Hospital Lafayette-West Lafayette, IN

Franciscan Health Lafayette

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

Franciscan Health Lafayette in Lafayette, IN publishes cash prices for 350 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are below the Indiana median for 236 of 344 procedures and above it for 106. By typical cash price it ranks #23 of 84 Indiana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1701 S CREASY LN LAFAYETTE, IN 47905 Collected Sep 27, 2026 Source price file (765) 502-4334

Acute care hospital Emergency department CMS star rating 3 of 5 CCN 150109 · CMS hospital register

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Ankle X-ray, complete, 3 or more views CPT 73610 Rad Exam Ankl; Compl 3 Vw Min	$186.97	$846.00	$68.29–$1,438.20	5% below	78%
Ankle X-ray, complete, 3 or more views inpatient CPT 73610 Rad Exam Ankl; Compl 3 Vw Min	$186.97	$846.00	$68.29–$1,438.20	—	78%
Ankle-brachial index (ABI), blood pressure test for leg arteries both sides CPT 93922 Noninvasive Phys Study Uea/Lea Sngl/Bilat	$303.21	$1,372.00	$131.27–$1,166.20	—	78%
Ankle-brachial index (ABI), blood pressure test for leg arteries inpatient both sides CPT 93922 Noninvasive Phys Study Uea/Lea Sngl/Bilat	$303.21	$1,372.00	$131.27–$1,166.20	—	78%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Rad Exam; Esophagus Sngl Contrast Study	$379.68	$1,718.00	$185.58–$1,460.30	18% below	78%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 Rad Exam; Esophagus Sngl Contrast Study	$379.68	$1,718.00	$185.58–$1,460.30	—	78%
Bone scan, whole body (nuclear medicine) CPT 78306 Bone Imaging; Whole Body	$1,031.19	$4,666.00	$422.96–$3,966.10	33% below	78%
Bone scan, whole body (nuclear medicine) inpatient CPT 78306 Bone Imaging; Whole Body	$1,031.19	$4,666.00	$422.96–$3,966.10	—	78%
Breast ultrasound, complete, one breast CPT 76641 Ultrasound Breast Complete Unil Hcode	$272.27	$1,232.00	$110.61–$2,094.40	37% below	78%
Breast ultrasound, complete, one breast inpatient CPT 76641 Ultrasound Breast Complete Unil Hcode	$272.27	$1,232.00	$110.61–$2,094.40	—	78%
Breast ultrasound, limited (one breast or one area) CPT 76642 Ultrasound Breast Limited Hcode	$272.27	$1,232.00	$92.07–$2,094.40	8% below	78%
Breast ultrasound, limited (one breast or one area) inpatient CPT 76642 Ultrasound Breast Limited Hcode	$272.27	$1,232.00	$92.07–$2,094.40	—	78%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT Angio Chest; W/WO Cont	$854.17	$3,865.00	$185.58–$3,285.25	25% below	78%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CT Angio Chest; W/WO Cont	$854.17	$3,865.00	$185.58–$3,285.25	—	78%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT Angio Hrt W/Cont & 3d	$595.82	$2,696.00	$369.11–$2,291.60	28% below	78%
CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score inpatient CPT 75574 CT Angio Hrt W/Cont & 3d	$595.82	$2,696.00	$369.11–$2,291.60	—	78%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd & Pelvis W/O Contrast	$636.04	$2,878.00	$252.44–$2,446.30	37% below	78%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd & Pelvis W/O Contrast	$636.04	$2,878.00	$252.44–$2,446.30	—	78%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd & Pelvis W/Contrast	$776.82	$3,515.00	$369.11–$2,987.75	47% below	78%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abd & Pelvis W/Contrast	$776.82	$3,515.00	$369.11–$2,987.75	—	78%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT-Abd/Pelvis WO/W Contrast	$1,163.79	$5,266.00	$369.11–$4,476.10	31% below	78%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT-Abd/Pelvis WO/W Contrast	$1,163.79	$5,266.00	$369.11–$4,476.10	—	78%
CT scan of the abdomen with contrast CPT 74160 CT Abd; W/Cont	$595.82	$2,696.00	$185.58–$2,291.60	34% below	78%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abd; W/Cont	$595.82	$2,696.00	$185.58–$2,291.60	—	78%
CT scan of the abdomen without contrast CPT 74150 CT Abd; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	38% below	78%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abd; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	—	78%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Area; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	38% below	78%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial Area; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	—	78%
CT scan of the head or brain, no contrast dye CPT 70450 CT Hd/Brain; W/O Cont	$384.10	$1,738.00	$110.61–$1,477.30	47% below	78%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Hd/Brain; W/O Cont	$384.10	$1,738.00	$110.61–$1,477.30	—	78%
CT scan of the head with contrast CPT 70460 CT Hd/Brain; W/Cont	$447.97	$2,027.00	$185.58–$1,722.95	46% below	78%
CT scan of the head with contrast inpatient CPT 70460 CT Hd/Brain; W/Cont	$447.97	$2,027.00	$185.58–$1,722.95	—	78%
CT scan of the head without and with contrast CPT 70470 CT Hd/Brain; W/WO Cont	$512.28	$2,318.00	$185.58–$1,970.30	50% below	78%
CT scan of the head without and with contrast inpatient CPT 70470 CT Hd/Brain; W/WO Cont	$512.28	$2,318.00	$185.58–$1,970.30	—	78%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumb Spin; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	41% below	78%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumb Spin; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	—	78%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cerv Spin; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	38% below	78%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cerv Spin; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	—	78%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelv; W/Cont	$640.02	$2,896.00	$185.58–$2,461.60	28% below	78%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelv; W/Cont	$640.02	$2,896.00	$185.58–$2,461.60	—	78%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 CARotid DPLX SCAN; COMPL BILAT STUDY	$708.75	$3,207.00	$252.44–$2,725.95	—	78%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 CARotid DPLX SCAN; COMPL BILAT STUDY	$708.75	$3,207.00	$252.44–$2,725.95	—	78%
Chest X-ray, 2 views CPT 71046 X-Ray Exam Chest 2 Views	$165.97	$751.00	$92.07–$638.35	19% below	78%
Chest X-ray, 2 views inpatient CPT 71046 X-Ray Exam Chest 2 Views	$165.97	$751.00	$92.07–$638.35	—	78%
Chest X-ray, single view CPT 71045 Xray Exam Babyscan Chest 1 View	$77.13	$349.00	$92.07–$390.96	52% below	78%
Chest X-ray, single view CPT 71045 X-Ray Exam Chest 1 View	$148.73	$673.00	$92.07–$572.05	8% below	78%
Chest X-ray, single view inpatient CPT 71045 Xray Exam Babyscan Chest 1 View	$77.13	$349.00	$92.07–$390.96	—	78%
Chest X-ray, single view inpatient CPT 71045 X-Ray Exam Chest 1 View	$148.73	$673.00	$92.07–$572.05	—	78%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal W/Image; Compl	$270.73	$1,225.00	$110.61–$1,041.25	45% below	78%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal W/Image; Compl	$270.73	$1,225.00	$110.61–$1,041.25	—	78%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA Bone Density Study; Axial Skeleton	$118.01	$534.00	$104.99–$480.96	58% below	78%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 DXA Bone Density Study; Axial Skeleton	$118.01	$534.00	$104.99–$480.96	—	78%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA Bn Density Study; Appendicular Skeleton	$93.70	$424.00	$45.08–$390.96	35% below	78%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 DXA Bn Density Study; Appendicular Skeleton	$93.70	$424.00	$45.08–$390.96	—	78%
Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 US Preg Uterus Detailed; 1st Gestation	$194.48	$880.00	$244.10–$1,050.84	64% below	78%
Detailed fetal anatomy ultrasound, through the belly, one baby inpatient CPT 76811 US Preg Uterus Detailed; 1st Gestation	$194.48	$880.00	$244.10–$1,050.84	—	78%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Chest; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	38% below	78%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Chest; W/O Cont	$491.95	$2,226.00	$110.61–$1,892.10	—	78%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Chest; W/Cont	$595.82	$2,696.00	$185.58–$2,291.60	31% below	78%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Chest; W/Cont	$595.82	$2,696.00	$185.58–$2,291.60	—	78%
Diagnostic mammogram, both breasts both sides CPT 77066 Dx Mammo Incl Cad Bi	$196.47	$889.00	$102.19–$755.65	—	78%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 Dx Mammo Incl Cad Bi	$196.47	$889.00	$102.19–$755.65	—	78%
Diagnostic mammogram, one breast CPT 77065 Dx Mammo Incl Cad Uni	$131.94	$597.00	$79.74–$507.45	32% below	78%
Diagnostic mammogram, one breast inpatient CPT 77065 Dx Mammo Incl Cad Uni	$131.94	$597.00	$79.74–$507.45	—	78%
Duplex ultrasound of the leg arteries, both legs both sides CPT 93925 Dplx Scan of Lea or Graft; Compl Bilat Study	$451.28	$2,042.00	$252.44–$1,735.70	—	78%
Duplex ultrasound of the leg arteries, both legs inpatient both sides CPT 93925 Dplx Scan of Lea or Graft; Compl Bilat Study	$451.28	$2,042.00	$252.44–$1,735.70	—	78%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 Dplx Scan Ext Veins; Compl Bilat Study	$741.23	$3,354.00	$252.44–$2,850.90	—	78%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 Dplx Scan Ext Veins; Compl Bilat Study	$741.23	$3,354.00	$252.44–$2,850.90	—	78%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 Echo Tte W/Doppler and Color Flow	$1,067.43	$4,830.00	$578.11–$4,105.50	35% below	78%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 Echo Tte W/Doppler and Color Flow	$1,067.43	$4,830.00	$578.11–$4,105.50	—	78%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Hepatobiliary System Imaging	$966.65	$4,374.00	$422.96–$3,717.90	26% below	78%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder inpatient CPT 78226 Hepatobiliary System Imaging	$966.65	$4,374.00	$422.96–$3,717.90	—	78%
Home sleep apnea test, unattended, recording breathing and oxygen CPT 95806 Home Sleep Test/Type 3 Porta	$232.27	$1,051.00	$228.45–$893.35	11% below	78%
Home sleep apnea test, unattended, recording breathing and oxygen inpatient CPT 95806 Home Sleep Test/Type 3 Porta	$232.27	$1,051.00	$228.45–$893.35	—	78%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 Pss W 4/> P W Cpap/Bipap	$1,575.51	$7,129.00	$780.39–$6,059.65	48% below	78%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 Pss W 4/> P W Cpap/Bipap	$1,575.51	$7,129.00	$780.39–$6,059.65	—	78%
Knee X-ray, 3 views CPT 73562 Rad Exam Knee; 3 Vw	$200.23	$906.00	$75.04–$1,540.20	13% below	78%
Knee X-ray, 3 views inpatient CPT 73562 Rad Exam Knee; 3 Vw	$200.23	$906.00	$75.04–$1,540.20	—	78%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abd W/Image; Ltd	$328.19	$1,485.00	$110.61–$1,262.25	21% below	78%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Bedside US Echo Exam of Abdomen Limited	$328.19	$1,485.00	$110.61–$1,262.25	21% below	78%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 Bedside US Echo Exam of Abdomen Limited	$328.19	$1,485.00	$110.61–$1,262.25	—	78%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abd W/Image; Ltd	$328.19	$1,485.00	$110.61–$1,262.25	—	78%
MRI of both breasts, without and then with contrast dye CPT 77049 MRI Breast WO/With Contrast W/Cad Bil	$308.96	$1,398.00	$369.11–$1,366.17	25% below	78%
MRI of both breasts, without and then with contrast dye inpatient CPT 77049 MRI Breast WO/With Contrast W/Cad Bil	$308.96	$1,398.00	$369.11–$1,366.17	—	78%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Lower Extremity Jnt; W/O Contrast	$762.01	$3,448.00	$252.44–$5,861.60	22% below	78%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI Lower Extremity Jnt; W/O Contrast	$762.01	$3,448.00	$252.44–$5,861.60	—	78%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Lower Extremity Jnt; W&W/O Contrast	$975.94	$4,416.00	$369.11–$7,507.20	33% below	78%
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	$975.94	$4,416.00	$369.11–$7,507.20	—	78%
MRI of the abdomen without contrast CPT 74181 MRI Abdomen; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	27% below	78%
MRI of the abdomen without contrast inpatient CPT 74181 MRI Abdomen; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	—	78%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI Abdomen; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	34% below	78%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MRI Abdomen; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	—	78%
MRI of the brain, no contrast dye CPT 70551 MRI Brain; W/O Contrast	$512.28	$2,318.00	$252.44–$1,970.30	48% below	78%
MRI of the brain, no contrast dye inpatient CPT 70551 MRI Brain; W/O Contrast	$512.28	$2,318.00	$252.44–$1,970.30	—	78%
MRI of the brain, with and without contrast dye CPT 70553 MRI Brain; W&W/O Contrast	$819.25	$3,707.00	$369.11–$3,150.95	36% below	78%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI Brain; W&W/O Contrast	$819.25	$3,707.00	$369.11–$3,150.95	—	78%
MRI of the lower back, no contrast dye CPT 72148 MRI Spine Lumbar; W/O Contrast	$682.67	$3,089.00	$227.92–$2,625.65	31% below	78%
MRI of the lower back, no contrast dye inpatient CPT 72148 MRI Spine Lumbar; W/O Contrast	$682.67	$3,089.00	$227.92–$2,625.65	—	78%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI Spine Lumbar; W&W/O Contrast	$975.94	$4,416.00	$369.11–$3,753.60	26% below	78%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MRI Spine Lumbar; W&W/O Contrast	$975.94	$4,416.00	$369.11–$3,753.60	—	78%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI Spine Thoracic; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	23% below	78%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MRI Spine Thoracic; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	—	78%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI Spine Cervical; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	32% below	78%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MRI Spine Cervical; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	—	78%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI Spine Cervical; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	28% below	78%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MRI Spine Cervical; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	—	78%
MRI of the pelvis without and with contrast CPT 72197 MRI Pelvis; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	33% below	78%
MRI of the pelvis without and with contrast inpatient CPT 72197 MRI Pelvis; W&W/O Contrast	$874.50	$3,957.00	$369.11–$3,363.45	—	78%
MRI of the pelvis, no contrast dye CPT 72195 MRI Pelvis; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	28% below	78%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MRI Pelvis; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	—	78%
MRI of the shoulder, elbow or wrist joint, no contrast dye CPT 73221 MRI Upper Extremity Jnt; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	37% below	78%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient CPT 73221 MRI Upper Extremity Jnt; W/O Contrast	$737.70	$3,338.00	$252.44–$2,837.30	—	78%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Myocardial W/Spect; Multiple Studies	$2,448.46	$11,079.00	$1,095.24–$9,417.15	32% below	78%
Nuclear stress test imaging (SPECT), rest and stress studies inpatient CPT 78452 Myocardial W/Spect; Multiple Studies	$2,448.46	$11,079.00	$1,095.24–$9,417.15	—	78%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Pet W/CT; Skull Base to Mid-Thigh	$1,964.91	$8,891.00	$1,512.90–$7,557.35	50% below	78%
PET/CT scan from the base of the skull to mid-thigh inpatient CPT 78815 Pet W/CT; Skull Base to Mid-Thigh	$1,964.91	$8,891.00	$1,512.90–$7,557.35	—	78%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Bedside US Exam Pelvic Limited	$232.49	$1,052.00	$94.34–$894.20	21% below	78%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Exam Pelvic Limited	$232.49	$1,052.00	$94.34–$894.20	21% below	78%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Exam Pelvic Limited	$232.49	$1,052.00	$94.34–$894.20	—	78%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 Bedside US Exam Pelvic Limited	$232.49	$1,052.00	$94.34–$894.20	—	78%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelv; Compl	$355.15	$1,607.00	$110.61–$1,365.95	18% below	78%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelv; Compl	$355.15	$1,607.00	$110.61–$1,365.95	—	78%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uterus >14wk; 1st Gest	$335.48	$1,518.00	$110.61–$1,290.30	37% below	78%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US Preg Uterus >14wk; 1st Gest	$335.48	$1,518.00	$110.61–$1,290.30	—	78%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US Preg Uter <14wk; 1st Gest	$216.58	$980.00	$110.61–$833.00	55% below	78%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US Preg Uter <14wk; 1st Gest	$216.58	$980.00	$110.61–$833.00	—	78%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Bedside US Preg Uterus Limited 1+ Fetus(S)	$191.61	$867.00	$110.61–$736.95	41% below	78%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US Preg Uter Ltd	$191.61	$867.00	$110.61–$736.95	41% below	78%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US Preg Uter Ltd	$191.61	$867.00	$110.61–$736.95	—	78%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Bedside US Preg Uterus Limited 1+ Fetus(S)	$191.61	$867.00	$110.61–$736.95	—	78%
Screening mammogram, both breasts both sides CPT 77067 Scr Mammo Bi Incl Cad	$126.85	$574.00	$84.38–$487.90	—	78%
Screening mammogram, both breasts inpatient both sides CPT 77067 Scr Mammo Bi Incl Cad	$126.85	$574.00	$84.38–$487.90	—	78%
Shoulder X-ray, complete, 2 or more views CPT 73030 Rad Exam Shldr; Compl 2 Vw Min	$196.91	$891.00	$57.64–$1,514.70	1% below	78%
Shoulder X-ray, complete, 2 or more views inpatient CPT 73030 Rad Exam Shldr; Compl 2 Vw Min	$196.91	$891.00	$57.64–$1,514.70	—	78%
Sleep study in a lab (polysomnography) CPT 95810 Pss W 4/> Param W Tech	$1,459.71	$6,605.00	$780.39–$5,614.25	32% below	78%
Sleep study in a lab (polysomnography) inpatient CPT 95810 Pss W 4/> Param W Tech	$1,459.71	$6,605.00	$780.39–$5,614.25	—	78%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Stress Tte Complete	$2,744.16	$12,417.00	$578.11–$10,554.45	56% above	78%
Stress echocardiogram, complete, including the stress test and supervision inpatient CPT 93351 Stress Tte Complete	$2,744.16	$12,417.00	$578.11–$10,554.45	—	78%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Swallowing Function W/Video Contrast Study	$259.01	$1,172.00	$179.36–$996.20	13% below	78%
Swallow study (modified barium swallow, video X-ray) inpatient CPT 74230 Swallowing Function W/Video Contrast Study	$259.01	$1,172.00	$179.36–$996.20	—	78%
Transvaginal pelvic ultrasound CPT 76830 US Transvag	$157.79	$714.00	$110.61–$606.90	55% below	78%
Transvaginal pelvic ultrasound inpatient CPT 76830 US Transvag	$157.79	$714.00	$110.61–$606.90	—	78%
Transvaginal ultrasound during pregnancy CPT 76817 ED Bedside US Preg Uterus Transvaginal	$191.61	$867.00	$110.61–$736.95	44% below	78%
Transvaginal ultrasound during pregnancy CPT 76817 US Preg Uter Transvag	$191.61	$867.00	$110.61–$736.95	44% below	78%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US Preg Uter Transvag	$191.61	$867.00	$110.61–$736.95	—	78%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 ED Bedside US Preg Uterus Transvaginal	$191.61	$867.00	$110.61–$736.95	—	78%
Ultrasound of the abdomen, complete CPT 76700 US Abd W/Image Doc; Compl	$230.95	$1,045.00	$110.61–$888.25	56% below	78%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abd W/Image Doc; Compl	$230.95	$1,045.00	$110.61–$888.25	—	78%
Ultrasound of the scrotum and testicles CPT 76870 HC US Scrotum	$355.15	$1,607.00	$110.61–$1,365.95	16% below	78%
Ultrasound of the scrotum and testicles CPT 76870 US Scrotum and Contents	$355.15	$1,607.00	$110.61–$1,365.95	16% below	78%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Scrotum and Contents	$355.15	$1,607.00	$110.61–$1,365.95	—	78%
Ultrasound of the scrotum and testicles inpatient CPT 76870 HC US Scrotum	$355.15	$1,607.00	$110.61–$1,365.95	—	78%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Sft Tissue Head/Neck W/Image	$355.15	$1,607.00	$110.61–$1,365.95	at median	78%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Bedside US Exam of Head and Neck	$355.15	$1,607.00	$110.61–$1,365.95	at median	78%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Sft Tissue Head/Neck W/Image	$355.15	$1,607.00	$110.61–$1,365.95	—	78%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 Bedside US Exam of Head and Neck	$355.15	$1,607.00	$110.61–$1,365.95	—	78%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Rad Exam Upper GI Sngl Contrast Study	$379.68	$1,718.00	$185.58–$1,460.30	27% below	78%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 Rad Exam Upper GI Sngl Contrast Study	$379.68	$1,718.00	$185.58–$1,460.30	—	78%
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	$644.44	$2,916.00	$110.61–$2,478.60	2% above	78%
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	$644.44	$2,916.00	$110.61–$2,478.60	2% above	78%
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	$644.44	$2,916.00	$110.61–$2,478.60	—	78%
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	$644.44	$2,916.00	$110.61–$2,478.60	—	78%
Wrist X-ray, complete, 3 or more views CPT 73110 Rad Exam Wrist; Compl 3 Vw Min	$152.49	$690.00	$79.87–$1,173.00	41% below	78%
Wrist X-ray, complete, 3 or more views inpatient CPT 73110 Rad Exam Wrist; Compl 3 Vw Min	$152.49	$690.00	$79.87–$1,173.00	—	78%
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	$341.89	$1,547.00	$80.85–$1,314.95	26% above	78%
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	$341.89	$1,547.00	$80.85–$1,314.95	—	78%
X-ray of the abdomen, 1 view CPT 74018 Xray Exam Babyscan Abdomen 1 View	$77.13	$349.00	$92.07–$390.96	63% below	78%
X-ray of the abdomen, 1 view CPT 74018 X-Ray Exam Abdomen 1 View	$159.12	$720.00	$92.07–$612.00	25% below	78%
X-ray of the abdomen, 1 view inpatient CPT 74018 Xray Exam Babyscan Abdomen 1 View	$77.13	$349.00	$92.07–$390.96	—	78%
X-ray of the abdomen, 1 view inpatient CPT 74018 X-Ray Exam Abdomen 1 View	$159.12	$720.00	$92.07–$612.00	—	78%
X-ray of the ankle, 2 views CPT 73600 Rad Exam Ankl; 2 Vw	$141.88	$642.00	$55.69–$1,091.40	5% below	78%
X-ray of the ankle, 2 views inpatient CPT 73600 Rad Exam Ankl; 2 Vw	$141.88	$642.00	$55.69–$1,091.40	—	78%
X-ray of the finger(s), 2 or more views CPT 73140 Rad Exam Fngr(S); 2 Vw Min	$162.44	$735.00	$72.15–$1,249.50	6% above	78%
X-ray of the finger(s), 2 or more views inpatient CPT 73140 Rad Exam Fngr(S); 2 Vw Min	$162.44	$735.00	$72.15–$1,249.50	—	78%
X-ray of the foot, 2 views CPT 73620 Rad Exam Ft; 2 Vw	$118.01	$534.00	$53.78–$907.80	19% below	78%
X-ray of the foot, 2 views inpatient CPT 73620 Rad Exam Ft; 2 Vw	$118.01	$534.00	$53.78–$907.80	—	78%
X-ray of the foot, complete, 3 or more views CPT 73630 Rad Exam Ft; Compl 3 Vw Min	$172.38	$780.00	$63.45–$1,326.00	12% below	78%
X-ray of the foot, complete, 3 or more views inpatient CPT 73630 Rad Exam Ft; Compl 3 Vw Min	$172.38	$780.00	$63.45–$1,326.00	—	78%
X-ray of the hand, 3 or more views CPT 73130 Rad Exam Hnd; 3 Vw Min	$190.06	$860.00	$27.10–$1,462.00	6% below	78%
X-ray of the hand, 3 or more views inpatient CPT 73130 Rad Exam Hnd; 3 Vw Min	$190.06	$860.00	$27.10–$1,462.00	—	78%
X-ray of the knee, 1 or 2 views CPT 73560 Rad Exam Knee; 1/2 Vw	$165.97	$751.00	$58.62–$1,276.70	21% below	78%
X-ray of the knee, 1 or 2 views inpatient CPT 73560 Rad Exam Knee; 1/2 Vw	$165.97	$751.00	$58.62–$1,276.70	—	78%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 Rad Exam Spine Lumbosacral;2/3 Vw	$173.49	$785.00	$66.34–$667.25	28% below	78%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 Rad Exam Spine Lumbosacral;2/3 Vw	$173.49	$785.00	$66.34–$667.25	—	78%
X-ray of the lower back, 4 or more views CPT 72110 Rad Exam Spine Lumbosacral; 4vw Min	$190.72	$863.00	$91.46–$733.55	44% below	78%
X-ray of the lower back, 4 or more views inpatient CPT 72110 Rad Exam Spine Lumbosacral; 4vw Min	$190.72	$863.00	$91.46–$733.55	—	78%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 Rad Exam Spine; Thor 2 Vw	$169.51	$767.00	$61.50–$651.95	24% below	78%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 Rad Exam Spine; Thor 2 Vw	$169.51	$767.00	$61.50–$651.95	—	78%
X-ray of the nasal bones, 3 or more views CPT 70160 Rad Exam Nasal Bns; Compl 3 Vw Min	$179.89	$814.00	$69.23–$691.90	10% below	78%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 Rad Exam Nasal Bns; Compl 3 Vw Min	$179.89	$814.00	$69.23–$691.90	—	78%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 Rad Exam Cerv Spine; 2/3 Vw	$203.98	$923.00	$66.34–$784.55	18% below	78%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 Rad Exam Cerv Spine; 2/3 Vw	$203.98	$923.00	$66.34–$784.55	—	78%
X-ray of the pelvis, 1 or 2 views CPT 72170 Rad Exam Pel; 1/2 Vw	$224.76	$1,017.00	$53.78–$864.45	16% above	78%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 Rad Exam Pel; 1/2 Vw	$224.76	$1,017.00	$53.78–$864.45	—	78%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 Rad Exam Sacrum/Coccyx 2 Vw Min	$214.37	$970.00	$55.69–$824.50	2% below	78%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 Rad Exam Sacrum/Coccyx 2 Vw Min	$214.37	$970.00	$55.69–$824.50	—	78%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Transferase; Alanine Amino	$19.23	$87.00	$4.19–$73.95	28% below	78%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 Transferase; Alanine Amino	$19.23	$87.00	$4.19–$73.95	—	78%
AST (aspartate aminotransferase) enzyme test CPT 84450 Ast or Sgot	$22.54	$102.00	$4.09–$86.70	20% below	78%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 Ast or Sgot	$22.54	$102.00	$4.09–$86.70	—	78%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute Hepatitis Panel	$79.12	$358.00	$37.63–$304.30	72% below	78%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Acute Hepatitis Panel	$79.12	$358.00	$37.63–$304.30	—	78%
Allergy blood test, specific IgE, per allergen CPT 86003 Allerg Sp Ige; Quan or Semiquan 493	$13.70	$62.00	$4.12–$52.70	20% below	78%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allerg Sp Ige; Quan or Semiquan 493	$13.70	$62.00	$4.12–$52.70	—	78%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 CCP Antibody	$57.02	$258.00	$10.23–$219.30	13% above	78%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 CCP Antibody	$57.02	$258.00	$10.23–$219.30	—	78%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (Ana);	$25.42	$115.00	$9.55–$97.75	58% below	78%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (Ana);	$25.42	$115.00	$9.55–$97.75	—	78%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic Peptide	$126.85	$574.00	$31.02–$487.90	24% below	78%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 Natriuretic Peptide	$126.85	$574.00	$31.02–$487.90	—	78%
Basic metabolic panel (blood test) CPT 80048 Bmp (Calcium Total)	$34.26	$155.00	$6.68–$131.75	56% below	78%
Basic metabolic panel (blood test) inpatient CPT 80048 Bmp (Calcium Total)	$34.26	$155.00	$6.68–$131.75	—	78%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Tissue Exam by Pathologist 009	$133.26	$603.00	$55.13–$512.55	48% below	78%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Tissue Exam by Pathologist 009	$133.26	$603.00	$55.13–$512.55	—	78%
Blood culture for bacteria CPT 87040 Aerob Bacterial Bld Culture	$104.31	$472.00	$8.15–$401.20	19% below	78%
Blood culture for bacteria inpatient CPT 87040 Aerob Bacterial Bld Culture	$104.31	$472.00	$8.15–$401.20	—	78%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Venipuncture	$7.96	$36.00	$7.38–$38.57	40% below	78%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 HC Pace Venipuncture	$7.96	$36.00	$7.38–$38.57	40% below	78%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 HC Pace Venipuncture	$7.96	$36.00	$7.38–$38.57	—	78%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Venipuncture	$7.96	$36.00	$7.38–$38.57	—	78%
Blood glucose (sugar) test CPT 82947 Glucose; Quan Bld 196	$16.13	$73.00	$3.10–$62.05	38% below	78%
Blood glucose (sugar) test CPT 82947 Glucose; Quan Bld 1262	$16.13	$73.00	$3.10–$62.05	38% below	78%
Blood glucose (sugar) test inpatient CPT 82947 Glucose; Quan Bld 1262	$16.13	$73.00	$3.10–$62.05	—	78%
Blood glucose (sugar) test inpatient CPT 82947 Glucose; Quan Bld 196	$16.13	$73.00	$3.10–$62.05	—	78%
Blood lead test CPT 83655 Lead 246	$76.25	$345.00	$9.57–$293.25	25% above	78%
Blood lead test inpatient CPT 83655 Lead 246	$76.25	$345.00	$9.57–$293.25	—	78%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Hcg; Qual	$47.52	$215.00	$5.94–$182.75	37% below	78%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Hcg; Qual	$47.52	$215.00	$5.94–$182.75	—	78%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bld Typing; Abo	$25.42	$115.00	$2.99–$521.03	48% below	78%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Bld Typing; Abo 641	$35.36	$160.00	$2.99–$521.03	28% below	78%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bld Typing; Abo	$25.42	$115.00	$2.99–$521.03	—	78%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 Bld Typing; Abo 641	$35.36	$160.00	$2.99–$521.03	—	78%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C-Reactive Protein	$51.05	$231.00	$4.09–$196.35	24% below	78%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C-Reactive Protein	$51.05	$231.00	$4.09–$196.35	—	78%
C. difficile toxin gene test (stool PCR) CPT 87493 C Diff Amplified Probe	$123.54	$559.00	$29.44–$475.15	6% below	78%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 C Diff Amplified Probe	$123.54	$559.00	$29.44–$475.15	—	78%
CA 19-9 blood test (tumor marker) CPT 86301 Ia Quant; Ca 19-9	$123.54	$559.00	$16.44–$475.15	15% below	78%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Ia Quant; Ca 19-9	$123.54	$559.00	$16.44–$475.15	—	78%
CA-125 blood test (ovarian cancer marker) CPT 86304 Ia Quant; Ca 125	$98.35	$445.00	$16.44–$378.25	39% below	78%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Ia Quant; Ca 125	$98.35	$445.00	$16.44–$378.25	—	78%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Sars-Cov-2 Covid-19 Amp Prb	$77.57	$351.00	$40.53–$298.35	26% below	78%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019 Ncov Any Technique	$82.21	$372.00	$40.53–$316.20	22% below	78%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 2019 Ncov Dx Panel	$82.21	$372.00	$40.53–$316.20	22% below	78%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 Sars-Cov-2 Covid-19 Amp Prb	$77.57	$351.00	$40.53–$298.35	—	78%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019 Ncov Any Technique	$82.21	$372.00	$40.53–$316.20	—	78%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient CPT 87635 2019 Ncov Dx Panel	$82.21	$372.00	$40.53–$316.20	—	78%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia T Amplif Na Probe 750	$76.25	$345.00	$27.72–$293.25	22% below	78%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia T Amplif Na Probe 750	$76.25	$345.00	$27.72–$293.25	—	78%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel	$29.17	$132.00	$10.58–$112.20	67% below	78%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel	$29.17	$132.00	$10.58–$112.20	—	78%
Complete blood count (CBC) with differential CPT 85025 Compl Cbc W Plt W Autom Diff	$23.87	$108.00	$6.14–$91.80	37% below	78%
Complete blood count (CBC) with differential inpatient CPT 85025 Compl Cbc W Plt W Autom Diff	$23.87	$108.00	$6.14–$91.80	—	78%
Complete blood count (CBC), no differential CPT 85027 Compl Autom Cbc W Plt	$12.38	$56.00	$5.11–$47.60	56% below	78%
Complete blood count (CBC), no differential inpatient CPT 85027 Compl Autom Cbc W Plt	$12.38	$56.00	$5.11–$47.60	—	78%
Comprehensive metabolic panel (blood test) CPT 80053 Comprehen Metabolic Panel 004	$38.45	$174.00	$8.34–$147.90	48% below	78%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehen Metabolic Panel 004	$38.45	$174.00	$8.34–$147.90	—	78%
D-dimer blood test (blood clot marker) CPT 85379 POCT D-Dimer - Quantitative	$79.12	$358.00	$8.04–$304.30	35% below	78%
D-dimer blood test (blood clot marker) inpatient CPT 85379 POCT D-Dimer - Quantitative	$79.12	$358.00	$8.04–$304.30	—	78%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone-Sulfate	$167.74	$759.00	$17.56–$645.15	14% above	78%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone-Sulfate	$167.74	$759.00	$17.56–$645.15	—	78%
Estradiol blood test CPT 82670 Estradiol	$136.14	$616.00	$22.07–$523.60	19% above	78%
Estradiol blood test inpatient CPT 82670 Estradiol	$136.14	$616.00	$22.07–$523.60	—	78%
FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin; Fsh	$117.79	$533.00	$14.68–$453.05	1% below	78%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Gonadotropin; Fsh	$117.79	$533.00	$14.68–$453.05	—	78%
Fecal calprotectin (stool inflammation test) CPT 83993 Assay for Calprotectin Fecal	$133.26	$603.00	$15.51–$512.55	25% below	78%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Assay for Calprotectin Fecal	$133.26	$603.00	$15.51–$512.55	—	78%
Ferritin blood test (iron stores) CPT 82728 Ferritin	$38.45	$174.00	$10.77–$147.90	34% below	78%
Ferritin blood test (iron stores) inpatient CPT 82728 Ferritin	$38.45	$174.00	$10.77–$147.90	—	78%
Folate (folic acid) blood test CPT 82746 Folic Acid; Serum	$60.78	$275.00	$11.61–$233.75	15% below	78%
Folate (folic acid) blood test inpatient CPT 82746 Folic Acid; Serum	$60.78	$275.00	$11.61–$233.75	—	78%
Free T3 thyroid hormone test CPT 84481 T3; Free	$101.66	$460.00	$13.38–$391.00	10% below	78%
Free T3 thyroid hormone test inpatient CPT 84481 T3; Free	$101.66	$460.00	$13.38–$391.00	—	78%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Free Thyroxine 395	$66.96	$303.00	$7.13–$257.55	10% below	78%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 Free Thyroxine 395	$66.96	$303.00	$7.13–$257.55	—	78%
Free testosterone test CPT 84402 Testosterone; Free	$129.95	$588.00	$20.12–$499.80	61% above	78%
Free testosterone test inpatient CPT 84402 Testosterone; Free	$129.95	$588.00	$20.12–$499.80	—	78%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General Health Panel	$202.88	$918.00	$253.97–$780.30	27% below	78%
General health panel: metabolic panel, blood count and TSH in one order inpatient CPT 80050 General Health Panel	$202.88	$918.00	$253.97–$780.30	—	78%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose; Post Glucose Dose 199	$35.36	$160.00	$3.75–$136.00	14% below	78%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose; Post Glucose Dose 199	$35.36	$160.00	$3.75–$136.00	—	78%
Glucose tolerance test, 3 samples CPT 82951 Glucose Tolerance Test (Gtt)	$57.02	$258.00	$10.17–$219.30	20% below	78%
Glucose tolerance test, 3 samples inpatient CPT 82951 Glucose Tolerance Test (Gtt)	$57.02	$258.00	$10.17–$219.30	—	78%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Neisseria Amplif Na Probe 768	$76.25	$345.00	$27.72–$293.25	22% below	78%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 Neisseria Amplif Na Probe 768	$76.25	$345.00	$27.72–$293.25	—	78%
H. pylori antibody blood test CPT 86677 Ab; Helicobacter Pylori	$126.85	$574.00	$13.31–$487.90	27% above	78%
H. pylori antibody blood test inpatient CPT 86677 Ab; Helicobacter Pylori	$126.85	$574.00	$13.31–$487.90	—	78%
H. pylori stool antigen test CPT 87338 Hpylori Stool Eia	$95.25	$431.00	$11.36–$366.35	23% below	78%
H. pylori stool antigen test inpatient CPT 87338 Hpylori Stool Eia	$95.25	$431.00	$11.36–$366.35	—	78%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Hiv-1 Na Quan	$114.26	$517.00	$67.23–$439.45	69% below	78%
HIV viral load test (HIV-1 RNA, quantitative) inpatient CPT 87536 Hiv-1 Na Quan	$114.26	$517.00	$67.23–$439.45	—	78%
HIV-1 and HIV-2 antibody test CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 596	$133.26	$603.00	$10.83–$512.55	122% above	78%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 Ab; Hiv-1 & Hiv-2 Sgl Assay 596	$133.26	$603.00	$10.83–$512.55	—	78%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab	$47.52	$215.00	$19.02–$182.75	19% below	78%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 Hiv-1 Ag W/Hiv-1 & Hiv-2 Ab	$47.52	$215.00	$19.02–$182.75	—	78%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Hpv High-Risk Types	$54.15	$245.00	$27.72–$208.25	47% below	78%
HPV test for high-risk types, one combined (pooled) result inpatient CPT 87624 Hpv High-Risk Types	$54.15	$245.00	$27.72–$208.25	—	78%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Glycosylated Hemoglobin Test	$47.52	$215.00	$7.67–$182.75	25% below	78%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Glycosylated Hemoglobin Test	$47.52	$215.00	$7.67–$182.75	—	78%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Ab: Hbsab	$38.45	$174.00	$10.74–$147.90	34% below	78%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Ab: Hbsab	$38.45	$174.00	$10.74–$147.90	—	78%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Surface Ag Eia 741	$38.45	$174.00	$10.33–$147.90	22% below	78%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Surface Ag Eia 741	$38.45	$174.00	$10.33–$147.90	—	78%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Ab 625	$54.15	$245.00	$11.27–$208.25	35% below	78%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Ab 625	$54.15	$245.00	$11.27–$208.25	—	78%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hep-C Na Quan 831	$183.43	$830.00	$33.84–$705.50	2% below	78%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hep-C Na Quan 831	$183.43	$830.00	$33.84–$705.50	—	78%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Test	$35.36	$160.00	$10.42–$136.00	29% below	78%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Test	$35.36	$160.00	$10.42–$136.00	—	78%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Type 2	$35.36	$160.00	$15.29–$136.00	50% below	78%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Type 2	$35.36	$160.00	$15.29–$136.00	—	78%
High-sensitivity CRP (hs-CRP) test CPT 86141 C-Reactive Protein Hs	$72.93	$330.00	$10.23–$280.50	4% above	78%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C-Reactive Protein Hs	$72.93	$330.00	$10.23–$280.50	—	78%
Homocysteine blood test CPT 83090 Assay of Homocystine	$196.47	$889.00	$14.16–$755.65	57% above	78%
Homocysteine blood test inpatient CPT 83090 Assay of Homocystine	$196.47	$889.00	$14.16–$755.65	—	78%
Insulin blood test CPT 83525 Insulin; Total	$76.25	$345.00	$9.03–$293.25	21% above	78%
Insulin blood test inpatient CPT 83525 Insulin; Total	$76.25	$345.00	$9.03–$293.25	—	78%
Iron blood test (serum iron) CPT 83540 IRON	$19.23	$87.00	$5.11–$73.95	53% below	78%
Iron blood test (serum iron) inpatient CPT 83540 IRON	$19.23	$87.00	$5.11–$73.95	—	78%
Iron-binding capacity (TIBC) test CPT 83550 Iron Binding Capacity	$38.45	$174.00	$6.90–$147.90	8% below	78%
Iron-binding capacity (TIBC) test inpatient CPT 83550 Iron Binding Capacity	$38.45	$174.00	$6.90–$147.90	—	78%
Kidney function blood test panel CPT 80069 Renal Function Panel	$31.60	$143.00	$6.86–$121.55	67% below	78%
Kidney function blood test panel inpatient CPT 80069 Renal Function Panel	$31.60	$143.00	$6.86–$121.55	—	78%
LH (luteinizing hormone) test CPT 83002 Gonadotropin; Luteinizing Hormone	$117.79	$533.00	$14.63–$453.05	16% below	78%
LH (luteinizing hormone) test inpatient CPT 83002 Gonadotropin; Luteinizing Hormone	$117.79	$533.00	$14.63–$453.05	—	78%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase 249	$41.33	$187.00	$5.44–$158.95	53% below	78%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase 249	$41.33	$187.00	$5.44–$158.95	—	78%
Liver function blood test panel CPT 80076 Hepatic Function Panel	$31.60	$143.00	$6.45–$121.55	65% below	78%
Liver function blood test panel inpatient CPT 80076 Hepatic Function Panel	$31.60	$143.00	$6.45–$121.55	—	78%
Lyme disease antibody test CPT 86618 Ab; Lyme's Disease	$126.85	$574.00	$13.45–$487.90	35% above	78%
Lyme disease antibody test inpatient CPT 86618 Ab; Lyme's Disease	$126.85	$574.00	$13.45–$487.90	—	78%
Magnesium blood test CPT 83735 Magnesium 256	$35.36	$160.00	$5.29–$136.00	20% below	78%
Magnesium blood test CPT 83735 Magnesium 259	$47.52	$215.00	$5.29–$182.75	8% above	78%
Magnesium blood test inpatient CPT 83735 Magnesium 256	$35.36	$160.00	$5.29–$136.00	—	78%
Magnesium blood test inpatient CPT 83735 Magnesium 259	$47.52	$215.00	$5.29–$182.75	—	78%
Measles (rubeola) antibody test CPT 86765 Ab; Rubeola	$114.26	$517.00	$10.18–$439.45	57% above	78%
Measles (rubeola) antibody test inpatient CPT 86765 Ab; Rubeola	$114.26	$517.00	$10.18–$439.45	—	78%
Mono test (heterophile antibody, Monospot) CPT 86308 Qual Heterophile Ab	$51.05	$231.00	$4.09–$196.35	30% below	78%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Qual Heterophile Ab	$51.05	$231.00	$4.09–$196.35	—	78%
Obstetric blood test panel CPT 80055 Obstetric Panel	$109.84	$497.00	$37.77–$422.45	63% below	78%
Obstetric blood test panel inpatient CPT 80055 Obstetric Panel	$109.84	$497.00	$37.77–$422.45	—	78%
PSA (prostate-specific antigen) blood test, free CPT 84154 Prostate Specific Antigen (Psa); Free	$29.84	$135.00	$14.53–$114.75	57% below	78%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 Prostate Specific Antigen (Psa); Free	$29.84	$135.00	$14.53–$114.75	—	78%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate Specific Antigen (Psa); Total	$37.35	$169.00	$14.53–$143.65	49% below	78%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate Specific Antigen (Psa); Total	$37.35	$169.00	$14.53–$143.65	—	78%
Pap test (liquid-based, automated screening with review) CPT 88175 Atl Scrn Cytopath W Rvw by Tech	$22.54	$102.00	$20.93–$119.75	71% below	78%
Pap test (liquid-based, automated screening with review) CPT 88175 Cytopath C/V Auto Fluid Redo 791	$22.54	$102.00	$21.02–$119.75	71% below	78%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Cytopath C/V Auto Fluid Redo 791	$22.54	$102.00	$21.02–$119.75	—	78%
Pap test (liquid-based, automated screening with review) inpatient CPT 88175 Atl Scrn Cytopath W Rvw by Tech	$22.54	$102.00	$20.93–$119.75	—	78%
Pap test lab reading: liquid-based cervical sample, manual screening CPT 88142 Cp Cerv/Vag; Atl; Manual Scrn	$22.54	$102.00	$20.26–$91.17	68% below	78%
Pap test lab reading: liquid-based cervical sample, manual screening inpatient CPT 88142 Cp Cerv/Vag; Atl; Manual Scrn	$22.54	$102.00	$20.26–$91.17	—	78%
Parathyroid hormone (PTH) blood test CPT 83970 Parathormone 339	$60.78	$275.00	$32.61–$233.75	68% below	78%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 Parathormone 339	$60.78	$275.00	$32.61–$233.75	—	78%
Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt; Plasma or Whole Bld 489	$28.95	$131.00	$4.75–$111.35	41% below	78%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Ptt; Plasma or Whole Bld 489	$28.95	$131.00	$4.75–$111.35	—	78%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 Fetal Chrmoml Aneuploidy	$759.36	$3,436.00	$599.65–$3,415.73	10% below	78%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 Fetal Chrmoml Aneuploidy	$759.36	$3,436.00	$599.65–$3,415.73	—	78%
Progesterone blood test CPT 84144 Progesterone Assay	$92.16	$417.00	$16.48–$354.45	32% below	78%
Progesterone blood test inpatient CPT 84144 Progesterone Assay	$92.16	$417.00	$16.48–$354.45	—	78%
Prolactin blood test CPT 84146 Prolactin Assay	$88.84	$402.00	$15.31–$341.70	9% below	78%
Prolactin blood test inpatient CPT 84146 Prolactin Assay	$88.84	$402.00	$15.31–$341.70	—	78%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time; 482	$9.28	$42.00	$3.39–$35.70	64% below	78%
Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time; 481	$9.28	$42.00	$3.39–$35.70	64% below	78%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time; 481	$9.28	$42.00	$3.39–$35.70	—	78%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Prothrombin Time; 482	$9.28	$42.00	$3.39–$35.70	—	78%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Test Prsmv Dir Opt Obs	$98.35	$445.00	$9.95–$378.25	10% above	78%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Test Prsmv Dir Opt Obs	$98.35	$445.00	$9.95–$378.25	—	78%
Rapid flu test (influenza antigen) CPT 87804 Infect Agent Detect; Influenza	$54.15	$245.00	$13.07–$208.25	12% above	78%
Rapid flu test (influenza antigen) inpatient CPT 87804 Infect Agent Detect; Influenza	$54.15	$245.00	$13.07–$208.25	—	78%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Infect Agent Detect; Strep	$44.64	$202.00	$13.06–$171.70	40% below	78%
Rapid strep A antigen test from a throat swab, read visually inpatient CPT 87880 Infect Agent Detect; Strep	$44.64	$202.00	$13.06–$171.70	—	78%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Quant	$47.52	$215.00	$4.48–$182.75	at median	78%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Quant	$47.52	$215.00	$4.48–$182.75	—	78%
Rubella antibody test (immunity check) CPT 86762 Ab; Rubella 613	$82.43	$373.00	$11.37–$317.05	24% above	78%
Rubella antibody test (immunity check) inpatient CPT 86762 Ab; Rubella 613	$82.43	$373.00	$11.37–$317.05	—	78%
Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 Autom Erythrocyte Sed Rate	$35.36	$160.00	$2.13–$136.00	9% below	78%
Sed rate (ESR, erythrocyte sedimentation rate) inpatient CPT 85652 Autom Erythrocyte Sed Rate	$35.36	$160.00	$2.13–$136.00	—	78%
Semen analysis: volume, sperm count, motility and morphology CPT 89320 Semen Anal Vol/Count/Mot	$92.16	$417.00	$9.72–$354.45	16% below	78%
Semen analysis: volume, sperm count, motility and morphology inpatient CPT 89320 Semen Anal Vol/Count/Mot	$92.16	$417.00	$9.72–$354.45	—	78%
Stool ova and parasites exam CPT 87177 Ova and Parasite Dir Smr W ID	$72.93	$330.00	$7.03–$280.50	55% above	78%
Stool ova and parasites exam inpatient CPT 87177 Ova and Parasite Dir Smr W ID	$72.93	$330.00	$7.03–$280.50	—	78%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Blood Occult; Qual Consecutive Specimens	$13.26	$60.00	$3.46–$51.00	63% below	78%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Blood Occult; Qual Consecutive Specimens	$13.26	$60.00	$3.46–$51.00	—	78%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Immunochemical Fecal Occult Blood	$25.42	$115.00	$12.58–$97.75	50% below	78%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Immunochemical Fecal Occult Blood	$25.42	$115.00	$12.58–$97.75	—	78%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis Test Non-Trep Qual 562	$38.45	$174.00	$3.37–$147.90	3% below	78%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis Test Non-Trep Qual 562	$38.45	$174.00	$3.37–$147.90	—	78%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 TB Test Cell Immun Measure	$47.52	$215.00	$48.96–$278.91	69% below	78%
TB blood test measuring immune response (IGRA, gamma interferon) inpatient CPT 86480 TB Test Cell Immun Measure	$47.52	$215.00	$48.96–$278.91	—	78%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone; Total	$129.95	$588.00	$20.39–$499.80	27% above	78%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone; Total	$129.95	$588.00	$20.39–$499.80	—	78%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal Ab Ea 552	$38.45	$174.00	$11.49–$147.90	54% below	78%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Microsomal Ab Ea 552	$38.45	$174.00	$11.49–$147.90	—	78%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Stimulating Hormone	$38.01	$172.00	$13.27–$146.20	53% below	78%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Stimulating Hormone	$38.01	$172.00	$13.27–$146.20	—	78%
Trichomonas test (NAAT) CPT 87661 Trichomonas Vaginalis Amplif	$47.52	$215.00	$27.72–$182.75	50% below	78%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas Vaginalis Amplif	$47.52	$215.00	$27.72–$182.75	—	78%
Uric acid blood test CPT 84550 Uric Acid; Bld 417	$19.23	$87.00	$3.57–$73.95	58% below	78%
Uric acid blood test inpatient CPT 84550 Uric Acid; Bld 417	$19.23	$87.00	$3.57–$73.95	—	78%
Urinalysis with microscope exam, automated CPT 81001 Urinalysis Auto W/Scope	$17.90	$81.00	$2.50–$68.85	57% below	78%
Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis Auto W/Scope	$17.90	$81.00	$2.50–$68.85	—	78%
Urinalysis with microscope exam, manual CPT 81000 Urinalysis; Non-Auto W/Micro	$29.39	$133.00	$3.18–$113.05	40% above	78%
Urinalysis with microscope exam, manual inpatient CPT 81000 Urinalysis; Non-Auto W/Micro	$29.39	$133.00	$3.18–$113.05	—	78%
Urinalysis without microscope exam, automated CPT 81003 Urinalysis; Auto WO/Micro 052	$13.04	$59.00	$1.78–$50.15	33% below	78%
Urinalysis without microscope exam, automated inpatient CPT 81003 Urinalysis; Auto WO/Micro 052	$13.04	$59.00	$1.78–$50.15	—	78%
Urinalysis without microscope exam, manual CPT 81002 Pace Urinalysis; Non-Auto WO/Micro	$15.47	$70.00	$2.75–$59.50	43% above	78%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis; Non-Auto WO/Micro	$19.23	$87.00	$2.75–$73.95	78% above	78%
Urinalysis without microscope exam, manual inpatient CPT 81002 Pace Urinalysis; Non-Auto WO/Micro	$15.47	$70.00	$2.75–$59.50	—	78%
Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis; Non-Auto WO/Micro	$19.23	$87.00	$2.75–$73.95	—	78%
Urine culture for bacteria, with colony count CPT 87086 Bact Culture - Urine; Quan Count	$10.17	$46.00	$6.38–$39.10	75% below	78%
Urine culture for bacteria, with colony count inpatient CPT 87086 Bact Culture - Urine; Quan Count	$10.17	$46.00	$6.38–$39.10	—	78%
Urine pregnancy test, read by color change CPT 81025 Urine Pregnancy Test	$35.36	$160.00	$6.80–$136.00	33% below	78%
Urine pregnancy test, read by color change inpatient CPT 81025 Urine Pregnancy Test	$35.36	$160.00	$6.80–$136.00	—	78%
Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (Vit B-12)	$63.43	$287.00	$11.91–$243.95	1% below	78%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Cyanocobalamin (Vit B-12)	$63.43	$287.00	$11.91–$243.95	—	78%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D; 25 Hydroxy	$95.25	$431.00	$23.38–$366.35	19% below	78%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D; 25 Hydroxy	$95.25	$431.00	$23.38–$366.35	—	78%
Zinc blood test CPT 84630 ZINC	$66.96	$303.00	$9.00–$257.55	1% below	78%
Zinc blood test inpatient CPT 84630 ZINC	$66.96	$303.00	$9.00–$257.55	—	78%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg; Quan 429	$82.43	$373.00	$11.89–$317.05	7% above	78%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Hcg; Quan 430	$82.65	$374.00	$11.89–$317.90	8% above	78%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg; Quan 429	$82.43	$373.00	$11.89–$317.05	—	78%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Hcg; Quan 430	$82.65	$374.00	$11.89–$317.90	—	78%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Adenoid removal (adenoidectomy), child under 12 CPT 42830 Adenoidectomy Primary <Age 12	$7,729.31	$34,974.26	$2,273.62–$12,983.28	101% above	78%
Anterior cervical discectomy and fusion (ACDF), one level CPT 22551 Arthrd Ant Interbody Decompress Cervical Belw C2	$26,180.89	$118,465.55	$8,048.20–$50,276.02	47% above	78%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Arthrs Aided Ant Cruciate Ligm Rpr/Agmntj/Rcnstj	$24,371.01	$110,276.05	$1,905.42–$50,276.02	74% above	78%
Arthroscopic rotator cuff repair of the shoulder CPT 29827 Surgical Arthroscopy Shoulder W/Rotator Cuff Rpr	$16,936.49	$76,635.69	$1,905.42–$28,415.19	259% above	78%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion CPT 19081 Bx Breast 1st Lesion Strtctc Hcode	$2,061.93	$9,330.00	$1,747.41–$7,930.50	9% below	78%
Breast needle biopsy guided by mammogram (stereotactic), with marker clip, first lesion inpatient CPT 19081 Bx Breast 1st Lesion Strtctc Hcode	$2,061.93	$9,330.00	$1,747.41–$7,930.50	—	78%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Corrj Hlx Vlgs Bncty Sesmdc Dstl Metar Osteot	$12,934.34	$58,526.43	$1,905.42–$13,183.00	491% above	78%
Cardiac catheterization with coronary angiogram CPT 93458 L Hrt Artery/Ventricle Angio	$8,231.81	$37,248.00	$3,430.00–$31,660.80	14% below	78%
Cardiac catheterization with coronary angiogram inpatient CPT 93458 L Hrt Artery/Ventricle Angio	$8,231.81	$37,248.00	$3,430.00–$31,660.80	—	78%
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion; Ext	$792.51	$3,586.00	$699.29–$3,048.10	43% below	78%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion; Ext	$792.51	$3,586.00	$699.29–$3,048.10	—	78%
Carpal tunnel release, open surgery CPT 64721 Neuroplasty &/Transpos Median Nrv Carpal Tunne	$5,048.22	$22,842.63	$1,728.79–$10,106.00	171% above	78%
Catheter ablation for atrial fibrillation CPT 93656 Comp Ep Eval Tx Atrial Fib Pulm Vein Isol	$9,146.09	$41,385.00	$19,988.96–$102,355.30	67% below	78%
Catheter ablation for atrial fibrillation inpatient CPT 93656 Comp Ep Eval Tx Atrial Fib Pulm Vein Isol	$9,146.09	$41,385.00	$19,988.96–$102,355.30	—	78%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Circumcision Age >28 Days	$552.72	$2,501.00	$1,728.79–$10,106.00	24% below	78%
Colonoscopy with polyp removal CPT 45385 Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$3,044.88	$13,777.76	$153.27–$4,686.01	63% above	78%
Colonoscopy with tissue sample CPT 45380 Colonoscopy W/Biopsy Single/Multiple	$3,013.49	$13,635.72	$153.27–$4,686.01	116% above	78%
Colonoscopy, diagnostic CPT 45378 Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$1,963.71	$8,885.55	$983.90–$4,106.00	69% above	78%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Colposcopy Cervix Bx Cervix & Endocrv Curretage	$4,984.52	$22,554.41	$648.18–$12,676.51	1408% above	78%
Cystoscopy with ureteral stent placement CPT 52332 Cysto W/Insert Ureteral Stent	$9,563.80	$43,275.13	$1,728.79–$13,803.75	60% above	78%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Tympanostomy General Anesthesia	$17,837.65	$80,713.37	$1,905.42–$23,181.94	5518% above	78%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Nasal/Sinus Ndsc W/Rmvl Tiss From Frontal Sinus	$17,286.66	$78,220.18	$2,273.62–$27,636.87	1494% above	78%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Nsl/Sinus Ndsc Max Antrost W/Rmvl Tiss Max Sinus	$15,943.15	$72,140.96	$1,905.42–$27,636.87	183% above	78%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx Interlaminar Crv/Thrc W/Image Guidance Hcode	$418.80	$1,895.00	$915.29–$3,057.00	58% below	78%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn	$1,629.10	$7,371.51	$746.83–$3,057.00	63% above	78%
Epidural steroid injection, neck or mid back, with imaging guidance inpatient CPT 62321 Njx Interlaminar Crv/Thrc W/Image Guidance Hcode	$418.80	$1,895.00	$915.29–$3,057.00	—	78%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection Facet Lumbar/Sacral; Single Lvl Hcode	$174.37	$789.00	$381.09–$3,057.00	84% below	78%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level	$1,533.08	$6,937.01	$935.78–$3,463.57	36% above	78%
Facet joint injection, lower back, one level, with imaging guidance inpatient CPT 64493 Injection Facet Lumbar/Sacral; Single Lvl Hcode	$174.37	$789.00	$381.09–$3,057.00	—	78%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Rpr Aa Hernia 1st 3-10 Cm Reducible	$20,495.83	$92,741.32	$6,849.37–$25,351.35	59% above	78%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Rpr Aa Hernia 1st < 3 Cm Reducible	$8,953.62	$40,514.12	$3,788.10–$15,662.09	22% above	78%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Sigmoidoscopy Flx Dx W/Collj Spec Br/Wa if Pfrmd	$2,028.71	$9,179.70	$153.27–$3,641.71	17% above	78%
Gallbladder removal, laparoscopic CPT 47562 Laparoscopy Surg Cholecystectomy	$16,989.74	$76,876.66	$4,211.34–$26,225.00	181% above	78%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Laps Surg Cholecystectomy W/Cholangiography	$16,586.49	$75,051.97	$4,211.34–$26,225.00	235% above	78%
Hammertoe correction surgery CPT 28285 Correction Hammertoe	$13,097.25	$59,263.58	$1,905.42–$28,415.19	104% above	78%
Hemorrhoid banding (rubber band ligation) CPT 46221 Hemorrhoidectomy Internal Rubber Band Ligations	$8,438.13	$38,181.60	$648.18–$3,641.71	1233% above	78%
Hemorrhoidectomy (internal and external), one area CPT 46255 Hemorrhoidectomy Ntrnl & Xtrnl 1 Column/Group	$5,656.14	$25,593.40	$1,905.42–$10,869.41	266% above	78%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Hysterosalpingography Cath	$354.26	$1,603.00	$285.87–$1,362.55	25% above	78%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes inpatient CPT 58340 Hysterosalpingography Cath	$354.26	$1,603.00	$285.87–$1,362.55	—	78%
Hysteroscopy with endometrial ablation CPT 58563 Hysteroscopy Endometrial Ablation	$7,791.76	$35,256.85	$2,273.62–$19,589.50	19% above	78%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$6,810.24	$30,815.55	$1,905.42–$12,676.51	20% above	78%
IUD insertion (the device itself billed separately) CPT 58300 Insertion Intrauterine Device Iud	$6,740.48	$30,499.92	$648.18–$19,589.50	2372% above	78%
Incision and drainage of a simple or single skin abscess CPT 10060 I & D Absc; Smpl or Sgl Hcode	$119.56	$541.00	$207.40–$785.68	71% below	78%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision and Drainage of Abscess; Smpl or Sgl	$154.70	$700.00	$207.40–$785.68	62% below	78%
Incision and drainage of a simple or single skin abscess CPT 10060 Incision and Drainage of Abscess; Smpl or Sgl	$483.80	$2,189.15	$212.27–$785.68	19% above	78%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 I & D Absc; Smpl or Sgl Hcode	$119.56	$541.00	$207.40–$785.68	—	78%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 Incision and Drainage of Abscess; Smpl or Sgl	$154.70	$700.00	$207.40–$785.68	—	78%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible	$10,066.69	$45,550.65	$2,273.62–$14,020.79	91% above	78%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Inj Tendon Sheath/Ligament	$206.19	$933.00	$285.87–$1,586.10	60% below	78%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection 1 Tendon Sheath/Ligament Aponeurosis	$351.67	$1,591.25	$285.87–$13,183.00	32% below	78%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Inj Tendon Sheath/Ligament	$206.19	$933.00	$285.87–$1,586.10	—	78%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis; Maj Jt Hcode	$277.13	$1,254.00	$285.87–$2,131.80	27% below	78%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Arthrocentesis; Maj Jt Hcode	$1,688.27	$7,639.21	$285.87–$1,202.01	342% above	78%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Arthrocentesis; Maj Jt Hcode	$277.13	$1,254.00	$285.87–$2,131.80	—	78%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Drain/Inj Interm Jnt/Bursa Hcode	$177.24	$802.00	$285.87–$1,202.01	50% below	78%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Drain/Inj Interm Jnt/Bursa Hcode	$177.24	$802.00	$285.87–$1,202.01	—	78%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Drain/Inject Sm Jnt/Bursa Hcode	$148.51	$672.00	$285.87–$571.20	46% below	78%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Drain/Inject Sm Jnt/Bursa Hcode	$148.51	$672.00	$285.87–$571.20	—	78%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Arthroscopy Kne Surg Meniscus Rpr Medial/Lateral	$19,146.62	$86,636.31	$1,905.42–$50,276.02	83% above	78%
Knee arthroscopy with meniscus trim CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$7,358.22	$33,295.12	$2,273.62–$13,183.00	104% above	78%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Arthrs Knee Surg Meniscectomy Med&Lat W/Shaving	$7,057.04	$31,932.30	$2,273.62–$13,183.00	87% above	78%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Laparoscopic Appendectomy	$14,218.30	$64,336.20	$1,905.42–$26,225.00	189% above	78%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Laps Surg Esopg/Gstr Fundoplasty	$30,483.65	$137,935.08	$1,905.42–$41,626.23	1083% above	78%
Laparoscopic hysterectomy (uterus 250 g or less) CPT 58570 Laparoscopy W Total Hysterectomy Uterus 250 Gm/<	$22,530.50	$101,947.97	$4,315.74–$41,626.23	619% above	78%
Laparoscopic hysterectomy, uterus 250 g or less, with tubes and/or ovaries CPT 58571 Laps Total Hysterect 250 Gm/< W/Rmvl Tube/Ovary	$22,296.70	$100,890.05	$4,315.74–$41,626.23	329% above	78%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Laparoscopy Surg Rpr Initial Inguinal Hernia	$21,092.96	$95,443.28	$2,273.62–$26,225.00	391% above	78%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Laps Surg Rpr Recurrent Inguinal Hernia	$23,331.88	$105,574.11	$3,957.76–$26,225.00	951% above	78%
Laparoscopic removal of fallopian tubes and/or ovaries CPT 58661 Laparoscopy W/Rmvl Adnexal Structures	$16,496.04	$74,642.70	$3,121.64–$26,225.00	725% above	78%
Left heart catheterization, diagnostic one side CPT 93452 Left Hrt Cath W/Ventrclgrphy	$2,622.39	$11,866.00	$3,430.00–$19,742.00	66% below	78%
Left heart catheterization, diagnostic inpatient one side CPT 93452 Left Hrt Cath W/Ventrclgrphy	$2,622.39	$11,866.00	$3,430.00–$19,742.00	—	78%
Lower-back epidural injection, with imaging guidance CPT 62323 Njx Interlaminar Lmbr/Sac W/Image Guidance Hcode	$698.36	$3,160.00	$746.83–$3,057.00	41% below	78%
Lower-back epidural injection, with imaging guidance CPT 62323 Njx Interlaminar Lmbr/Sac W/Image Guidance Hcode	$1,644.78	$7,442.46	$746.83–$3,057.00	40% above	78%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Njx Interlaminar Lmbr/Sac W/Image Guidance Hcode	$698.36	$3,160.00	$746.83–$3,057.00	—	78%
Lower-back epidural injection, without imaging guidance CPT 62322 Njx Interlaminar Lmbr/Sac W/O Image Guidance Hcode	$418.80	$1,895.00	$915.29–$3,057.00	68% below	78%
Lower-back epidural injection, without imaging guidance CPT 62322 Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/O Img Gdn	$26,322.15	$119,104.77	$1,905.42–$50,276.02	1926% above	78%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 Njx Interlaminar Lmbr/Sac W/O Image Guidance Hcode	$418.80	$1,895.00	$915.29–$3,057.00	—	78%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection Transforaminal; Lumbar Single Lvl Hcode	$483.99	$2,190.00	$1,057.77–$3,723.00	69% below	78%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level	$1,631.69	$7,383.21	$935.78–$3,463.57	4% above	78%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection Transforaminal; Lumbar Single Lvl Hcode	$483.99	$2,190.00	$1,057.77–$3,723.00	—	78%
Lumbar discectomy or laminotomy to free a nerve root, one level CPT 63030 Laminotomy Dcmprn Nrv Root 1 Ntrspc Lumbar	$13,747.10	$62,204.06	$4,315.74–$28,415.19	38% above	78%
Lumbar laminectomy (spinal decompression), one level CPT 63047 Lam Facetectomy & Foramotomy 1 Vrt Sgm Lumbar	$12,992.31	$58,788.74	$4,315.74–$28,415.19	31% above	78%
Lumpectomy (partial mastectomy) CPT 19301 Mastectomy Partial	$13,115.03	$59,344.01	$1,905.42–$26,002.76	784% above	78%
Mastectomy (total removal of the breast) CPT 19303 Mastectomy Simple Complete	$17,607.47	$79,671.82	$2,273.62–$26,002.76	747% above	78%
Miscarriage treatment with D&C, first trimester CPT 59820 Tx Missed Abortion First Trimester Surgical	$4,563.23	$20,648.11	$1,242.31–$12,676.51	187% above	78%
Nail removal (partial or complete), one nail CPT 11730 Avulsion Nail Plate Partial/Complete Simple 1	$5,279.18	$23,887.70	$285.87–$3,057.00	1519% above	78%
Pacemaker implant (dual chamber) CPT 33208 Insrt Heart Pm Atrial & Vent	$2,255.31	$10,205.00	$4,929.02–$77,684.00	81% below	78%
Pacemaker implant (dual chamber) inpatient CPT 33208 Insrt Heart Pm Atrial & Vent	$2,255.31	$10,205.00	$4,929.02–$77,684.00	—	78%
Paracentesis with imaging guidance CPT 49083 Abd Paracentesis W/Imaging	$998.92	$4,520.00	$959.60–$4,106.00	26% below	78%
Paracentesis with imaging guidance inpatient CPT 49083 Abd Paracentesis W/Imaging	$998.92	$4,520.00	$959.60–$4,106.00	—	78%
Partial knee replacement (one compartment) CPT 27446 Arthrp Knee Condyle&Plateau Medial/Lat Cmprt	$29,544.44	$133,685.27	$3,121.64–$50,276.02	473% above	78%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Excision Nail&Nail Matrix Prtl/Compl Perm Rmvl	$4,993.23	$22,593.81	$430.10–$1,591.89	710% above	78%
Prostate biopsy CPT 55700 Biopsy Prostate; Needle/Punch	$3,521.64	$15,935.00	$379.24–$4,106.00	10% above	78%
Radiofrequency ablation of facet joint nerves, lower back, one level CPT 64635 Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral	$3,587.15	$16,231.46	$2,066.00–$10,106.00	75% above	78%
Removal of a breast lump, open surgery CPT 19120 Exc Cyst/Aberrant Breast Tissue Open 1/> Lesion	$7,317.04	$33,108.79	$1,905.42–$15,332.75	558% above	78%
Removal of a foreign object under the skin, simple CPT 10120 Incision & Removal FB Sq;Simple	$262.77	$1,189.00	$381.15–$1,010.65	39% below	78%
Removal of a foreign object under the skin, simple CPT 10120 Foreign Body Removal; Simple	$3,634.51	$16,445.76	$381.15–$1,591.89	742% above	78%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Incision & Removal FB Sq;Simple	$262.77	$1,189.00	$381.15–$1,010.65	—	78%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 Total Thyroid Lobectomy Uni W/WO Isthmusectomy	$20,603.56	$93,228.78	$1,728.79–$26,225.00	667% above	78%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 Colon Ca Scrn Not Hi Rsk Ind	$1,962.49	$8,880.05	$153.27–$3,641.71	19% above	78%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 Colorectal Scrn; Hi Risk Ind	$2,174.41	$9,838.95	$153.27–$4,106.00	68% above	78%
Septoplasty to straighten the nasal septum CPT 30520 Septoplasty/Submucous Resecj W/WO Cartilage Grf	$9,203.89	$41,646.58	$2,273.62–$12,983.28	269% above	78%
Shoulder arthroscopy with removal of the end of the collarbone (distal clavicle) CPT 29824 Surgical Arthroscopy Shoulder Dstl Claviculc	$16,433.26	$74,358.63	$3,121.64–$28,415.19	791% above	78%
Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls	$18,850.29	$85,295.44	$2,273.62–$28,415.19	161% above	78%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<	$13,493.02	$61,054.39	$381.15–$26,225.00	5116% above	78%
Skin biopsy, punch, one lesion CPT 11104 Punch Bx Skin Single Lesion Hcode	$1,907.67	$8,632.00	$430.10–$1,591.89	378% above	78%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Spinal Lumbar Puncture Diagnostic HCODE	$579.90	$2,624.00	$746.83–$3,057.00	39% below	78%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Spinal Lumbar Puncture Diagnostic HCODE	$579.90	$2,624.00	$746.83–$3,057.00	—	78%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm	$2,478.69	$11,215.80	$430.10–$1,591.89	701% above	78%
Thoracentesis with imaging guidance CPT 32555 Aspirate Pleura W/ Imaging Hcode	$1,095.50	$4,957.00	$663.69–$8,426.90	at median	78%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspirate Pleura W/ Imaging Hcode	$1,095.50	$4,957.00	$663.69–$8,426.90	—	78%
Tonsil and adenoid removal, age 12 or older CPT 42821 Tonsillectomy & Adenoidectomy Age 12/>	$7,816.35	$35,368.09	$3,121.64–$12,983.28	141% above	78%
Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12	$7,592.29	$34,354.26	$3,121.64–$23,181.94	152% above	78%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Tonsillectomy Primary/Secondary Age 12/>	$17,260.68	$78,102.64	$2,273.62–$23,181.94	2834% above	78%
Total hip replacement CPT 27130 Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft	$27,088.36	$122,571.75	$13,583.45–$50,276.02	334% above	78%
Total knee replacement CPT 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments	$29,209.53	$132,169.80	$13,583.45–$50,276.02	157% above	78%
Total shoulder replacement CPT 23472 Arthroplasty Glenohumeral Joint Total Shoulder	$34,812.00	$157,520.34	$18,550.96–$68,662.07	115% above	78%
Total thyroid removal (thyroidectomy) CPT 60240 Thyroidectomy Total/Complete	$23,757.10	$107,498.20	$4,315.74–$26,225.00	981% above	78%
Trigger finger release surgery CPT 26055 Tendon Sheath Incision	$4,476.40	$20,255.22	$1,728.79–$10,106.00	123% above	78%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Sngl/Multiple Points 1 or 2 Mucscle Hcode	$175.92	$796.00	$285.87–$1,353.20	66% below	78%
Trigger point injections, 1 or 2 muscles CPT 20552 Inj Sngl/Multiple Points 1 or 2 Mucscle Hcode	$584.84	$2,646.35	$285.87–$1,202.01	14% above	78%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 Inj Sngl/Multiple Points 1 or 2 Mucscle Hcode	$175.92	$796.00	$285.87–$1,353.20	—	78%
Ultrasound-guided breast needle biopsy with marker clip, first lesion CPT 19083 Bx Breast 1st Lesion US Imag Hcode	$1,643.14	$7,435.00	$1,747.41–$12,639.50	14% below	78%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient CPT 19083 Bx Breast 1st Lesion US Imag Hcode	$1,643.14	$7,435.00	$1,747.41–$12,639.50	—	78%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Egd Balloon Dilation Esophagus <30 Mm Diam	$3,168.76	$14,338.30	$153.27–$7,514.39	6% above	78%
Upper endoscopy (EGD) with biopsy CPT 43239 Egd Transoral Biopsy Single/Multiple	$2,583.13	$11,688.36	$153.27–$4,106.00	31% above	78%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Egd Removal Tumor Polyp/Other Lesion Snare Tech	$2,989.05	$13,525.10	$153.27–$7,514.39	49% above	78%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Egd Insert Guide Wire Dilator Passage Esophagus	$2,268.01	$10,262.49	$153.27–$4,106.00	3% above	78%
Upper endoscopy (EGD), diagnostic CPT 43235 Esophagogastroduodenoscopy Transoral Diagnostic	$2,101.80	$9,510.42	$153.27–$4,106.00	57% above	78%
Ureteroscopy with laser stone breaking and stent placement CPT 52356 Cysto/Uretero W/Lithotripsy &Indwell Stent Insrt	$14,457.56	$65,418.83	$5,672.83–$20,996.67	27% above	78%
Vein ablation, radiofrequency, first vein CPT 36475 Endovenous Rf 1st Vein	$10,700.23	$48,417.35	$3,121.64–$21,790.40	145% above	78%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq Tissue 20 Sq Cm or Less Hcode	$277.13	$1,254.00	$430.10–$2,074.55	60% below	78%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Debride Subq Tissue 20 Sq Cm or Less Hcode	$678.47	$3,070.00	$430.10–$2,074.55	2% below	78%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Debride Subq Tissue 20 Sq Cm or Less Hcode	$277.13	$1,254.00	$430.10–$2,074.55	—	78%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Optx Dstl Rdl X-Artic Fx/Epiphysl Separation	$16,867.70	$76,324.45	$3,121.64–$28,415.19	901% above	78%

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	$395.15	$1,788.00	$466.77–$1,727.63	56% below	78%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood or Blood Components	$460.34	$2,083.00	$466.77–$1,770.55	49% below	78%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 4 Hours	$643.99	$2,914.00	$466.77–$2,476.90	28% below	78%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 6 Hours	$858.59	$3,885.00	$466.77–$3,302.25	5% below	78%
Blood transfusion (giving blood or blood components) CPT 36430 Transfusion Blood 8 Hours	$1,073.18	$4,856.00	$466.77–$4,127.60	19% above	78%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 2 Hours	$395.15	$1,788.00	$466.77–$1,727.63	—	78%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood or Blood Components	$460.34	$2,083.00	$466.77–$1,770.55	—	78%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 4 Hours	$643.99	$2,914.00	$466.77–$2,476.90	—	78%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 6 Hours	$858.59	$3,885.00	$466.77–$3,302.25	—	78%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Transfusion Blood 8 Hours	$1,073.18	$4,856.00	$466.77–$4,127.60	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Pep Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Mdi/Dpi Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Nebulizer Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Ippb Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Aerosol Treatment;Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Aerosol	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Pep	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Mdi/Dpi	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; Nebulizer	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Airway Inhalation Treatment; E-Z Pap	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 E-Z Pap Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	69% below	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Pep Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Mdi/Dpi	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Pep	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Aerosol	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Nebulizer Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Aerosol Treatment;Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; E-Z Pap	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Ippb Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 E-Z Pap Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Airway Inhalation Treatment; Nebulizer	$34.70	$157.00	$24.84–$857.51	—	78%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Mdi/Dpi Treatment; Subseq	$34.70	$157.00	$24.84–$857.51	—	78%
Chemotherapy IV infusion, first hour CPT 96413 Chemo Admin IV Inf Up to 1 Hr Sgl or Init Subs	$579.90	$2,624.00	$324.60–$2,230.40	4% below	78%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Chemo Admin IV Inf Up to 1 Hr Sgl or Init Subs	$579.90	$2,624.00	$324.60–$2,230.40	—	78%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive Audio Evaluation	$119.12	$539.00	$136.14–$503.90	29% below	78%
Comprehensive hearing test: tone and speech audiometry, both ears inpatient CPT 92557 Comprehensive Audio Evaluation	$119.12	$539.00	$136.14–$503.90	—	78%
Critical care, first 30 to 74 minutes CPT 99291 Emergency Visit Level 6	$1,322.91	$5,986.00	$295.62–$5,088.10	31% below	78%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 7 Tta Consult/Eval	$2,150.11	$9,729.00	$295.62–$8,269.65	13% above	78%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 8	$2,977.09	$13,471.00	$295.62–$11,450.35	56% above	78%
Critical care, first 30 to 74 minutes CPT 99291 Emerg Visit Lvl 9 Tta Full Alert	$3,638.77	$16,465.00	$295.62–$13,995.25	90% above	78%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emergency Visit Level 6	$1,322.91	$5,986.00	$295.62–$5,088.10	—	78%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 7 Tta Consult/Eval	$2,150.11	$9,729.00	$295.62–$8,269.65	—	78%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 8	$2,977.09	$13,471.00	$295.62–$11,450.35	—	78%
Critical care, first 30 to 74 minutes inpatient CPT 99291 Emerg Visit Lvl 9 Tta Full Alert	$3,638.77	$16,465.00	$295.62–$13,995.25	—	78%
EEG (brain wave test), awake and drowsy, routine CPT 95816 Eeg; Incl Record Awake / Drowsy	$644.44	$2,916.00	$228.45–$2,478.60	1% below	78%
EEG (brain wave test), awake and drowsy, routine inpatient CPT 95816 Eeg; Incl Record Awake / Drowsy	$644.44	$2,916.00	$228.45–$2,478.60	—	78%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Ekg/12 Lds; Tracing Only	$76.91	$348.00	$62.41–$295.80	62% below	78%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 Ekg/12 Lds; Tracing Only	$76.91	$348.00	$62.41–$295.80	—	78%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency Visit Level 1	$99.45	$450.00	$89.22–$382.50	33% below	78%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 Emergency Visit Level 1	$99.45	$450.00	$89.22–$382.50	—	78%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency Visit Level 2	$198.68	$899.00	$162.45–$764.15	36% below	78%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 Emergency Visit Level 2	$198.68	$899.00	$162.45–$764.15	—	78%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency Visit Level 3	$463.44	$2,097.00	$288.81–$1,782.45	26% below	78%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 Emergency Visit Level 3	$463.44	$2,097.00	$288.81–$1,782.45	—	78%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency Visit Level 4	$661.67	$2,994.00	$295.62–$2,544.90	35% below	78%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 Emergency Visit Level 4	$661.67	$2,994.00	$295.62–$2,544.90	—	78%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency Visit Level 5	$992.51	$4,491.00	$295.62–$3,817.35	35% below	78%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 Emergency Visit Level 5	$992.51	$4,491.00	$295.62–$3,817.35	—	78%
Exercise stress test, tracing only, the hospital charge CPT 93017 Cardio Stress Test; Tracing Only	$335.48	$1,518.00	$228.45–$1,290.30	52% below	78%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Cardio Stress Test; Tracing Only	$335.48	$1,518.00	$228.45–$1,290.30	—	78%
Family therapy with the patient, 50 minutes CPT 90847 Family Therapy W Pt	$306.09	$1,385.00	$79.56–$1,177.25	61% above	78%
Family therapy with the patient, 50 minutes inpatient CPT 90847 Family Therapy W Pt	$306.09	$1,385.00	$79.56–$1,177.25	—	78%
Group psychotherapy session CPT 90853 Nutrition Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Leisure Skills Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Medication Education Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Relaxation Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Discharge Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Community Meeting Group Therapy	$97.02	$439.00	$79.56–$373.15	52% below	78%
Group psychotherapy session CPT 90853 Ot Group Therapy Not Multi-Family	$106.52	$482.00	$79.56–$409.70	47% below	78%
Group psychotherapy session CPT 90853 Group Therapy Not Multi-Family	$106.52	$482.00	$79.56–$409.70	47% below	78%
Group psychotherapy session inpatient CPT 90853 Relaxation Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Community Meeting Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Leisure Skills Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Medication Education Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Discharge Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Nutrition Group Therapy	$97.02	$439.00	$79.56–$373.15	—	78%
Group psychotherapy session inpatient CPT 90853 Ot Group Therapy Not Multi-Family	$106.52	$482.00	$79.56–$409.70	—	78%
Group psychotherapy session inpatient CPT 90853 Group Therapy Not Multi-Family	$106.52	$482.00	$79.56–$409.70	—	78%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 IV Inf Hydration; Init 31-60 Min	$131.50	$595.00	$73.71–$832.95	64% below	78%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 IV Inf Hydration; Init 31-60 Min	$131.50	$595.00	$73.71–$832.95	—	78%
IV infusion of a medicine, first hour CPT 96365 IV Inf Tx/Dx/Proph; Init Up to 1 Hr	$162.44	$735.00	$73.71–$832.95	59% below	78%
IV infusion of a medicine, first hour inpatient CPT 96365 IV Inf Tx/Dx/Proph; Init Up to 1 Hr	$162.44	$735.00	$73.71–$832.95	—	78%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Ther/Proph/Diag Inj Sc/Im	$45.53	$206.00	$76.18–$281.96	54% below	78%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Tx/Dx/Proph; Im	$45.53	$206.00	$76.18–$281.96	54% below	78%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Inj Tx/Dx/Proph; Im Sq	$48.40	$219.00	$73.71–$281.96	51% below	78%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Ther/Proph/Diag Inj Sc/Im	$45.53	$206.00	$76.18–$281.96	—	78%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Tx/Dx/Proph; Im	$45.53	$206.00	$76.18–$281.96	—	78%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Inj Tx/Dx/Proph; Im Sq	$48.40	$219.00	$73.71–$281.96	—	78%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 Psych Diagnostic Eval	$186.97	$846.00	$159.12–$719.10	9% below	78%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 Psych Diagnostic Eval	$186.97	$846.00	$159.12–$719.10	—	78%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Motor&/Sens 7-8 Nrv Cndj Tst	$1,127.54	$5,102.00	$168.13–$4,336.70	84% above	78%
Nerve conduction study, 7 or 8 nerve studies inpatient CPT 95910 Motor&/Sens 7-8 Nrv Cndj Tst	$1,127.54	$5,102.00	$168.13–$4,336.70	—	78%
Neuromuscular re-education, 15 minutes CPT 97112 Pace Neuromuscular Reeducation 15m Pt	$55.03	$249.00	$31.57–$223.75	20% below	78%
Neuromuscular re-education, 15 minutes CPT 97112 Pace Neuromuscular Reeducation 15m Ot	$55.03	$249.00	$31.57–$223.75	20% below	78%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Ea 15 Min Pt	$58.34	$264.00	$31.57–$224.40	15% below	78%
Neuromuscular re-education, 15 minutes CPT 97112 Neuromuscular Reeducation Ea 15 Min Ot	$58.34	$264.00	$31.57–$224.40	15% below	78%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pace Neuromuscular Reeducation 15m Ot	$55.03	$249.00	$31.57–$223.75	—	78%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Pace Neuromuscular Reeducation 15m Pt	$55.03	$249.00	$31.57–$223.75	—	78%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Ea 15 Min Ot	$58.34	$264.00	$31.57–$224.40	—	78%
Neuromuscular re-education, 15 minutes inpatient CPT 97112 Neuromuscular Reeducation Ea 15 Min Pt	$58.34	$264.00	$31.57–$224.40	—	78%
New patient office visit, about 30 minutes CPT 99203 Pace OP Visit E&M of New Patient; Level 3	$58.12	$263.00	$67.80–$223.55	57% below	78%
New patient office visit, about 30 minutes CPT 99203 OP Visit E&M of New Patient;Level 3	$113.15	$512.00	$140.86–$435.20	15% below	78%
New patient office visit, about 30 minutes CPT 99203 OP Visit E&M of New Patient; Level 3	$152.71	$691.00	$135.60–$587.35	14% above	78%
New patient office visit, about 30 minutes inpatient CPT 99203 Pace OP Visit E&M of New Patient; Level 3	$58.12	$263.00	$67.80–$223.55	—	78%
New patient office visit, about 30 minutes inpatient CPT 99203 OP Visit E&M of New Patient;Level 3	$113.15	$512.00	$140.86–$435.20	—	78%
New patient office visit, about 30 minutes inpatient CPT 99203 OP Visit E&M of New Patient; Level 3	$152.71	$691.00	$135.60–$587.35	—	78%
New patient office visit, about 45 minutes CPT 99204 Pace OP Visit E&M of New Patient; Level 4	$67.85	$307.00	$111.17–$260.95	55% below	78%
New patient office visit, about 45 minutes CPT 99204 OP Visit E&M of New Patient;Level 4	$128.18	$580.00	$140.86–$493.00	15% below	78%
New patient office visit, about 45 minutes CPT 99204 OP Visit E&M of New Patient; Level 4	$182.77	$827.00	$140.86–$702.95	21% above	78%
New patient office visit, about 45 minutes inpatient CPT 99204 Pace OP Visit E&M of New Patient; Level 4	$67.85	$307.00	$111.17–$260.95	—	78%
New patient office visit, about 45 minutes inpatient CPT 99204 OP Visit E&M of New Patient;Level 4	$128.18	$580.00	$140.86–$493.00	—	78%
New patient office visit, about 45 minutes inpatient CPT 99204 OP Visit E&M of New Patient; Level 4	$182.77	$827.00	$140.86–$702.95	—	78%
New patient office visit, about 60 minutes CPT 99205 Pace OP Visit E&M of New Patient; Level 5	$83.98	$380.00	$151.85–$323.00	55% below	78%
New patient office visit, about 60 minutes CPT 99205 OP Visit E&M of New Patient;Level 5	$146.30	$662.00	$142.67–$562.70	22% below	78%
New patient office visit, about 60 minutes CPT 99205 OP Visit E&M of New Patient; Level 5	$213.04	$964.00	$142.67–$819.40	14% above	78%
New patient office visit, about 60 minutes inpatient CPT 99205 Pace OP Visit E&M of New Patient; Level 5	$83.98	$380.00	$151.85–$323.00	—	78%
New patient office visit, about 60 minutes inpatient CPT 99205 OP Visit E&M of New Patient;Level 5	$146.30	$662.00	$142.67–$562.70	—	78%
New patient office visit, about 60 minutes inpatient CPT 99205 OP Visit E&M of New Patient; Level 5	$213.04	$964.00	$142.67–$819.40	—	78%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 Pace OP Visit E&M of New Patient; Level 2	$48.18	$218.00	$39.32–$190.94	52% below	78%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit E&M of New Patient;Level 2	$98.12	$444.00	$140.86–$377.40	3% below	78%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 OP Visit E&M of New Patient; Level 2	$122.21	$553.00	$140.86–$470.05	21% above	78%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 Pace OP Visit E&M of New Patient; Level 2	$48.18	$218.00	$39.32–$190.94	—	78%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP Visit E&M of New Patient;Level 2	$98.12	$444.00	$140.86–$377.40	—	78%
New patient office visit, straightforward problem or 15+ minutes inpatient CPT 99202 OP Visit E&M of New Patient; Level 2	$122.21	$553.00	$140.86–$470.05	—	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Mnt; Init Assmnt Ea 15 Min	$14.37	$65.00	$25.61–$55.25	57% below	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Medical Nutrition Indiv In	$15.47	$70.00	$25.61–$59.50	54% below	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Pace Mnt; Init Assmnt Ea 15 Min	$29.39	$133.00	$25.61–$113.05	13% below	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Mnt; Init Assmnt Ea 15 Min	$14.37	$65.00	$25.61–$55.25	—	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Medical Nutrition Indiv In	$15.47	$70.00	$25.61–$59.50	—	78%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 Pace Mnt; Init Assmnt Ea 15 Min	$29.39	$133.00	$25.61–$113.05	—	78%
Occupational therapy evaluation, low complexity CPT 97165 Pace Ot Eval Low Complex; 30 Min	$79.78	$361.00	$97.29–$306.85	50% below	78%
Occupational therapy evaluation, low complexity CPT 97165 Ot Eval Low Complex 30 Min	$106.96	$484.00	$97.29–$411.40	33% below	78%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Pace Ot Eval Low Complex; 30 Min	$79.78	$361.00	$97.29–$306.85	—	78%
Occupational therapy evaluation, low complexity inpatient CPT 97165 Ot Eval Low Complex 30 Min	$106.96	$484.00	$97.29–$411.40	—	78%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pace Pt Eval High Complex; 45 Min	$119.12	$539.00	$94.80–$458.15	48% below	78%
Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 Pt Eval High Complex 45 Min	$238.46	$1,079.00	$94.80–$917.15	3% above	78%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pace Pt Eval High Complex; 45 Min	$119.12	$539.00	$94.80–$458.15	—	78%
Physical therapy evaluation, high complexity (typically about 45 minutes) inpatient CPT 97163 Pt Eval High Complex 45 Min	$238.46	$1,079.00	$94.80–$917.15	—	78%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pace Pt Eval Low Complex; 20 Min	$79.78	$361.00	$94.80–$306.85	43% below	78%
Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 Pt Eval Low Complex 20 Min	$113.15	$512.00	$94.80–$435.20	20% below	78%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pace Pt Eval Low Complex; 20 Min	$79.78	$361.00	$94.80–$306.85	—	78%
Physical therapy evaluation, low complexity (typically about 20 minutes) inpatient CPT 97161 Pt Eval Low Complex 20 Min	$113.15	$512.00	$94.80–$435.20	—	78%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pace Pt Eval Mod Complex; 30 Min	$113.15	$512.00	$94.80–$435.20	37% below	78%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 Pt Eval Mod Complex 30 Min	$171.05	$774.00	$94.80–$657.90	5% below	78%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pace Pt Eval Mod Complex; 30 Min	$113.15	$512.00	$94.80–$435.20	—	78%
Physical therapy evaluation, moderate complexity (typically about 30 minutes) inpatient CPT 97162 Pt Eval Mod Complex 30 Min	$171.05	$774.00	$94.80–$657.90	—	78%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 HC Pace Manual Therapy 1> Regions Ea 15 Mins Ot	$35.80	$162.00	$26.73–$223.75	34% below	78%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Pace Manual Therapy 1> Regions Ea 15 Mins Pt	$35.80	$162.00	$26.73–$223.75	34% below	78%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Pt	$61.22	$277.00	$26.73–$235.45	13% above	78%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Ot	$61.22	$277.00	$26.73–$235.45	13% above	78%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Pace Manual Therapy 1> Regions Ea 15 Mins Pt	$35.80	$162.00	$26.73–$223.75	—	78%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 HC Pace Manual Therapy 1> Regions Ea 15 Mins Ot	$35.80	$162.00	$26.73–$223.75	—	78%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Pt	$61.22	$277.00	$26.73–$235.45	—	78%
Physical therapy, hands-on manual therapy (15-minute unit) inpatient CPT 97140 Manual Therapy 1/> Regions Ea 15 Mins Ot	$61.22	$277.00	$26.73–$235.45	—	78%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pace Therapeutic Exercises 15 Min Ot	$35.80	$162.00	$28.03–$223.75	34% below	78%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pace Therapeutic Exercises 15 Min Pt	$35.80	$162.00	$28.03–$223.75	34% below	78%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises Ea 15 Min Ot	$61.22	$277.00	$28.03–$235.45	13% above	78%
Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapeutic Exercises Ea 15 Min Pt	$61.22	$277.00	$28.03–$235.45	13% above	78%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pace Therapeutic Exercises 15 Min Pt	$35.80	$162.00	$28.03–$223.75	—	78%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Pace Therapeutic Exercises 15 Min Ot	$35.80	$162.00	$28.03–$223.75	—	78%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises Ea 15 Min Pt	$61.22	$277.00	$28.03–$235.45	—	78%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapeutic Exercises Ea 15 Min Ot	$61.22	$277.00	$28.03–$235.45	—	78%
Psychiatric evaluation with medical services CPT 90792 Psych Diag Eval W/Med Srvcs	$103.43	$468.00	$159.12–$397.80	30% below	78%
Psychiatric evaluation with medical services inpatient CPT 90792 Psych Diag Eval W/Med Srvcs	$103.43	$468.00	$159.12–$397.80	—	78%
Psychotherapy session, 30 minutes CPT 90832 Pace Psytx Pt&/Family 30 Mins Typ 4	$80.67	$365.00	$159.12–$310.25	10% below	78%
Psychotherapy session, 30 minutes CPT 90832 Psytx Pt 30 Mins Typ 4	$122.66	$555.00	$159.12–$471.75	36% above	78%
Psychotherapy session, 30 minutes inpatient CPT 90832 Pace Psytx Pt&/Family 30 Mins Typ 4	$80.67	$365.00	$159.12–$310.25	—	78%
Psychotherapy session, 30 minutes inpatient CPT 90832 Psytx Pt 30 Mins Typ 4	$122.66	$555.00	$159.12–$471.75	—	78%
Psychotherapy session, 60 minutes CPT 90837 Psytx Pt 60 Mins	$212.60	$962.00	$159.12–$817.70	20% above	78%
Psychotherapy session, 60 minutes inpatient CPT 90837 Psytx Pt 60 Mins	$212.60	$962.00	$159.12–$817.70	—	78%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Behav Chng Smoking Greater Than 3 Min Up to 10 Min	$13.70	$62.00	$29.95–$146.71	52% below	78%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Tobacco-Use Counsel 3-10 Min	$13.70	$62.00	$29.95–$146.71	52% below	78%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Behav Chng Smoking Greater Than 3 Min Up to 10 Min	$13.70	$62.00	$29.95–$146.71	—	78%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 Tobacco-Use Counsel 3-10 Min	$13.70	$62.00	$29.95–$146.71	—	78%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Pace OP Visit E&M of Established Patient; Level 5	$83.98	$380.00	$120.15–$323.00	16% below	78%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit E&M of Established Patient;Level 5	$122.21	$553.00	$140.86–$470.05	22% above	78%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 OP Visit E&M of Established Patient; Level 5	$213.04	$964.00	$140.86–$819.40	113% above	78%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 Pace OP Visit E&M of Established Patient; Level 5	$83.98	$380.00	$120.15–$323.00	—	78%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP Visit E&M of Established Patient;Level 5	$122.21	$553.00	$140.86–$470.05	—	78%
Returning patient office visit, high complexity or 40+ minutes inpatient CPT 99215 OP Visit E&M of Established Patient; Level 5	$213.04	$964.00	$140.86–$819.40	—	78%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Pace OP Visit E&M of Established Patient; Level 3	$51.94	$235.00	$55.10–$199.75	8% below	78%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit E&M of Established Patient;Level 3	$91.49	$414.00	$140.86–$351.90	62% above	78%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 OP Visit E&M of Established Patient; Level 3	$152.71	$691.00	$140.86–$587.35	171% above	78%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 Pace OP Visit E&M of Established Patient; Level 3	$51.94	$235.00	$55.10–$199.75	—	78%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP Visit E&M of Established Patient;Level 3	$91.49	$414.00	$140.86–$351.90	—	78%
Returning patient office visit, low complexity or 20+ minutes inpatient CPT 99213 OP Visit E&M of Established Patient; Level 3	$152.71	$691.00	$140.86–$587.35	—	78%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Pace OP Visit E&M of Established Patient; Level 4	$61.66	$279.00	$80.95–$237.15	18% below	78%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit E&M of Established Patient;Level 4	$106.96	$484.00	$140.86–$411.40	42% above	78%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OP Visit E&M of Established Patient; Level 4	$182.77	$827.00	$140.86–$702.95	143% above	78%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 Pace OP Visit E&M of Established Patient; Level 4	$61.66	$279.00	$80.95–$237.15	—	78%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP Visit E&M of Established Patient;Level 4	$106.96	$484.00	$140.86–$411.40	—	78%
Returning patient office visit, moderate complexity or 30+ minutes inpatient CPT 99214 OP Visit E&M of Established Patient; Level 4	$182.77	$827.00	$140.86–$702.95	—	78%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Pace OP Visit E&M of Established Patient; Level 2	$42.21	$191.00	$29.62–$190.94	2% above	78%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit E&M of Established Patient;Level 2	$76.25	$345.00	$56.34–$293.25	83% above	78%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OP Visit E&M of Established Patient; Level 2	$122.21	$553.00	$56.34–$470.05	194% above	78%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Pace OP Visit E&M of Established Patient; Level 2	$42.21	$191.00	$29.62–$190.94	—	78%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP Visit E&M of Established Patient;Level 2	$76.25	$345.00	$56.34–$293.25	—	78%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 OP Visit E&M of Established Patient; Level 2	$122.21	$553.00	$56.34–$470.05	—	78%
Speech and language evaluation CPT 92523 Speech Sound Lang Comprehen	$166.41	$753.00	$186.46–$640.05	18% below	78%
Speech and language evaluation inpatient CPT 92523 Speech Sound Lang Comprehen	$166.41	$753.00	$186.46–$640.05	—	78%
Speech therapy session, individual CPT 92507 Speech/Hearing Therapy, Individual	$149.84	$678.00	$73.98–$576.30	52% above	78%
Speech therapy session, individual inpatient CPT 92507 Speech/Hearing Therapy, Individual	$149.84	$678.00	$73.98–$576.30	—	78%
Spirometry (breathing test) CPT 94010 Spirometry	$145.20	$657.00	$141.84–$845.56	40% below	78%
Spirometry (breathing test) inpatient CPT 94010 Spirometry	$145.20	$657.00	$141.84–$845.56	—	78%
Spirometry before and after a bronchodilator CPT 94060 Bronchospasm - Pre & Post Bd	$175.25	$793.00	$141.84–$1,461.27	68% below	78%
Spirometry before and after a bronchodilator inpatient CPT 94060 Bronchospasm - Pre & Post Bd	$175.25	$793.00	$141.84–$1,461.27	—	78%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Ea 15 Min Ot	$39.78	$180.00	$33.60–$223.75	31% below	78%
Therapeutic activities (functional training), 15 minutes CPT 97530 Therapeutic Activities Ea 15 Min Pt	$39.78	$180.00	$33.60–$223.75	31% below	78%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pace Therapeutic Activities Pt	$55.03	$249.00	$33.60–$223.75	4% below	78%
Therapeutic activities (functional training), 15 minutes CPT 97530 Pace Therapeutic Activities Ot	$55.03	$249.00	$33.60–$223.75	4% below	78%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Ea 15 Min Pt	$39.78	$180.00	$33.60–$223.75	—	78%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Therapeutic Activities Ea 15 Min Ot	$39.78	$180.00	$33.60–$223.75	—	78%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pace Therapeutic Activities Pt	$55.03	$249.00	$33.60–$223.75	—	78%
Therapeutic activities (functional training), 15 minutes inpatient CPT 97530 Pace Therapeutic Activities Ot	$55.03	$249.00	$33.60–$223.75	—	78%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Therapeutic	$180.56	$817.00	$140.77–$694.45	11% below	78%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Phlebotomy Therapeutic 073	$180.56	$817.00	$140.77–$694.45	11% below	78%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy Therapeutic 073	$180.56	$817.00	$140.77–$694.45	—	78%
Therapeutic phlebotomy (removing blood as treatment) inpatient CPT 99195 Phlebotomy Therapeutic	$180.56	$817.00	$140.77–$694.45	—	78%

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	$390.53	$1,767.10	$200.93–$1,502.04	4% above	78%
Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP	$390.53	$1,767.10	$200.93–$1,502.04	—	78%
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	$7.74	$35.00	$22.75–$46.44	81% below	78%
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	$7.74	$35.00	$22.75–$46.44	—	78%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE	$635.18	$2,874.10	$344.76–$2,442.99	1% above	78%
HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE	$635.18	$2,874.10	$344.76–$2,442.99	—	78%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SYRINGE	$161.58	$731.15	$315.35–$621.48	5% below	78%
Hepatitis A vaccine, adult dose CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SUSPENSION	$163.56	$740.10	$315.35–$629.09	4% below	78%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SYRINGE	$161.58	$731.15	$315.35–$621.48	—	78%
Hepatitis A vaccine, adult dose inpatient CPT 90632 HEPATITIS A VIRUS VACCINE (PF) 50 UNIT/ML INTRAMUSCULAR SUSPENSION	$163.56	$740.10	$315.35–$629.09	—	78%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP	$124.17	$561.85	$124.00–$477.57	29% below	78%
Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP	$124.17	$561.85	$124.00–$477.57	—	78%
MMR vaccine (measles, mumps and rubella), live CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$206.73	$935.45	$451.82–$795.13	10% below	78%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT	$206.73	$935.45	$451.82–$795.13	—	78%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$68.51	$310.00	$212.97–$1,298.99	89% below	78%
Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE	$68.51	$310.00	$212.97–$1,298.99	—	78%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$932.21	$4,218.15	$2,741.80–$3,585.43	18% below	78%
RSV antibody shot for infants, seasonal dose (0.5 mL) inpatient CPT 90380 NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE	$932.21	$4,218.15	$2,741.80–$3,585.43	—	78%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy CPT 90678 RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION	$555.05	$2,511.55	$1,632.51–$2,134.82	11% below	78%
RSV vaccine (Abrysvo), one dose for older adults or during pregnancy inpatient CPT 90678 RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION	$555.05	$2,511.55	$1,632.51–$2,134.82	—	78%
Rabies vaccine, one dose CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION	$731.42	$3,309.60	$319.75–$2,813.16	10% below	78%
Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION	$731.42	$3,309.60	$319.75–$2,813.16	—	78%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION	$322.74	$1,460.35	$226.28–$1,241.30	17% below	78%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT	$456.98	$2,067.80	$998.75–$1,757.63	17% above	78%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOP E VACCINE (VIAL 2 OF 2) 50 MCG IM SUSPENSION	$322.74	$1,460.35	$226.28–$1,241.30	—	78%
Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT	$456.98	$2,067.80	$998.75–$1,757.63	—	78%
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	$82.08	$371.40	$128.90–$315.69	19% below	78%
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 SUSP	$82.08	$371.40	$128.90–$315.69	19% below	78%
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	$82.08	$371.40	$128.90–$315.69	—	78%
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 SUSP	$82.08	$371.40	$128.90–$315.69	—	78%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 DIPHTH,PERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP	$102.09	$461.95	$174.02–$392.66	17% below	78%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 DIPHTH,PERTUS(ACEL)TETANUS(PF)2LF-(2.5-5-3-5MCG)-5 LF/0.5 ML IM SUSP	$102.09	$461.95	$174.02–$392.66	—	78%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immun Admin; 1 Vac	$40.22	$182.00	$76.18–$281.96	31% below	78%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immun Admin; 1 Vac	$40.22	$182.00	$76.18–$281.96	—	78%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immun Admin; Ea Add Vac	$25.86	$117.00	$56.51–$99.45	30% below	78%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immun Admin; Ea Add Vac	$25.86	$117.00	$56.51–$99.45	—	78%

Source file: https://images.franciscanhealth.org/pdfs/enterprise/price_transparency/352056396_franciscan-health-lafayette_standardcharges.zip