Hospital Plymouth, IN

Community Hospital of Bremen

Community Hospital of Bremen in Bremen, IN publishes cash prices for 290 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Indiana median for 202 of 288 procedures and above it for 81. By typical cash price it ranks #15 of 84 Indiana hospitals, cheapest first. Select a procedure to compare it with other hospitals nearby.

1020 HIGH RD, BREMEN, IN 46506 Collected Sep 28, 2026 Source price file Check a bill from this hospital (574) 546-2211

Critical access hospital (rural, 25 beds or fewer) Nonprofit hospital Emergency department CCN 151300 · CMS hospital register NPI 1568417004

Financial assistance

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

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

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

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

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Abdominal CT scan without and with contrast CPT 74170 CT Abdomen W W-O Contrast	$1,970.15	$3,031.00	$939.61–$3,940.30	45% above	35%
Abdominal CT scan without and with contrast inpatient CPT 74170 CT Abdomen W W-O Contrast	$1,970.15	$3,031.00	$1,515.50–$3,940.30	—	35%
Abdominal X-ray, 2 views CPT 74019 DX--ABDOMEN 2 VIEWS	$254.15	$391.00	$121.21–$508.30	6% below	35%
Abdominal X-ray, 2 views inpatient CPT 74019 DX--ABDOMEN 2 VIEWS	$254.15	$391.00	$195.50–$508.30	—	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 DX Ankle Three Views LT	$190.45	$293.00	$90.83–$380.90	3% below	35%
Ankle X-ray, complete, 3 or more views one side CPT 73610 DX Ankle Three Views RT	$190.45	$293.00	$90.83–$380.90	3% below	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 DX Ankle Three Views RT	$190.45	$293.00	$146.50–$380.90	—	35%
Ankle X-ray, complete, 3 or more views inpatient one side CPT 73610 DX Ankle Three Views LT	$190.45	$293.00	$146.50–$380.90	—	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity W-O Contrast RT	$1,207.05	$1,857.00	$575.67–$2,414.10	50% above	35%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT Upper Extremity W-O Contrast LT	$1,218.75	$1,875.00	$581.25–$2,437.50	52% above	35%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity W-O Contrast RT	$1,207.05	$1,857.00	$928.50–$2,414.10	—	35%
Arm CT scan without contrast (shoulder to hand, any part) inpatient one side CPT 73200 CT Upper Extremity W-O Contrast LT	$1,218.75	$1,875.00	$937.50–$2,437.50	—	35%
Barium swallow (esophagus X-ray with contrast) CPT 74220 DX Esophagus	$310.05	$477.00	$147.87–$620.10	33% below	35%
Barium swallow (esophagus X-ray with contrast) inpatient CPT 74220 DX Esophagus	$310.05	$477.00	$238.50–$620.10	—	35%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete RT	$235.95	$363.00	$112.53–$471.90	46% below	35%
Breast ultrasound, complete, one breast one side CPT 76641 US Breast Complete LT	$235.95	$363.00	$112.53–$471.90	46% below	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete RT	$235.95	$363.00	$181.50–$471.90	—	35%
Breast ultrasound, complete, one breast inpatient one side CPT 76641 US Breast Complete LT	$235.95	$363.00	$181.50–$471.90	—	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast (ER or IP ONLY) LT	$156.00	$240.00	$74.40–$312.00	52% below	35%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 US Breast (ER or IP ONLY) RT	$156.00	$240.00	$74.40–$312.00	52% below	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast (ER or IP ONLY) RT	$156.00	$240.00	$120.00–$312.00	—	35%
Breast ultrasound, limited (one breast or one area) inpatient one side CPT 76642 US Breast (ER or IP ONLY) LT	$156.00	$240.00	$120.00–$312.00	—	35%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abd/Pelvis for Dissection	$2,337.40	$3,596.00	$1,114.76–$4,674.80	24% above	35%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CTA Abdomen Pelvis GI Bleed	$2,337.40	$3,596.00	$1,114.76–$4,674.80	24% above	35%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abd/Pelvis for Dissection	$2,337.40	$3,596.00	$1,798.00–$4,674.80	—	35%
CT angiography (CTA) of the abdomen and pelvis inpatient CPT 74174 CTA Abdomen Pelvis GI Bleed	$2,337.40	$3,596.00	$1,798.00–$4,674.80	—	35%
CT angiography (CTA) of the head CPT 70496 CT Venogram Brain	$1,408.55	$2,167.00	$671.77–$2,817.10	11% above	35%
CT angiography (CTA) of the head inpatient CPT 70496 CT Venogram Brain	$1,408.55	$2,167.00	$1,083.50–$2,817.10	—	35%
CT angiography (CTA) of the neck CPT 70498 CTA Neck	$1,132.30	$1,742.00	$540.02–$2,264.60	7% below	35%
CT angiography (CTA) of the neck inpatient CPT 70498 CTA Neck	$1,132.30	$1,742.00	$871.00–$2,264.60	—	35%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CTA Chest Dissection	$1,695.85	$2,609.00	$808.79–$3,391.70	33% above	35%
CT angiography of the chest (CTA), for blood clots in the lungs inpatient CPT 71275 CTA Chest Dissection	$1,695.85	$2,609.00	$1,304.50–$3,391.70	—	35%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT Abd Pelvis W-O Contrast Renal Stone	$2,155.40	$3,316.00	$1,027.96–$4,310.80	80% above	35%
CT scan of abdomen and pelvis, no contrast dye inpatient CPT 74176 CT Abd Pelvis W-O Contrast Renal Stone	$2,155.40	$3,316.00	$1,658.00–$4,310.80	—	35%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abdomen and Pelvis W-Contrast	$2,586.72	$3,979.57	$1,233.67–$5,173.44	50% above	35%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT Abdomen and Pelvis W-Contrast	$2,586.72	$3,979.57	$1,989.78–$5,173.44	—	35%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT Abdomen Pelvis W W-O Contrast	$3,179.15	$4,891.00	$1,516.21–$6,358.30	85% above	35%
CT scan of abdomen and pelvis, without and then with contrast dye inpatient CPT 74178 CT Abdomen Pelvis W W-O Contrast	$3,179.15	$4,891.00	$2,445.50–$6,358.30	—	35%
CT scan of the abdomen with contrast CPT 74160 CT Abdomen W-Contrast	$1,543.75	$2,375.00	$736.25–$3,087.50	45% above	35%
CT scan of the abdomen with contrast inpatient CPT 74160 CT Abdomen W-Contrast	$1,543.75	$2,375.00	$1,187.50–$3,087.50	—	35%
CT scan of the abdomen without contrast CPT 74150 CT Abdomen W-O Contrast	$1,140.75	$1,755.00	$544.05–$2,281.50	35% above	35%
CT scan of the abdomen without contrast inpatient CPT 74150 CT Abdomen W-O Contrast	$1,140.75	$1,755.00	$877.50–$2,281.50	—	35%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT Maxillofacial Area W-O Contrast	$966.55	$1,487.00	$460.97–$1,933.10	16% above	35%
CT scan of the face and sinuses, no contrast dye inpatient CPT 70486 CT Maxillofacial Area W-O Contrast	$966.55	$1,487.00	$743.50–$1,933.10	—	35%
CT scan of the head or brain, no contrast dye CPT 70450 CT Brain W-O Contrast AIS	$892.45	$1,373.00	$425.63–$1,784.90	17% above	35%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT Brain W-O Contrast AIS	$892.45	$1,373.00	$686.50–$1,784.90	—	35%
CT scan of the head with contrast CPT 70460 CT Brain W-Contrast	$1,220.05	$1,877.00	$581.87–$2,440.10	43% above	35%
CT scan of the head with contrast inpatient CPT 70460 CT Brain W-Contrast	$1,220.05	$1,877.00	$938.50–$2,440.10	—	35%
CT scan of the head without and with contrast CPT 70470 CT Brain W W-O Contrast	$1,584.05	$2,437.00	$755.47–$3,168.10	52% above	35%
CT scan of the head without and with contrast inpatient CPT 70470 CT Brain W W-O Contrast	$1,584.05	$2,437.00	$1,218.50–$3,168.10	—	35%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT Lumbar Spine W-O Contrast	$1,083.55	$1,667.00	$516.77–$2,167.10	22% above	35%
CT scan of the lower back (lumbar spine) without contrast inpatient CPT 72131 CT Lumbar Spine W-O Contrast	$1,083.55	$1,667.00	$833.50–$2,167.10	—	35%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT Cervical Spine W-O Contrast	$1,543.75	$2,375.00	$736.25–$3,087.50	85% above	35%
CT scan of the neck (cervical spine), no contrast dye inpatient CPT 72125 CT Cervical Spine W-O Contrast	$1,543.75	$2,375.00	$1,187.50–$3,087.50	—	35%
CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W-Contrast	$992.55	$1,527.00	$473.37–$1,985.10	8% above	35%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT Pelvis W-Contrast	$992.55	$1,527.00	$763.50–$1,985.10	—	35%
Carotid artery ultrasound (duplex), both sides of the neck both sides CPT 93880 US Carotid Doppler Complete Bilateral	$622.70	$958.00	$296.98–$1,245.40	—	35%
Carotid artery ultrasound (duplex), both sides of the neck inpatient both sides CPT 93880 US Carotid Doppler Complete Bilateral	$622.70	$958.00	$479.00–$1,245.40	—	35%
Chest CT scan without and with contrast CPT 71270 CT Esophagus W W-O Contrast 71270	$1,712.10	$2,634.00	$816.54–$3,424.20	58% above	35%
Chest CT scan without and with contrast inpatient CPT 71270 CT Esophagus W W-O Contrast 71270	$1,712.10	$2,634.00	$1,317.00–$3,424.20	—	35%
Chest X-ray, 2 views CPT 71046 DX CHEST INSPIRATION & EXPIRATION ONLY	$196.30	$302.00	$93.62–$392.60	5% below	35%
Chest X-ray, 2 views inpatient CPT 71046 DX CHEST INSPIRATION & EXPIRATION ONLY	$196.30	$302.00	$151.00–$392.60	—	35%
Chest X-ray, single view CPT 71045 DX Chest-KUB Neonate Portable	$220.35	$339.00	$105.09–$440.70	36% above	35%
Chest X-ray, single view inpatient CPT 71045 DX Chest-KUB Neonate Portable	$220.35	$339.00	$169.50–$440.70	—	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 DX Clavicle LT	$187.85	$289.00	$89.59–$375.70	2% below	35%
Collarbone (clavicle) X-ray, complete one side CPT 73000 DX Clavicle RT	$187.85	$289.00	$89.59–$375.70	2% below	35%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 DX Clavicle LT	$187.85	$289.00	$144.50–$375.70	—	35%
Collarbone (clavicle) X-ray, complete inpatient one side CPT 73000 DX Clavicle RT	$187.85	$289.00	$144.50–$375.70	—	35%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US Retroperitoneal Complete	$585.65	$901.00	$279.31–$1,171.30	17% above	35%
Complete ultrasound of the back of the abdomen, such as both kidneys inpatient CPT 76770 US Retroperitoneal Complete	$585.65	$901.00	$450.50–$1,171.30	—	35%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 BD Bone Densitometry Axial	$217.10	$334.00	$103.54–$434.20	25% below	35%
DEXA bone density scan of the hip, pelvis or spine inpatient CPT 77080 BD Bone Densitometry Axial	$217.10	$334.00	$167.00–$434.20	—	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 BD--BONE DENSITY DXA APPENDICULAR	$84.50	$130.00	$40.30–$169.00	42% below	35%
DEXA bone density scan of the wrist, heel or finger (peripheral) inpatient CPT 77081 BD--BONE DENSITY DXA APPENDICULAR	$84.50	$130.00	$65.00–$169.00	—	35%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT Esophagus W-O Contrast 71250	$1,199.25	$1,845.00	$571.95–$2,398.50	44% above	35%
Diagnostic CT scan of the chest, no contrast dye inpatient CPT 71250 CT Esophagus W-O Contrast 71250	$1,199.25	$1,845.00	$922.50–$2,398.50	—	35%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT Esophagus W-Contrast 71260	$1,474.20	$2,268.00	$703.08–$2,948.40	57% above	35%
Diagnostic CT scan of the chest, with contrast dye inpatient CPT 71260 CT Esophagus W-Contrast 71260	$1,474.20	$2,268.00	$1,134.00–$2,948.40	—	35%
Diagnostic mammogram, both breasts CPT 77066 MA Digital Diagnostic Mammo	$317.20	$488.00	$151.28–$634.40	27% below	35%
Diagnostic mammogram, both breasts inpatient CPT 77066 MA Digital Diagnostic Mammo	$317.20	$488.00	$244.00–$634.40	—	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Digital Diagnostic Mammo RT	$240.50	$370.00	$114.70–$481.00	8% above	35%
Diagnostic mammogram, one breast one side CPT 77065 MA Digital Diagnostic Mammo LT	$240.50	$370.00	$114.70–$481.00	8% above	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Digital Diagnostic Mammo LT	$240.50	$370.00	$185.00–$481.00	—	35%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MA Digital Diagnostic Mammo RT	$240.50	$370.00	$185.00–$481.00	—	35%
Duplex ultrasound of the leg arteries, both legs CPT 93925 US Lower Extremity Arteries Comp Bil	$618.15	$951.00	$294.81–$1,236.30	34% below	35%
Duplex ultrasound of the leg arteries, both legs inpatient CPT 93925 US Lower Extremity Arteries Comp Bil	$618.15	$951.00	$475.50–$1,236.30	—	35%
Duplex ultrasound of the leg veins, both legs both sides CPT 93970 US Venous Doppler Lower Ext Bilat	$698.75	$1,075.00	$333.25–$1,397.50	—	35%
Duplex ultrasound of the leg veins, both legs inpatient both sides CPT 93970 US Venous Doppler Lower Ext Bilat	$698.75	$1,075.00	$537.50–$1,397.50	—	35%
Echocardiogram through the chest wall, complete, with Doppler CPT 93306 COMPLETE ECHO W/COLOR FLOW DOPPLR CHG ONLY	$1,513.20	$2,328.00	$721.68–$3,026.40	8% below	35%
Echocardiogram through the chest wall, complete, with Doppler inpatient CPT 93306 COMPLETE ECHO W/COLOR FLOW DOPPLR CHG ONLY	$1,513.20	$2,328.00	$1,164.00–$3,026.40	—	35%
Elbow X-ray, 2 views one side CPT 73070 DX Elbow 2 Views LT	$176.80	$272.00	$84.32–$353.60	7% above	35%
Elbow X-ray, 2 views one side CPT 73070 DX Elbow 2 Views RT	$176.80	$272.00	$84.32–$353.60	7% above	35%
Elbow X-ray, 2 views inpatient one side CPT 73070 DX Elbow 2 Views LT	$176.80	$272.00	$136.00–$353.60	—	35%
Elbow X-ray, 2 views inpatient one side CPT 73070 DX Elbow 2 Views RT	$176.80	$272.00	$136.00–$353.60	—	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 DX Elbow Complete LT	$209.95	$323.00	$100.13–$419.90	18% below	35%
Elbow X-ray, complete, 3 or more views one side CPT 73080 DX Elbow Complete RT	$209.95	$323.00	$100.13–$419.90	18% below	35%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 DX Elbow Complete RT	$209.95	$323.00	$161.50–$419.90	—	35%
Elbow X-ray, complete, 3 or more views inpatient one side CPT 73080 DX Elbow Complete LT	$209.95	$323.00	$161.50–$419.90	—	35%
Eye socket (orbit) CT scan without contrast CPT 70480 CT Post Fossa-Orbit-Sella W-O Contrast	$989.95	$1,523.00	$472.13–$1,979.90	16% above	35%
Eye socket (orbit) CT scan without contrast inpatient CPT 70480 CT Post Fossa-Orbit-Sella W-O Contrast	$989.95	$1,523.00	$761.50–$1,979.90	—	35%
Facial bones X-ray, complete, 3 or more views CPT 70150 DX Facial Bones Complete	$273.00	$420.00	$130.20–$546.00	at median	35%
Facial bones X-ray, complete, 3 or more views inpatient CPT 70150 DX Facial Bones Complete	$273.00	$420.00	$210.00–$546.00	—	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 DX Forearm LT	$188.50	$290.00	$89.90–$377.00	2% above	35%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 DX Forearm RT	$188.50	$290.00	$89.90–$377.00	2% above	35%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 DX Forearm RT	$188.50	$290.00	$145.00–$377.00	—	35%
Forearm X-ray (radius and ulna), 2 views inpatient one side CPT 73090 DX Forearm LT	$188.50	$290.00	$145.00–$377.00	—	35%
Hand X-ray, 2 views one side CPT 73120 DX Hand 2 Views RT	$184.60	$284.00	$88.04–$369.20	8% above	35%
Hand X-ray, 2 views one side CPT 73120 DX Hand 2 Views LT	$184.60	$284.00	$88.04–$369.20	8% above	35%
Hand X-ray, 2 views inpatient one side CPT 73120 DX Hand 2 Views LT	$184.60	$284.00	$142.00–$369.20	—	35%
Hand X-ray, 2 views inpatient one side CPT 73120 DX Hand 2 Views RT	$184.60	$284.00	$142.00–$369.20	—	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 DX OS Calcis Heel LT	$180.70	$278.00	$86.18–$361.40	15% below	35%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 DX OS Calcis Heel RT	$180.70	$278.00	$86.18–$361.40	15% below	35%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 DX OS Calcis Heel RT	$180.70	$278.00	$139.00–$361.40	—	35%
Heel bone (calcaneus) X-ray, 2 or more views inpatient one side CPT 73650 DX OS Calcis Heel LT	$180.70	$278.00	$139.00–$361.40	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 RC CPAP Titration-Sleep Lab	$3,311.10	$5,094.00	$1,579.14–$6,622.20	2% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older CPT 95811 COMBINED SLEEP STUDY	$3,311.10	$5,094.00	$1,579.14–$6,622.20	2% above	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 COMBINED SLEEP STUDY	$3,311.10	$5,094.00	$2,547.00–$6,622.20	—	35%
In-lab sleep study with CPAP or bilevel titration, age 6 and older inpatient CPT 95811 RC CPAP Titration-Sleep Lab	$3,311.10	$5,094.00	$2,547.00–$6,622.20	—	35%
Knee X-ray, 3 views one side CPT 73562 DX Knee Minimum Three Views LT	$210.60	$324.00	$100.44–$421.20	8% below	35%
Knee X-ray, 3 views one side CPT 73562 DX Knee Minimum Three Views RT	$210.60	$324.00	$100.44–$421.20	8% below	35%
Knee X-ray, 3 views inpatient one side CPT 73562 DX Knee Minimum Three Views RT	$210.60	$324.00	$162.00–$421.20	—	35%
Knee X-ray, 3 views inpatient one side CPT 73562 DX Knee Minimum Three Views LT	$210.60	$324.00	$162.00–$421.20	—	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 DX Knee Complete- 4 or More Views RT	$243.10	$374.00	$115.94–$486.20	7% below	35%
Knee X-ray, complete, 4 or more views one side CPT 73564 DX Knee Complete- 4 or More Views LT	$243.10	$374.00	$115.94–$486.20	7% below	35%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 DX Knee Complete- 4 or More Views LT	$243.10	$374.00	$187.00–$486.20	—	35%
Knee X-ray, complete, 4 or more views inpatient one side CPT 73564 DX Knee Complete- 4 or More Views RT	$243.10	$374.00	$187.00–$486.20	—	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity W-O Contrast LT	$1,207.05	$1,857.00	$575.67–$2,414.10	54% above	35%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT Lower Extremity W-O Contrast RT	$1,207.05	$1,857.00	$575.67–$2,414.10	54% above	35%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity W-O Contrast LT	$1,207.05	$1,857.00	$928.50–$2,414.10	—	35%
Leg CT scan without contrast (hip to foot, any part) inpatient one side CPT 73700 CT Lower Extremity W-O Contrast RT	$1,207.05	$1,857.00	$928.50–$2,414.10	—	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 US Abdomen LTD	$417.30	$642.00	$199.02–$834.60	9% below	35%
Limited abdominal ultrasound of one organ or area, such as the gallbladder inpatient CPT 76705 US Abdomen LTD	$417.30	$642.00	$321.00–$834.60	—	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vasc Limited RT 76882	$388.05	$597.00	$185.07–$776.10	28% above	35%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 US Extremity Non-Vasc Limited LT 76882	$388.05	$597.00	$185.07–$776.10	28% above	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vasc Limited RT 76882	$388.05	$597.00	$298.50–$776.10	—	35%
Limited ultrasound of an arm or leg (non-vascular) inpatient one side CPT 76882 US Extremity Non-Vasc Limited LT 76882	$388.05	$597.00	$298.50–$776.10	—	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT Chest Lung Screen	$141.70	$218.00	$67.58–$283.40	26% below	35%
Low-dose CT of the chest for lung cancer screening, no contrast dye inpatient CPT 71271 CT Chest Lung Screen	$141.70	$218.00	$109.00–$283.40	—	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 DX Tibia - Fibula LT	$193.05	$297.00	$92.07–$386.10	3% below	35%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 DX Tibia - Fibula RT	$193.05	$297.00	$92.07–$386.10	3% below	35%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 DX Tibia - Fibula RT	$193.05	$297.00	$148.50–$386.10	—	35%
Lower leg X-ray (tibia and fibula), 2 views inpatient one side CPT 73590 DX Tibia - Fibula LT	$193.05	$297.00	$148.50–$386.10	—	35%
MR angiography (MRA) of the head without contrast CPT 70544 MRV Brain W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	18% above	35%
MR angiography (MRA) of the head without contrast inpatient CPT 70544 MRV Brain W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Lower Ext Joint W-O Contrast LT	$1,320.80	$2,032.00	$629.92–$2,641.60	28% above	35%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MR Lower Ext Joint W-O Contrast RT	$1,320.80	$2,032.00	$629.92–$2,641.60	28% above	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Lower Ext Joint W-O Contrast RT	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 MR Lower Ext Joint W-O Contrast LT	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Lower Ext Joint W W-O Contrast LT	$1,651.65	$2,541.00	$787.71–$3,303.30	14% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MR Lower Ext Joint W W-O Contrast RT	$1,651.65	$2,541.00	$787.71–$3,303.30	14% above	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Lower Ext Joint W W-O Contrast RT	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 MR Lower Ext Joint W W-O Contrast LT	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the abdomen without contrast CPT 74181 MR Abdomen W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	24% above	35%
MRI of the abdomen without contrast inpatient CPT 74181 MR Abdomen W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the abdomen, without and then with contrast dye CPT 74183 MR Abdomen W W-O Contrast	$1,651.65	$2,541.00	$787.71–$3,303.30	5% above	35%
MRI of the abdomen, without and then with contrast dye inpatient CPT 74183 MR Abdomen W W-O Contrast	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the brain, no contrast dye CPT 70551 MR Brain W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	30% above	35%
MRI of the brain, no contrast dye inpatient CPT 70551 MR Brain W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the brain, with and without contrast dye CPT 70553 MR Brain W W-O Contrast	$1,651.65	$2,541.00	$787.71–$3,303.30	26% above	35%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR Brain W W-O Contrast	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the lower back, no contrast dye CPT 72148 MR Lumbar Spine W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	30% above	35%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR Lumbar Spine W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the lower back, without and then with contrast dye CPT 72158 MR Lumbar Spine W W-O Contrast	$1,651.65	$2,541.00	$787.71–$3,303.30	13% above	35%
MRI of the lower back, without and then with contrast dye inpatient CPT 72158 MR Lumbar Spine W W-O Contrast	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MR Thoracic Spine W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	31% above	35%
MRI of the mid back (thoracic spine), no contrast dye inpatient CPT 72146 MR Thoracic Spine W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MR Cervical Spine W W-O Contrast	$1,651.65	$2,541.00	$787.71–$3,303.30	13% above	35%
MRI of the neck (cervical spine) without and with contrast inpatient CPT 72156 MR Cervical Spine W W-O Contrast	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MR Cervical Spine W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	27% above	35%
MRI of the neck (cervical spine), no contrast dye inpatient CPT 72141 MR Cervical Spine W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the pelvis without and with contrast CPT 72197 MR Pelvis W W-O Contrast	$1,651.65	$2,541.00	$787.71–$3,303.30	13% above	35%
MRI of the pelvis without and with contrast inpatient CPT 72197 MR Pelvis W W-O Contrast	$1,651.65	$2,541.00	$1,270.50–$3,303.30	—	35%
MRI of the pelvis, no contrast dye CPT 72195 MR Pelvis W-O Contrast	$1,320.80	$2,032.00	$629.92–$2,641.60	26% above	35%
MRI of the pelvis, no contrast dye inpatient CPT 72195 MR Pelvis W-O Contrast	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR Upper Ext Joint W-O Contrast RT (LTD)	$1,320.80	$2,032.00	$629.92–$2,641.60	24% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MR Upper Ext Joint W-O Contrast LT (LTD)	$1,320.80	$2,032.00	$629.92–$2,641.60	24% above	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR Upper Ext Joint W-O Contrast RT (LTD)	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
MRI of the shoulder, elbow or wrist joint, no contrast dye inpatient one side CPT 73221 MR Upper Ext Joint W-O Contrast LT (LTD)	$1,320.80	$2,032.00	$1,016.00–$2,641.60	—	35%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 DX Spine Cervical 4 Views	$325.65	$501.00	$155.31–$651.30	6% below	35%
Neck (cervical spine) X-ray, 4 or 5 views inpatient CPT 72050 DX Spine Cervical 4 Views	$325.65	$501.00	$250.50–$651.30	—	35%
Neck soft tissue CT scan with contrast CPT 70491 CT Neck Soft Tissue W-Contrast	$1,368.90	$2,106.00	$652.86–$2,737.80	40% above	35%
Neck soft tissue CT scan with contrast inpatient CPT 70491 CT Neck Soft Tissue W-Contrast	$1,368.90	$2,106.00	$1,053.00–$2,737.80	—	35%
Neck soft tissue CT scan without contrast CPT 70490 CT Neck Soft Tissue W-O Contrast	$1,199.25	$1,845.00	$571.95–$2,398.50	44% above	35%
Neck soft tissue CT scan without contrast inpatient CPT 70490 CT Neck Soft Tissue W-O Contrast	$1,199.25	$1,845.00	$922.50–$2,398.50	—	35%
Neck soft tissue X-ray CPT 70360 DX Neck Soft Tissue Examination	$147.55	$227.00	$70.37–$295.10	15% below	35%
Neck soft tissue X-ray inpatient CPT 70360 DX Neck Soft Tissue Examination	$147.55	$227.00	$113.50–$295.10	—	35%
Pelvic CT scan without contrast CPT 72192 CT Pelvis W-O Contrast	$926.90	$1,426.00	$442.06–$1,853.80	11% above	35%
Pelvic CT scan without contrast inpatient CPT 72192 CT Pelvis W-O Contrast	$926.90	$1,426.00	$713.00–$1,853.80	—	35%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US Pelvic LTD	$235.95	$363.00	$112.53–$471.90	34% below	35%
Pelvic ultrasound (not pregnancy), limited or follow-up inpatient CPT 76857 US Pelvic LTD	$235.95	$363.00	$181.50–$471.90	—	35%
Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US Pelvic Complete	$464.10	$714.00	$221.34–$928.20	at median	35%
Pelvic ultrasound through the belly, complete (not pregnancy) inpatient CPT 76856 US Pelvic Complete	$464.10	$714.00	$357.00–$928.20	—	35%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB Greater Than 14 Wks	$401.05	$617.00	$191.27–$802.10	28% below	35%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB Greater Than 14 Wks	$401.05	$617.00	$308.50–$802.10	—	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 US OB Less Than 14 Wks Gest	$458.25	$705.00	$218.55–$916.50	11% below	35%
Pregnancy ultrasound before 14 weeks, through the belly, one baby inpatient CPT 76801 US OB Less Than 14 Wks Gest	$458.25	$705.00	$352.50–$916.50	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 US OB Limited	$303.55	$467.00	$144.77–$607.10	20% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Done	$312.00	$480.00	$148.80–$624.00	18% below	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 US OB Limited	$303.55	$467.00	$233.50–$607.10	—	35%
Pregnancy ultrasound, limited (heartbeat, position, fluid) inpatient CPT 76815 Done	$312.00	$480.00	$240.00–$624.00	—	35%
Rib X-ray, one side, 2 views one side CPT 71100 DX Ribs LT	$199.55	$307.00	$95.17–$399.10	2% below	35%
Rib X-ray, one side, 2 views one side CPT 71100 DX Ribs RT	$199.55	$307.00	$95.17–$399.10	2% below	35%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 DX Ribs LT	$199.55	$307.00	$153.50–$399.10	—	35%
Rib X-ray, one side, 2 views inpatient one side CPT 71100 DX Ribs RT	$199.55	$307.00	$153.50–$399.10	—	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 DX Ribs LT and PA Chest	$260.00	$400.00	$124.00–$520.00	7% above	35%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 DX Ribs RT and PA Chest	$260.00	$400.00	$124.00–$520.00	7% above	35%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 DX Ribs RT and PA Chest	$260.00	$400.00	$200.00–$520.00	—	35%
Rib X-ray, one side, with a chest view, 3 or more views inpatient one side CPT 71101 DX Ribs LT and PA Chest	$260.00	$400.00	$200.00–$520.00	—	35%
Screening mammogram, both breasts CPT 77067 MA Digital Screening Mammo	$188.50	$290.00	$89.90–$377.00	24% below	35%
Screening mammogram, both breasts inpatient CPT 77067 MA Digital Screening Mammo	$188.50	$290.00	$145.00–$377.00	—	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 DX Shoulder Complete RT	$197.60	$304.00	$94.24–$395.20	5% below	35%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 DX Shoulder Complete LT	$197.60	$304.00	$94.24–$395.20	5% below	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 DX Shoulder Complete RT	$197.60	$304.00	$152.00–$395.20	—	35%
Shoulder X-ray, complete, 2 or more views inpatient one side CPT 73030 DX Shoulder Complete LT	$197.60	$304.00	$152.00–$395.20	—	35%
Sinus X-ray, complete, 3 or more views CPT 70220 DX Sinuses Paranasal Complete	$247.00	$380.00	$117.80–$494.00	13% below	35%
Sinus X-ray, complete, 3 or more views inpatient CPT 70220 DX Sinuses Paranasal Complete	$247.00	$380.00	$190.00–$494.00	—	35%
Skull X-ray, fewer than 4 views CPT 70250 DX--SKULL PARTIAL	$182.00	$280.00	$86.80–$364.00	22% below	35%
Skull X-ray, fewer than 4 views inpatient CPT 70250 DX--SKULL PARTIAL	$182.00	$280.00	$140.00–$364.00	—	35%
Sleep study in a lab (polysomnography) CPT 95810 DIAGNOSTIC SLEEP STUDY	$2,954.25	$4,545.00	$1,408.95–$5,908.50	12% above	35%
Sleep study in a lab (polysomnography) inpatient CPT 95810 DIAGNOSTIC SLEEP STUDY	$2,954.25	$4,545.00	$2,272.50–$5,908.50	—	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 DX Femur RT 2 View	$204.10	$314.00	$97.34–$408.20	2% above	35%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 DX Femur LT 2 View	$204.10	$314.00	$97.34–$408.20	2% above	35%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 DX Femur RT 2 View	$204.10	$314.00	$157.00–$408.20	—	35%
Thigh bone (femur) X-ray, 2 or more views inpatient one side CPT 73552 DX Femur LT 2 View	$204.10	$314.00	$157.00–$408.20	—	35%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT Thoracic Spine W-O Contrast	$1,543.75	$2,375.00	$736.25–$3,087.50	82% above	35%
Thoracic spine (mid back) CT scan without contrast inpatient CPT 72128 CT Thoracic Spine W-O Contrast	$1,543.75	$2,375.00	$1,187.50–$3,087.50	—	35%
Toe X-ray, 2 or more views one side CPT 73660 DX Toes LT	$160.55	$247.00	$76.57–$321.10	5% above	35%
Toe X-ray, 2 or more views one side CPT 73660 DX Toes RT	$160.55	$247.00	$76.57–$321.10	5% above	35%
Toe X-ray, 2 or more views inpatient one side CPT 73660 DX Toes RT	$160.55	$247.00	$123.50–$321.10	—	35%
Toe X-ray, 2 or more views inpatient one side CPT 73660 DX Toes LT	$160.55	$247.00	$123.50–$321.10	—	35%
Transvaginal pelvic ultrasound CPT 76830 US--Transvaginal Non OB	$406.90	$626.00	$194.06–$813.80	at median	35%
Transvaginal pelvic ultrasound inpatient CPT 76830 US--Transvaginal Non OB	$406.90	$626.00	$313.00–$813.80	—	35%
Transvaginal ultrasound during pregnancy CPT 76817 US--OB Transvaginal	$458.25	$705.00	$218.55–$916.50	24% above	35%
Transvaginal ultrasound during pregnancy inpatient CPT 76817 US--OB Transvaginal	$458.25	$705.00	$352.50–$916.50	—	35%
Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete	$666.90	$1,026.00	$318.06–$1,333.80	27% above	35%
Ultrasound of the abdomen, complete inpatient CPT 76700 US Abdomen Complete	$666.90	$1,026.00	$513.00–$1,333.80	—	35%
Ultrasound of the scrotum and testicles CPT 76870 US Testicular	$568.10	$874.00	$270.94–$1,136.20	34% above	35%
Ultrasound of the scrotum and testicles inpatient CPT 76870 US Testicular	$568.10	$874.00	$437.00–$1,136.20	—	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US Thyroid Head Neck	$352.95	$543.00	$168.33–$705.90	17% below	35%
Ultrasound of the soft tissues of the head and neck, such as the thyroid inpatient CPT 76536 US Thyroid Head Neck	$352.95	$543.00	$271.50–$705.90	—	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 DX Upper GI W/O Air Contrast	$435.50	$670.00	$207.70–$871.00	17% below	35%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) inpatient CPT 74240 DX Upper GI W/O Air Contrast	$435.50	$670.00	$335.00–$871.00	—	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 DX Humerus RT	$186.55	$287.00	$88.97–$373.10	3% below	35%
Upper arm X-ray (humerus), 2 views one side CPT 73060 DX Humerus LT	$186.55	$287.00	$88.97–$373.10	3% below	35%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 DX Humerus LT	$186.55	$287.00	$143.50–$373.10	—	35%
Upper arm X-ray (humerus), 2 views inpatient one side CPT 73060 DX Humerus RT	$186.55	$287.00	$143.50–$373.10	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Doppler Lower Ext RT	$381.55	$587.00	$181.97–$763.10	40% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 US Venous Doppler Lower Ext LT	$381.55	$587.00	$181.97–$763.10	40% below	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Doppler Lower Ext RT	$381.55	$587.00	$293.50–$763.10	—	35%
Vein ultrasound (duplex) of one arm or leg, or a limited study inpatient one side CPT 93971 US Venous Doppler Lower Ext LT	$381.55	$587.00	$293.50–$763.10	—	35%
Wrist X-ray, 2 views one side CPT 73100 DX Wrist 2 Views RT	$172.25	$265.00	$82.15–$344.50	10% above	35%
Wrist X-ray, 2 views one side CPT 73100 DX Wrist 2 Views LT	$172.25	$265.00	$82.15–$344.50	10% above	35%
Wrist X-ray, 2 views inpatient one side CPT 73100 DX Wrist 2 Views LT	$172.25	$265.00	$132.50–$344.50	—	35%
Wrist X-ray, 2 views inpatient one side CPT 73100 DX Wrist 2 Views RT	$172.25	$265.00	$132.50–$344.50	—	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 DX Wrist Complete RT	$203.45	$313.00	$97.03–$406.90	20% below	35%
Wrist X-ray, complete, 3 or more views one side CPT 73110 DX Wrist Complete LT	$203.45	$313.00	$97.03–$406.90	20% below	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 DX Wrist Complete LT	$203.45	$313.00	$156.50–$406.90	—	35%
Wrist X-ray, complete, 3 or more views inpatient one side CPT 73110 DX Wrist Complete RT	$203.45	$313.00	$156.50–$406.90	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 DX Hip Unilateral Complete RT	$187.85	$289.00	$89.59–$375.70	29% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 DX Hip Unilateral Complete LT	$187.85	$289.00	$89.59–$375.70	29% below	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 DX Hip Unilateral Complete LT	$187.85	$289.00	$144.50–$375.70	—	35%
X-ray of one hip, 2 or 3 views, with the pelvis when included inpatient one side CPT 73502 DX Hip Unilateral Complete RT	$187.85	$289.00	$144.50–$375.70	—	35%
X-ray of the abdomen, 1 view CPT 74018 DX--Abdomen AP (KUB)	$179.40	$276.00	$85.56–$358.80	17% below	35%
X-ray of the abdomen, 1 view inpatient CPT 74018 DX--Abdomen AP (KUB)	$179.40	$276.00	$138.00–$358.80	—	35%
X-ray of the ankle, 2 views one side CPT 73600 DX Ankle 2 Views RT	$159.90	$246.00	$76.26–$319.80	at median	35%
X-ray of the ankle, 2 views one side CPT 73600 DX Ankle 2 Views LT	$159.90	$246.00	$76.26–$319.80	at median	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 DX Ankle 2 Views RT	$159.90	$246.00	$123.00–$319.80	—	35%
X-ray of the ankle, 2 views inpatient one side CPT 73600 DX Ankle 2 Views LT	$159.90	$246.00	$123.00–$319.80	—	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 DX Fingers RT	$160.55	$247.00	$76.57–$321.10	1% above	35%
X-ray of the finger(s), 2 or more views one side CPT 73140 DX Fingers LT	$160.55	$247.00	$76.57–$321.10	1% above	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 DX Fingers LT	$160.55	$247.00	$123.50–$321.10	—	35%
X-ray of the finger(s), 2 or more views inpatient one side CPT 73140 DX Fingers RT	$160.55	$247.00	$123.50–$321.10	—	35%
X-ray of the foot, 2 views one side CPT 73620 DX Foot Two Views LT	$141.70	$218.00	$67.58–$283.40	13% below	35%
X-ray of the foot, 2 views one side CPT 73620 DX Foot Two Views RT	$141.70	$218.00	$67.58–$283.40	13% below	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 DX Foot Two Views RT	$141.70	$218.00	$109.00–$283.40	—	35%
X-ray of the foot, 2 views inpatient one side CPT 73620 DX Foot Two Views LT	$141.70	$218.00	$109.00–$283.40	—	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 DX Foot Complete RT	$190.45	$293.00	$90.83–$380.90	5% below	35%
X-ray of the foot, complete, 3 or more views one side CPT 73630 DX Foot Complete LT	$190.45	$293.00	$90.83–$380.90	5% below	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 DX Foot Complete LT	$190.45	$293.00	$146.50–$380.90	—	35%
X-ray of the foot, complete, 3 or more views inpatient one side CPT 73630 DX Foot Complete RT	$190.45	$293.00	$146.50–$380.90	—	35%
X-ray of the hand, 3 or more views one side CPT 73130 DX Hand Complete LT	$203.45	$313.00	$97.03–$406.90	1% above	35%
X-ray of the hand, 3 or more views one side CPT 73130 DX Hand Complete RT	$203.45	$313.00	$97.03–$406.90	1% above	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 DX Hand Complete RT	$203.45	$313.00	$156.50–$406.90	—	35%
X-ray of the hand, 3 or more views inpatient one side CPT 73130 DX Hand Complete LT	$203.45	$313.00	$156.50–$406.90	—	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 DX Knee 1 or 2 Views RT	$181.35	$279.00	$86.49–$362.70	13% below	35%
X-ray of the knee, 1 or 2 views one side CPT 73560 DX Knee 1 or 2 Views LT	$181.35	$279.00	$86.49–$362.70	13% below	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 DX Knee 1 or 2 Views RT	$181.35	$279.00	$139.50–$362.70	—	35%
X-ray of the knee, 1 or 2 views inpatient one side CPT 73560 DX Knee 1 or 2 Views LT	$181.35	$279.00	$139.50–$362.70	—	35%
X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 DX Spine Lumbar AP-Lat	$280.80	$432.00	$133.92–$561.60	12% above	35%
X-ray of the lower back (lumbar spine), 2 or 3 views inpatient CPT 72100 DX Spine Lumbar AP-Lat	$280.80	$432.00	$216.00–$561.60	—	35%
X-ray of the lower back, 4 or more views CPT 72110 DX Spine Lumbar 4 Views	$337.35	$519.00	$160.89–$674.70	3% below	35%
X-ray of the lower back, 4 or more views inpatient CPT 72110 DX Spine Lumbar 4 Views	$337.35	$519.00	$259.50–$674.70	—	35%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 DX Spine Thoracic AP-LAT NO Swim	$172.90	$266.00	$82.46–$345.80	26% below	35%
X-ray of the mid back (thoracic spine), 2 views inpatient CPT 72070 DX Spine Thoracic AP-LAT NO Swim	$172.90	$266.00	$133.00–$345.80	—	35%
X-ray of the nasal bones, 3 or more views CPT 70160 DX Nasal Bones	$189.15	$291.00	$90.21–$378.30	7% below	35%
X-ray of the nasal bones, 3 or more views inpatient CPT 70160 DX Nasal Bones	$189.15	$291.00	$145.50–$378.30	—	35%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 DX Spine Cervical 2VW FLEX/EXT	$201.50	$310.00	$96.10–$403.00	19% below	35%
X-ray of the neck (cervical spine), 2 or 3 views inpatient CPT 72040 DX Spine Cervical 2VW FLEX/EXT	$201.50	$310.00	$155.00–$403.00	—	35%
X-ray of the pelvis, 1 or 2 views CPT 72170 DX Pelvis 1 or 2 Views	$163.80	$252.00	$78.12–$327.60	17% below	35%
X-ray of the pelvis, 1 or 2 views inpatient CPT 72170 DX Pelvis 1 or 2 Views	$163.80	$252.00	$126.00–$327.60	—	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 DX Sacrum and Coccyx	$196.30	$302.00	$93.62–$392.60	10% below	35%
X-ray of the tailbone (sacrum and coccyx), 2 or more views inpatient CPT 72220 DX Sacrum and Coccyx	$196.30	$302.00	$151.00–$392.60	—	35%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
ACTH blood test CPT 82024 Adrenocorticotropic Hormone (ACTH), Plasma	$25.35	$39.00	$12.09–$50.70	90% below	35%
ACTH blood test inpatient CPT 82024 Adrenocorticotropic Hormone (ACTH), Plasma	$25.35	$39.00	$19.50–$50.70	—	35%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 84460 ALANINE AMINO (ALT) (SGPT)	$4.55	$7.00	$2.17–$9.10	83% below	35%
ALT (alanine aminotransferase) liver enzyme test inpatient CPT 84460 84460 ALANINE AMINO (ALT) (SGPT)	$4.55	$7.00	$3.50–$9.10	—	35%
AST (aspartate aminotransferase) enzyme test CPT 84450 84450 TRANSFERASE (AST) (SGOT)	$4.55	$7.00	$2.17–$9.10	84% below	35%
AST (aspartate aminotransferase) enzyme test inpatient CPT 84450 84450 TRANSFERASE (AST) (SGOT)	$4.55	$7.00	$3.50–$9.10	—	35%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Hepatitis Panel Acute (HAV, HBV, HCV) w/ Reflexes	$42.25	$65.00	$20.15–$84.50	87% below	35%
Acute hepatitis panel (hepatitis A, B and C) inpatient CPT 80074 Hepatitis Panel Acute (HAV, HBV, HCV) w/ Reflexes	$42.25	$65.00	$32.50–$84.50	—	35%
Albumin blood test CPT 82040 82040 ASSAY OF SERUM ALBUMIN	$4.55	$7.00	$2.17–$9.10	80% below	35%
Albumin blood test inpatient CPT 82040 82040 ASSAY OF SERUM ALBUMIN	$4.55	$7.00	$3.50–$9.10	—	35%
Aldosterone blood test CPT 82088 82088 ASSAY OF ALDOSTERONE	$19.50	$30.00	$9.30–$39.00	91% below	35%
Aldosterone blood test inpatient CPT 82088 82088 ASSAY OF ALDOSTERONE	$19.50	$30.00	$15.00–$39.00	—	35%
Alkaline phosphatase (ALP) blood test CPT 84075 84075 ASSAY ALKALINE PHOSPHATASE	$6.50	$10.00	$3.10–$13.00	80% below	35%
Alkaline phosphatase (ALP) blood test inpatient CPT 84075 84075 ASSAY ALKALINE PHOSPHATASE	$6.50	$10.00	$5.00–$13.00	—	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Insect, Hornet, White Face I002-IgE	$3.18	$4.89	$1.52–$6.36	83% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Food, Tomato F025-IgE	$5.20	$8.00	$2.48–$10.40	73% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Food, Egg White F001-IgE w/ Component Reflexes	$7.80	$12.00	$3.72–$15.60	59% below	35%
Allergy blood test, specific IgE, per allergen CPT 86003 Allergen Food, Gluten F079-IgE	$22.75	$35.00	$10.85–$45.50	18% above	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Insect, Hornet, White Face I002-IgE	$3.18	$4.89	$2.44–$6.36	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Food, Tomato F025-IgE	$5.20	$8.00	$4.00–$10.40	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Food, Egg White F001-IgE w/ Component Reflexes	$7.80	$12.00	$6.00–$15.60	—	35%
Allergy blood test, specific IgE, per allergen inpatient CPT 86003 Allergen Food, Gluten F079-IgE	$22.75	$35.00	$17.50–$45.50	—	35%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-Fetoprotein (AFP) Tumor Marker Serum	$19.50	$30.00	$9.30–$39.00	81% below	35%
Alpha-fetoprotein (AFP) blood test inpatient CPT 82105 Alpha-Fetoprotein (AFP) Tumor Marker Serum	$19.50	$30.00	$15.00–$39.00	—	35%
Ammonia blood test CPT 82140 Ammonia Plasma	$18.85	$29.00	$8.99–$37.70	84% below	35%
Ammonia blood test inpatient CPT 82140 Ammonia Plasma	$18.85	$29.00	$14.50–$37.70	—	35%
Amylase blood test CPT 82150 Amylase Total Serum	$7.15	$11.00	$3.41–$14.30	86% below	35%
Amylase blood test CPT 82150 Amylase Pancreatic Serum	$16.25	$25.00	$7.75–$32.50	69% below	35%
Amylase blood test inpatient CPT 82150 Amylase Total Serum	$7.15	$11.00	$5.50–$14.30	—	35%
Amylase blood test inpatient CPT 82150 Amylase Pancreatic Serum	$16.25	$25.00	$12.50–$32.50	—	35%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Cyclic Citrullinated Peptide (CCP) Abs. IgA IgG ELISA	$40.30	$62.00	$19.22–$80.60	24% below	35%
Anti-CCP antibody test (rheumatoid arthritis) inpatient CPT 86200 Cyclic Citrullinated Peptide (CCP) Abs. IgA IgG ELISA	$40.30	$62.00	$31.00–$80.60	—	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) by MI w/Rflx to 5-biomarkers (ENA) (dsDNA, RNP, Sm, SS-A/B)	$7.15	$11.00	$3.41–$14.30	88% below	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) Qualitative by Multiplex Immunoassay	$7.15	$11.00	$3.41–$14.30	88% below	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) by IFA w/Rflx to Titer and Pattern	$7.15	$11.00	$3.41–$14.30	88% below	35%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Antinuclear Ab (ANA) by IFA w/Rflx to 11 (dsDNA,RNP,Sm,SS-A/B, Scl-70,Chrom,Jo-1,Centro B,Sm/RNP,Rib	$24.70	$38.00	$11.78–$49.40	59% below	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) by IFA w/Rflx to Titer and Pattern	$7.15	$11.00	$5.50–$14.30	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) by MI w/Rflx to 5-biomarkers (ENA) (dsDNA, RNP, Sm, SS-A/B)	$7.15	$11.00	$5.50–$14.30	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) Qualitative by Multiplex Immunoassay	$7.15	$11.00	$5.50–$14.30	—	35%
Antinuclear antibody (ANA) blood test, screen inpatient CPT 86038 Antinuclear Ab (ANA) by IFA w/Rflx to 11 (dsDNA,RNP,Sm,SS-A/B, Scl-70,Chrom,Jo-1,Centro B,Sm/RNP,Rib	$24.70	$38.00	$19.00–$49.40	—	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NT pro BNP	$26.65	$41.00	$12.71–$53.30	84% below	35%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 BNP B Type Natriuretic Polypeptide	$26.65	$41.00	$12.71–$53.30	84% below	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 NT pro BNP	$26.65	$41.00	$20.50–$53.30	—	35%
BNP or NT-proBNP blood test (heart failure marker) inpatient CPT 83880 BNP B Type Natriuretic Polypeptide	$26.65	$41.00	$20.50–$53.30	—	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 87070 CULTURE OTHR SPECIMN AEROBIC	$14.95	$23.00	$7.13–$29.90	84% below	35%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) inpatient CPT 87070 87070 CULTURE OTHR SPECIMN AEROBIC	$14.95	$23.00	$11.50–$29.90	—	35%
Bilirubin blood test, total CPT 82247 82247 BILIRUBIN TOTAL	$7.15	$11.00	$3.41–$14.30	79% below	35%
Bilirubin blood test, total inpatient CPT 82247 82247 BILIRUBIN TOTAL	$7.15	$11.00	$5.50–$14.30	—	35%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Bill Only 88305-Tc L4 Complicated	$193.05	$297.00	$92.07–$386.10	26% below	35%
Biopsy tissue exam by a pathologist (level IV) inpatient CPT 88305 Bill Only 88305-Tc L4 Complicated	$193.05	$297.00	$148.50–$386.10	—	35%
Blood culture for bacteria CPT 87040 Culture Blood Routine Low Volume	$13.00	$20.00	$6.20–$26.00	90% below	35%
Blood culture for bacteria CPT 87040 SPECIMEN - BLOOD CULTURE	$109.85	$169.00	$52.39–$219.70	16% below	35%
Blood culture for bacteria inpatient CPT 87040 Culture Blood Routine Low Volume	$13.00	$20.00	$10.00–$26.00	—	35%
Blood culture for bacteria inpatient CPT 87040 SPECIMEN - BLOOD CULTURE	$109.85	$169.00	$84.50–$219.70	—	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only Venipuncture Collection Fee EGH	$1.95	$3.00	$0.93–$3.90	88% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Bill Only 36415 Venipuncture	$1.95	$3.00	$0.93–$3.90	88% below	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Done	$18.20	$28.00	$8.68–$36.40	10% above	35%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Per RN/Assistant #Venous	$18.20	$28.00	$8.68–$36.40	10% above	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only 36415 Venipuncture	$1.95	$3.00	$1.50–$3.90	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Bill Only Venipuncture Collection Fee EGH	$1.95	$3.00	$1.50–$3.90	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Per RN/Assistant #Venous	$18.20	$28.00	$14.00–$36.40	—	35%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Done	$18.20	$28.00	$14.00–$36.40	—	35%
Blood glucose (sugar) test CPT 82947 82947 ASSAY GLUCOSE BLOOD QUANT	$5.85	$9.00	$2.79–$11.70	78% below	35%
Blood glucose (sugar) test inpatient CPT 82947 82947 ASSAY GLUCOSE BLOOD QUANT	$5.85	$9.00	$4.50–$11.70	—	35%
Blood lead test CPT 83655 83655 ASSAY OF LEAD	$5.85	$9.00	$2.79–$11.70	92% below	35%
Blood lead test CPT 83655 Lead Capillary (Fingerstick) Blood Pediatric	$8.45	$13.00	$4.03–$16.90	88% below	35%
Blood lead test CPT 83655 Lead Venous Blood Pediatric	$69.55	$107.00	$33.17–$139.10	2% below	35%
Blood lead test inpatient CPT 83655 83655 ASSAY OF LEAD	$5.85	$9.00	$4.50–$11.70	—	35%
Blood lead test inpatient CPT 83655 Lead Capillary (Fingerstick) Blood Pediatric	$8.45	$13.00	$6.50–$16.90	—	35%
Blood lead test inpatient CPT 83655 Lead Venous Blood Pediatric	$69.55	$107.00	$53.50–$139.10	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 Indeterminate	$8.37	$12.87	$3.99–$16.73	89% below	35%
Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 hCG Qualitative Pregnancy Serum	$8.45	$13.00	$4.03–$16.90	88% below	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 Indeterminate	$8.37	$12.87	$6.44–$16.73	—	35%
Blood pregnancy test (hCG, qualitative: yes or no) inpatient CPT 84703 hCG Qualitative Pregnancy Serum	$8.45	$13.00	$6.50–$16.90	—	35%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 ABO and Rh Type Neonate Less than 4 Months	$16.90	$26.00	$8.06–$33.80	66% below	35%
Blood type test, ABO group only (Rh factor is a separate test) inpatient CPT 86900 ABO and Rh Type Neonate Less than 4 Months	$16.90	$26.00	$13.00–$33.80	—	35%
Blood urea nitrogen (BUN) test CPT 84520 Urea Nitrogen Blood	$3.90	$6.00	$1.86–$7.80	83% below	35%
Blood urea nitrogen (BUN) test inpatient CPT 84520 Urea Nitrogen Blood	$3.90	$6.00	$3.00–$7.80	—	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 C Reactive Protein Quantitative	$6.50	$10.00	$3.10–$13.00	91% below	35%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) inpatient CPT 86140 C Reactive Protein Quantitative	$6.50	$10.00	$5.00–$13.00	—	35%
C. difficile toxin gene test (stool PCR) CPT 87493 Clostridium difficile Toxin Gene by NAAT with Reflex to Toxins A and B by EIA Feces	$40.30	$62.00	$19.22–$80.60	70% below	35%
C. difficile toxin gene test (stool PCR) inpatient CPT 87493 Clostridium difficile Toxin Gene by NAAT with Reflex to Toxins A and B by EIA Feces	$40.30	$62.00	$31.00–$80.60	—	35%
CA 19-9 blood test (tumor marker) CPT 86301 Carbohydrate Antigen (CA) 19-9	$16.90	$26.00	$8.06–$33.80	88% below	35%
CA 19-9 blood test (tumor marker) inpatient CPT 86301 Carbohydrate Antigen (CA) 19-9	$16.90	$26.00	$13.00–$33.80	—	35%
CA-125 blood test (ovarian cancer marker) CPT 86304 Cancer Antigen (CA) 125	$13.00	$20.00	$6.20–$26.00	92% below	35%
CA-125 blood test (ovarian cancer marker) inpatient CPT 86304 Cancer Antigen (CA) 125	$13.00	$20.00	$10.00–$26.00	—	35%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Coronavirus COVID-19 2019 Novel by RT-PCR LabCorp	$51.35	$79.00	$24.49–$102.70	51% below	35%
COVID-19 PCR test (SARS-CoV-2 lab test) one side CPT 87635 Beacon Coronavirus COVID-19 by RT-PCR	$82.55	$127.00	$39.37–$165.10	22% below	35%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 Coronavirus COVID-19 2019 Novel by RT-PCR LabCorp	$51.35	$79.00	$39.50–$102.70	—	35%
COVID-19 PCR test (SARS-CoV-2 lab test) inpatient one side CPT 87635 Beacon Coronavirus COVID-19 by RT-PCR	$82.55	$127.00	$63.50–$165.10	—	35%
Calcium blood test, total CPT 82310 82310 ASSAY OF CALCIUM	$7.15	$11.00	$3.41–$14.30	73% below	35%
Calcium blood test, total CPT 82310 Calcium Blood	$7.15	$11.00	$3.41–$14.30	73% below	35%
Calcium blood test, total inpatient CPT 82310 82310 ASSAY OF CALCIUM	$7.15	$11.00	$5.50–$14.30	—	35%
Calcium blood test, total inpatient CPT 82310 Calcium Blood	$7.15	$11.00	$5.50–$14.30	—	35%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic Antigen, Body Fluid	$11.05	$17.00	$5.27–$22.10	91% below	35%
Carcinoembryonic antigen (CEA) test inpatient CPT 82378 Carcinoembryonic Antigen, Body Fluid	$11.05	$17.00	$8.50–$22.10	—	35%
Chickenpox (varicella) immunity blood test CPT 86787 Varicella Zoster Virus (VZV) Antibodies, IgG	$25.35	$39.00	$12.09–$50.70	74% below	35%
Chickenpox (varicella) immunity blood test inpatient CPT 86787 Varicella Zoster Virus (VZV) Antibodies, IgG	$25.35	$39.00	$19.50–$50.70	—	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Chlamydia trachomatis NAA, Conjunctival Swab (Aptima, Labcorp)	$59.80	$92.00	$28.52–$119.60	39% below	35%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87491 Chlamydia trachomatis NAA, Conjunctival Swab (Aptima, Labcorp)	$59.80	$92.00	$46.00–$119.60	—	35%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel with LDL Cholesterol Direct Measurement, if Indicated	$12.35	$19.00	$5.89–$24.70	88% below	35%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid Panel with LDL Cholesterol Direct Measurement, if Indicated	$12.35	$19.00	$9.50–$24.70	—	35%
Complete blood count (CBC) with differential CPT 85025 CBC wDiff	$7.15	$11.00	$3.41–$14.30	83% below	35%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC wDiff	$7.15	$11.00	$5.50–$14.30	—	35%
Complete blood count (CBC), no differential CPT 85027 CBC	$5.85	$9.00	$2.79–$11.70	80% below	35%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC	$5.85	$9.00	$4.50–$11.70	—	35%
Cortisol blood test, total CPT 82533 Cortisol (Dexamethasone Suppression Test) w/ Rflx to Dexamethasone	$11.05	$17.00	$5.27–$22.10	88% below	35%
Cortisol blood test, total inpatient CPT 82533 Cortisol (Dexamethasone Suppression Test) w/ Rflx to Dexamethasone	$11.05	$17.00	$8.50–$22.10	—	35%
Creatine kinase (CK) blood test, total CPT 82550 Creatine Kinase Total with CKMB	$8.45	$13.00	$4.03–$16.90	78% below	35%
Creatine kinase (CK) blood test, total inpatient CPT 82550 Creatine Kinase Total with CKMB	$8.45	$13.00	$6.50–$16.90	—	35%
Creatinine blood test CPT 82565 Glomerular Filtration Rate, Estimated (eGFR)	$4.55	$7.00	$2.17–$9.10	84% below	35%
Creatinine blood test inpatient CPT 82565 Glomerular Filtration Rate, Estimated (eGFR)	$4.55	$7.00	$3.50–$9.10	—	35%
Cytomegalovirus (CMV) antibody test CPT 86644 Cytomegalovirus (CMV) Antibodies IgG	$9.10	$14.00	$4.34–$18.20	89% below	35%
Cytomegalovirus (CMV) antibody test inpatient CPT 86644 Cytomegalovirus (CMV) Antibodies IgG	$9.10	$14.00	$7.00–$18.20	—	35%
D-dimer blood test (blood clot marker) CPT 85379 D Dimer Quantitative Plasma	$16.90	$26.00	$8.06–$33.80	86% below	35%
D-dimer blood test (blood clot marker) inpatient CPT 85379 D Dimer Quantitative Plasma	$16.90	$26.00	$13.00–$33.80	—	35%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (DHEA) Sulfate, LC/MS-MS	$120.90	$186.00	$57.66–$241.80	18% below	35%
DHEA sulfate (DHEA-S) blood test inpatient CPT 82627 Dehydroepiandrosterone (DHEA) Sulfate, LC/MS-MS	$120.90	$186.00	$93.00–$241.80	—	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 10 With Reflex Confirmation (AMP,BAR,BZO,COC,PCP,THC,OPI,OXY,MD,PPX), Serum	$18.20	$28.00	$8.68–$36.40	84% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 10 with Conf/Quant Urine	$18.20	$28.00	$8.68–$36.40	84% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Nicotine Metabolite Screen, Urine	$30.55	$47.00	$14.57–$61.10	73% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 9 (No Propoxyphene) w/ Confirmations, Serum	$71.50	$110.00	$34.10–$143.00	37% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Blood Alcohol	$76.05	$117.00	$36.27–$152.10	33% below	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Drug Screen 8 plus Alcohol Urine	$113.75	$175.00	$54.25–$227.50	at median	35%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Comprehensive Umbilical Cord Drug Screen (USDTL)	$331.50	$510.00	$158.10–$663.00	190% above	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 10 With Reflex Confirmation (AMP,BAR,BZO,COC,PCP,THC,OPI,OXY,MD,PPX), Serum	$18.20	$28.00	$14.00–$36.40	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 10 with Conf/Quant Urine	$18.20	$28.00	$14.00–$36.40	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Nicotine Metabolite Screen, Urine	$30.55	$47.00	$23.50–$61.10	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 9 (No Propoxyphene) w/ Confirmations, Serum	$71.50	$110.00	$55.00–$143.00	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Blood Alcohol	$76.05	$117.00	$58.50–$152.10	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Drug Screen 8 plus Alcohol Urine	$113.75	$175.00	$87.50–$227.50	—	35%
Drug screen by lab instrument (any number of drug classes) inpatient CPT 80307 Comprehensive Umbilical Cord Drug Screen (USDTL)	$331.50	$510.00	$255.00–$663.00	—	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus Antibody to Viral Capsid Antigen IgA	$37.70	$58.00	$17.98–$75.40	54% below	35%
Epstein-Barr virus (EBV) antibody test CPT 86665 Epstein-Barr Virus (EBV) Antibodies to Viral Capsid Antigen (VCA) IgM	$50.05	$77.00	$23.87–$100.10	39% below	35%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus Antibody to Viral Capsid Antigen IgA	$37.70	$58.00	$29.00–$75.40	—	35%
Epstein-Barr virus (EBV) antibody test inpatient CPT 86665 Epstein-Barr Virus (EBV) Antibodies to Viral Capsid Antigen (VCA) IgM	$50.05	$77.00	$38.50–$100.10	—	35%
Estradiol blood test CPT 82670 Estradiol Serum	$19.50	$30.00	$9.30–$39.00	85% below	35%
Estradiol blood test CPT 82670 Estradiol, Sensitive, LC/MS	$23.40	$36.00	$11.16–$46.80	82% below	35%
Estradiol blood test inpatient CPT 82670 Estradiol Serum	$19.50	$30.00	$15.00–$39.00	—	35%
Estradiol blood test inpatient CPT 82670 Estradiol, Sensitive, LC/MS	$23.40	$36.00	$18.00–$46.80	—	35%
FSH (follicle-stimulating hormone) test CPT 83001 Follicle-stimulating Hormone (FSH), Pediatric (Endocrine Sciences)	$8.45	$13.00	$4.03–$16.90	93% below	35%
FSH (follicle-stimulating hormone) test inpatient CPT 83001 Follicle-stimulating Hormone (FSH), Pediatric (Endocrine Sciences)	$8.45	$13.00	$6.50–$16.90	—	35%
Fecal calprotectin (stool inflammation test) CPT 83993 Calprotectin, Feces	$178.75	$275.00	$85.25–$357.50	1% below	35%
Fecal calprotectin (stool inflammation test) inpatient CPT 83993 Calprotectin, Feces	$178.75	$275.00	$137.50–$357.50	—	35%
Ferritin blood test (iron stores) CPT 82728 82728 FERRITIN	$12.35	$19.00	$5.89–$24.70	85% below	35%
Ferritin blood test (iron stores) inpatient CPT 82728 82728 FERRITIN	$12.35	$19.00	$9.50–$24.70	—	35%
Fibrinogen blood test CPT 85384 REFLEX: Fibrinogen Activity 500709	$6.50	$10.00	$3.10–$13.00	89% below	35%
Fibrinogen blood test inpatient CPT 85384 REFLEX: Fibrinogen Activity 500709	$6.50	$10.00	$5.00–$13.00	—	35%
Folate (folic acid) blood test CPT 82746 82746 ASSAY OF FOLIC ACID SERUM	$13.65	$21.00	$6.51–$27.30	82% below	35%
Folate (folic acid) blood test inpatient CPT 82746 82746 ASSAY OF FOLIC ACID SERUM	$13.65	$21.00	$10.50–$27.30	—	35%
Free T3 thyroid hormone test CPT 84481 T3 Free	$13.00	$20.00	$6.20–$26.00	90% below	35%
Free T3 thyroid hormone test inpatient CPT 84481 T3 Free	$13.00	$20.00	$10.00–$26.00	—	35%
Free T4 (free thyroxine) thyroid blood test CPT 84439 T4 Thyroxine Free, Dialysis Mass Spectrometry	$8.45	$13.00	$4.03–$16.90	90% below	35%
Free T4 (free thyroxine) thyroid blood test inpatient CPT 84439 T4 Thyroxine Free, Dialysis Mass Spectrometry	$8.45	$13.00	$6.50–$16.90	—	35%
Free testosterone test CPT 84402 84402 ASSAY OF FREE TESTOSTERONE	$22.75	$35.00	$10.85–$45.50	73% below	35%
Free testosterone test inpatient CPT 84402 84402 ASSAY OF FREE TESTOSTERONE	$22.75	$35.00	$17.50–$45.50	—	35%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 GGT Gamma Glutamyl Transferase Blood	$9.10	$14.00	$4.34–$18.20	72% below	35%
Gamma-glutamyl transferase (GGT) blood test inpatient CPT 82977 GGT Gamma Glutamyl Transferase Blood	$9.10	$14.00	$7.00–$18.20	—	35%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Glucose 1 Hr Challenge 50 G Gestational	$5.85	$9.00	$2.79–$11.70	86% below	35%
Glucose challenge test (1-hour glucose after a sugar drink) inpatient CPT 82950 Glucose 1 Hr Challenge 50 G Gestational	$5.85	$9.00	$4.50–$11.70	—	35%
Glucose tolerance test, 3 samples CPT 82951 82951 GLUCOSE TOLERANCE TEST (GTT)	$161.20	$248.00	$76.88–$322.40	118% above	35%
Glucose tolerance test, 3 samples inpatient CPT 82951 82951 GLUCOSE TOLERANCE TEST (GTT)	$161.20	$248.00	$124.00–$322.40	—	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 87591 N.GONORRHOEAE DNA AMP PROB	$59.80	$92.00	$28.52–$119.60	39% below	35%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) inpatient CPT 87591 87591 N.GONORRHOEAE DNA AMP PROB	$59.80	$92.00	$46.00–$119.60	—	35%
H. pylori stool antigen test CPT 87338 Fec H pyl RL	$22.10	$34.00	$10.54–$44.20	83% below	35%
H. pylori stool antigen test inpatient CPT 87338 Fec H pyl RL	$22.10	$34.00	$17.00–$44.20	—	35%
HIV viral load test (HIV-1 RNA, quantitative) one side CPT 87536 HIV-1 Quant RT PCR (Nongraphical)	$50.05	$77.00	$23.87–$100.10	86% below	35%
HIV viral load test (HIV-1 RNA, quantitative) inpatient one side CPT 87536 HIV-1 Quant RT PCR (Nongraphical)	$50.05	$77.00	$38.50–$100.10	—	35%
HIV-1 and HIV-2 antibody test CPT 86703 HIV 1/2 Antibody Qual w/ Rflx to Confirmation	$94.90	$146.00	$45.26–$189.80	58% above	35%
HIV-1 and HIV-2 antibody test inpatient CPT 86703 HIV 1/2 Antibody Qual w/ Rflx to Confirmation	$94.90	$146.00	$73.00–$189.80	—	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV p24 Ag/Ab Combo w/ Rflx to Confirmation	$13.00	$20.00	$6.20–$26.00	78% below	35%
HIV-1/2 antigen and antibody combination blood test (4th generation) inpatient CPT 87389 HIV p24 Ag/Ab Combo w/ Rflx to Confirmation	$13.00	$20.00	$10.00–$26.00	—	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C (w/ Est Avg Glucose)	$9.10	$14.00	$4.34–$18.20	86% below	35%
Hemoglobin A1C blood test (average blood sugar over about 3 months) inpatient CPT 83036 Hemoglobin A1C (w/ Est Avg Glucose)	$9.10	$14.00	$7.00–$18.20	—	35%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B Virus (HBV) Core Antibody, Total with Reflex to IgM	$16.90	$26.00	$8.06–$33.80	75% below	35%
Hepatitis B core antibody test (total) CPT 86704 86704 HEPATITIS B CORE ANTIBODY (HBcAb); Total	$16.90	$26.00	$8.06–$33.80	75% below	35%
Hepatitis B core antibody test (total) inpatient CPT 86704 86704 HEPATITIS B CORE ANTIBODY (HBcAb); Total	$16.90	$26.00	$13.00–$33.80	—	35%
Hepatitis B core antibody test (total) inpatient CPT 86704 Hepatitis B Virus (HBV) Core Antibody, Total with Reflex to IgM	$16.90	$26.00	$13.00–$33.80	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Virus (HBV) Surface Antibody Quantitative	$6.50	$10.00	$3.10–$13.00	90% below	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B Virus (HBV) Surface Antibody Qualitative	$6.50	$10.00	$3.10–$13.00	90% below	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Virus (HBV) Surface Antibody Quantitative	$6.50	$10.00	$5.00–$13.00	—	35%
Hepatitis B surface antibody (anti-HBs) test, immunity check inpatient CPT 86706 Hepatitis B Virus (HBV) Surface Antibody Qualitative	$6.50	$10.00	$5.00–$13.00	—	35%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Hepatitis B Virus (HBV) Surface Antigen w Reflex to HBs Ag Neutralization	$9.75	$15.00	$4.65–$19.50	84% below	35%
Hepatitis B surface antigen (HBsAg) test inpatient CPT 87340 Hepatitis B Virus (HBV) Surface Antigen w Reflex to HBs Ag Neutralization	$9.75	$15.00	$7.50–$19.50	—	35%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C Virus (HCV) Antibody Cascade to Quant PCR and Genotyping	$13.65	$21.00	$6.51–$27.30	86% below	35%
Hepatitis C antibody blood test (screening) inpatient CPT 86803 Hepatitis C Virus (HCV) Antibody Cascade to Quant PCR and Genotyping	$13.65	$21.00	$10.50–$27.30	—	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C (HCV) Quant PCR w/ Rflx to Genotyping (Nongraphical)	$65.00	$100.00	$31.00–$130.00	71% below	35%
Hepatitis C viral load (HCV RNA) test CPT 87522 Hepatitis C Virus (HCV) GT1a NS5A Profile	$414.70	$638.00	$197.78–$829.40	85% above	35%
Hepatitis C viral load (HCV RNA) test one side CPT 87522 REFLEX: HCV RT-PCR, Quant (Non-Graph) 55036	$65.00	$100.00	$31.00–$130.00	71% below	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C (HCV) Quant PCR w/ Rflx to Genotyping (Nongraphical)	$65.00	$100.00	$50.00–$130.00	—	35%
Hepatitis C viral load (HCV RNA) test inpatient CPT 87522 Hepatitis C Virus (HCV) GT1a NS5A Profile	$414.70	$638.00	$319.00–$829.40	—	35%
Hepatitis C viral load (HCV RNA) test inpatient one side CPT 87522 REFLEX: HCV RT-PCR, Quant (Non-Graph) 55036	$65.00	$100.00	$50.00–$130.00	—	35%
Herpes blood test, HSV-1 antibody CPT 86695 Herpes Simplex Virus (HSV) Type 1-Specific Antibodies IgG	$9.75	$15.00	$4.65–$19.50	81% below	35%
Herpes blood test, HSV-1 antibody CPT 86695 86695 HERPES SIMPLEX TYPE 1 TEST	$23.40	$36.00	$11.16–$46.80	54% below	35%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 Herpes Simplex Virus (HSV) Type 1-Specific Antibodies IgG	$9.75	$15.00	$7.50–$19.50	—	35%
Herpes blood test, HSV-1 antibody inpatient CPT 86695 86695 HERPES SIMPLEX TYPE 1 TEST	$23.40	$36.00	$18.00–$46.80	—	35%
Herpes blood test, HSV-2 antibody CPT 86696 Herpes Simplex Virus (HSV) Type 2-Specific Abs, IgG	$9.75	$15.00	$4.65–$19.50	87% below	35%
Herpes blood test, HSV-2 antibody CPT 86696 86696 HERPES SIMPLEX TYPE 2 TEST	$23.40	$36.00	$11.16–$46.80	68% below	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 Herpes Simplex Virus (HSV) Type 2-Specific Abs, IgG	$9.75	$15.00	$7.50–$19.50	—	35%
Herpes blood test, HSV-2 antibody inpatient CPT 86696 86696 HERPES SIMPLEX TYPE 2 TEST	$23.40	$36.00	$18.00–$46.80	—	35%
High-sensitivity CRP (hs-CRP) test CPT 86141 C Reactive Protein High Sensitivity Cardiac	$15.60	$24.00	$7.44–$31.20	79% below	35%
High-sensitivity CRP (hs-CRP) test inpatient CPT 86141 C Reactive Protein High Sensitivity Cardiac	$15.60	$24.00	$12.00–$31.20	—	35%
Homocysteine blood test CPT 83090 Homocysteine, Plasma or Serum	$45.50	$70.00	$21.70–$91.00	65% below	35%
Homocysteine blood test inpatient CPT 83090 Homocysteine, Plasma or Serum	$45.50	$70.00	$35.00–$91.00	—	35%
Insulin blood test CPT 83525 83525 ASSAY OF INSULIN	$20.80	$32.00	$9.92–$41.60	71% below	35%
Insulin blood test CPT 83525 Insulin Total RL	$20.80	$32.00	$9.92–$41.60	71% below	35%
Insulin blood test inpatient CPT 83525 Insulin Total RL	$20.80	$32.00	$16.00–$41.60	—	35%
Insulin blood test inpatient CPT 83525 83525 ASSAY OF INSULIN	$20.80	$32.00	$16.00–$41.60	—	35%
Iron blood test (serum iron) CPT 83540 83540 IRON BINDING CAPACITY	$5.85	$9.00	$2.79–$11.70	88% below	35%
Iron blood test (serum iron) CPT 83540 Iron Liver Tissue	$24.70	$38.00	$11.78–$49.40	49% below	35%
Iron blood test (serum iron) inpatient CPT 83540 83540 IRON BINDING CAPACITY	$5.85	$9.00	$4.50–$11.70	—	35%
Iron blood test (serum iron) inpatient CPT 83540 Iron Liver Tissue	$24.70	$38.00	$19.00–$49.40	—	35%
Iron-binding capacity (TIBC) test CPT 83550 83550 IRON BINDING TEST	$7.80	$12.00	$3.72–$15.60	82% below	35%
Iron-binding capacity (TIBC) test inpatient CPT 83550 83550 IRON BINDING TEST	$7.80	$12.00	$6.00–$15.60	—	35%
Kidney function blood test panel CPT 80069 Renal	$10.40	$16.00	$4.96–$20.80	90% below	35%
Kidney function blood test panel inpatient CPT 80069 Renal	$10.40	$16.00	$8.00–$20.80	—	35%
LH (luteinizing hormone) test CPT 83002 Luteinizing Hormone (Lh) Serum	$11.05	$17.00	$5.27–$22.10	92% below	35%
LH (luteinizing hormone) test inpatient CPT 83002 Luteinizing Hormone (Lh) Serum	$11.05	$17.00	$8.50–$22.10	—	35%
Lactate (lactic acid) blood test CPT 83605 REFLEX: Lactic Acid 3hr	$13.00	$20.00	$6.20–$26.00	86% below	35%
Lactate (lactic acid) blood test inpatient CPT 83605 REFLEX: Lactic Acid 3hr	$13.00	$20.00	$10.00–$26.00	—	35%
Lactate dehydrogenase (LDH) blood test CPT 83615 83615 Lactate LD LDH Enzyme	$5.20	$8.00	$2.48–$10.40	88% below	35%
Lactate dehydrogenase (LDH) blood test inpatient CPT 83615 83615 Lactate LD LDH Enzyme	$5.20	$8.00	$4.00–$10.40	—	35%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase Serum	$6.50	$10.00	$3.10–$13.00	93% below	35%
Lipase blood test (pancreas enzyme) inpatient CPT 83690 Lipase Serum	$6.50	$10.00	$5.00–$13.00	—	35%
Lyme disease antibody test CPT 86618 Lyme Disease Total Antibody w/ Rflx to Immunoassay	$11.05	$17.00	$5.27–$22.10	91% below	35%
Lyme disease antibody test inpatient CPT 86618 Lyme Disease Total Antibody w/ Rflx to Immunoassay	$11.05	$17.00	$8.50–$22.10	—	35%
Magnesium blood test CPT 83735 Mg Magnesium Blood	$5.85	$9.00	$2.79–$11.70	88% below	35%
Magnesium blood test inpatient CPT 83735 Mg Magnesium Blood	$5.85	$9.00	$4.50–$11.70	—	35%
Measles (rubeola) antibody test CPT 86765 Measles (Rubeola) Antibodies, IgM	$9.10	$14.00	$4.34–$18.20	88% below	35%
Measles (rubeola) antibody test inpatient CPT 86765 Measles (Rubeola) Antibodies, IgM	$9.10	$14.00	$7.00–$18.20	—	35%
Mono test (heterophile antibody, Monospot) CPT 86308 Infectious Mononucleosis Screen	$6.50	$10.00	$3.10–$13.00	92% below	35%
Mono test (heterophile antibody, Monospot) inpatient CPT 86308 Infectious Mononucleosis Screen	$6.50	$10.00	$5.00–$13.00	—	35%
Mumps immunity blood test CPT 86735 Mumps Antibodies, IgG	$9.10	$14.00	$4.34–$18.20	88% below	35%
Mumps immunity blood test inpatient CPT 86735 Mumps Antibodies, IgG	$9.10	$14.00	$7.00–$18.20	—	35%
PSA (prostate-specific antigen) blood test, free CPT 84154 84154 ASSAY OF PSA FREE	$8.45	$13.00	$4.03–$16.90	88% below	35%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 84154 ASSAY OF PSA FREE	$8.45	$13.00	$6.50–$16.90	—	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 Prostate-specific Antigen (PSA), Free:Total Ratio Reflex	$8.45	$13.00	$4.03–$16.90	89% below	35%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA Prostate Specific Antigen Total Diagnostic	$16.90	$26.00	$8.06–$33.80	79% below	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 Prostate-specific Antigen (PSA), Free:Total Ratio Reflex	$8.45	$13.00	$6.50–$16.90	—	35%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA Prostate Specific Antigen Total Diagnostic	$16.90	$26.00	$13.00–$33.80	—	35%
Parathyroid hormone (PTH) blood test CPT 83970 PTH Intact Parathyroid Hormone, Blood, No Calcium	$50.05	$77.00	$23.87–$100.10	74% below	35%
Parathyroid hormone (PTH) blood test CPT 83970 83970 ASSAY OF PARATHORMONE	$50.05	$77.00	$23.87–$100.10	74% below	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 PTH Intact Parathyroid Hormone, Blood, No Calcium	$50.05	$77.00	$38.50–$100.10	—	35%
Parathyroid hormone (PTH) blood test inpatient CPT 83970 83970 ASSAY OF PARATHORMONE	$50.05	$77.00	$38.50–$100.10	—	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 85730 THROMBOPLASTIN TIME PARTIAL	$7.80	$12.00	$3.72–$15.60	84% below	35%
Partial thromboplastin time (PTT) clotting test CPT 85730 Factor VIII Inhibitor Profile Comprehensive	$9.10	$14.00	$4.34–$18.20	82% below	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 85730 THROMBOPLASTIN TIME PARTIAL	$7.80	$12.00	$6.00–$15.60	—	35%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Factor VIII Inhibitor Profile Comprehensive	$9.10	$14.00	$7.00–$18.20	—	35%
Phosphorus (phosphate) blood test CPT 84100 Phosphorus Serum	$4.55	$7.00	$2.17–$9.10	84% below	35%
Phosphorus (phosphate) blood test inpatient CPT 84100 Phosphorus Serum	$4.55	$7.00	$3.50–$9.10	—	35%
Potassium blood test CPT 84132 Potassium Blood	$3.90	$6.00	$1.86–$7.80	86% below	35%
Potassium blood test inpatient CPT 84132 Potassium Blood	$3.90	$6.00	$3.00–$7.80	—	35%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) CPT 81420 81420 Fetal Chrmoml Aneuploidy	$499.85	$769.00	$238.39–$999.70	41% below	35%
Prenatal cell-free DNA screen for trisomy 21, 18 and 13 (NIPT) inpatient CPT 81420 81420 Fetal Chrmoml Aneuploidy	$499.85	$769.00	$384.50–$999.70	—	35%
Progesterone blood test CPT 84144 84144 ASSAY OF PROGESTERONE	$178.10	$274.00	$84.94–$356.20	30% above	35%
Progesterone blood test inpatient CPT 84144 84144 ASSAY OF PROGESTERONE	$178.10	$274.00	$137.00–$356.20	—	35%
Prolactin blood test CPT 84146 Prolactin	$12.35	$19.00	$5.89–$24.70	88% below	35%
Prolactin blood test inpatient CPT 84146 Prolactin	$12.35	$19.00	$9.50–$24.70	—	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PT Prothrombin Time w/ INR	$3.90	$6.00	$1.86–$7.80	85% below	35%
Prothrombin time (PT/INR) clotting test CPT 85610 PT Prothrombin Time with Mixing Studies if Indicated	$9.10	$14.00	$4.34–$18.20	66% below	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT Prothrombin Time w/ INR	$3.90	$6.00	$3.00–$7.80	—	35%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT Prothrombin Time with Mixing Studies if Indicated	$9.10	$14.00	$7.00–$18.20	—	35%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Drug Screen 10, Urine (Bremen Lab)	$78.00	$120.00	$37.20–$156.00	22% below	35%
Rapid drug screen read by eye (cup, dipstick or card), per day inpatient CPT 80305 Drug Screen 10, Urine (Bremen Lab)	$78.00	$120.00	$60.00–$156.00	—	35%
Rapid flu test (influenza antigen) CPT 87804 87804 INFLUENZA ASSAY W/OPTIC	$73.45	$113.00	$35.03–$146.90	40% above	35%
Rapid flu test (influenza antigen) inpatient CPT 87804 87804 INFLUENZA ASSAY W/OPTIC	$73.45	$113.00	$56.50–$146.90	—	35%
Renin blood test CPT 84244 Renin Activity, Plasma	$22.10	$34.00	$10.54–$44.20	80% below	35%
Renin blood test inpatient CPT 84244 Renin Activity, Plasma	$22.10	$34.00	$17.00–$44.20	—	35%
Rh blood typing CPT 86901 86901 RL BLOOD TYPING SEROLOGIC RH(D)	$13.65	$21.00	$6.51–$27.30	65% below	35%
Rh blood typing inpatient CPT 86901 86901 RL BLOOD TYPING SEROLOGIC RH(D)	$13.65	$21.00	$10.50–$27.30	—	35%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid Factor Blood	$51.35	$79.00	$24.49–$102.70	5% above	35%
Rheumatoid factor (RF) test CPT 86431 86431 RHEUMATOID FACTOR QUANT	$51.35	$79.00	$24.49–$102.70	5% above	35%
Rheumatoid factor (RF) test inpatient CPT 86431 86431 RHEUMATOID FACTOR QUANT	$51.35	$79.00	$39.50–$102.70	—	35%
Rheumatoid factor (RF) test inpatient CPT 86431 Rheumatoid Factor Blood	$51.35	$79.00	$39.50–$102.70	—	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgG	$5.85	$9.00	$2.79–$11.70	91% below	35%
Rubella antibody test (immunity check) CPT 86762 Rubella Antibodies IgM	$8.45	$13.00	$4.03–$16.90	87% below	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgG	$5.85	$9.00	$4.50–$11.70	—	35%
Rubella antibody test (immunity check) inpatient CPT 86762 Rubella Antibodies IgM	$8.45	$13.00	$6.50–$16.90	—	35%
Sodium blood test CPT 84295 Sodium Blood	$3.90	$6.00	$1.86–$7.80	89% below	35%
Sodium blood test inpatient CPT 84295 Sodium Blood	$3.90	$6.00	$3.00–$7.80	—	35%
Stool ova and parasites exam CPT 87177 87177 OVA AND PARASITES SMEARS	$105.95	$163.00	$50.53–$211.90	118% above	35%
Stool ova and parasites exam inpatient CPT 87177 87177 OVA AND PARASITES SMEARS	$105.95	$163.00	$81.50–$211.90	—	35%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Occult Blood Screen Feces KIT (3 Cards)	$11.70	$18.00	$5.58–$23.40	68% below	35%
Stool test for hidden blood (guaiac FOBT) inpatient CPT 82270 Occult Blood Screen Feces KIT (3 Cards)	$11.70	$18.00	$9.00–$23.40	—	35%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Occult Blood Immunoassay Diagnostic Feces	$14.30	$22.00	$6.82–$28.60	72% below	35%
Stool test for hidden blood by immunoassay (FIT) inpatient CPT 82274 Occult Blood Immunoassay Diagnostic Feces	$14.30	$22.00	$11.00–$28.60	—	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 Syphilis: Treponemal Abs w/ Rflx to RPR and RPR Titer, Reverse Screening and Dx Algorithm	$3.90	$6.00	$1.86–$7.80	94% below	35%
Syphilis antibody test (Treponema pallidum) CPT 86780 REFLEX: Treponemal Antibodies, T. pallidum Particle Agglutination (TPPA)	$36.40	$56.00	$17.36–$72.80	46% below	35%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 Syphilis: Treponemal Abs w/ Rflx to RPR and RPR Titer, Reverse Screening and Dx Algorithm	$3.90	$6.00	$3.00–$7.80	—	35%
Syphilis antibody test (Treponema pallidum) inpatient CPT 86780 REFLEX: Treponemal Antibodies, T. pallidum Particle Agglutination (TPPA)	$36.40	$56.00	$28.00–$72.80	—	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis: RPR w/ Rflx to RPR Titer and Treponemal Abs, Traditional Screening and Dx Algorithm	$5.85	$9.00	$2.79–$11.70	86% below	35%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result inpatient CPT 86592 Syphilis: RPR w/ Rflx to RPR Titer and Treponemal Abs, Traditional Screening and Dx Algorithm	$5.85	$9.00	$4.50–$11.70	—	35%
Testosterone blood test, total (not free testosterone) CPT 84403 84403 ASSAY OF TOTAL TESTOSTERONE	$27.95	$43.00	$13.33–$55.90	76% below	35%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone Total, Women/Children/Hypogonadal Males, LC/MS-MS	$34.45	$53.00	$16.43–$68.90	71% below	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 84403 ASSAY OF TOTAL TESTOSTERONE	$27.95	$43.00	$21.50–$55.90	—	35%
Testosterone blood test, total (not free testosterone) inpatient CPT 84403 Testosterone Total, Women/Children/Hypogonadal Males, LC/MS-MS	$34.45	$53.00	$26.50–$68.90	—	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 Liver-Kidney Microsomal (LKM) Antibodies	$16.90	$26.00	$8.06–$33.80	82% below	35%
Thyroid peroxidase (TPO) antibody test CPT 86376 86376 MICROSOMAL ANTIBODY EACH	$16.90	$26.00	$8.06–$33.80	82% below	35%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 Liver-Kidney Microsomal (LKM) Antibodies	$16.90	$26.00	$13.00–$33.80	—	35%
Thyroid peroxidase (TPO) antibody test inpatient CPT 86376 86376 MICROSOMAL ANTIBODY EACH	$16.90	$26.00	$13.00–$33.80	—	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH (Thyroid Stimulating Hormone) Sensitive w/Rflx to Free T4	$15.60	$24.00	$7.44–$31.20	81% below	35%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Thyroid Cascade Profile	$37.70	$58.00	$17.98–$75.40	54% below	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH (Thyroid Stimulating Hormone) Sensitive w/Rflx to Free T4	$15.60	$24.00	$12.00–$31.20	—	35%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Thyroid Cascade Profile	$37.70	$58.00	$29.00–$75.40	—	35%
Total IgE blood test CPT 82785 82785 ASSAY OF IGE	$13.65	$21.00	$6.51–$27.30	82% below	35%
Total IgE blood test CPT 82785 Immunoglobulin E (IgE) Quantitative, Serum	$13.65	$21.00	$6.51–$27.30	82% below	35%
Total IgE blood test inpatient CPT 82785 Immunoglobulin E (IgE) Quantitative, Serum	$13.65	$21.00	$10.50–$27.30	—	35%
Total IgE blood test inpatient CPT 82785 82785 ASSAY OF IGE	$13.65	$21.00	$10.50–$27.30	—	35%
Total cholesterol blood test CPT 82465 Cholesterol Total Blood	$5.20	$8.00	$2.48–$10.40	83% below	35%
Total cholesterol blood test CPT 82465 82465 ASSAY BLD/SERUM CHOLESTEROL	$7.15	$11.00	$3.41–$14.30	77% below	35%
Total cholesterol blood test inpatient CPT 82465 Cholesterol Total Blood	$5.20	$8.00	$4.00–$10.40	—	35%
Total cholesterol blood test inpatient CPT 82465 82465 ASSAY BLD/SERUM CHOLESTEROL	$7.15	$11.00	$5.50–$14.30	—	35%
Total thyroxine (T4) blood test CPT 84436 84436 T4 TOTAL SERUM	$6.50	$10.00	$3.10–$13.00	86% below	35%
Total thyroxine (T4) blood test CPT 84436 T4 Total	$27.95	$43.00	$13.33–$55.90	41% below	35%
Total thyroxine (T4) blood test inpatient CPT 84436 84436 T4 TOTAL SERUM	$6.50	$10.00	$5.00–$13.00	—	35%
Total thyroxine (T4) blood test inpatient CPT 84436 T4 Total	$27.95	$43.00	$21.50–$55.90	—	35%
Total triiodothyronine (T3) blood test CPT 84480 T3 Total	$68.90	$106.00	$32.86–$137.80	43% below	35%
Total triiodothyronine (T3) blood test inpatient CPT 84480 T3 Total	$68.90	$106.00	$53.00–$137.80	—	35%
Transferrin blood test CPT 84466 Transferrin Serum	$16.90	$26.00	$8.06–$33.80	80% below	35%
Transferrin blood test inpatient CPT 84466 Transferrin Serum	$16.90	$26.00	$13.00–$33.80	—	35%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis by PCR, Swab or Urine (Xpert Kit, Beacon Labs)	$16.90	$26.00	$8.06–$33.80	82% below	35%
Trichomonas test (NAAT) CPT 87661 Trichomonas vaginalis, NAA (Aptima or ThinPrep)	$17.55	$27.00	$8.37–$35.10	82% below	35%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis by PCR, Swab or Urine (Xpert Kit, Beacon Labs)	$16.90	$26.00	$13.00–$33.80	—	35%
Trichomonas test (NAAT) inpatient CPT 87661 Trichomonas vaginalis, NAA (Aptima or ThinPrep)	$17.55	$27.00	$13.50–$35.10	—	35%
Triglycerides blood test CPT 84478 84478 ASSAY OF TRIGLYCERIDES	$5.20	$8.00	$2.48–$10.40	85% below	35%
Triglycerides blood test CPT 84478 Triglycerides Body Fluid	$27.30	$42.00	$13.02–$54.60	24% below	35%
Triglycerides blood test inpatient CPT 84478 84478 ASSAY OF TRIGLYCERIDES	$5.20	$8.00	$4.00–$10.40	—	35%
Triglycerides blood test inpatient CPT 84478 Triglycerides Body Fluid	$27.30	$42.00	$21.00–$54.60	—	35%
Troponin test, quantitative CPT 84484 REFLEX: Troponin I HS 1hr	$125.45	$193.00	$59.83–$250.90	4% above	35%
Troponin test, quantitative CPT 84484 Troponin I High Sensitivity (CHB Lab)	$125.45	$193.00	$59.83–$250.90	4% above	35%
Troponin test, quantitative inpatient CPT 84484 REFLEX: Troponin I HS 1hr	$125.45	$193.00	$96.50–$250.90	—	35%
Troponin test, quantitative inpatient CPT 84484 Troponin I High Sensitivity (CHB Lab)	$125.45	$193.00	$96.50–$250.90	—	35%
Uric acid blood test CPT 84550 84550 ASSAY OF BLOOD/URIC ACID	$5.85	$9.00	$2.79–$11.70	88% below	35%
Uric acid blood test inpatient CPT 84550 84550 ASSAY OF BLOOD/URIC ACID	$5.85	$9.00	$4.50–$11.70	—	35%
Urinalysis with microscope exam, manual CPT 81000 Done	$7.15	$11.00	$3.41–$14.30	73% below	35%
Urinalysis with microscope exam, manual inpatient CPT 81000 Done	$7.15	$11.00	$5.50–$14.30	—	35%
Urinalysis without microscope exam, automated CPT 81003 UA Macro	$2.60	$4.00	$1.24–$5.20	89% below	35%
Urinalysis without microscope exam, automated inpatient CPT 81003 UA Macro	$2.60	$4.00	$2.00–$5.20	—	35%
Urinalysis without microscope exam, manual CPT 81002 URINE DIB STICK	$118.95	$183.00	$56.73–$237.90	662% above	35%
Urinalysis without microscope exam, manual inpatient CPT 81002 URINE DIB STICK	$118.95	$183.00	$91.50–$237.90	—	35%
Urine culture for bacteria, with colony count CPT 87086 Urine Culture, Urology Workup	$7.15	$11.00	$3.41–$14.30	84% below	35%
Urine culture for bacteria, with colony count inpatient CPT 87086 Urine Culture, Urology Workup	$7.15	$11.00	$5.50–$14.30	—	35%
Urine microalbumin (albumin) test CPT 82043 82043 IH MICROALBUMIN QUANTITATIVE	$5.85	$9.00	$2.79–$11.70	83% below	35%
Urine microalbumin (albumin) test CPT 82043 U Malb 24 RL	$156.65	$241.00	$74.71–$313.30	352% above	35%
Urine microalbumin (albumin) test inpatient CPT 82043 82043 IH MICROALBUMIN QUANTITATIVE	$5.85	$9.00	$4.50–$11.70	—	35%
Urine microalbumin (albumin) test inpatient CPT 82043 U Malb 24 RL	$156.65	$241.00	$120.50–$313.30	—	35%
Urine pregnancy test, read by color change CPT 81025 UCG Qualitative Pregnancy Test Urine	$7.80	$12.00	$3.72–$15.60	86% below	35%
Urine pregnancy test, read by color change CPT 81025 Surg Pregnancy Test	$44.85	$69.00	$21.39–$89.70	17% below	35%
Urine pregnancy test, read by color change CPT 81025 BEDSIDE PREG TEST-URINE	$44.85	$69.00	$21.39–$89.70	17% below	35%
Urine pregnancy test, read by color change inpatient CPT 81025 UCG Qualitative Pregnancy Test Urine	$7.80	$12.00	$6.00–$15.60	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 Surg Pregnancy Test	$44.85	$69.00	$34.50–$89.70	—	35%
Urine pregnancy test, read by color change inpatient CPT 81025 BEDSIDE PREG TEST-URINE	$44.85	$69.00	$34.50–$89.70	—	35%
Vitamin B12 (cobalamin) blood test CPT 82607 Vitamin B12 Deficiency Cascade	$13.65	$21.00	$6.51–$27.30	82% below	35%
Vitamin B12 (cobalamin) blood test inpatient CPT 82607 Vitamin B12 Deficiency Cascade	$13.65	$21.00	$10.50–$27.30	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 25-Hydroxy Vitamin D (D2+D3 Fractionated) LC/MS-MS	$32.50	$50.00	$15.50–$65.00	76% below	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D 25 Hydroxy	$36.40	$56.00	$17.36–$72.80	73% below	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 25-Hydroxy Vitamin D (D2+D3 Fractionated) LC/MS-MS	$32.50	$50.00	$25.00–$65.00	—	35%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) inpatient CPT 82306 Vitamin D 25 Hydroxy	$36.40	$56.00	$28.00–$72.80	—	35%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Vitamin D 1 25 Dihydroxy (Calcitrol)	$37.70	$58.00	$17.98–$75.40	79% below	35%
Vitamin D, 1,25-dihydroxy blood test inpatient CPT 82652 Vitamin D 1 25 Dihydroxy (Calcitrol)	$37.70	$58.00	$29.00–$75.40	—	35%
Zinc blood test CPT 84630 Zinc Serum or Plasma	$15.60	$24.00	$7.44–$31.20	81% below	35%
Zinc blood test CPT 84630 Zinc, Whole Blood	$150.48	$231.51	$71.77–$300.96	82% above	35%
Zinc blood test inpatient CPT 84630 Zinc Serum or Plasma	$15.60	$24.00	$12.00–$31.20	—	35%
Zinc blood test inpatient CPT 84630 Zinc, Whole Blood	$150.48	$231.51	$115.76–$300.96	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 hCG Quantitative Serum	$8.45	$13.00	$4.03–$16.90	89% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Human Chorionic Gonadotropin (hCG) Tumor Marker	$40.95	$63.00	$19.53–$81.90	49% below	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 hCG Quantitative Serum	$8.45	$13.00	$6.50–$16.90	—	35%
hCG pregnancy hormone blood test, quantitative (measures the level) inpatient CPT 84702 Human Chorionic Gonadotropin (hCG) Tumor Marker	$40.95	$63.00	$31.50–$81.90	—	35%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Cardioversion, elective (restoring heart rhythm) CPT 92960 Cardioversion Elective Arrhythmia External	$1,075.75	$1,655.00	$513.05–$2,151.50	23% below	35%
Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ECC	$1,075.75	$1,655.00	$513.05–$2,151.50	23% below	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 Cardioversion Elective Arrhythmia External	$1,075.75	$1,655.00	$827.50–$2,151.50	—	35%
Cardioversion, elective (restoring heart rhythm) inpatient CPT 92960 CARDIOVERSION ECC	$1,075.75	$1,655.00	$827.50–$2,151.50	—	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Mogan	$274.95	$423.00	$131.13–$549.90	61% below	35%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Mogan	$274.95	$423.00	$211.50–$549.90	—	35%
Circumcision, surgical, older than a newborn CPT 54160 Plastibell	$261.95	$403.00	$124.93–$523.90	34% below	35%
Circumcision, surgical, older than a newborn inpatient CPT 54160 Plastibell	$261.95	$403.00	$201.50–$523.90	—	35%
Earwax removal by irrigation (rinsing), one ear CPT 69209 REMOVE IMPACTED EARWAX UNI	$70.20	$108.00	$33.48–$140.40	60% below	35%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 REMOVE IMPACTED EARWAX UNI	$70.20	$108.00	$54.00–$140.40	—	35%
Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX	$159.90	$246.00	$76.26–$319.80	at median	35%
Earwax removal with instruments, one ear inpatient CPT 69210 REMOVE IMPACTED EAR WAX	$159.90	$246.00	$123.00–$319.80	—	35%
Incision and drainage of a simple or single skin abscess CPT 10060 DRAINAGE OF SKIN ABSCESS	$346.45	$533.00	$165.23–$692.90	25% below	35%
Incision and drainage of a simple or single skin abscess inpatient CPT 10060 DRAINAGE OF SKIN ABSCESS	$346.45	$533.00	$266.50–$692.90	—	35%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 INJECT TEND SHEATH LIGAMENT CYST	$462.15	$711.00	$220.41–$924.30	14% below	35%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 INJECT TEND SHEATH LIGAMENT CYST	$462.15	$711.00	$355.50–$924.30	—	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 ASPIR/INJ JOINT/BURSA/CYST-MAJOR	$453.05	$697.00	$216.07–$906.10	10% above	35%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 ASPIR/INJ JOINT/BURSA/CYST-MAJOR	$453.05	$697.00	$348.50–$906.10	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium join	$341.25	$525.00	$162.75–$682.50	20% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 ASPIR-INJ JNT-BURSA CYST-INTERMED	$341.25	$525.00	$162.75–$682.50	20% below	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 ASPIR-INJ JNT-BURSA CYST-INTERMED	$341.25	$525.00	$262.50–$682.50	—	35%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspiration and/or injection of fluid from medium join	$341.25	$525.00	$262.50–$682.50	—	35%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 ASPIRAT INJECT JOINT BURSA CYST	$286.65	$441.00	$136.71–$573.30	2% below	35%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 ASPIRAT INJECT JOINT BURSA CYST	$286.65	$441.00	$220.50–$573.30	—	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 LAYER CLOSURE WOUNDS .1-2.5 CM	$307.45	$473.00	$146.63–$614.90	57% below	35%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 LAYER CLOSURE WOUNDS .1-2.5 CM	$307.45	$473.00	$236.50–$614.90	—	35%
Nail removal (partial or complete), one nail CPT 11730 RC AVULSION OF NAIL PLATE	$222.95	$343.00	$106.33–$445.90	44% below	35%
Nail removal (partial or complete), one nail inpatient CPT 11730 RC AVULSION OF NAIL PLATE	$222.95	$343.00	$171.50–$445.90	—	35%
Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING	$1,580.15	$2,431.00	$753.61–$3,160.30	14% above	35%
Paracentesis with imaging guidance inpatient CPT 49083 ABD PARACENTESIS W/IMAGING	$1,580.15	$2,431.00	$1,215.50–$3,160.30	—	35%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 EXCISION OF NAIL	$692.25	$1,065.00	$330.15–$1,384.50	at median	35%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 EXCISION OF NAIL	$692.25	$1,065.00	$532.50–$1,384.50	—	35%
Removal of a foreign object under the skin, simple CPT 10120 INCIS REMOVE FOREIGN BODY-SUBCUT	$481.65	$741.00	$229.71–$963.30	22% below	35%
Removal of a foreign object under the skin, simple inpatient CPT 10120 INCIS REMOVE FOREIGN BODY-SUBCUT	$481.65	$741.00	$370.50–$963.30	—	35%
Short arm splint (forearm and hand) CPT 29125 APPLICATION-FOREARM SPLINT	$150.15	$231.00	$71.61–$300.30	17% below	35%
Short arm splint (forearm and hand) inpatient CPT 29125 APPLICATION-FOREARM SPLINT	$150.15	$231.00	$115.50–$300.30	—	35%
Short leg splint (calf to foot) CPT 29515 APPLICATION-SHORT LEG SPLINT	$148.85	$229.00	$70.99–$297.70	38% below	35%
Short leg splint (calf to foot) inpatient CPT 29515 APPLICATION-SHORT LEG SPLINT	$148.85	$229.00	$114.50–$297.70	—	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 REPAIR SUPERFIC WOUNDS -1 2-5 CM	$510.90	$786.00	$243.66–$1,021.80	17% above	35%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs inpatient CPT 12001 REPAIR SUPERFIC WOUNDS -1 2-5 CM	$510.90	$786.00	$393.00–$1,021.80	—	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 SPINAL PUNCTURE-LUMBAR/DIAGNOSTIC	$684.45	$1,053.00	$326.43–$1,368.90	33% below	35%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Lumbar Puncture - Diagnostic	$687.05	$1,057.00	$327.67–$1,374.10	33% below	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 SPINAL PUNCTURE-LUMBAR/DIAGNOSTIC	$684.45	$1,053.00	$526.50–$1,368.90	—	35%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Lumbar Puncture - Diagnostic	$687.05	$1,057.00	$528.50–$1,374.10	—	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 REPAIR SUPERFIC WOUNDS 2.6-7.5 CM	$230.10	$354.00	$109.74–$460.20	42% below	35%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 REPAIR SUPERFIC WOUNDS 2.6-7.5 CM	$230.10	$354.00	$177.00–$460.20	—	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 REPAIR SUPERFIC WOUNDS -1 2-5 C/1	$292.50	$450.00	$139.50–$585.00	32% below	35%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 REPAIR SUPERFIC WOUNDS -1 2-5 C/1	$292.50	$450.00	$225.00–$585.00	—	35%
Trigger point injections, 1 or 2 muscles CPT 20552 INJ TRIGGER POINT	$236.60	$364.00	$112.84–$473.20	58% below	35%
Trigger point injections, 1 or 2 muscles inpatient CPT 20552 INJ TRIGGER POINT	$236.60	$364.00	$182.00–$473.20	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 MA Bx Brst 1st Lesion US Imag RT	$4,065.75	$6,255.00	$1,939.05–$8,131.50	75% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 MA Bx Brst 1st Lesion US Imag LT	$4,065.75	$6,255.00	$1,939.05–$8,131.50	75% above	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 MA Bx Brst 1st Lesion US Imag RT	$4,065.75	$6,255.00	$3,127.50–$8,131.50	—	35%
Ultrasound-guided breast needle biopsy with marker clip, first lesion inpatient one side CPT 19083 MA Bx Brst 1st Lesion US Imag LT	$4,065.75	$6,255.00	$3,127.50–$8,131.50	—	35%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Blood transfusion (giving blood or blood components) CPT 36430 BLOOD TRANSFUSION	$505.70	$778.00	$241.18–$1,011.40	44% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion-Platelets	$527.80	$812.00	$251.72–$1,055.60	41% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion-FFP	$527.80	$812.00	$251.72–$1,055.60	41% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Blood Transfusion-Packed RBC	$527.80	$812.00	$251.72–$1,055.60	41% below	35%
Blood transfusion (giving blood or blood components) CPT 36430 Given	$527.80	$812.00	$251.72–$1,055.60	41% below	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 BLOOD TRANSFUSION	$505.70	$778.00	$389.00–$1,011.40	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-FFP	$527.80	$812.00	$406.00–$1,055.60	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Given	$527.80	$812.00	$406.00–$1,055.60	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-Packed RBC	$527.80	$812.00	$406.00–$1,055.60	—	35%
Blood transfusion (giving blood or blood components) inpatient CPT 36430 Blood Transfusion-Platelets	$527.80	$812.00	$406.00–$1,055.60	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 High Flow # NC 0-24 hr	$204.75	$315.00	$97.65–$409.50	82% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 MDI # Treatment	$204.75	$315.00	$97.65–$409.50	82% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Neb with Heliox # MHSB	$204.75	$315.00	$97.65–$409.50	82% above	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 Neb with Heliox # MHSB	$204.75	$315.00	$157.50–$409.50	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 High Flow # NC 0-24 hr	$204.75	$315.00	$157.50–$409.50	—	35%
Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 MDI # Treatment	$204.75	$315.00	$157.50–$409.50	—	35%
Chemotherapy IV infusion, first hour CPT 96413 Given	$494.00	$760.00	$235.60–$988.00	27% below	35%
Chemotherapy IV infusion, first hour inpatient CPT 96413 Given	$494.00	$760.00	$380.00–$988.00	—	35%
Critical care, first 30 to 74 minutes CPT 99291 ED Critical Care (Face to Face ) Initial 30-74 Min	$1,589.25	$2,445.00	$757.95–$3,178.50	25% below	35%
Critical care, first 30 to 74 minutes inpatient CPT 99291 ED Critical Care (Face to Face ) Initial 30-74 Min	$1,589.25	$2,445.00	$1,222.50–$3,178.50	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Charge - ECC	$181.35	$279.00	$86.49–$362.70	10% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG Request	$189.15	$291.00	$90.21–$378.30	6% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 EKG	$189.15	$291.00	$90.21–$378.30	6% below	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Charge - ECC	$181.35	$279.00	$139.50–$362.70	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG Request	$189.15	$291.00	$145.50–$378.30	—	35%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge inpatient CPT 93005 EKG	$189.15	$291.00	$145.50–$378.30	—	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 ED Level 1 (Brief) (1-2)	$182.65	$281.00	$87.11–$365.30	16% below	35%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor inpatient CPT 99281 ED Level 1 (Brief) (1-2)	$182.65	$281.00	$140.50–$365.30	—	35%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 ED Level 2 (Limited) (3-5)	$319.15	$491.00	$152.21–$638.30	24% below	35%
Emergency room visit, level 2 of 5, straightforward problem inpatient CPT 99282 ED Level 2 (Limited) (3-5)	$319.15	$491.00	$245.50–$638.30	—	35%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 ED Level 3 (Intermediate) (6-8)	$536.90	$826.00	$256.06–$1,073.80	31% below	35%
Emergency room visit, level 3 of 5, low-complexity problem inpatient CPT 99283 ED Level 3 (Intermediate) (6-8)	$536.90	$826.00	$413.00–$1,073.80	—	35%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 ED Level 4 (Extended) (9-13)	$839.15	$1,291.00	$400.21–$1,678.30	29% below	35%
Emergency room visit, level 4 of 5, moderate-complexity problem inpatient CPT 99284 ED Level 4 (Extended) (9-13)	$839.15	$1,291.00	$645.50–$1,678.30	—	35%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 ED Level 5 (Comprehensive) (>/=14)	$1,251.25	$1,925.00	$596.75–$2,502.50	28% below	35%
Emergency room visit, level 5 of 5, high-complexity problem inpatient CPT 99285 ED Level 5 (Comprehensive) (>/=14)	$1,251.25	$1,925.00	$962.50–$2,502.50	—	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Diagnostic Stress Exercise Treadmill MHSB	$278.20	$428.00	$132.68–$556.40	63% below	35%
Exercise stress test, tracing only, the hospital charge CPT 93017 Diagnostic Exercise Test	$278.20	$428.00	$132.68–$556.40	63% below	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Diagnostic Exercise Test	$278.20	$428.00	$214.00–$556.40	—	35%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Diagnostic Stress Exercise Treadmill MHSB	$278.20	$428.00	$214.00–$556.40	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Hydration IV-ER-1st hour	$239.20	$368.00	$114.08–$478.40	35% below	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Done	$248.95	$383.00	$118.73–$497.90	32% below	35%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 O/P Hydration Infusion - 1st. hr	$248.95	$383.00	$118.73–$497.90	32% below	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Hydration IV-ER-1st hour	$239.20	$368.00	$184.00–$478.40	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 Done	$248.95	$383.00	$191.50–$497.90	—	35%
IV hydration (fluids through a vein), first 31 to 60 minutes inpatient CPT 96360 O/P Hydration Infusion - 1st. hr	$248.95	$383.00	$191.50–$497.90	—	35%
IV infusion of a medicine, first hour CPT 96365 Infusion Therapy-ER-1st hour	$242.45	$373.00	$115.63–$484.90	40% below	35%
IV infusion of a medicine, first hour CPT 96365 Given	$251.55	$387.00	$119.97–$503.10	38% below	35%
IV infusion of a medicine, first hour CPT 96365 O/P Infusion Therapy-1St Hr	$251.55	$387.00	$119.97–$503.10	38% below	35%
IV infusion of a medicine, first hour inpatient CPT 96365 Infusion Therapy-ER-1st hour	$242.45	$373.00	$186.50–$484.90	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 O/P Infusion Therapy-1St Hr	$251.55	$387.00	$193.50–$503.10	—	35%
IV infusion of a medicine, first hour inpatient CPT 96365 Given	$251.55	$387.00	$193.50–$503.10	—	35%
IV push of a medicine, first drug CPT 96374 IV push, Initial 0-15 mins	$148.20	$228.00	$70.68–$296.40	30% below	35%
IV push of a medicine, first drug CPT 96374 Intravenous Injection-Ther/Prop/Diag	$154.70	$238.00	$73.78–$309.40	27% below	35%
IV push of a medicine, first drug CPT 96374 Given	$154.70	$238.00	$73.78–$309.40	27% below	35%
IV push of a medicine, first drug inpatient CPT 96374 IV push, Initial 0-15 mins	$148.20	$228.00	$114.00–$296.40	—	35%
IV push of a medicine, first drug inpatient CPT 96374 Given	$154.70	$238.00	$119.00–$309.40	—	35%
IV push of a medicine, first drug inpatient CPT 96374 Intravenous Injection-Ther/Prop/Diag	$154.70	$238.00	$119.00–$309.40	—	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection SQ or IM (non-vaccine)	$76.70	$118.00	$36.58–$153.40	27% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Subq/Intramusc Inject-Ther/Prop/Diag	$79.95	$123.00	$38.13–$159.90	24% below	35%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Drug SC/IM-Each Seq Diff Drug	$79.95	$123.00	$38.13–$159.90	24% below	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Injection SQ or IM (non-vaccine)	$76.70	$118.00	$59.00–$153.40	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Drug SC/IM-Each Seq Diff Drug	$79.95	$123.00	$61.50–$159.90	—	35%
Injection under the skin or into a muscle, for treatment or testing inpatient CPT 96372 Subq/Intramusc Inject-Ther/Prop/Diag	$79.95	$123.00	$61.50–$159.90	—	35%
Mental health diagnostic evaluation (intake), without medical services CPT 90791 PSYCHIATRIC EVAL	$513.50	$790.00	$244.90–$1,027.00	105% above	35%
Mental health diagnostic evaluation (intake), without medical services inpatient CPT 90791 PSYCHIATRIC EVAL	$513.50	$790.00	$395.00–$1,027.00	—	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 INITIAL MNT-DB	$38.35	$59.00	$18.29–$76.70	12% above	35%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes inpatient CPT 97802 INITIAL MNT-DB	$38.35	$59.00	$29.50–$76.70	—	35%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 SMOKING CESSATION ADVISED 3 MIN OR GREAT	$126.10	$194.00	$60.14–$252.20	320% above	35%
Quit-smoking counseling, 3 to 10 minutes inpatient CPT 99406 SMOKING CESSATION ADVISED 3 MIN OR GREAT	$126.10	$194.00	$97.00–$252.20	—	35%
Spirometry (breathing test) CPT 94010 PEAK FLOW - ECC	$564.85	$869.00	$269.39–$1,129.70	131% above	35%
Spirometry (breathing test) CPT 94010 MHSB # Bedside PFT	$564.85	$869.00	$269.39–$1,129.70	131% above	35%
Spirometry (breathing test) inpatient CPT 94010 PEAK FLOW - ECC	$564.85	$869.00	$434.50–$1,129.70	—	35%
Spirometry (breathing test) inpatient CPT 94010 MHSB # Bedside PFT	$564.85	$869.00	$434.50–$1,129.70	—	35%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 STRESS TEST/TREADMILL	$479.05	$737.00	$228.47–$958.10	42% below	35%
Treadmill or drug stress test with ECG, supervision and report inpatient CPT 93015 STRESS TEST/TREADMILL	$479.05	$737.00	$368.50–$958.10	—	35%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
MMR vaccine (measles, mumps and rubella), live CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj	$325.00	$500.00	$155.00–$650.00	26% above	35%
MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 measles/mumps/rubella virus vaccine SubQ Inj	$325.00	$500.00	$250.00–$650.00	—	35%
Rabies vaccine, one dose CPT 90675 rabies vaccine, chick embryo 2.5 intl units IM Inj (RabAvert)	$1,453.40	$2,236.00	$693.16–$2,906.80	82% above	35%
Rabies vaccine, one dose CPT 90675 rabies vaccine, human diploid cell 2.5 intl units IM Inj (Imovax)	$1,522.95	$2,343.00	$726.33–$3,045.90	90% above	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, chick embryo 2.5 intl units IM Inj (RabAvert)	$1,453.40	$2,236.00	$1,118.00–$2,906.80	—	35%
Rabies vaccine, one dose inpatient CPT 90675 rabies vaccine, human diploid cell 2.5 intl units IM Inj (Imovax)	$1,522.95	$2,343.00	$1,171.50–$3,045.90	—	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Inj 0.5 mL	$167.05	$257.00	$79.67–$334.10	36% above	35%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 tetanus/diphth/pertussis (Adacel Tdap) IM Inj 0.5 mL	$167.05	$257.00	$128.50–$334.10	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Immunization Admin, 1 Vaccine	$73.45	$113.00	$35.03–$146.90	19% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Done	$76.70	$118.00	$36.58–$153.40	25% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 RC Immunization Adm 1 Vaccine	$76.70	$118.00	$36.58–$153.40	25% above	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Immunization Admin, 1 Vaccine	$73.45	$113.00	$56.50–$146.90	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 Done	$76.70	$118.00	$59.00–$153.40	—	35%
Vaccine administration fee (giving the shot), first vaccine of the visit inpatient CPT 90471 RC Immunization Adm 1 Vaccine	$76.70	$118.00	$59.00–$153.40	—	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Immunization Admin, Ea Addl Vaccine	$20.15	$31.00	$9.61–$40.30	49% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Each add'l vaccine	$21.45	$33.00	$10.23–$42.90	46% below	35%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 RC Immunization Adm EA Addl Vac	$21.45	$33.00	$10.23–$42.90	46% below	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Immunization Admin, Ea Addl Vaccine	$20.15	$31.00	$15.50–$40.30	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 RC Immunization Adm EA Addl Vac	$21.45	$33.00	$16.50–$42.90	—	35%
Vaccine administration fee, each additional vaccine at the same visit inpatient CPT 90472 Each add'l vaccine	$21.45	$33.00	$16.50–$42.90	—	35%

Procedure The service, with its billing code (CPT or HCPCS) and, in small type, the line exactly as the hospital wrote it in its price file. More

Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More

List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More

Insurers pay The lowest and highest rates this hospital has agreed with insurance plans for the same item, from its price file. If the cash price is below what your plan pays and you have not met your deductible, paying cash can cost you less. More

Against the state median This hospital's cash price compared with the median cash price of hospitals in the state for the same code. Shown when at least three hospitals in the state price it.

Off list How much lower the cash price is than the list price.

No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More

At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More

Check the item The description in the hospital file looks like a supply or device (a catheter, a brace, an implant), not this procedure. The hospital may have filed it under the wrong code: ask before relying on this price.

Source file: https://www.beaconhealthsystem.org/wp-content/uploads/2026/03/350835006_Community-Hospital-of-Bremen_standardcharges-8.csv?v=3