36.00	$4.50–$38.57	—	77%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Pace Venipuncture	$8.32	$36.00	$4.50–$38.57	—	77%
Blood glucose (sugar) test CPT 82947 Glucose; Quan Bld 196	$22.87	$99.00	$3.10–$89.10	14% below	77%
Blood glucose (sugar) test CPT 82947 Glucose; Quan Bld 1262	$22.87	$99.00	$3.10–$89.10	14% below	77%
Blood glucose (sugar) test CPT 82947 Glucose; Quan Blood-Oh	$22.87	$99.00	$3.10–$89.10	14% below	77%
Blood glucose (sugar) test one side CPT 82947 Glucose; Quan Blood-Rt	$22.87	$99.00	$3.10–$89.10	14% below	77%
Blood glucose (sugar) test inpatient CPT 82947 Glucose; Quan Blood-Oh	$22.87	$99.00	$3.10–$89.10	—	77%
Blood glucose (sugar) test inpatient CPT 82947 Glucose; Quan Bld 1262	$22.87	$99.00	$3.10–$89.10	—	77%
Blood glucose (sugar) test inpatient CPT 82947 Glucose; Quan Bld 196	$22.87	$99.00	$3.10–$89.10	—	77%
Blood glucose (sugar) test inpatient one side CPT 82947 Glucose; Quan Blood-Rt	$22.87	$99.00	$3.10–$89.10	—	77%
Blood lead test CPT 83655 Lead 246	$48.05	$208.00	$9.57–$187.20	36% below	77%
Blood lead test CPT 83655 POCT Bld Lead 931	$79.70	$345.00	$9.57–$310.50	7% above	77%
Blood lead test inpatient CPT 83655 Lead 246	$48.05	$208.00	$9.57–$187.20	—	77%
Blood lead test inpatient CPT 83655 POCT Bld Lead 931	$79.70	$345.00	$9.57–$310.50	—	77%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg; Qual	$25.64	$111.00	$5.94–$99.90	64% below	77%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg; Qual	$25.64	$111.00	$5.94–$99.90	—	77%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bld Typing; Abo	$23.56	$102.00	$2.99–$553.46	51% below	77%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bld Typing; Abo 642	$38.81	$168.00	$2.99–$553.46	20% below	77%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bld Typing; Abo 641	$89.40	$387.00	$2.99–$553.46	84% above	77%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bld Typing; Abo	$23.56	$102.00	$2.99–$553.46	—	77%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bld Typing; Abo 642	$38.81	$168.00	$2.99–$553.46	—	77%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bld Typing; Abo 641	$89.40	$387.00	$2.99–$553.46	—	77%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen; Quan 413	$8.78	$38.00	$3.12–$34.20	63% below	77%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen; Quan 414	$11.09	$48.00	$3.12–$43.20	53% below	77%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen; Quan 413	$8.78	$38.00	$3.12–$34.20	—	77%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen; Quan 414	$11.09	$48.00	$3.12–$43.20	—	77%
C-peptide blood test CPT 84681 C-Peptide	$83.39	$361.00	$16.44–$324.90	39% below	77%
C-peptide blood test inpatient CPT 84681 C-Peptide	$83.39	$361.00	$16.44–$324.90	—	77%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$41.58	$180.00	$4.09–$162.00	39% below	77%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$41.58	$180.00	$4.09–$162.00	—	77%
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Amplified Probe	$73.69	$319.00	$29.44–$287.10	45% below	77%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Amplified Probe	$73.69	$319.00	$29.44–$287.10	—	77%
CA 19-9 blood test (tumor marker) CPT 86301 Ia Quant; Ca 19-9	$83.39	$361.00	$16.44–$324.90	42% below	77%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Ia Quant; Ca 19-9	$83.39	$361.00	$16.44–$324.90	—	77%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ia Quant; Ca 125	$83.39	$361.00	$16.44–$324.90	49% below	77%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Ia Quant; Ca 125	$83.39	$361.00	$16.44–$324.90	—	77%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-Cov-2 Covid-19 Amp Prb	$36.27	$157.00	$40.53–$230.90	66% below	77%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019 Ncov Dx Panel	$82.93	$359.00	$40.53–$323.10	22% below	77%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019 Ncov Any Technique	$82.93	$359.00	$40.53–$323.10	22% below	77%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars-Cov-2 Covid-19 Amp Prb	$36.27	$157.00	$40.53–$230.90	—	77%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019 Ncov Any Technique	$82.93	$359.00	$40.53–$323.10	—	77%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019 Ncov Dx Panel	$82.93	$359.00	$40.53–$323.10	—	77%
Calcium blood test, total CPT 82310 Calcium; Total	$12.94	$56.00	$4.08–$50.40	48% below	77%
Calcium blood test, total inpatient CPT 82310 Calcium; Total	$12.94	$56.00	$4.08–$50.40	—	77%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen 121	$79.70	$345.00	$14.98–$310.50	33% below	77%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen 122	$79.70	$345.00	$14.98–$310.50	33% below	77%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen 121	$79.70	$345.00	$14.98–$310.50	—	77%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen 122	$79.70	$345.00	$14.98–$310.50	—	77%
Chickenpox (varicella) immunity blood test CPT 86787 Ab; Varicella-Zoster 620	$41.58	$180.00	$10.18–$162.00	56% below	77%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella-Zoster Antibody	$48.05	$208.00	$10.18–$187.20	49% below	77%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Ab; Varicella-Zoster 620	$41.58	$180.00	$10.18–$162.00	—	77%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella-Zoster Antibody	$48.05	$208.00	$10.18–$187.20	—	77%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia T Amplif Na Probe 900	$86.39	$374.00	$27.72–$336.60	11% below	77%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia T Amplif Na Probe 750	$86.39	$374.00	$27.72–$336.60	11% below	77%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia T Amplif Na Probe 900	$86.39	$374.00	$27.72–$336.60	—	77%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia T Amplif Na Probe 750	$86.39	$374.00	$27.72–$336.60	—	77%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$54.52	$236.00	$10.58–$212.40	48% below	77%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$54.52	$236.00	$10.58–$212.40	—	77%
Complete blood count (CBC) with differential CPT 85025 Compl Cbc W Plt W Autom Diff	$24.26	$105.00	$6.14–$94.50	41% below	77%
Complete blood count (CBC) with differential inpatient CPT 85025 Compl Cbc W Plt W Autom Diff	$24.26	$105.00	$6.14–$94.50	—	77%
Complete blood count (CBC), no differential CPT 85027 Compl Autom Cbc W Plt	$18.25	$79.00	$5.11–$71.10	38% below	77%
Complete blood count (CBC), no differential inpatient CPT 85027 Compl Autom Cbc W Plt	$18.25	$79.00	$5.11–$71.10	—	77%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel 004	$51.28	$222.00	$8.34–$199.80	44% below	77%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel 004	$51.28	$222.00	$8.34–$199.80	—	77%
Cortisol blood test, total CPT 82533 Cortisol; Total	$57.52	$249.00	$12.88–$224.10	36% below	77%
Cortisol blood test, total inpatient CPT 82533 Cortisol; Total	$57.52	$249.00	$12.88–$224.10	—	77%
Creatine kinase (CK) blood test, total CPT 82550 Cpk Total 150	$38.81	$168.00	$5.14–$151.20	at median	77%
Creatine kinase (CK) blood test, total CPT 82550 Cpk Total 151	$38.81	$168.00	$5.14–$151.20	at median	77%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Cpk Total 151	$38.81	$168.00	$5.14–$151.20	—	77%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Cpk Total 150	$38.81	$168.00	$5.14–$151.20	—	77%
Creatinine blood test CPT 82565 Creatinine;Bld	$18.94	$82.00	$4.04–$73.80	34% below	77%
Creatinine blood test CPT 82565 Creatinine; Bld 155	$18.94	$82.00	$4.04–$73.80	34% below	77%
Creatinine blood test CPT 82565 Creatinine; Bld 156	$18.94	$82.00	$4.04–$73.80	34% below	77%
Creatinine blood test inpatient CPT 82565 Creatinine;Bld	$18.94	$82.00	$4.04–$73.80	—	77%
Creatinine blood test inpatient CPT 82565 Creatinine; Bld 155	$18.94	$82.00	$4.04–$73.80	—	77%
Creatinine blood test inpatient CPT 82565 Creatinine; Bld 156	$18.94	$82.00	$4.04–$73.80	—	77%
Cytomegalovirus (CMV) antibody test CPT 86644 Ab; Cmv 579	$57.52	$249.00	$11.37–$224.10	32% below	77%
Cytomegalovirus (CMV) antibody test CPT 86644 Ab; Cmv 578	$57.52	$249.00	$11.37–$224.10	32% below	77%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Ab; Cmv 579	$57.52	$249.00	$11.37–$224.10	—	77%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Ab; Cmv 578	$57.52	$249.00	$11.37–$224.10	—	77%
D-dimer blood test (blood clot marker) CPT 85379 POCT D-Dimer - Quantitative	$124.51	$539.00	$8.04–$485.10	2% above	77%
D-dimer blood test (blood clot marker) inpatient CPT 85379 POCT D-Dimer - Quantitative	$124.51	$539.00	$8.04–$485.10	—	77%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-Sulfate	$86.39	$374.00	$17.56–$336.60	40% below	77%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone-Sulfate	$86.39	$374.00	$17.56–$336.60	—	77%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen Class List A	$102.56	$444.00	$49.09–$399.60	13% below	77%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen Class List A	$102.56	$444.00	$49.09–$399.60	—	77%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Electrolyte Panel	$28.88	$125.00	$5.54–$112.50	59% below	77%
Electrolyte panel (sodium, potassium, chloride, CO2) one side CPT 80051 Electrolyte Panel-Rt	$13.86	$60.00	$5.54–$54.00	80% below	77%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient CPT 80051 Electrolyte Panel	$28.88	$125.00	$5.54–$112.50	—	77%
Electrolyte panel (sodium, potassium, chloride, CO2) inpatient one side CPT 80051 Electrolyte Panel-Rt	$13.86	$60.00	$5.54–$54.00	—	77%
Epstein-Barr virus (EBV) antibody test CPT 86665 Ab; Eb Vca	$44.58	$193.00	$14.33–$173.70	44% below	77%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Ab; Eb Vca	$44.58	$193.00	$14.33–$173.70	—	77%
Estradiol blood test CPT 82670 Estradiol	$108.57	$470.00	$22.07–$423.00	10% below	77%
Estradiol blood test inpatient CPT 82670 Estradiol	$108.57	$470.00	$22.07–$423.00	—	77%
FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; Fsh	$79.70	$345.00	$14.68–$310.50	33% below	77%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Gonadotropin; Fsh	$79.70	$345.00	$14.68–$310.50	—	77%
Fecal calprotectin (stool inflammation test) CPT 83993 Assay for Calprotectin Fecal	$76.69	$332.00	$15.51–$298.80	57% below	77%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Assay for Calprotectin Fecal	$76.69	$332.00	$15.51–$298.80	—	77%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$79.70	$345.00	$10.77–$310.50	1% above	77%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$79.70	$345.00	$10.77–$310.50	—	77%
Fibrinogen blood test CPT 85384 Fibrinogen; Activity	$35.34	$153.00	$7.68–$137.70	41% below	77%
Fibrinogen blood test inpatient CPT 85384 Fibrinogen; Activity	$35.34	$153.00	$7.68–$137.70	—	77%
Folate (folic acid) blood test CPT 82746 Folic Acid; Serum	$76.69	$332.00	$11.61–$298.80	at median	77%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid; Serum	$76.69	$332.00	$11.61–$298.80	—	77%
Free T3 thyroid hormone test CPT 84481 T3; Free	$159.62	$691.00	$13.38–$621.90	13% above	77%
Free T3 thyroid hormone test inpatient CPT 84481 T3; Free	$159.62	$691.00	$13.38–$621.90	—	77%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free Thyroxine 396	$95.63	$414.00	$7.13–$372.60	19% above	77%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free Thyroxine 395	$95.63	$414.00	$7.13–$372.60	19% above	77%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free Thyroxine 396	$95.63	$414.00	$7.13–$372.60	—	77%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free Thyroxine 395	$95.63	$414.00	$7.13–$372.60	—	77%
Free testosterone test CPT 84402 Testosterone; Free	$98.87	$428.00	$20.12–$385.20	19% above	77%
Free testosterone test inpatient CPT 84402 Testosterone; Free	$98.87	$428.00	$20.12–$385.20	—	77%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase Gamma	$28.88	$125.00	$5.69–$112.50	11% below	77%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 Glutamyltransferase Gamma	$28.88	$125.00	$5.69–$112.50	—	77%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$140.91	$610.00	$70.82–$549.00	53% below	77%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$140.91	$610.00	$70.82–$549.00	—	77%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; Post Glucose Dose 199	$22.87	$99.00	$3.75–$89.10	45% below	77%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose; Post Glucose Dose 199	$22.87	$99.00	$3.75–$89.10	—	77%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance Test (Gtt)	$51.28	$222.00	$10.17–$199.80	31% below	77%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tolerance Test (Gtt)	$51.28	$222.00	$10.17–$199.80	—	77%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Amplif Na Probe 837	$76.69	$332.00	$27.72–$298.80	22% below	77%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Amplif Na Probe 768	$76.69	$332.00	$27.72–$298.80	22% below	77%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Amplif Na Probe 837	$76.69	$332.00	$27.72–$298.80	—	77%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Amplif Na Probe 768	$76.69	$332.00	$27.72–$298.80	—	77%
H. pylori antibody blood test CPT 86677 Ab; Helicobacter Pylori	$48.05	$208.00	$13.31–$187.20	50% below	77%
H. pylori antibody blood test inpatient CPT 86677 Ab; Helicobacter Pylori	$48.05	$208.00	$13.31–$187.20	—	77%
H. pylori stool antigen test CPT 87338 Hpylori Stool Eia	$57.52	$249.00	$11.36–$224.10	55% below	77%
H. pylori stool antigen test inpatient CPT 87338 Hpylori Stool Eia	$57.52	$249.00	$11.36–$224.10	—	77%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Na Quan	$350.66	$1,518.00	$67.23–$1,366.20	1% below	77%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hiv-1 Na Quan	$350.66	$1,518.00	$67.23–$1,366.20	—	77%
HIV-1 and HIV-2 antibody test CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 597	$54.52	$236.00	$10.83–$212.40	9% below	77%
HIV-1 and HIV-2 antibody test CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 596	$54.52	$236.00	$10.83–$212.40	9% below	77%
HIV-1 and HIV-2 antibody test CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 595	$66.99	$290.00	$10.83–$261.00	12% above	77%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 596	$54.52	$236.00	$10.83–$212.40	—	77%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 597	$54.52	$236.00	$10.83–$212.40	—	77%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 595	$66.99	$290.00	$10.83–$261.00	—	77%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab	$44.58	$193.00	$19.02–$173.70	25% below	77%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab	$44.58	$193.00	$19.02–$173.70	—	77%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High-Risk Types	$137.21	$594.00	$27.72–$534.60	31% above	77%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv High-Risk Types	$137.21	$594.00	$27.72–$534.60	—	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated Hemoglobin Test-POC	$92.86	$402.00	$7.67–$361.80	42% above	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated Hemoglobin Test	$92.86	$402.00	$7.67–$361.80	42% above	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 POCT Glycosylated Hbg 930	$92.86	$402.00	$7.67–$361.80	42% above	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated Hemoglobin Test	$92.86	$402.00	$7.67–$361.80	—	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated Hemoglobin Test-POC	$92.86	$402.00	$7.67–$361.80	—	77%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 POCT Glycosylated Hbg 930	$92.86	$402.00	$7.67–$361.80	—	77%
Hemoglobin blood test CPT 85018 Hemoglobin	$15.48	$67.00	$1.87–$60.30	19% below	77%
Hemoglobin blood test inpatient CPT 85018 Hemoglobin	$15.48	$67.00	$1.87–$60.30	—	77%
Hepatitis B core antibody test (total) CPT 86704 Ab; Hbcab - Total 599	$48.05	$208.00	$12.05–$187.20	28% below	77%
Hepatitis B core antibody test (total) CPT 86704 Ab; Hbcab-Total 1285	$48.05	$208.00	$12.05–$187.20	28% below	77%
Hepatitis B core antibody test (total) CPT 86704 Ab; Hbcab - Total 598	$92.86	$402.00	$12.05–$361.80	40% above	77%
Hepatitis B core antibody test (total) inpatient CPT 86704 Ab; Hbcab - Total 599	$48.05	$208.00	$12.05–$187.20	—	77%
Hepatitis B core antibody test (total) inpatient CPT 86704 Ab; Hbcab-Total 1285	$48.05	$208.00	$12.05–$187.20	—	77%
Hepatitis B core antibody test (total) inpatient CPT 86704 Ab; Hbcab - Total 598	$92.86	$402.00	$12.05–$361.80	—	77%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Ab: Hbsab	$41.58	$180.00	$10.74–$162.00	34% below	77%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Ab: Hbsab	$41.58	$180.00	$10.74–$162.00	—	77%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag Eia 741	$38.81	$168.00	$10.33–$151.20	36% below	77%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag Eia 869	$38.81	$168.00	$10.33–$151.20	36% below	77%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag Eia 740	$76.69	$332.00	$10.33–$298.80	26% above	77%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag Eia 869	$38.81	$168.00	$10.33–$151.20	—	77%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag Eia 741	$38.81	$168.00	$10.33–$151.20	—	77%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag Eia 740	$76.69	$332.00	$10.33–$298.80	—	77%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab 1287	$57.52	$249.00	$11.27–$224.10	41% below	77%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab 625	$57.52	$249.00	$11.27–$224.10	41% below	77%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab 624	$79.70	$345.00	$11.27–$310.50	18% below	77%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab 625	$57.52	$249.00	$11.27–$224.10	—	77%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab 1287	$57.52	$249.00	$11.27–$224.10	—	77%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab 624	$79.70	$345.00	$11.27–$310.50	—	77%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep-C Na Quan 831	$166.09	$719.00	$33.84–$647.10	26% below	77%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep-C Na Quan 831	$166.09	$719.00	$33.84–$647.10	—	77%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Test	$18.94	$82.00	$10.42–$73.80	63% below	77%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Test	$18.94	$82.00	$10.42–$73.80	—	77%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2	$38.81	$168.00	$15.29–$151.20	47% below	77%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Type 2	$38.81	$168.00	$15.29–$151.20	—	77%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein Hs	$38.81	$168.00	$10.23–$151.20	46% below	77%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein Hs	$38.81	$168.00	$10.23–$151.20	—	77%
Homocysteine blood test CPT 83090 Assay of Homocystine	$124.51	$539.00	$14.16–$485.10	4% below	77%
Homocysteine blood test inpatient CPT 83090 Assay of Homocystine	$124.51	$539.00	$14.16–$485.10	—	77%
Insulin blood test CPT 83525 Insulin; Total	$48.05	$208.00	$9.03–$187.20	33% below	77%
Insulin blood test inpatient CPT 83525 Insulin; Total	$48.05	$208.00	$9.03–$187.20	—	77%
Iron blood test (serum iron) CPT 83540 IRON	$35.34	$153.00	$5.11–$137.70	26% below	77%
Iron blood test (serum iron) CPT 83540 Iron 1425	$35.34	$153.00	$5.11–$137.70	26% below	77%
Iron blood test (serum iron) inpatient CPT 83540 Iron 1425	$35.34	$153.00	$5.11–$137.70	—	77%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$35.34	$153.00	$5.11–$137.70	—	77%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$41.58	$180.00	$6.90–$162.00	6% below	77%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$41.58	$180.00	$6.90–$162.00	—	77%
Kidney function blood test panel CPT 80069 Renal Function Panel	$49.90	$216.00	$6.86–$194.40	48% below	77%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$49.90	$216.00	$6.86–$194.40	—	77%
LH (luteinizing hormone) test CPT 83002 Gonadotropin; Luteinizing Hormone	$73.69	$319.00	$14.63–$287.10	48% below	77%
LH (luteinizing hormone) test CPT 83002 Gonadotropin; Luteinizing Hormone 1313	$73.69	$319.00	$14.63–$287.10	48% below	77%
LH (luteinizing hormone) test inpatient CPT 83002 Gonadotropin; Luteinizing Hormone 1313	$73.69	$319.00	$14.63–$287.10	—	77%
LH (luteinizing hormone) test inpatient CPT 83002 Gonadotropin; Luteinizing Hormone	$73.69	$319.00	$14.63–$287.10	—	77%
Lactate (lactic acid) blood test CPT 83605 Lactate	$60.98	$264.00	$9.14–$237.60	32% below	77%
Lactate (lactic acid) blood test CPT 83605 Assay of Lactic Acid	$60.98	$264.00	$9.14–$237.60	32% below	77%
Lactate (lactic acid) blood test CPT 83605 Lactate-Or	$60.98	$264.00	$9.14–$237.60	32% below	77%
Lactate (lactic acid) blood test CPT 83605 HC Lactate 1423	$60.98	$264.00	$9.14–$237.60	32% below	77%
Lactate (lactic acid) blood test inpatient CPT 83605 HC Lactate 1423	$60.98	$264.00	$9.14–$237.60	—	77%
Lactate (lactic acid) blood test inpatient CPT 83605 Assay of Lactic Acid	$60.98	$264.00	$9.14–$237.60	—	77%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate	$60.98	$264.00	$9.14–$237.60	—	77%
Lactate (lactic acid) blood test inpatient CPT 83605 Lactate-Or	$60.98	$264.00	$9.14–$237.60	—	77%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate Dehydrogenase 244	$22.87	$99.00	$4.77–$89.10	46% below	77%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 Lactate Dehydrogenase 244	$22.87	$99.00	$4.77–$89.10	—	77%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase 249	$51.28	$222.00	$5.44–$199.80	42% below	77%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase 249	$51.28	$222.00	$5.44–$199.80	—	77%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$35.34	$153.00	$6.45–$137.70	61% below	77%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$35.34	$153.00	$6.45–$137.70	—	77%
Lyme disease antibody test CPT 86618 Ab; Lyme's Disease	$54.52	$236.00	$13.45–$212.40	54% below	77%
Lyme disease antibody test inpatient CPT 86618 Ab; Lyme's Disease	$54.52	$236.00	$13.45–$212.40	—	77%
Magnesium blood test CPT 83735 Magnesium 256	$44.58	$193.00	$5.29–$173.70	5% below	77%
Magnesium blood test CPT 83735 Magnesium 259	$44.58	$193.00	$5.29–$173.70	5% below	77%
Magnesium blood test inpatient CPT 83735 Magnesium 256	$44.58	$193.00	$5.29–$173.70	—	77%
Magnesium blood test inpatient CPT 83735 Magnesium 259	$44.58	$193.00	$5.29–$173.70	—	77%
Measles (rubeola) antibody test CPT 86765 Ab; Rubeola	$124.51	$539.00	$10.18–$485.10	58% above	77%
Measles (rubeola) antibody test inpatient CPT 86765 Ab; Rubeola	$124.51	$539.00	$10.18–$485.10	—	77%
Mono test (heterophile antibody, Monospot) CPT 86308 Qual Heterophile Ab	$18.94	$82.00	$4.09–$73.80	75% below	77%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Qual Heterophile Ab	$18.94	$82.00	$4.09–$73.80	—	77%
Mumps immunity blood test CPT 86735 Ab; Mumps	$118.27	$512.00	$10.31–$460.80	55% above	77%
Mumps immunity blood test inpatient CPT 86735 Ab; Mumps	$118.27	$512.00	$10.31–$460.80	—	77%
Obstetric blood test panel CPT 80055 Obstetric Panel	$114.81	$497.00	$37.77–$447.30	64% below	77%
Obstetric blood test panel inpatient CPT 80055 Obstetric Panel	$114.81	$497.00	$37.77–$447.30	—	77%
PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Specific Antigen (Psa); Free	$23.79	$103.00	$14.53–$92.70	66% below	77%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Specific Antigen (Psa); Free	$23.79	$103.00	$14.53–$92.70	—	77%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen (Psa); Total	$23.79	$103.00	$14.53–$92.70	71% below	77%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen (Psa); Total	$23.79	$103.00	$14.53–$92.70	—	77%
Pap test (liquid-based, automated screening with review) CPT 88175 Atl Scrn Cytopath W Rvw by Tech	$41.58	$180.00	$20.93–$162.00	50% below	77%
Pap test (liquid-based, automated screening with review) CPT 88175 Cytopath C/V Auto Fluid Redo 791	$41.58	$180.00	$21.02–$162.00	50% below	77%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Cytopath C/V Auto Fluid Redo 791	$41.58	$180.00	$21.02–$162.00	—	77%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Atl Scrn Cytopath W Rvw by Tech	$41.58	$180.00	$20.93–$162.00	—	77%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cp Cerv/Vag; Atl; Manual Scrn	$32.11	$139.00	$20.26–$125.10	54% below	77%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Cp Cerv/Vag; Atl; Manual Scrn	$32.11	$139.00	$20.26–$125.10	—	77%
Parathyroid hormone (PTH) blood test CPT 83970 Parathormone 339	$137.21	$594.00	$32.61–$534.60	28% below	77%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathormone 339	$137.21	$594.00	$32.61–$534.60	—	77%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt; Plasma or Whole Bld 489	$38.81	$168.00	$4.75–$151.20	22% below	77%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt; Plasma or Whole Bld 489	$38.81	$168.00	$4.75–$151.20	—	77%
Phosphorus (phosphate) blood test CPT 84100 Phosphate 345	$11.09	$48.00	$3.74–$43.20	61% below	77%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphate 345	$11.09	$48.00	$3.74–$43.20	—	77%
Potassium blood test CPT 84132 Assay of Serum Potassium-Oh	$14.55	$63.00	$3.76–$56.70	49% below	77%
Potassium blood test CPT 84132 Assay of Serum Potassium	$14.55	$63.00	$3.76–$56.70	49% below	77%
Potassium blood test CPT 84132 Assay of Serum Potassium 934	$14.55	$63.00	$3.76–$56.70	49% below	77%
Potassium blood test CPT 84132 Assay of Serum Potassium 1257	$14.55	$63.00	$3.76–$56.70	49% below	77%
Potassium blood test inpatient CPT 84132 Assay of Serum Potassium-Oh	$14.55	$63.00	$3.76–$56.70	—	77%
Potassium blood test inpatient CPT 84132 Assay of Serum Potassium	$14.55	$63.00	$3.76–$56.70	—	77%
Potassium blood test inpatient CPT 84132 Assay of Serum Potassium 934	$14.55	$63.00	$3.76–$56.70	—	77%
Potassium blood test inpatient CPT 84132 Assay of Serum Potassium 1257	$14.55	$63.00	$3.76–$56.70	—	77%
Progesterone blood test CPT 84144 Progesterone Assay	$89.40	$387.00	$16.48–$348.30	35% below	77%
Progesterone blood test inpatient CPT 84144 Progesterone Assay	$89.40	$387.00	$16.48–$348.30	—	77%
Prolactin blood test CPT 84146 Prolactin Assay	$86.39	$374.00	$15.31–$336.60	14% below	77%
Prolactin blood test inpatient CPT 84146 Prolactin Assay	$86.39	$374.00	$15.31–$336.60	—	77%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time; 481	$9.24	$40.00	$3.39–$36.00	65% below	77%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time; 482	$9.24	$40.00	$3.39–$36.00	65% below	77%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time; 482	$9.24	$40.00	$3.39–$36.00	—	77%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time; 481	$9.24	$40.00	$3.39–$36.00	—	77%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Test Prsmv Dir Opt Obs	$99.56	$431.00	$9.95–$387.90	at median	77%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Test Prsmv Dir Opt Obs	$99.56	$431.00	$9.95–$387.90	—	77%
Rapid flu test (influenza antigen) CPT 87804 Infect Agent Detect; Influenza	$22.87	$99.00	$13.07–$89.10	56% below	77%
Rapid flu test (influenza antigen) inpatient CPT 87804 Infect Agent Detect; Influenza	$22.87	$99.00	$13.07–$89.10	—	77%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Infect Agent Detect; Strep	$38.81	$168.00	$13.06–$151.20	50% below	77%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Infect Agent Detect; Strep	$38.81	$168.00	$13.06–$151.20	—	77%
Renin blood test CPT 84244 Renin	$86.39	$374.00	$17.37–$336.60	19% below	77%
Renin blood test inpatient CPT 84244 Renin	$86.39	$374.00	$17.37–$336.60	—	77%
Rh blood typing CPT 86901 Bld Typing; Rh D 643	$41.58	$180.00	$2.99–$162.00	8% above	77%
Rh blood typing CPT 86901 Bld Typing; Rh D 645	$41.58	$180.00	$2.99–$162.00	8% above	77%
Rh blood typing inpatient CPT 86901 Bld Typing; Rh D 645	$41.58	$180.00	$2.99–$162.00	—	77%
Rh blood typing inpatient CPT 86901 Bld Typing; Rh D 643	$41.58	$180.00	$2.99–$162.00	—	77%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant	$5.54	$24.00	$4.48–$25.52	89% below	77%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant	$5.54	$24.00	$4.48–$25.52	—	77%
Rubella antibody test (immunity check) CPT 86762 Ab; Rubella 613	$60.98	$264.00	$11.37–$237.60	8% below	77%
Rubella antibody test (immunity check) inpatient CPT 86762 Ab; Rubella 613	$60.98	$264.00	$11.37–$237.60	—	77%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Autom Erythrocyte Sed Rate	$38.81	$168.00	$2.13–$151.20	at median	77%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Autom Erythrocyte Sed Rate	$38.81	$168.00	$2.13–$151.20	—	77%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Anal Vol/Count/Mot	$99.56	$431.00	$9.72–$387.90	9% below	77%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Anal Vol/Count/Mot	$99.56	$431.00	$9.72–$387.90	—	77%
Sodium blood test CPT 84295 Sodium; Whole Bld 1260	$18.94	$82.00	$3.80–$73.80	45% below	77%
Sodium blood test CPT 84295 Assay of Serum Sodium	$18.94	$82.00	$3.80–$73.80	45% below	77%
Sodium blood test CPT 84295 Sodium; Whole Bld	$18.94	$82.00	$3.80–$73.80	45% below	77%
Sodium blood test CPT 84295 Assay of Serum Sodium-Oh	$18.94	$82.00	$3.80–$73.80	45% below	77%
Sodium blood test inpatient CPT 84295 Assay of Serum Sodium	$18.94	$82.00	$3.80–$73.80	—	77%
Sodium blood test inpatient CPT 84295 Sodium; Whole Bld 1260	$18.94	$82.00	$3.80–$73.80	—	77%
Sodium blood test inpatient CPT 84295 Assay of Serum Sodium-Oh	$18.94	$82.00	$3.80–$73.80	—	77%
Sodium blood test inpatient CPT 84295 Sodium; Whole Bld	$18.94	$82.00	$3.80–$73.80	—	77%
Stool ova and parasites exam CPT 87177 Ova and Parasite Dir Smr W ID	$14.32	$62.00	$7.03–$55.80	70% below	77%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite Dir Smr W ID	$14.32	$62.00	$7.03–$55.80	—	77%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood Occult; Qual Consecutive Specimens	$22.87	$99.00	$3.46–$89.10	36% below	77%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Blood Occult; Qual Consecutive Specimens	$22.87	$99.00	$3.46–$89.10	—	77%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Immunochemical Fecal Occult Blood	$32.11	$139.00	$12.58–$125.10	36% below	77%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Immunochemical Fecal Occult Blood	$32.11	$139.00	$12.58–$125.10	—	77%
Syphilis antibody test (Treponema pallidum) CPT 86780 Treponema Pallidum 618	$79.70	$345.00	$10.46–$310.50	18% above	77%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Treponema Pallidum 618	$79.70	$345.00	$10.46–$310.50	—	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test Non-Trep Qual 564	$16.17	$70.00	$3.37–$63.00	59% below	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test Non-Trep Qual 562	$16.17	$70.00	$3.37–$63.00	59% below	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test Non-Trep Qual 561	$32.11	$139.00	$3.37–$125.10	19% below	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test Non-Trep Qual 562	$16.17	$70.00	$3.37–$63.00	—	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test Non-Trep Qual 564	$16.17	$70.00	$3.37–$63.00	—	77%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test Non-Trep Qual 561	$32.11	$139.00	$3.37–$125.10	—	77%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test Cell Immun Measure	$137.21	$594.00	$48.96–$534.60	18% below	77%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test Cell Immun Measure	$137.21	$594.00	$48.96–$534.60	—	77%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; Total	$102.56	$444.00	$20.39–$399.60	6% below	77%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone; Total	$102.56	$444.00	$20.39–$399.60	—	77%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Ab Ea 552	$57.52	$249.00	$11.49–$224.10	38% below	77%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal Ab Ea 552	$57.52	$249.00	$11.49–$224.10	—	77%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone 959	$25.64	$111.00	$13.27–$99.90	69% below	77%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone 955	$25.64	$111.00	$13.27–$99.90	69% below	77%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$95.63	$414.00	$13.27–$372.60	17% above	77%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone 959	$25.64	$111.00	$13.27–$99.90	—	77%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone 955	$25.64	$111.00	$13.27–$99.90	—	77%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$95.63	$414.00	$13.27–$372.60	—	77%
Total IgE blood test CPT 82785 Assay of Ige 185	$57.52	$249.00	$13.00–$224.10	19% below	77%
Total IgE blood test inpatient CPT 82785 Assay of Ige 185	$57.52	$249.00	$13.00–$224.10	—	77%
Total cholesterol blood test CPT 82465 Cholesterol Serum or Whole Bld Total 133	$22.87	$99.00	$3.44–$89.10	25% below	77%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Serum or Whole Bld Total 133	$22.87	$99.00	$3.44–$89.10	—	77%
Total thyroxine (T4) blood test CPT 84436 Thyroxine; Total 393	$25.64	$111.00	$5.43–$99.90	45% below	77%
Total thyroxine (T4) blood test CPT 84436 Thyroxine; Total 392	$25.64	$111.00	$5.43–$99.90	45% below	77%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine; Total 393	$25.64	$111.00	$5.43–$99.90	—	77%
Total thyroxine (T4) blood test inpatient CPT 84436 Thyroxine; Total 392	$25.64	$111.00	$5.43–$99.90	—	77%
Total triiodothyronine (T3) blood test CPT 84480 T3; Total	$73.69	$319.00	$11.20–$287.10	39% below	77%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3; Total	$73.69	$319.00	$11.20–$287.10	—	77%
Transferrin blood test CPT 84466 Transferrin	$51.28	$222.00	$10.08–$199.80	38% below	77%
Transferrin blood test inpatient CPT 84466 Transferrin	$51.28	$222.00	$10.08–$199.80	—	77%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis Amplif	$63.99	$277.00	$27.72–$249.30	33% below	77%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis Amplif	$63.99	$277.00	$27.72–$249.30	—	77%
Triglycerides blood test CPT 84478 Triglycerides 404	$28.88	$125.00	$4.53–$112.50	19% below	77%
Triglycerides blood test CPT 84478 Triglycerides 406	$57.52	$249.00	$4.53–$224.10	61% above	77%
Triglycerides blood test inpatient CPT 84478 Triglycerides 404	$28.88	$125.00	$4.53–$112.50	—	77%
Triglycerides blood test inpatient CPT 84478 Triglycerides 406	$57.52	$249.00	$4.53–$224.10	—	77%
Troponin test, quantitative CPT 84484 Troponin Quan 411	$63.99	$277.00	$9.85–$249.30	46% below	77%
Troponin test, quantitative CPT 84484 Troponin Quantitative	$63.99	$277.00	$9.85–$249.30	46% below	77%
Troponin test, quantitative inpatient CPT 84484 Troponin Quantitative	$63.99	$277.00	$9.85–$249.30	—	77%
Troponin test, quantitative inpatient CPT 84484 Troponin Quan 411	$63.99	$277.00	$9.85–$249.30	—	77%
Uric acid blood test CPT 84550 Uric Acid; Bld 417	$32.11	$139.00	$3.57–$125.10	33% below	77%
Uric acid blood test inpatient CPT 84550 Uric Acid; Bld 417	$32.11	$139.00	$3.57–$125.10	—	77%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W/Scope	$14.32	$62.00	$2.50–$55.80	66% below	77%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W/Scope	$14.32	$62.00	$2.50–$55.80	—	77%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis; Non-Auto W/Micro	$25.64	$111.00	$3.18–$99.90	4% below	77%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis; Non-Auto W/Micro	$25.64	$111.00	$3.18–$99.90	—	77%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis; Auto WO/Micro 052	$9.47	$41.00	$1.78–$36.90	60% below	77%
Urinalysis without microscope exam, automated CPT 81003 POCT Urinalysis 929	$9.47	$41.00	$1.78–$36.90	60% below	77%
Urinalysis without microscope exam, automated inpatient CPT 81003 POCT Urinalysis 929	$9.47	$41.00	$1.78–$36.90	—	77%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis; Auto WO/Micro 052	$9.47	$41.00	$1.78–$36.90	—	77%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis; Non-Auto WO/Micro	$9.70	$42.00	$2.75–$37.80	37% below	77%
Urinalysis without microscope exam, manual CPT 81002 Pace Urinalysis; Non-Auto WO/Micro	$16.17	$70.00	$2.75–$63.00	5% above	77%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis; Non-Auto WO/Micro	$9.70	$42.00	$2.75–$37.80	—	77%
Urinalysis without microscope exam, manual inpatient CPT 81002 Pace Urinalysis; Non-Auto WO/Micro	$16.17	$70.00	$2.75–$63.00	—	77%
Urine culture for bacteria, with colony count CPT 87086 Bact Culture - Urine; Quan Count	$76.69	$332.00	$6.38–$298.80	74% above	77%
Urine culture for bacteria, with colony count inpatient CPT 87086 Bact Culture - Urine; Quan Count	$76.69	$332.00	$6.38–$298.80	—	77%
Urine microalbumin (albumin) test CPT 82043 Microalbumin; Urine Quan	$28.88	$125.00	$4.57–$112.50	15% below	77%
Urine microalbumin (albumin) test inpatient CPT 82043 Microalbumin; Urine Quan	$28.88	$125.00	$4.57–$112.50	—	77%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test	$35.34	$153.00	$6.80–$137.70	34% below	77%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test	$35.34	$153.00	$6.80–$137.70	—	77%
Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vit B-12)	$63.99	$277.00	$11.91–$249.30	11% below	77%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Cyanocobalamin (Vit B-12)	$63.99	$277.00	$11.91–$249.30	—	77%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 Hydroxy	$143.45	$621.00	$23.38–$558.90	6% above	77%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D; 25 Hydroxy	$143.45	$621.00	$23.38–$558.90	—	77%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vit D1 25-Dihydroxy	$150.15	$650.00	$30.42–$585.00	15% below	77%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vit D1 25-Dihydroxy	$150.15	$650.00	$30.42–$585.00	—	77%
Zinc blood test CPT 84630 ZINC	$41.58	$180.00	$9.00–$162.00	47% below	77%
Zinc blood test inpatient CPT 84630 ZINC	$41.58	$180.00	$9.00–$162.00	—	77%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg; Quan 430	$41.58	$180.00	$11.89–$162.00	48% below	77%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg; Quan 429	$41.58	$180.00	$11.89–$162.00	48% below	77%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg; Quan 430	$41.58	$180.00	$11.89–$162.00	—	77%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg; Quan 429	$41.58	$180.00	$11.89–$162.00	—	77%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast 1st Lesion Strtctc Hcode	$2,056.36	$8,902.00	$1,747.41–$8,011.80	14% below	77%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Bx Breast 1st Lesion Strtctc Hcode	$2,056.36	$8,902.00	$1,747.41–$8,011.80	—	77%
Cardiac catheterization with coronary angiogram CPT 93458 L Hrt Artery/Ventricle Angio	$9,559.94	$41,385.00	$3,430.00–$37,246.50	1% below	77%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L Hrt Artery/Ventricle Angio	$9,559.94	$41,385.00	$3,430.00–$37,246.50	—	77%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion; Ext	$828.37	$3,586.00	$699.29–$3,227.40	40% below	77%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion; Ext	$828.37	$3,586.00	$699.29–$3,227.40	—	77%
Catheter ablation for atrial fibrillation CPT 93656 Comp Ep Eval Tx Atrial Fib Pulm Vein Isol	$14,340.25	$62,079.00	$26,103.48–$108,726.39	48% below	77%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Comp Ep Eval Tx Atrial Fib Pulm Vein Isol	$14,340.25	$62,079.00	$26,103.48–$108,726.39	—	77%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$2,484.90	$10,757.15	$153.27–$4,977.69	20% below	77%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$2,349.57	$10,171.28	$153.27–$4,977.69	15% below	77%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,947.01	$8,428.60	$153.27–$3,868.39	1% below	77%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx Interlaminar Crv/Thrc W/Image Guidance Hcode	$548.39	$2,374.00	$1,512.24–$2,286.51	48% below	77%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Njx Interlaminar Crv/Thrc W/Image Guidance Hcode	$548.39	$2,374.00	$1,512.24–$2,286.51	—	77%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection Facet Lumbar/Sacral; Single Lvl Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	41% below	77%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Injection Facet Lumbar/Sacral; Single Lvl Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	—	77%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy Internal Rubber Band Ligations	$2,199.33	$9,520.90	$401.86–$3,868.39	7% above	77%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Ntrnl & Xtrnl 1 Column/Group	$3,718.21	$16,096.15	$1,905.42–$11,545.98	30% below	77%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hysterosalpingography Cath	$154.31	$668.00	$285.87–$601.20	46% below	77%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hysterosalpingography Cath	$154.31	$668.00	$285.87–$601.20	—	77%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D Absc; Smpl or Sgl Hcode	$445.83	$1,930.00	$207.40–$1,737.00	3% below	77%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D Absc; Smpl or Sgl Hcode	$445.83	$1,930.00	$207.40–$1,737.00	—	77%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament	$514.21	$2,226.00	$285.87–$2,003.40	9% below	77%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament	$514.21	$2,226.00	$285.87–$2,003.40	—	77%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis; Maj Jt Hcode	$301.69	$1,306.00	$285.87–$1,276.83	38% below	77%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis; Maj Jt Hcode	$301.69	$1,306.00	$285.87–$1,276.83	—	77%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inj Interm Jnt/Bursa Hcode	$281.13	$1,217.00	$285.87–$1,276.83	25% below	77%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inj Interm Jnt/Bursa Hcode	$281.13	$1,217.00	$285.87–$1,276.83	—	77%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inject Sm Jnt/Bursa Hcode	$205.82	$891.00	$285.87–$801.90	29% below	77%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inject Sm Jnt/Bursa Hcode	$205.82	$891.00	$285.87–$801.90	—	77%
Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W/Ventrclgrphy	$6,373.29	$27,590.00	$3,430.00–$24,831.00	18% below	77%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W/Ventrclgrphy	$6,373.29	$27,590.00	$3,430.00–$24,831.00	—	77%
Lower-back epidural injection, with imaging guidance CPT 62323 Njx Interlaminar Lmbr/Sac W/Image Guidance Hcode	$509.82	$2,207.00	$746.83–$2,936.29	60% below	77%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Interlaminar Lmbr/Sac W/Image Guidance Hcode	$509.82	$2,207.00	$746.83–$2,936.29	—	77%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection Transforaminal; Lumbar Single Lvl Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	62% below	77%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection Transforaminal; Lumbar Single Lvl Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	—	77%
Occipital nerve block (injection for headaches) CPT 64405 Inject Anesthesia; Greater Occipital Nerve Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	13% above	77%
Occipital nerve block (injection for headaches) inpatient CPT 64405 Inject Anesthesia; Greater Occipital Nerve Hcode	$685.84	$2,969.00	$1,242.31–$2,672.10	—	77%
Pacemaker implant (dual chamber) CPT 33208 Insrt Heart Pm Atrial & Vent	$6,169.09	$26,706.00	$8,683.74–$43,477.46	49% below	77%
Pacemaker implant (dual chamber) inpatient CPT 33208 Insrt Heart Pm Atrial & Vent	$6,169.09	$26,706.00	$8,683.74–$43,477.46	—	77%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Imaging	$1,919.38	$8,309.00	$959.60–$7,478.10	39% above	77%
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Imaging	$1,919.38	$8,309.00	$959.60–$7,478.10	—	77%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal FB Sq;Simple	$274.66	$1,189.00	$381.15–$1,070.10	46% below	77%
Removal of a foreign object under the skin, simple CPT 10120 Foreign Body Removal; Simple	$583.04	$2,524.00	$381.15–$2,271.60	15% above	77%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal FB Sq;Simple	$274.66	$1,189.00	$381.15–$1,070.10	—	77%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Foreign Body Removal; Simple	$583.04	$2,524.00	$381.15–$2,271.60	—	77%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$2,002.92	$8,670.65	$153.27–$3,868.39	at median	77%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Scrn; Hi Risk Ind	$2,021.63	$8,751.65	$153.27–$3,868.39	3% above	77%
Short leg cast (below the knee) CPT 29405 Apply Short Leg Cast	$158.00	$684.00	$186.46–$1,163.46	58% below	77%
Short leg cast (below the knee) inpatient CPT 29405 Apply Short Leg Cast	$158.00	$684.00	$186.46–$1,163.46	—	77%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Lumbar Puncture Diagnostic HCODE	$480.25	$2,079.00	$746.83–$2,936.29	53% below	77%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Lumbar Puncture Diagnostic HCODE	$480.25	$2,079.00	$746.83–$2,936.29	—	77%
Thoracentesis with imaging guidance CPT 32555 Aspirate Pleura W/ Imaging Hcode	$1,919.38	$8,309.00	$663.69–$7,478.10	75% above	77%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate Pleura W/ Imaging Hcode	$1,919.38	$8,309.00	$663.69–$7,478.10	—	77%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Sngl/Multiple Points 1 or 2 Mucscle Hcode	$168.40	$729.00	$285.87–$1,276.83	71% below	77%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Sngl/Multiple Points 1 or 2 Mucscle Hcode	$168.40	$729.00	$285.87–$1,276.83	—	77%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast 1st Lesion US Imag Hcode	$2,570.34	$11,127.00	$123.42–$10,014.30	5% below	77%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Bx Breast 1st Lesion US Imag Hcode	$2,570.34	$11,127.00	$123.42–$10,014.30	—	77%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq Tissue 20 Sq Cm or Less Hcode	$891.20	$3,858.00	$430.10–$3,472.20	14% above	77%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Subq Tissue 20 Sq Cm or Less Hcode	$891.20	$3,858.00	$430.10–$3,472.20	—	77%

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 Blood 2 Hours	$304.46	$1,318.00	$466.77–$1,835.17	66% below	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 4 Hours	$496.42	$2,149.00	$466.77–$1,934.10	45% below	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood or Blood Components	$541.00	$2,342.00	$466.77–$2,107.80	40% below	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 6 Hours	$661.58	$2,864.00	$466.77–$2,577.60	27% below	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 8 Hours	$826.52	$3,578.00	$466.77–$3,220.20	8% below	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 10 Hours	$991.91	$4,294.00	$466.77–$3,864.60	10% above	77%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 12 Hours	$1,157.77	$5,012.00	$466.77–$4,510.80	29% above	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 2 Hours	$304.46	$1,318.00	$466.77–$1,835.17	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 4 Hours	$496.42	$2,149.00	$466.77–$1,934.10	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood or Blood Components	$541.00	$2,342.00	$466.77–$2,107.80	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 6 Hours	$661.58	$2,864.00	$466.77–$2,577.60	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 8 Hours	$826.52	$3,578.00	$466.77–$3,220.20	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 10 Hours	$991.91	$4,294.00	$466.77–$3,864.60	—	77%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 12 Hours	$1,157.77	$5,012.00	$466.77–$4,510.80	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Mdi/Dpi	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pep Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Pep	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Aerosol	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi/Dpi Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ippb Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment;Subseq	$26.57	$115.00	$24.84–$910.89	76% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 E-Z Pap Treatment; Subseq	$39.50	$171.00	$24.84–$910.89	65% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; E-Z Pap	$39.50	$171.00	$24.84–$910.89	65% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment; Subseq	$40.19	$174.00	$24.84–$910.89	64% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Nebulizer	$40.19	$174.00	$24.84–$910.89	64% below	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Mdi/Dpi	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ippb Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pep Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment;Subseq	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi/Dpi Treatment; Subseq	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Aerosol	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Pep	$26.57	$115.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; E-Z Pap	$39.50	$171.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 E-Z Pap Treatment; Subseq	$39.50	$171.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Treatment; Subseq	$40.19	$174.00	$24.84–$910.89	—	77%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Nebulizer	$40.19	$174.00	$24.84–$910.89	—	77%
Chemotherapy IV infusion, first hour CPT 96413 Chemo Admin IV Inf Up to 1 Hr Sgl or Init Subs	$606.14	$2,624.00	$324.60–$2,361.60	10% below	77%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Admin IV Inf Up to 1 Hr Sgl or Init Subs	$606.14	$2,624.00	$324.60–$2,361.60	—	77%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive Audio Evaluation	$266.81	$1,155.00	$136.14–$1,039.50	38% above	77%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comprehensive Audio Evaluation	$266.81	$1,155.00	$136.14–$1,039.50	—	77%
Critical care, first 30 to 74 minutes CPT 99291 Emergency Visit Level 6	$1,885.42	$8,162.00	$295.62–$11,645.00	11% below	77%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 7 Tta Consult/Eval	$2,247.40	$9,729.00	$295.62–$11,645.00	6% above	77%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 8	$3,111.80	$13,471.00	$295.62–$12,123.90	47% above	77%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 9 Tta Full Alert	$3,803.42	$16,465.00	$295.62–$14,818.50	79% above	77%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emergency Visit Level 6	$1,885.42	$8,162.00	$295.62–$11,645.00	—	77%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 7 Tta Consult/Eval	$2,247.40	$9,729.00	$295.62–$11,645.00	—	77%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 8	$3,111.80	$13,471.00	$295.62–$12,123.90	—	77%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 9 Tta Full Alert	$3,803.42	$16,465.00	$295.62–$14,818.50	—	77%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg; Incl Record Awake / Drowsy	$538.92	$2,333.00	$231.39–$2,099.70	21% below	77%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg; Incl Record Awake / Drowsy	$538.92	$2,333.00	$231.39–$2,099.70	—	77%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg/12 Lds; Tracing Only	$74.61	$323.00	$62.41–$290.70	63% below	77%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg/12 Lds; Tracing Only	$74.61	$323.00	$62.41–$290.70	—	77%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 OB Emergency Visit Level 1	$99.56	$431.00	$89.22–$576.00	52% below	77%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Visit Level 1	$99.56	$431.00	$89.22–$576.00	52% below	77%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Visit Level 1	$99.56	$431.00	$89.22–$576.00	—	77%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 OB Emergency Visit Level 1	$99.56	$431.00	$89.22–$576.00	—	77%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Visit Level 2	$231.69	$1,003.00	$162.45–$1,127.00	45% below	77%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 OB Emergency Visit Level 2	$231.69	$1,003.00	$162.45–$1,127.00	45% below	77%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Visit Level 2	$231.69	$1,003.00	$162.45–$1,127.00	—	77%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 OB Emergency Visit Level 2	$231.69	$1,003.00	$162.45–$1,127.00	—	77%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 OB Emergency Visit Level 3	$628.55	$2,721.00	$288.81–$2,448.90	19% below	77%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Visit Level 3	$628.55	$2,721.00	$288.81–$2,448.90	19% below	77%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 OB Emergency Visit Level 3	$628.55	$2,721.00	$288.81–$2,448.90	—	77%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Visit Level 3	$628.55	$2,721.00	$288.81–$2,448.90	—	77%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Visit Level 4	$1,025.41	$4,439.00	$295.62–$3,995.10	13% below	77%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 OB Emergency Visit Level 4	$1,025.41	$4,439.00	$295.62–$3,995.10	13% below	77%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Visit Level 4	$1,025.41	$4,439.00	$295.62–$3,995.10	—	77%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 OB Emergency Visit Level 4	$1,025.41	$4,439.00	$295.62–$3,995.10	—	77%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Visit Level 5	$1,521.37	$6,586.00	$295.62–$5,927.40	13% below	77%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 OB Emergency Visit Level 5	$1,521.37	$6,586.00	$295.62–$5,927.40	13% below	77%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Visit Level 5	$1,521.37	$6,586.00	$295.62–$5,927.40	—	77%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 OB Emergency Visit Level 5	$1,521.37	$6,586.00	$295.62–$5,927.40	—	77%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardio Stress Test; Tracing Only	$446.29	$1,932.00	$228.45–$1,738.80	40% below	77%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardio Stress Test; Tracing Only	$446.29	$1,932.00	$228.45–$1,738.80	—	77%
Family therapy with the patient, 50 minutes CPT 90847 Family/Marital Therapy W Pt 50 Min	$95.63	$414.00	$79.56–$372.60	49% below	77%
Family therapy with the patient, 50 minutes CPT 90847 Family/Marital Therapy W Pt 50 Min Cw	$101.41	$439.00	$79.56–$395.10	46% below	77%
Family therapy with the patient, 50 minutes CPT 90847 Brief Family Therapy W Pt	$156.62	$678.00	$79.56–$610.20	17% below	77%
Family therapy with the patient, 50 minutes CPT 90847 Family Therapy W Pt	$156.62	$678.00	$79.56–$610.20	17% below	77%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family/Marital Therapy W Pt 50 Min	$95.63	$414.00	$79.56–$372.60	—	77%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family/Marital Therapy W Pt 50 Min Cw	$101.41	$439.00	$79.56–$395.10	—	77%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Brief Family Therapy W Pt	$156.62	$678.00	$79.56–$610.20	—	77%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy W Pt	$156.62	$678.00	$79.56–$610.20	—	77%
Family therapy without the patient, 50 minutes CPT 90846 Family Therapy W/O Pt 50 Min	$111.80	$484.00	$79.56–$435.60	45% below	77%
Family therapy without the patient, 50 minutes inpatient CPT 90846 Family Therapy W/O Pt 50 Min	$111.80	$484.00	$79.56–$435.60	—	77%
Group psychotherapy session CPT 90853 Group Therapy Not Multi-Family	$54.29	$235.00	$79.56–$211.50	73% below	77%
Group psychotherapy session inpatient CPT 90853 Group Therapy Not Multi-Family	$54.29	$235.00	$79.56–$211.50	—	77%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Inf Hydration; Init 31-60 Min	$404.48	$1,751.00	$73.71–$1,575.90	10% above	77%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Inf Hydration; Init 31-60 Min	$404.48	$1,751.00	$73.71–$1,575.90	—	77%
IV infusion of a medicine, first hour CPT 96365 IV Inf Tx/Dx/Proph; Init Up to 1 Hr	$404.48	$1,751.00	$73.71–$1,575.90	at median	77%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Inf Tx/Dx/Proph; Init Up to 1 Hr	$404.48	$1,751.00	$73.71–$1,575.90	—	77%
IV push of a medicine, first drug CPT 96374 Inj Tx/Dx/Proph; IV push sngl init	$117.81	$510.00	$73.71–$884.79	44% below	77%
IV push of a medicine, first drug inpatient CPT 96374 Inj Tx/Dx/Proph; IV push sngl init	$117.81	$510.00	$73.71–$884.79	—	77%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj Sc/Im	$18.94	$82.00	$48.71–$299.51	82% below	77%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Tx/Dx/Proph; Im	$60.75	$263.00	$76.18–$299.51	42% below	77%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Tx/Dx/Proph; Im Sq	$67.22	$291.00	$73.71–$299.51	36% below	77%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj Sc/Im	$18.94	$82.00	$48.71–$299.51	—	77%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Tx/Dx/Proph; Im	$60.75	$263.00	$76.18–$299.51	—	77%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Tx/Dx/Proph; Im Sq	$67.22	$291.00	$73.71–$299.51	—	77%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Eval	$114.81	$497.00	$159.12–$447.30	54% below	77%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Eval	$114.81	$497.00	$159.12–$447.30	—	77%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Motor&/Sens 7-8 Nrv Cndj Tst	$538.92	$2,333.00	$168.13–$2,099.70	37% below	77%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Motor&/Sens 7-8 Nrv Cndj Tst	$538.92	$2,333.00	$168.13–$2,099.70	—	77%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Ea 15 Min Ot	$57.52	$249.00	$31.57–$224.10	25% below	77%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Ea 15 Min Pt	$57.52	$249.00	$31.57–$224.10	25% below	77%
Neuromuscular re-education, 15 minutes CPT 97112 Pace Neuromuscular Reeducation 15m Pt	$57.52	$249.00	$31.57–$224.10	25% below	77%
Neuromuscular re-education, 15 minutes CPT 97112 Pace Neuromuscular Reeducation 15m Ot	$57.52	$249.00	$31.57–$224.10	25% below	77%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Ea 15 Min Ot	$57.52	$249.00	$31.57–$224.10	—	77%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pace Neuromuscular Reeducation 15m Pt	$57.52	$249.00	$31.57–$224.10	—	77%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Ea 15 Min Pt	$57.52	$249.00	$31.57–$224.10	—	77%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pace Neuromuscular Reeducation 15m Ot	$57.52	$249.00	$31.57–$224.10	—	77%
New patient office visit, about 30 minutes CPT 99203 OP Visit E&M of New Patient; Level 3	$57.52	$249.00	$135.60–$224.10	67% below	77%
New patient office visit, about 30 minutes CPT 99203 Pace OP Visit E&M of New Patient; Level 3	$60.75	$263.00	$67.80–$236.70	65% below	77%
New patient office visit, about 30 minutes CPT 99203 OP Visit E&M of New Patient;Level 3	$111.80	$484.00	$140.86–$435.60	35% below	77%
New patient office visit, about 30 minutes inpatient CPT 99203 OP Visit E&M of New Patient; Level 3	$57.52	$249.00	$135.60–$224.10	—	77%
New patient office visit, about 30 minutes inpatient CPT 99203 Pace OP Visit E&M of New Patient; Level 3	$60.75	$263.00	$67.80–$236.70	—	77%
New patient office visit, about 30 minutes inpatient CPT 99203 OP Visit E&M of New Patient;Level 3	$111.80	$484.00	$140.86–$435.60	—	77%
New patient office visit, about 45 minutes CPT 99204 OP Visit E&M of New Patient; Level 4	$66.99	$290.00	$137.63–$275.26	67% below	77%
New patient office visit, about 45 minutes CPT 99204 Pace OP Visit E&M of New Patient; Level 4	$70.92	$307.00	$111.17–$276.30	65% below	77%
New patient office visit, about 45 minutes CPT 99204 OP Visit E&M of New Patient;Level 4	$127.74	$553.00	$137.63–$497.70	37% below	77%
New patient office visit, about 45 minutes inpatient CPT 99204 OP Visit E&M of New Patient; Level 4	$66.99	$290.00	$137.63–$275.26	—	77%
New patient office visit, about 45 minutes inpatient CPT 99204 Pace OP Visit E&M of New Patient; Level 4	$70.92	$307.00	$111.17–$276.30	—	77%
New patient office visit, about 45 minutes inpatient CPT 99204 OP Visit E&M of New Patient;Level 4	$127.74	$553.00	$137.63–$497.70	—	77%
New patient office visit, about 60 minutes CPT 99205 OP Visit E&M of New Patient; Level 5	$76.69	$332.00	$142.67–$298.80	70% below	77%
New patient office visit, about 60 minutes CPT 99205 Pace OP Visit E&M of New Patient; Level 5	$87.78	$380.00	$151.85–$342.00	65% below	77%
New patient office visit, about 60 minutes CPT 99205 OP Visit E&M of New Patient;Level 5	$143.45	$621.00	$142.67–$558.90	43% below	77%
New patient office visit, about 60 minutes inpatient CPT 99205 OP Visit E&M of New Patient; Level 5	$76.69	$332.00	$142.67–$298.80	—	77%
New patient office visit, about 60 minutes inpatient CPT 99205 Pace OP Visit E&M of New Patient; Level 5	$87.78	$380.00	$151.85–$342.00	—	77%
New patient office visit, about 60 minutes inpatient CPT 99205 OP Visit E&M of New Patient;Level 5	$143.45	$621.00	$142.67–$558.90	—	77%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit E&M of New Patient; Level 2	$48.05	$208.00	$123.55–$281.72	66% below	77%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Pace OP Visit E&M of New Patient; Level 2	$50.36	$218.00	$39.32–$196.20	64% below	77%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit E&M of New Patient;Level 2	$95.63	$414.00	$140.86–$372.60	32% below	77%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP Visit E&M of New Patient; Level 2	$48.05	$208.00	$123.55–$281.72	—	77%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Pace OP Visit E&M of New Patient; Level 2	$50.36	$218.00	$39.32–$196.20	—	77%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP Visit E&M of New Patient;Level 2	$95.63	$414.00	$140.86–$372.60	—	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Indiv In	$16.17	$70.00	$25.61–$63.00	53% below	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt; Init Assmnt Ea 15 Min	$17.56	$76.00	$25.61–$68.40	48% below	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Pace Mnt; Init Assmnt Ea 15 Min	$30.72	$133.00	$25.61–$119.70	10% below	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical Nutrition Indiv In	$16.17	$70.00	$25.61–$63.00	—	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt; Init Assmnt Ea 15 Min	$17.56	$76.00	$25.61–$68.40	—	77%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Pace Mnt; Init Assmnt Ea 15 Min	$30.72	$133.00	$25.61–$119.70	—	77%
Occupational therapy evaluation, low complexity CPT 97165 Pace Ot Eval Low Complex; 30 Min	$83.39	$361.00	$97.29–$424.40	48% below	77%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Low Complex 30 Min	$86.39	$374.00	$97.29–$424.40	46% below	77%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Pace Ot Eval Low Complex; 30 Min	$83.39	$361.00	$97.29–$424.40	—	77%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot Eval Low Complex 30 Min	$86.39	$374.00	$97.29–$424.40	—	77%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pace Pt Eval High Complex; 45 Min	$124.51	$539.00	$94.80–$485.10	47% below	77%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complex 45 Min	$124.51	$539.00	$94.80–$485.10	47% below	77%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pace Pt Eval High Complex; 45 Min	$124.51	$539.00	$94.80–$485.10	—	77%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt Eval High Complex 45 Min	$124.51	$539.00	$94.80–$485.10	—	77%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Low Complex 20 Min	$82.93	$359.00	$94.80–$424.40	41% below	77%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pace Pt Eval Low Complex; 20 Min	$83.39	$361.00	$94.80–$424.40	40% below	77%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Eval Low Complex 20 Min	$82.93	$359.00	$94.80–$424.40	—	77%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pace Pt Eval Low Complex; 20 Min	$83.39	$361.00	$94.80–$424.40	—	77%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pace Pt Eval Mod Complex; 30 Min	$118.27	$512.00	$94.80–$460.80	34% below	77%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Mod Complex 30 Min	$118.27	$512.00	$94.80–$460.80	34% below	77%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pace Pt Eval Mod Complex; 30 Min	$118.27	$512.00	$94.80–$460.80	—	77%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt Eval Mod Complex 30 Min	$118.27	$512.00	$94.80–$460.80	—	77%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pace Manual Therapy 1> Regions Ea 15 Mins Pt	$37.42	$162.00	$26.73–$223.75	56% below	77%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pace Manual Therapy 1> Regions Ea 15 Mins Ot	$37.42	$162.00	$26.73–$223.75	56% below	77%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Ot	$57.52	$249.00	$26.73–$224.10	33% below	77%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Pt	$57.52	$249.00	$26.73–$224.10	33% below	77%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Pace Manual Therapy 1> Regions Ea 15 Mins Pt	$37.42	$162.00	$26.73–$223.75	—	77%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pace Manual Therapy 1> Regions Ea 15 Mins Ot	$37.42	$162.00	$26.73–$223.75	—	77%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Pt	$57.52	$249.00	$26.73–$224.10	—	77%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Ot	$57.52	$249.00	$26.73–$224.10	—	77%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pace Therapeutic Exercises 15 Min Ot	$37.42	$162.00	$28.03–$223.75	48% below	77%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pace Therapeutic Exercises 15 Min Pt	$37.42	$162.00	$28.03–$223.75	48% below	77%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises Ea 15 Min Ot	$57.52	$249.00	$28.03–$224.10	19% below	77%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises Ea 15 Min Pt	$57.52	$249.00	$28.03–$224.10	19% below	77%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pace Therapeutic Exercises 15 Min Pt	$37.42	$162.00	$28.03–$223.75	—	77%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pace Therapeutic Exercises 15 Min Ot	$37.42	$162.00	$28.03–$223.75	—	77%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises Ea 15 Min Ot	$57.52	$249.00	$28.03–$224.10	—	77%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises Ea 15 Min Pt	$57.52	$249.00	$28.03–$224.10	—	77%
Psychiatric evaluation with medical services CPT 90792 Psych Diag Eval W/Med Srvcs	$101.41	$439.00	$159.12–$395.10	48% below	77%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diag Eval W/Med Srvcs	$101.41	$439.00	$159.12–$395.10	—	77%
Psychological testing evaluation by a psychologist or physician, first hour CPT 96130 Psycl Tst Eval Phys/Qhp 1st	$138.14	$598.00	$159.12–$538.20	at median	77%
Psychological testing evaluation by a psychologist or physician, first hour inpatient CPT 96130 Psycl Tst Eval Phys/Qhp 1st	$138.14	$598.00	$159.12–$538.20	—	77%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psytx Crisis Initial 60 Mins	$101.41	$439.00	$159.12–$395.10	9% below	77%
Psychotherapy for crisis, first 60 minutes inpatient CPT 90839 Psytx Crisis Initial 60 Mins	$101.41	$439.00	$159.12–$395.10	—	77%
Psychotherapy session, 30 minutes CPT 90832 Psytx Pt 30 Mins Typ 4	$71.15	$308.00	$159.12–$277.20	28% below	77%
Psychotherapy session, 30 minutes CPT 90832 Pace Psytx Pt&/Family 30 Mins Typ 4	$84.32	$365.00	$159.12–$328.50	14% below	77%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx Pt 30 Mins Typ 4	$71.15	$308.00	$159.12–$277.20	—	77%
Psychotherapy session, 30 minutes inpatient CPT 90832 Pace Psytx Pt&/Family 30 Mins Typ 4	$84.32	$365.00	$159.12–$328.50	—	77%
Psychotherapy session, 45 minutes CPT 90834 Psytx W Pt 45 Minutes	$76.23	$330.00	$159.12–$297.00	46% below	77%
Psychotherapy session, 45 minutes inpatient CPT 90834 Psytx W Pt 45 Minutes	$76.23	$330.00	$159.12–$297.00	—	77%
Psychotherapy session, 60 minutes CPT 90837 Psytx Pt 60 Mins	$128.90	$558.00	$159.12–$502.20	39% below	77%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx Pt 60 Mins	$128.90	$558.00	$159.12–$502.20	—	77%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco-Use Counsel 3-10 Min	$15.25	$66.00	$39.20–$155.84	49% below	77%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav Chng Smoking Greater Than 3 Min Up to 10 Min	$15.25	$66.00	$39.20–$155.84	49% below	77%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav Chng Smoking Greater Than 3 Min Up to 10 Min	$15.25	$66.00	$39.20–$155.84	—	77%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco-Use Counsel 3-10 Min	$15.25	$66.00	$39.20–$155.84	—	77%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit E&M of Established Patient; Level 5	$70.69	$306.00	$140.86–$281.72	53% below	77%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Pace OP Visit E&M of Established Patient; Level 5	$87.78	$380.00	$120.15–$342.00	42% below	77%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit E&M of Established Patient;Level 5	$127.74	$553.00	$140.86–$497.70	15% below	77%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP Visit E&M of Established Patient; Level 5	$70.69	$306.00	$140.86–$281.72	—	77%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Pace OP Visit E&M of Established Patient; Level 5	$87.78	$380.00	$120.15–$342.00	—	77%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP Visit E&M of Established Patient;Level 5	$127.74	$553.00	$140.86–$497.70	—	77%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit E&M of Established Patient; Level 3	$51.28	$222.00	$131.87–$275.26	45% below	77%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Pace OP Visit E&M of Established Patient; Level 3	$54.29	$235.00	$55.10–$211.50	42% below	77%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit E&M of Established Patient;Level 3	$95.63	$414.00	$137.63–$372.60	3% above	77%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP Visit E&M of Established Patient; Level 3	$51.28	$222.00	$131.87–$275.26	—	77%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Pace OP Visit E&M of Established Patient; Level 3	$54.29	$235.00	$55.10–$211.50	—	77%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP Visit E&M of Established Patient;Level 3	$95.63	$414.00	$137.63–$372.60	—	77%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit E&M of Established Patient; Level 4	$60.98	$264.00	$140.86–$281.72	47% below	77%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Pace OP Visit E&M of Established Patient; Level 4	$64.45	$279.00	$80.95–$251.10	44% below	77%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit E&M of Established Patient;Level 4	$111.80	$484.00	$140.86–$435.60	2% below	77%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP Visit E&M of Established Patient; Level 4	$60.98	$264.00	$140.86–$281.72	—	77%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Pace OP Visit E&M of Established Patient; Level 4	$64.45	$279.00	$80.95–$251.10	—	77%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP Visit E&M of Established Patient;Level 4	$111.80	$484.00	$140.86–$435.60	—	77%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit E&M of Established Patient; Level 2	$41.58	$180.00	$106.92–$281.72	19% below	77%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pace OP Visit E&M of Established Patient; Level 2	$44.12	$191.00	$29.62–$190.94	14% below	77%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit E&M of Established Patient;Level 2	$79.70	$345.00	$140.86–$310.50	55% above	77%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP Visit E&M of Established Patient; Level 2	$41.58	$180.00	$106.92–$281.72	—	77%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Pace OP Visit E&M of Established Patient; Level 2	$44.12	$191.00	$29.62–$190.94	—	77%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP Visit E&M of Established Patient;Level 2	$79.70	$345.00	$140.86–$310.50	—	77%
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$185.49	$803.00	$186.46–$964.62	9% below	77%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$185.49	$803.00	$186.46–$964.62	—	77%
Speech therapy session, individual CPT 92507 Speech/Hearing Therapy, Individual	$157.08	$680.00	$73.98–$612.00	13% above	77%
Speech therapy session, individual inpatient CPT 92507 Speech/Hearing Therapy, Individual	$157.08	$680.00	$73.98–$612.00	—	77%
Spirometry (breathing test) CPT 94010 Spirometry	$242.78	$1,051.00	$141.84–$945.90	1% below	77%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$242.78	$1,051.00	$141.84–$945.90	—	77%
Spirometry before and after a bronchodilator CPT 94060 Bronchospasm - Pre & Post Bd	$572.42	$2,478.00	$141.84–$2,230.20	5% above	77%
Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchospasm - Pre & Post Bd	$572.42	$2,478.00	$141.84–$2,230.20	—	77%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pace Therapeutic Activities Pt	$57.52	$249.00	$33.60–$224.10	26% below	77%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pace Therapeutic Activities Ot	$57.52	$249.00	$33.60–$224.10	26% below	77%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Ea 15 Min Pt	$57.52	$249.00	$33.60–$224.10	26% below	77%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Ea 15 Min Ot	$57.52	$249.00	$33.60–$224.10	26% below	77%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Ea 15 Min Pt	$57.52	$249.00	$33.60–$224.10	—	77%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pace Therapeutic Activities Pt	$57.52	$249.00	$33.60–$224.10	—	77%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Ea 15 Min Ot	$57.52	$249.00	$33.60–$224.10	—	77%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pace Therapeutic Activities Ot	$57.52	$249.00	$33.60–$224.10	—	77%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Therapeutic	$131.90	$571.00	$140.77–$553.46	36% below	77%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy Therapeutic	$131.90	$571.00	$140.77–$553.46	—	77%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$408.20	$1,767.10	$200.93–$1,590.39	at median	77%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$408.20	$1,767.10	$200.93–$1,590.39	—	77%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP	$82.17	$355.70	$226.58–$320.13	at median	77%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 inpatient CPT 90700 DIPH,PERTUS(ACEL),TET PEDI (PF) 15 LF UNIT-10 MCG-5 LF/0.5 ML IM SUSP	$82.17	$355.70	$226.58–$320.13	—	77%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 FLU VACCINE TV2025(9 YR UP)RCMB(PF)135 MCG(45 MCGX3)/0.5 ML IM SYRINGE	$17.33	$75.00	$47.78–$196.32	12% below	77%
Flu shot, recombinant, egg-free (Flublok) inpatient CPT 90673 FLU VACCINE TV2025(9 YR UP)RCMB(PF)135 MCG(45 MCGX3)/0.5 ML IM SYRINGE	$17.33	$75.00	$47.78–$196.32	—	77%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$8.09	$35.00	$22.30–$46.44	74% below	77%
Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE	$8.09	$35.00	$22.30–$46.44	—	77%
Hepatitis B vaccine, child and teen dose (3-dose schedule) CPT 90744 HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$59.71	$258.50	$54.78–$232.65	15% below	77%
Hepatitis B vaccine, child and teen dose (3-dose schedule) inpatient CPT 90744 HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$59.71	$258.50	$54.78–$232.65	—	77%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN	$33.16	$143.55	$91.44–$129.20	32% below	77%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) inpatient CPT 90648 HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN	$33.16	$143.55	$91.44–$129.20	—	77%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$216.09	$935.45	$555.66–$841.91	14% below	77%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$216.09	$935.45	$555.66–$841.91	—	77%
Meningococcal B vaccine (Trumenba) CPT 90621 N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$373.79	$1,618.15	$216.90–$1,456.34	6% below	77%
Meningococcal B vaccine (Trumenba) inpatient CPT 90621 N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE	$373.79	$1,618.15	$216.90–$1,456.34	—	77%
Nasal spray flu vaccine, live (FluMist) CPT 90660 Flu Mist Vaccine MD	$3.70	$16.00	$10.19–$59.42	71% below	77%
Nasal spray flu vaccine, live (FluMist) inpatient CPT 90660 Flu Mist Vaccine MD	$3.70	$16.00	$10.19–$59.42	—	77%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$71.61	$310.00	$197.47–$1,298.99	88% below	77%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$71.61	$310.00	$197.47–$1,298.99	—	77%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) CPT 90684 PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$71.61	$310.00	$197.47–$688.50	12% below	77%
Pneumonia vaccine, 21-valent conjugate (Capvaxive) inpatient CPT 90684 PNEUMOCOCCAL 21-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$71.61	$310.00	$197.47–$688.50	—	77%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION	$627.67	$2,717.20	$319.75–$2,445.48	24% below	77%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION	$627.67	$2,717.20	$319.75–$2,445.48	—	77%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION	$477.66	$2,067.80	$226.28–$1,861.02	22% above	77%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT	$477.66	$2,067.80	$1,228.27–$1,861.02	22% above	77%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT	$477.66	$2,067.80	$1,228.27–$1,861.02	—	77%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION	$477.66	$2,067.80	$226.28–$1,861.02	—	77%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$85.79	$371.40	$128.90–$334.26	29% below	77%
Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TETANUS AND DIPHTHERIA TOX (PF) 5 LF UNIT-2 LF UNIT/0.5 ML IM SYRINGE	$85.79	$371.40	$128.90–$334.26	—	77%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$106.70	$461.90	$174.02–$415.71	13% below	77%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUS(AC)TETANUS(PF)2 LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SYRINGE	$106.70	$461.90	$174.02–$415.71	—	77%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immun Admin; 1 Vac	$46.66	$202.00	$76.18–$299.51	32% below	77%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immun Admin; 1 Vac	$46.66	$202.00	$76.18–$299.51	—	77%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immun Admin; Ea Add Vac	$30.26	$131.00	$77.81–$117.90	27% below	77%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immun Admin; Ea Add Vac	$30.26	$131.00	$77.81–$117.90	—	77%

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://images.franciscanhealth.org/pdfs/enterprise/price_transparency/350913537_franciscan-health-carmel_standardcharges.zip