Hospital

Rush Memorial Hospital

Rush Memorial Hospital in Rushville, IN publishes cash prices for 436 common procedures listed here, from its own machine-readable price file updated Apr 27, 2026. Compared with other hospitals in the state, its outpatient cash prices are below the Indiana median for 218 of 436 procedures and above it for 215. By typical cash price it ranks #37 of 89 Indiana hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.

1300 N Main St Rushville IN 46173 Collected Sep 29, 2026 Source price file (765) 932-4111

Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 151304 · CMS hospital register NPI 1497726020

CMS price transparency record

The federal Centers for Medicare & Medicaid Services (CMS) enforces the rule that makes hospitals publish their prices. Its public enforcement list shows 2 actions for a hospital named Rush Memorial Hospital in Rushville, IN:

Feb 21, 2024 Warning notice
May 24, 2024 Case closed

Warning notice: CMS reviewed the hospital and told it that it had found possible violations of the price transparency rules. Case closed: CMS closed the case after the hospital addressed the problems.

A notice records a step in a CMS review; it is not a court finding. Source: CMS, Hospital Price Transparency Enforcement Activities and Outcomes, actions through Jul 31, 2026.

Scans and imaging

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Abdominal CT scan without and with contrast CPT 74170 CT scan of abdomen before and after contrast	$503.03	$670.70	$197.52–$657.29	60% below	25%
Abdominal X-ray, 2 views CPT 74019 X-ray of abdomen, 2 views	$2,076.38	$2,768.50	$815.32–$2,713.13	669% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 X-ray of ankle, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	156% above	25%
Ankle X-ray, complete, 3 or more views one side CPT 73610 X-ray of ankle, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	156% above	25%
Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 Ultrasound study of arm and leg arteries	$1,831.47	$2,441.96	$719.16–$2,393.12	378% above	25%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT scan of arm without contrast	$2,212.25	$2,949.66	$868.67–$2,890.67	175% above	25%
Arm CT scan without contrast (shoulder to hand, any part) one side CPT 73200 CT scan of arm without contrast	$2,256.49	$3,008.65	$886.05–$2,948.48	181% above	25%
Barium swallow (esophagus X-ray with contrast) CPT 74220 Single contrast X-ray of esophagus	$4,585.12	$6,113.49	$1,388.00–$5,991.22	879% above	25%
Bone scan, whole body (nuclear medicine) CPT 78306 Nuclear medicine study of bone and/or joint whole body	$822.53	$1,096.70	$322.98–$1,074.77	48% below	25%
Breast ultrasound, complete, one breast one side CPT 76641 Complete ultrasound scan of 1 breast	$1,775.47	$2,367.29	$697.17–$2,319.94	308% above	25%
Breast ultrasound, complete, one breast one side CPT 76641 Complete ultrasound scan of 1 breast	$1,775.47	$2,367.29	$697.17–$2,319.94	308% above	25%
Breast ultrasound, limited (one breast or one area) CPT 76642 Limited ultrasound scan of 1 breast	$2,265.17	$3,020.22	$889.45–$2,959.82	598% above	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Limited ultrasound scan of 1 breast	$1,420.37	$1,893.83	$557.73–$1,855.95	338% above	25%
Breast ultrasound, limited (one breast or one area) one side CPT 76642 Limited ultrasound scan of 1 breast	$1,420.37	$1,893.83	$557.73–$1,855.95	338% above	25%
CT angiography (CTA) of the abdomen and pelvis CPT 74174 CT scan of blood vessels of abdomen and pelvis with contrast	$497.28	$663.04	$195.27–$649.78	74% below	25%
CT angiography (CTA) of the head CPT 70496 CT scan of blood vessels of head with contrast	$2,408.50	$3,211.33	$945.74–$3,147.10	89% above	25%
CT angiography (CTA) of the neck CPT 70498 CT scan of blood vessels of neck with contrast	$4,701.02	$6,268.03	$1,388.00–$6,142.67	287% above	25%
CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT scan of blood vessels of chest with contrast	$2,292.59	$3,056.79	$900.22–$2,995.65	82% above	25%
CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT scan of heart with evaluation of blood vessel calcium	$1,202.02	$1,602.69	$471.99–$1,570.64	484% above	25%
CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT scan of abdomen and pelvis without contrast	$396.27	$528.36	$155.60–$517.79	62% below	25%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast	$1,424.34	$1,899.12	$559.29–$1,861.14	6% below	25%
CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT scan of abdomen and pelvis before and after contrast	$4,858.42	$6,477.89	$1,388.00–$6,348.33	183% above	25%
CT scan of the abdomen with contrast CPT 74160 CT scan of abdomen with contrast	$1,304.45	$1,739.26	$512.21–$1,704.47	22% above	25%
CT scan of the abdomen without contrast CPT 74150 CT scan of abdomen without contrast	$351.79	$469.05	$138.14–$459.67	58% below	25%
CT scan of the face and sinuses, no contrast dye CPT 70486 CT scan of face without contrast	$693.21	$924.28	$272.20–$905.79	17% below	25%
CT scan of the head or brain, no contrast dye CPT 70450 CT scan head or brain without contrast	$2,126.25	$2,835.00	$32.90–$1,984.50	170% above	25%
CT scan of the head with contrast CPT 70460 CT scan head or brain with contrast	$3,021.00	$4,028.00	$43.46–$2,819.60	246% above	25%
CT scan of the head without and with contrast CPT 70470 CT scan of head or brain before and after contrast	$731.25	$975.00	$48.88–$682.50	30% below	25%
CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT scan of lower spine without contrast	$821.99	$1,095.98	$322.77–$1,074.06	7% below	25%
CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT scan of upper spine without contrast	$354.13	$472.17	$139.05–$462.73	57% below	25%
CT scan of the pelvis, with contrast dye CPT 72193 CT scan of pelvis with contrast	$4,701.02	$6,268.03	$1,388.00–$6,142.67	389% above	25%
Carotid artery ultrasound (duplex), both sides of the neck CPT 93880 Ultrasound of both sides of head and neck blood flow	$1,831.47	$2,441.96	$719.16–$2,393.12	76% above	25%
Chest CT scan without and with contrast CPT 71270 CT scan of chest before and after contrast	$968.16	$1,290.88	$380.16–$1,265.06	9% below	25%
Chest X-ray, 2 views CPT 71046 X-ray of chest, 2 views	$2,574.93	$3,433.24	$1,011.09–$3,364.58	1141% above	25%
Chest X-ray, single view CPT 71045 X-ray of chest, 1 view	$2,574.93	$3,433.24	$1,011.09–$3,364.58	1484% above	25%
Collarbone (clavicle) X-ray, complete one side CPT 73000 X-ray of collar bone	$503.03	$670.70	$197.52–$657.29	162% above	25%
Collarbone (clavicle) X-ray, complete one side CPT 73000 X-ray of collar bone	$503.03	$670.70	$197.52–$657.29	162% above	25%
Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 Complete ultrasound scan behind abdominal cavity	$1,226.16	$1,634.88	$481.47–$2,345.00	139% above	25%
DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA bone density measurement of hip, pelvis, spine	$490.03	$653.37	$177.00–$640.30	69% above	25%
Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT scan of chest without contrast	$4,851.17	$6,468.22	$1,904.89–$6,338.86	482% above	25%
Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT scan of chest with contrast	$781.61	$1,042.15	$306.91–$1,021.31	15% below	25%
Diagnostic mammogram, one breast CPT 77065 Diagnostic mammography of 1 breast	$209.36	$279.14	$82.21–$273.56	6% below	25%
Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography of 1 breast	$490.03	$653.37	$177.00–$640.30	120% above	25%
Diagnostic mammogram, one breast one side CPT 77065 Diagnostic mammography of 1 breast	$490.03	$653.37	$177.00–$640.30	120% above	25%
Duplex ultrasound of the leg arteries, both legs CPT 93925 Ultrasound of leg arteries or artery grafts	$1,403.51	$1,871.35	$551.11–$1,833.92	49% above	25%
Duplex ultrasound of the leg veins, both legs CPT 93970 Ultrasound study of arm or leg veins with compression and maneuvers	$133.50	$178.00	$26.54–$186.27	90% below	25%
Elbow X-ray, 2 views one side CPT 73070 X-ray of elbow, 2 views	$503.03	$670.70	$197.52–$657.29	202% above	25%
Elbow X-ray, 2 views one side CPT 73070 X-ray of elbow, 2 views	$503.03	$670.70	$197.52–$657.29	202% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 X-ray of elbow, minimum of 3 views	$751.61	$1,002.15	$295.13–$982.11	195% above	25%
Elbow X-ray, complete, 3 or more views one side CPT 73080 X-ray of elbow, minimum of 3 views	$751.61	$1,002.15	$295.13–$982.11	195% above	25%
Eye socket (orbit) CT scan without contrast CPT 70480 CT scan of cranial cavity without contrast	$362.65	$483.53	$142.40–$473.86	55% below	25%
Facial bones X-ray, complete, 3 or more views CPT 70150 X-ray of face bones, minimum of 3 views	$120.00	$160.00	$10.37–$112.00	56% below	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 X-ray of forearm, 2 views	$503.03	$670.70	$197.52–$657.29	170% above	25%
Forearm X-ray (radius and ulna), 2 views one side CPT 73090 X-ray of forearm, 2 views	$503.03	$670.70	$197.52–$657.29	170% above	25%
HIDA scan: nuclear imaging of the liver, bile ducts and gallbladder CPT 78226 Nuclear medicine study of liver and bile duct system	$1,310.30	$1,747.07	$514.51–$1,712.13	at median	25%
Hand X-ray, 2 views one side CPT 73120 X-ray of hand, 2 views	$359.85	$479.80	$141.30–$470.20	110% above	25%
Hand X-ray, 2 views one side CPT 73120 X-ray of hand, 2 views	$359.85	$479.80	$141.30–$470.20	110% above	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 X-ray of heel, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	133% above	25%
Heel bone (calcaneus) X-ray, 2 or more views one side CPT 73650 X-ray of heel, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	133% above	25%
Knee X-ray, 3 views one side CPT 73562 X-ray of knee, 3 views	$751.61	$1,002.15	$295.13–$982.11	228% above	25%
Knee X-ray, 3 views one side CPT 73562 X-ray of knee, 3 views	$751.61	$1,002.15	$295.13–$982.11	228% above	25%
Knee X-ray, complete, 4 or more views one side CPT 73564 X-ray of knee, 4 or more views	$871.64	$1,162.18	$342.26–$1,138.94	233% above	25%
Knee X-ray, complete, 4 or more views one side CPT 73564 X-ray of knee, 4 or more views	$871.64	$1,162.18	$342.26–$1,138.94	233% above	25%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT scan of leg without contrast	$2,256.49	$3,008.65	$886.05–$2,948.48	188% above	25%
Leg CT scan without contrast (hip to foot, any part) one side CPT 73700 CT scan of leg without contrast	$2,256.49	$3,008.65	$886.05–$2,948.48	188% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 Limited ultrasound scan of abdomen	$1,439.31	$1,919.08	$565.17–$2,345.00	215% above	25%
Limited abdominal ultrasound of one organ or area, such as the gallbladder one side CPT 76705 Limited ultrasound scan of abdomen	$1,585.22	$2,113.63	$622.46–$2,071.36	247% above	25%
Limited ultrasound of an arm or leg (non-vascular) CPT 76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	$1,386.65	$1,848.87	$544.49–$1,811.89	358% above	25%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	$843.86	$1,125.14	$331.35–$1,102.64	179% above	25%
Limited ultrasound of an arm or leg (non-vascular) one side CPT 76882 Limited ultrasound scan of joint or other extremity structure except blood vessels	$843.86	$1,125.14	$331.35–$1,102.64	179% above	25%
Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 Low dose CT scan of chest for lung cancer screening	$2,292.59	$3,056.79	$900.22–$2,995.65	1091% above	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 X-ray of lower leg, 2 views	$503.03	$670.70	$197.52–$657.29	153% above	25%
Lower leg X-ray (tibia and fibula), 2 views one side CPT 73590 X-ray of lower leg, 2 views	$503.03	$670.70	$197.52–$657.29	153% above	25%
MR angiography (MRA) of the head without contrast CPT 70544 MRI scan of blood vessels of head without contrast	$2,292.59	$3,056.79	$900.22–$2,995.65	113% above	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI scan of leg joint without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	212% above	25%
MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI scan of leg joint without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	212% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI scan of leg joint before and after contrast	$4,851.17	$6,468.22	$1,904.89–$6,338.86	235% above	25%
MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI scan of leg joint before and after contrast	$4,851.17	$6,468.22	$1,904.89–$6,338.86	235% above	25%
MRI of the abdomen without contrast CPT 74181 MRI scan of abdomen without contrast	$4,858.42	$6,477.89	$1,388.00–$6,348.33	355% above	25%
MRI of the abdomen, without and then with contrast dye CPT 74183 MRI scan of abdomen before and after contrast	$2,574.93	$3,433.24	$1,011.09–$3,364.58	63% above	25%
MRI of the brain, no contrast dye CPT 70551 MRI scan of brain without contrast	$3,337.48	$4,449.97	$1,310.52–$4,360.97	222% above	25%
MRI of the brain, with and without contrast dye CPT 70553 MRI scan of brain before and after contrast	$3,337.24	$4,449.65	$1,310.42–$4,360.66	142% above	25%
MRI of the lower back, no contrast dye CPT 72148 MRI scan of lower spinal canal without contrast	$1,985.62	$2,647.49	$779.69–$2,594.54	92% above	25%
MRI of the lower back, without and then with contrast dye CPT 72158 MRI scan of lower spinal canal before and after contrast	$4,701.02	$6,268.03	$1,388.00–$6,142.67	221% above	25%
MRI of the mid back (thoracic spine), no contrast dye CPT 72146 MRI scan of middle spinal canal without contrast	$1,096.83	$1,462.44	$430.69–$1,433.19	7% above	25%
MRI of the neck (cervical spine) without and with contrast CPT 72156 MRI scan of upper spinal canal before and after contrast	$2,394.13	$3,192.17	$940.09–$3,128.33	64% above	25%
MRI of the neck (cervical spine), no contrast dye CPT 72141 MRI scan of upper spinal canal without contrast	$1,009.09	$1,345.45	$396.24–$1,318.54	3% below	25%
MRI of the pelvis without and with contrast CPT 72197 MRI scan of pelvis before and after contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	121% above	25%
MRI of the pelvis, no contrast dye CPT 72195 MRI scan of pelvis without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	198% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI scan of arm joint without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	201% above	25%
MRI of the shoulder, elbow or wrist joint, no contrast dye one side CPT 73221 MRI scan of arm joint without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	201% above	25%
Neck (cervical spine) X-ray, 4 or 5 views CPT 72050 X-ray of upper spine, 4-5 views	$3,337.24	$4,449.65	$1,310.42–$4,360.66	859% above	25%
Neck soft tissue CT scan with contrast CPT 70491 CT scan of soft tissue of neck with contrast	$2,292.59	$3,056.79	$900.22–$2,995.65	134% above	25%
Neck soft tissue CT scan without contrast CPT 70490 CT scan of soft tissue of neck without contrast	$3,211.94	$4,282.58	$1,261.22–$4,196.93	286% above	25%
Neck soft tissue X-ray CPT 70360 X-ray of soft tissue of neck	$690.00	$920.00	$7.26–$644.00	299% above	25%
Nuclear stress test imaging (SPECT), rest and stress studies CPT 78452 Nuclear medicine studies of heart muscle at rest and with stress and SPECT	$1,930.85	$2,574.47	$758.18–$2,522.98	49% below	25%
PET/CT scan from the base of the skull to mid-thigh CPT 78815 Nuclear medicine study from skull base to mid-thigh with CT scan	$5,234.11	$6,978.81	$2,055.26–$6,839.23	29% above	25%
Pelvic CT scan without contrast CPT 72192 CT scan of pelvis without contrast	$2,408.50	$3,211.33	$945.74–$3,147.10	189% above	25%
Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 Limited ultrasound scan of pelvis	$66.75	$89.00	$26.21–$87.22	80% below	25%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus	$1,093.19	$1,457.59	$429.26–$1,428.44	98% above	25%
Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus	$1,526.43	$2,035.24	$599.38–$1,994.54	202% above	25%
Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 Limited ultrasound of pregnant uterus	$1,775.47	$2,367.29	$697.17–$2,319.94	357% above	25%
Rib X-ray, one side, 2 views one side CPT 71100 X-ray of ribs on side of body, 2 views	$549.98	$733.30	$215.96–$718.63	169% above	25%
Rib X-ray, one side, 2 views one side CPT 71100 X-ray of ribs on side of body, 2 views	$549.98	$733.30	$215.96–$718.63	169% above	25%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-ray of ribs on side of body, minimum of 3 views	$587.96	$783.94	$230.87–$768.26	142% above	25%
Rib X-ray, one side, with a chest view, 3 or more views one side CPT 71101 X-ray of ribs on side of body, minimum of 3 views	$587.96	$783.94	$230.87–$768.26	142% above	25%
Screening mammogram, both breasts CPT 77067 Screening mammography	$2,278.92	$3,038.56	$894.86–$2,977.79	813% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-ray of shoulder, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	141% above	25%
Shoulder X-ray, complete, 2 or more views one side CPT 73030 X-ray of shoulder, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	141% above	25%
Sinus X-ray, complete, 3 or more views CPT 70220 X-ray of paranasal sinus, minimum of 3 views	$225.00	$300.00	$8.67–$210.00	21% below	25%
Skull X-ray, fewer than 4 views CPT 70250 X-ray of skull, 1-3 views	$147.07	$196.09	$7.26–$137.26	37% below	25%
Stress echocardiogram, complete, including the stress test and supervision CPT 93351 Ultrasound of heart with continuous electrocardiogram (ECG) during rest, exercise and/or drug induced stress with review and report	$2,281.30	$3,041.73	$895.79–$2,980.90	27% above	25%
Swallow study (modified barium swallow, video X-ray) CPT 74230 Imaging for evaluation of swallowing function	$4,557.77	$6,077.03	$1,388.00–$5,955.49	1138% above	25%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 X-ray of thigh bone, minimum 2 views	$503.03	$670.70	$197.52–$657.29	151% above	25%
Thigh bone (femur) X-ray, 2 or more views one side CPT 73552 X-ray of thigh bone, minimum 2 views	$503.03	$670.70	$197.52–$657.29	151% above	25%
Thoracic spine (mid back) CT scan without contrast CPT 72128 CT scan of middle spine without contrast	$974.02	$1,298.69	$382.46–$1,272.72	12% above	25%
Toe X-ray, 2 or more views one side CPT 73660 X-ray of toe, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	239% above	25%
Toe X-ray, 2 or more views one side CPT 73660 X-ray of toe, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	239% above	25%
Transvaginal pelvic ultrasound CPT 76830 Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina	$1,059.74	$1,412.99	$416.13–$1,384.73	160% above	25%
Transvaginal ultrasound during pregnancy CPT 76817 Vaginal ultrasound of pregnant uterus	$1,017.73	$1,356.97	$399.63–$1,329.83	175% above	25%
Ultrasound of the abdomen, complete CPT 76700 Complete ultrasound scan of abdomen	$102.15	$136.20	$31.34–$127.48	80% below	25%
Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 Ultrasound scan of head and neck soft tissue	$2,574.93	$3,433.24	$1,011.09–$3,364.58	504% above	25%
Upper GI series (X-ray of esophagus, stomach and duodenum with contrast) CPT 74240 Single contrast X-ray of upper digestive tract	$5,149.91	$6,866.55	$1,388.00–$6,729.22	883% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 X-ray of upper arm, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	161% above	25%
Upper arm X-ray (humerus), 2 views one side CPT 73060 X-ray of upper arm, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	161% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Ultrasound study of one arm or leg veins with compression and maneuvers	$1,501.34	$2,001.79	$589.53–$1,961.75	131% above	25%
Vein ultrasound (duplex) of one arm or leg, or a limited study one side CPT 93971 Ultrasound study of one arm or leg veins with compression and maneuvers	$1,501.34	$2,001.79	$589.53–$1,961.75	131% above	25%
Wrist X-ray, 2 views one side CPT 73100 X-ray of wrist, 2 views	$354.13	$472.17	$139.05–$462.73	125% above	25%
Wrist X-ray, 2 views one side CPT 73100 X-ray of wrist, 2 views	$354.13	$472.17	$139.05–$462.73	125% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 X-ray of wrist, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	97% above	25%
Wrist X-ray, complete, 3 or more views one side CPT 73110 X-ray of wrist, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	97% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-ray of hip, 2-3 views	$826.06	$1,101.41	$324.37–$1,079.38	209% above	25%
X-ray of one hip, 2 or 3 views, with the pelvis when included one side CPT 73502 X-ray of hip, 2-3 views	$826.06	$1,101.41	$324.37–$1,079.38	209% above	25%
X-ray of the abdomen, 1 view CPT 74018 X-ray of abdomen, 1 view	$544.00	$725.33	$213.61–$710.82	143% above	25%
X-ray of the ankle, 2 views one side CPT 73600 X-ray of ankle, 2 views	$400.68	$534.24	$157.33–$523.56	151% above	25%
X-ray of the ankle, 2 views one side CPT 73600 X-ray of ankle, 2 views	$400.68	$534.24	$157.33–$523.56	151% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 X-ray of finger, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	222% above	25%
X-ray of the finger(s), 2 or more views one side CPT 73140 X-ray of finger, minimum of 2 views	$503.03	$670.70	$197.52–$657.29	222% above	25%
X-ray of the foot, 2 views one side CPT 73620 X-ray of foot, 2 views	$397.78	$530.37	$156.19–$519.76	142% above	25%
X-ray of the foot, 2 views one side CPT 73620 X-ray of foot, 2 views	$397.78	$530.37	$156.19–$519.76	142% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-ray of foot, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	151% above	25%
X-ray of the foot, complete, 3 or more views one side CPT 73630 X-ray of foot, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	151% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 X-ray of hand, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	150% above	25%
X-ray of the hand, 3 or more views one side CPT 73130 X-ray of hand, minimum of 3 views	$503.03	$670.70	$197.52–$657.29	150% above	25%
X-ray of the knee, 1 or 2 views CPT 73560 X-ray of knee, 1-2 views	$4,701.02	$6,268.03	$1,388.00–$6,142.67	2151% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 X-ray of knee, 1-2 views	$503.03	$670.70	$197.52–$657.29	141% above	25%
X-ray of the knee, 1 or 2 views one side CPT 73560 X-ray of knee, 1-2 views	$503.03	$670.70	$197.52–$657.29	141% above	25%
X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-ray of middle spine, 2 views	$3,337.24	$4,449.65	$1,310.42–$4,360.66	1302% above	25%
X-ray of the nasal bones, 3 or more views CPT 70160 X-ray of nose bones, minimum of 3 views	$2,040.75	$2,721.00	$6.97–$1,904.70	898% above	25%
X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-ray of upper spine, 2-3 views	$3,337.24	$4,449.65	$1,310.42–$4,360.66	1233% above	25%
X-ray of the pelvis, 1 or 2 views CPT 72170 X-ray of pelvis, 1-2 views	$2,408.50	$3,211.33	$945.74–$3,147.10	1119% above	25%
X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-ray of sacrum and tailbone, minimum of 2 views	$4,342.70	$5,790.26	$1,705.23–$5,674.45	1883% above	25%

Lab tests

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
ACTH blood test CPT 82024 Adrenocorticotropic hormone (ACTH) level	$946.02	$1,261.36	$371.47–$1,236.13	263% above	25%
ALT (alanine aminotransferase) liver enzyme test CPT 84460 Liver enzyme (SGPT), level	$148.14	$197.52	$58.17–$193.57	429% above	25%
AST (aspartate aminotransferase) enzyme test CPT 84450 Liver enzyme (SGOT), level	$267.14	$356.19	$104.90–$349.07	821% above	25%
Acute hepatitis panel (hepatitis A, B and C) CPT 80074 Acute hepatitis panel	$2,017.71	$2,690.28	$792.29–$2,636.47	536% above	25%
Albumin blood test CPT 82040 Albumin (protein) level	$315.20	$420.27	$123.77–$411.86	1265% above	25%
Aldosterone blood test CPT 82088 Aldosterone hormone level	$434.51	$579.34	$170.62–$567.75	110% above	25%
Alkaline phosphatase (ALP) blood test CPT 84075 Phosphatase (enzyme) level, alkaline	$75.71	$100.95	$29.73–$98.93	133% above	25%
Allergy blood test, specific IgE, per allergen CPT 86003 Measurement of antibody (IgE) to allergic substance, crude allergen extract, each	$58.08	$77.44	$22.81–$75.89	202% above	25%
Alpha-fetoprotein (AFP) blood test CPT 82105 Alpha-fetoprotein (AFP) level, serum	$56.41	$75.21	$22.15–$73.71	45% below	25%
Ammonia blood test CPT 82140 Ammonia level	$34.19	$45.58	$13.42–$44.67	72% below	25%
Amylase blood test CPT 82150 Amylase (enzyme) level	$35.03	$46.70	$13.75–$45.77	31% below	25%
Anti-CCP antibody test (rheumatoid arthritis) CPT 86200 Measurement of antibody for rheumatoid arthritis assessment	$100.71	$134.28	$39.55–$131.59	90% above	25%
Antinuclear antibody (ANA) blood test, screen CPT 86038 Screening test for autoimmune disorder	$37.63	$50.17	$14.78–$49.17	37% below	25%
BNP or NT-proBNP blood test (heart failure marker) CPT 83880 Natriuretic peptide (heart and blood vessel protein) level	$73.24	$97.65	$28.76–$95.70	57% below	25%
Bacterial culture of a sample other than urine, blood or stool (wound, throat, fluid) CPT 87070 Bacterial culture, any other source except urine, blood or stool, aerobic	$575.24	$766.98	$225.88–$751.64	516% above	25%
Basic metabolic panel (blood test) CPT 80048 Blood test, basic group of blood chemicals (Calcium, total)	$2,662.15	$3,549.53	$1,045.34–$3,478.54	3187% above	25%
Bilirubin blood test, total CPT 82247 Bilirubin level, total	$49.30	$65.73	$19.36–$64.42	47% above	25%
Biopsy tissue exam by a pathologist (level IV) CPT 88305 Pathology examination of tissue using a microscope, intermediate complexity	$374.68	$499.57	$147.12–$489.58	45% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample	$1,031.77	$1,375.69	$405.14–$1,348.18	6041% above	25%
Blood draw from a vein (venipuncture), collection fee only CPT 36415 Insertion of needle into vein for collection of blood sample	$1,359.97	$1,813.29	$534.01–$1,777.02	7995% above	25%
Blood draw from a vein (venipuncture), collection fee only inpatient CPT 36415 Insertion of needle into vein for collection of blood sample	$1,359.97	$1,813.29	$534.01–$1,777.02	—	25%
Blood glucose (sugar) test CPT 82947 Blood glucose (sugar) level	$375.02	$500.02	$147.26–$490.02	1296% above	25%
Blood lead test CPT 83655 Lead level	$160.40	$213.86	$62.98–$209.58	125% above	25%
Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 Blood group typing (ABO)	$216.69	$288.92	$85.09–$283.14	321% above	25%
Blood urea nitrogen (BUN) test CPT 84520 Urea nitrogen level to assess kidney function, quantitative	$46.34	$61.79	$18.20–$60.55	93% above	25%
C-peptide blood test CPT 84681 C-peptide (protein) level	$44.15	$58.87	$17.34–$57.69	67% below	25%
C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 Measurement C-reactive protein for detection of infection or inflammation	$26.75	$35.67	$10.50–$34.96	62% below	25%
C. difficile toxin gene test (stool PCR) CPT 87493 Detection test by nucleic acid for clostridium difficile, amplified probe technique	$145.71	$194.28	$57.22–$190.39	8% above	25%
CA 19-9 blood test (tumor marker) CPT 86301 Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9	$303.55	$404.73	$119.19–$396.64	108% above	25%
CA-125 blood test (ovarian cancer marker) CPT 86304 Immunologic analysis for detection of tumor antigen, quantitative; CA 125	$163.37	$217.82	$64.15–$213.46	at median	25%
COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen	$317.51	$423.35	$124.68–$414.88	199% above	25%
Calcium blood test, total CPT 82310 Calcium level, total	$46.34	$61.79	$18.20–$60.55	70% above	25%
Carcinoembryonic antigen (CEA) test CPT 82378 Carcinoembryonic antigen (CEA) protein level	$182.96	$243.95	$71.84–$239.07	44% above	25%
Chickenpox (varicella) immunity blood test CPT 86787 Analysis for antibody to varicella-zoster virus (chicken pox)	$111.43	$148.57	$43.75–$145.60	10% above	25%
Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique	$59.27	$79.03	$23.27–$77.45	42% below	25%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides)	$2,575.29	$3,433.72	$1,011.23–$3,365.05	2234% above	25%
Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	$39.76	$53.01	$15.61–$51.95	1% below	25%
Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	$45.06	$60.08	$17.69–$58.88	48% above	25%
Comprehensive metabolic panel (blood test) CPT 80053 Blood test, comprehensive group of blood chemicals	$2,472.47	$3,296.62	$970.85–$3,230.69	2310% above	25%
Cortisol blood test, total CPT 82533 Cortisol (hormone) measurement, total	$28.43	$37.90	$11.16–$37.14	70% below	25%
Creatine kinase (CK) blood test, total CPT 82550 Creatine kinase (cardiac enzyme) level, total	$105.05	$140.07	$41.25–$137.27	171% above	25%
Creatinine blood test CPT 82565 Blood creatinine level	$43.13	$57.51	$16.94–$56.36	50% above	25%
Cytomegalovirus (CMV) antibody test CPT 86644 Analysis for antibody to Cytomegalovirus (CMV)	$22.52	$30.02	$8.84–$29.42	71% below	25%
D-dimer blood test (blood clot marker) CPT 85379 Coagulation function measurement, D-dimer; quantitative	$117.90	$157.20	$46.30–$154.06	4% below	25%
DHEA sulfate (DHEA-S) blood test CPT 82627 Dehydroepiandrosterone (DHEA-S) hormone level	$94.81	$126.41	$37.23–$123.88	38% below	25%
Drug screen by lab instrument (any number of drug classes) CPT 80307 Testing for presence of drug, by chemistry analyzers	$200.20	$266.93	$78.61–$261.59	77% above	25%
Electrolyte panel (sodium, potassium, chloride, CO2) CPT 80051 Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)	$2,244.31	$2,992.41	$881.26–$2,932.56	3389% above	25%
Epstein-Barr virus (EBV) antibody test CPT 86665 Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid	$119.30	$159.06	$46.84–$155.88	40% above	25%
Estradiol blood test CPT 82670 Measurement of total estradiol (hormone)	$251.27	$335.03	$98.67–$328.33	90% above	25%
FSH (follicle-stimulating hormone) test CPT 83001 Gonadotropin, follicle stimulating (reproductive hormone) level	$16.05	$21.40	$6.30–$20.97	87% below	25%
Fecal calprotectin (stool inflammation test) CPT 83993 Stool calprotectin (protein) level	$85.07	$113.42	$33.40–$111.15	52% below	25%
Ferritin blood test (iron stores) CPT 82728 Ferritin (blood protein) level	$72.80	$97.06	$28.58–$95.12	7% below	25%
Fibrinogen blood test CPT 85384 Fibrinogen (factor 1) activity measurement	$122.92	$163.89	$48.27–$160.61	94% above	25%
Folate (folic acid) blood test CPT 82746 Folic acid level, serum	$41.07	$54.76	$16.13–$53.66	46% below	25%
Free T3 thyroid hormone test CPT 84481 Thyroid hormone, T3 measurement, free	$221.19	$294.92	$86.85–$289.02	48% above	25%
Free T4 (free thyroxine) thyroid blood test CPT 84439 Thyroxine (thyroid chemical), free	$26.00	$34.66	$10.21–$33.97	68% below	25%
Free testosterone test CPT 84402 Testosterone (hormone) level, free	$130.68	$174.24	$51.31–$170.76	56% above	25%
Gamma-glutamyl transferase (GGT) blood test CPT 82977 Glutamyltransferase (liver enzyme) level	$46.34	$61.79	$18.20–$60.55	36% above	25%
General health panel: metabolic panel, blood count and TSH in one order CPT 80050 General health panel	$1,856.48	$2,475.30	$728.98–$2,425.79	505% above	25%
Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 Blood glucose (sugar) level after receiving dose of glucose	$300.50	$400.66	$117.99–$392.65	624% above	25%
Glucose tolerance test, 3 samples CPT 82951 Blood glucose (sugar) tolerance test, 3 specimens	$42.42	$56.56	$16.66–$55.43	43% below	25%
Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique	$198.77	$265.02	$78.05–$259.72	100% above	25%
H. pylori stool antigen test CPT 87338 Detection test by immunoassay technique for Helicobacter pylori (GI tract bacteria) in stool	$18.94	$25.25	$3.63–$23.73	85% below	25%
HIV viral load test (HIV-1 RNA, quantitative) CPT 87536 Detection test by nucleic acid for HIV-1 virus, quantification	$338.90	$451.87	$133.08–$442.83	9% below	25%
HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 Detection test by immunoassay technique for HIV-1 antigen and HIV-1 and HIV-2 antibodies	$45.16	$60.21	$17.73–$59.01	24% below	25%
HPV test for high-risk types, one combined (pooled) result CPT 87624 Detection test by nucleic acid for Human Papillomavirus (HPV), high-risk types	$150.00	$200.00	$58.90–$196.00	45% above	25%
Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 Hemoglobin A1C level	$141.68	$188.91	$55.63–$185.13	111% above	25%
Hemoglobin blood test CPT 85018 Blood count, hemoglobin	$154.07	$205.42	$60.50–$201.31	724% above	25%
Hepatitis B core antibody test (total) CPT 86704 Hepatitis B core antibody measurement	$118.74	$158.32	$46.63–$155.15	75% above	25%
Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 Hepatitis B surface antibody measurement	$55.79	$74.38	$21.90–$72.89	15% below	25%
Hepatitis B surface antigen (HBsAg) test CPT 87340 Detection test by immunoassay technique for hepatitis B surface antigen	$77.30	$103.06	$30.35–$101.00	27% above	25%
Hepatitis C antibody blood test (screening) CPT 86803 Hepatitis C antibody measurement	$162.95	$217.27	$63.99–$212.92	60% above	25%
Hepatitis C viral load (HCV RNA) test CPT 87522 Detection test by nucleic acid for Hepatitis C virus, quantification	$311.18	$414.90	$122.19–$406.60	41% above	25%
Herpes blood test, HSV-1 antibody CPT 86695 Analysis for antibody to Herpes simplex virus, type 1	$28.64	$38.18	$11.24–$37.42	44% below	25%
Herpes blood test, HSV-2 antibody CPT 86696 Analysis for antibody to Herpes simplex virus, type 2	$23.26	$31.01	$9.13–$30.39	68% below	25%
High-sensitivity CRP (hs-CRP) test CPT 86141 Measurement C-reactive protein for detection of infection or inflammation, high sensitivity	$26.75	$35.67	$10.50–$34.96	64% below	25%
Homocysteine blood test CPT 83090 Homocysteine (amino acid) level	$92.43	$123.24	$36.29–$120.78	28% below	25%
Insulin blood test CPT 83525 Insulin measurement, total	$184.11	$245.48	$72.29–$240.57	141% above	25%
Iron blood test (serum iron) CPT 83540 Iron level	$125.69	$167.59	$49.36–$164.24	162% above	25%
Iron-binding capacity (TIBC) test CPT 83550 Iron binding capacity	$767.54	$1,023.39	$301.39–$1,002.92	1615% above	25%
Kidney function blood test panel CPT 80069 Kidney function blood test panel	$4,592.21	$6,122.94	$1,803.21–$6,000.48	4261% above	25%
LH (luteinizing hormone) test CPT 83002 Gonadotropin, luteinizing (reproductive hormone) level	$15.00	$20.00	$5.89–$19.60	89% below	25%
Lactate (lactic acid) blood test CPT 83605 Lactic acid level	$398.84	$531.79	$156.61–$521.15	343% above	25%
Lactate dehydrogenase (LDH) blood test CPT 83615 Lactate dehydrogenase (enzyme) level	$41.39	$55.18	$16.25–$54.08	3% below	25%
Lipase blood test (pancreas enzyme) CPT 83690 Lipase (fat enzyme) level	$43.82	$58.43	$17.21–$57.26	51% below	25%
Liver function blood test panel CPT 80076 Liver function blood test panel	$216.23	$288.31	$84.91–$282.54	104% above	25%
Lyme disease antibody test CPT 86618 Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	$29.83	$39.77	$11.71–$38.97	77% below	25%
Magnesium blood test CPT 83735 Magnesium level	$53.46	$71.28	$20.99–$69.85	16% above	25%
Measles (rubeola) antibody test CPT 86765 Analysis for antibody to Rubeola (measles virus)	$138.16	$184.21	$54.25–$180.53	69% above	25%
Mono test (heterophile antibody, Monospot) CPT 86308 Screening test for mononucleosis (mono)	$168.30	$224.40	$66.09–$219.91	103% above	25%
Mumps immunity blood test CPT 86735 Analysis for antibody to mumps virus	$210.41	$280.55	$82.62–$274.94	174% above	25%
Obstetric blood test panel CPT 80055 Obstetric blood test panel	$2,766.74	$3,688.99	$1,086.41–$3,615.21	732% above	25%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free	$14.21	$18.95	$5.58–$18.57	80% below	25%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total	$156.60	$208.80	$61.49–$204.62	95% above	25%
Pap test (liquid-based, automated screening with review) CPT 88175 Pap test, automated thin layer preparation; automated system and manual rescreening	$52.11	$69.48	$20.46–$68.09	34% below	25%
Parathyroid hormone (PTH) blood test CPT 83970 Parathormone (parathyroid hormone) level	$198.09	$264.12	$77.78–$258.84	1% above	25%
Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood	$92.89	$123.85	$36.47–$121.37	84% above	25%
Phosphorus (phosphate) blood test CPT 84100 Phosphate level	$115.82	$154.43	$45.48–$151.34	289% above	25%
Potassium blood test CPT 84132 Blood potassium level	$19.88	$26.50	$7.80–$25.97	30% below	25%
Progesterone blood test CPT 84144 Progesterone (reproductive hormone) level	$157.62	$210.16	$61.89–$205.96	14% above	25%
Prolactin blood test CPT 84146 Prolactin (milk producing hormone) level	$62.44	$83.25	$24.52–$81.59	38% below	25%
Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time	$160.85	$214.47	$63.16–$210.18	507% above	25%
Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 Testing for presence of drug, read by direct observation	$185.33	$247.10	$72.77–$242.16	77% above	25%
Rapid flu test (influenza antigen) CPT 87804 Detection test by immunoassay with direct visual observation for influenza virus	$32.35	$43.13	$12.70–$42.27	40% below	25%
Rapid strep A antigen test from a throat swab, read visually CPT 87880 Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep)	$24.89	$33.19	$9.77–$32.53	67% below	25%
Renin blood test CPT 84244 Renin (kidney enzyme) level	$97.37	$129.82	$38.23–$127.22	12% below	25%
Rh blood typing CPT 86901 Blood typing for Rh (D) antigen	$124.67	$166.22	$48.95–$162.90	220% above	25%
Rheumatoid factor (RF) test CPT 86431 Rheumatoid factor level	$246.14	$328.19	$96.65–$321.63	379% above	25%
Rubella antibody test (immunity check) CPT 86762 Analysis for antibody to Rubella (German measles virus)	$181.40	$241.86	$71.23–$237.02	165% above	25%
Sodium blood test CPT 84295 Blood sodium level	$92.82	$123.76	$36.45–$121.28	152% above	25%
Stool ova and parasites exam CPT 87177 Smear for parasites	$64.20	$85.60	$25.21–$83.89	31% above	25%
Stool test for hidden blood (guaiac FOBT) CPT 82270 Stool analysis for blood to screen for colon tumors	$132.50	$176.66	$52.03–$173.13	263% above	25%
Stool test for hidden blood by immunoassay (FIT) CPT 82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay	$160.85	$214.47	$63.16–$210.18	199% above	25%
Syphilis antibody test (Treponema pallidum) CPT 86780 Analysis for antibody, Treponema pallidum	$70.19	$93.58	$27.56–$91.71	4% below	25%
Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 Syphilis detection test	$110.52	$147.36	$43.40–$144.41	170% above	25%
TB blood test measuring immune response (IGRA, gamma interferon) CPT 86480 Tuberculosis test, gamma interferon	$202.64	$270.18	$79.57–$264.78	22% above	25%
Testosterone blood test, total (not free testosterone) CPT 84403 Testosterone (hormone) level, total	$60.94	$81.25	$23.93–$79.63	47% below	25%
Thyroid peroxidase (TPO) antibody test CPT 86376 Microsomal antibodies (autoantibody) measurement	$70.64	$94.18	$27.74–$92.30	24% below	25%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH)	$28.01	$37.34	$11.00–$36.59	66% below	25%
Total IgE blood test CPT 82785 IgE (immune system protein) level	$69.97	$93.29	$27.47–$91.42	7% below	25%
Total cholesterol blood test CPT 82465 Cholesterol level	$179.83	$239.77	$70.61–$234.97	471% above	25%
Total thyroxine (T4) blood test CPT 84436 Thyroxine (thyroid chemical), total	$24.32	$32.42	$9.55–$31.77	49% below	25%
Total triiodothyronine (T3) blood test CPT 84480 Thyroid hormone, T3 measurement, total	$105.92	$141.22	$41.59–$138.40	13% below	25%
Transferrin blood test CPT 84466 Transferrin (iron binding protein) level	$70.23	$93.64	$27.58–$91.77	16% below	25%
Trichomonas test (NAAT) CPT 87661 Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique	$495.68	$660.91	$194.64–$647.69	419% above	25%
Triglycerides blood test CPT 84478 Triglycerides level	$508.40	$677.87	$199.63–$664.31	1312% above	25%
Troponin test, quantitative CPT 84484 Troponin (protein) analysis, quantitative	$172.11	$229.48	$67.58–$224.89	39% above	25%
Uric acid blood test CPT 84550 Uric acid level, blood	$40.82	$54.42	$16.03–$53.33	15% below	25%
Urinalysis with microscope exam, automated CPT 81001 Manual urinalysis test with examination using microscope, automated	$117.27	$156.36	$46.05–$153.23	173% above	25%
Urinalysis without microscope exam, automated CPT 81003 Automated urinalysis test	$227.91	$303.88	$89.49–$297.80	830% above	25%
Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test	$117.27	$156.36	$46.05–$153.23	594% above	25%
Urine culture for bacteria, with colony count CPT 87086 Bacterial colony count, urine	$155.56	$207.41	$61.08–$203.26	253% above	25%
Urine microalbumin (albumin) test CPT 82043 Urine microalbumin (protein) level	$114.08	$152.11	$44.80–$149.07	229% above	25%
Urine pregnancy test, read by color change CPT 81025 Urine pregnancy test	$175.49	$233.99	$68.91–$229.31	222% above	25%
Vitamin B12 (cobalamin) blood test CPT 82607 Cyanocobalamin (vitamin B-12) level	$224.31	$299.08	$88.08–$293.10	196% above	25%
Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 Vitamin D-3 level	$110.39	$147.18	$43.34–$144.24	12% below	25%
Vitamin D, 1,25-dihydroxy blood test CPT 82652 Dihydroxyvitamin D, 1, 25 level	$94.81	$126.41	$37.23–$123.88	46% below	25%
Zinc blood test CPT 84630 Zinc level	$22.19	$29.59	$8.71–$29.00	70% below	25%
hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 Gonadotropin, chorionic (reproductive hormone) level	$44.99	$59.98	$17.66–$58.78	43% below	25%

Surgery and procedures

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Appendectomy for a ruptured appendix with abscess or peritonitis CPT 44960 Removal of ruptured infected appendix	$830.85	$1,107.80	$326.25–$1,085.64	56% below	25%
Appendectomy for a ruptured appendix with abscess or peritonitis inpatient CPT 44960 Removal of ruptured infected appendix	$830.85	$1,107.80	$326.25–$1,085.64	—	25%
Appendectomy, open surgery CPT 44950 Removal of appendix	$360.60	$480.80	$141.60–$471.18	82% below	25%
Appendectomy, open surgery inpatient CPT 44950 Removal of appendix	$360.60	$480.80	$141.60–$471.18	—	25%
Arthroscopic ACL reconstruction or repair of the knee CPT 29888 Repair of anterior cruciate ligament of knee using an endoscope	$2,280.00	$3,040.00	$711.80–$2,128.00	86% below	25%
Balloon dilation of the maxillary sinus opening, one side CPT 31295 Dilation of nasal sinus using an endoscope	$462.00	$616.00	$109.41–$2,598.31	79% below	25%
Botox injections for chronic migraine CPT 64615 Injection of chemical for paralysis of facial and neck nerve muscles on both sides of face	$226.10	$301.46	$83.96–$245.96	65% below	25%
Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 Closed treatment of broken outside lower leg bone at ankle	$1,086.75	$1,449.00	$236.10–$1,014.30	124% above	25%
Broken foot (metatarsal) treatment without surgery or setting CPT 28470 Closed treatment of broken bone in forefoot or midfoot	$1,350.00	$1,800.00	$168.84–$1,260.00	155% above	25%
Bunion correction with a bone cut near the head of the first metatarsal CPT 28296 Correction of bunion with alignment correction of midfoot bone toward toe area	$858.23	$1,144.31	$337.00–$1,121.42	91% below	25%
Bunion correction with a bone cut near the head of the first metatarsal inpatient CPT 28296 Correction of bunion with alignment correction of midfoot bone toward toe area	$858.23	$1,144.31	$337.00–$1,121.42	—	25%
Bunion correction with removal of part of the big toe joint CPT 28292 Correction of bunion	$579.00	$772.00	$376.31–$1,171.52	83% below	25%
Cardioversion, elective (restoring heart rhythm) CPT 92960 External shock to heart to regulate heart beat	$165.75	$221.00	$78.72–$239.93	88% below	25%
Cervical biopsy CPT 57500 Biopsy of cervix or removal of growth	$1,130.37	$1,507.16	$443.86–$1,477.02	13% below	25%
Cervical biopsy CPT 57500 Biopsy of cervix or removal of growth	$1,155.95	$1,541.26	$55.01–$1,078.88	11% below	25%
Cervical biopsy inpatient CPT 57500 Biopsy of cervix or removal of growth	$1,130.37	$1,507.16	$443.86–$1,477.02	—	25%
Circumcision by surgical excision, older than 28 days (children and adults) CPT 54161 Removal of foreskin (older than 28 days)	$418.64	$558.19	$164.39–$547.03	91% below	25%
Circumcision by surgical excision, older than 28 days (children and adults) inpatient CPT 54161 Removal of foreskin (older than 28 days)	$418.64	$558.19	$164.39–$547.03	—	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns CPT 54150 Removal of foreskin using clamp or device	$598.99	$798.65	$235.20–$782.68	12% below	25%
Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 Removal of foreskin using clamp or device	$598.99	$798.65	$235.20–$782.68	—	25%
Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 Closed treatment of broken forearm (radius) bone at the wrist area on the thumb side of the wrist without manipulation	$2,123.27	$2,831.03	$274.54–$1,981.72	271% above	25%
Colonoscopy with polyp removal CPT 45385 Removal of polyps or growths of large bowel using an endoscope with mechanical snare	$1,397.59	$1,863.45	$183.14–$1,304.42	54% below	25%
Colonoscopy with tissue sample CPT 45380 Biopsy of large bowel using a flexible endoscope	$1,884.66	$2,512.88	$145.29–$1,759.02	36% below	25%
Colonoscopy, diagnostic CPT 45378 Diagnostic exam of large bowel using a flexible endoscope	$753.71	$1,004.95	$134.29–$703.47	62% below	25%
Colposcopy with LEEP (loop electrosurgical excision) CPT 57460 Biopsy of cervix using an endoscope with loop electrode	$1,800.00	$2,400.00	$113.92–$1,680.00	67% below	25%
Colposcopy with cervical biopsy and scraping of the cervical canal CPT 57454 Biopsy and scraping of cervix using an endoscope	$334.50	$446.00	$95.59–$312.20	49% below	25%
D&C (dilation and curettage), not related to pregnancy CPT 58120 Dilation and scraping of uterus	$315.88	$421.17	$168.26–$494.32	96% below	25%
Destruction of a precancerous skin lesion (actinic keratosis), first lesion CPT 17000 Destruction of precancer skin growth, 1 growth	$124.99	$166.65	$39.00–$116.66	33% below	25%
Ear tube placement (tympanostomy) under general anesthesia, one ear CPT 69436 Incision of eardrum with placement of eardrum tube under general anesthesia	$158.25	$211.00	$105.50–$269.39	97% below	25%
Ear tube placement (tympanostomy) with local anesthesia, one ear CPT 69433 Incision of eardrum with insertion of eardrum tube under local or topical anesthesia	$162.11	$216.14	$96.99–$334.82	73% below	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal of impacted ear wax by washing	$213.89	$285.19	$13.61–$199.63	22% above	25%
Earwax removal by irrigation (rinsing), one ear CPT 69209 Removal of impacted ear wax by washing	$708.47	$944.63	$278.19–$925.74	303% above	25%
Earwax removal by irrigation (rinsing), one ear inpatient CPT 69209 Removal of impacted ear wax by washing	$708.47	$944.63	$278.19–$925.74	—	25%
Earwax removal with instruments, one ear CPT 69210 Removal of impacted ear wax	$147.20	$196.27	$22.18–$137.39	2% below	25%
Earwax removal with instruments, one ear CPT 69210 Removal of impacted ear wax	$455.68	$607.57	$178.93–$595.42	205% above	25%
Earwax removal with instruments, one ear inpatient CPT 69210 Removal of impacted ear wax	$455.68	$607.57	$178.93–$595.42	—	25%
Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 Biopsy of lining of uterus	$75.75	$101.00	$29.74–$98.98	73% below	25%
Endoscopic sinus surgery: full ethmoid sinus opening CPT 31255 Removal of nasal sinus using an endoscope	$882.38	$1,176.51	$346.48–$1,152.98	94% below	25%
Endoscopic sinus surgery: full ethmoid sinus opening inpatient CPT 31255 Removal of nasal sinus using an endoscope	$882.38	$1,176.51	$346.48–$1,152.98	—	25%
Endoscopic sinus surgery: opening the frontal sinus CPT 31276 Exploration of nasal sinus using an endoscope	$1,014.75	$1,353.00	$258.10–$947.10	91% below	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus CPT 31256 Incision of nasal sinus using an endoscope	$882.38	$1,176.51	$346.48–$1,152.98	90% below	25%
Endoscopic sinus surgery: opening the maxillary (cheek) sinus inpatient CPT 31256 Incision of nasal sinus using an endoscope	$882.38	$1,176.51	$346.48–$1,152.98	—	25%
Endoscopic sinus surgery: opening the maxillary sinus with removal of tissue CPT 31267 Removal of nasal sinus tissue using an endoscope	$708.75	$945.00	$181.97–$661.50	92% below	25%
Epidural steroid injection, neck or mid back, with imaging guidance CPT 62321 Injection of substance into middle or upper spine canal using imaging guidance	$690.35	$920.46	$63.00–$644.32	35% below	25%
Facet joint injection, lower back, one level, with imaging guidance CPT 64493 Injection of lower or sacral spine facet joint using imaging guidance, single level	$586.85	$782.46	$67.08–$547.72	49% below	25%
First repair of a front abdominal hernia (such as umbilical) 3 to 10 cm CPT 49593 Initial repair of sliding hernia of abdomen, 3-10 cm in length	$463.59	$618.12	$309.06–$638.10	97% below	25%
First repair of a front abdominal hernia larger than 10 cm CPT 49595 Initial repair of sliding hernia of abdomen, more than 10 cm in length	$1,143.62	$1,524.83	$449.06–$1,494.33	96% below	25%
First repair of a front abdominal hernia larger than 10 cm inpatient CPT 49595 Initial repair of sliding hernia of abdomen, more than 10 cm in length	$1,143.62	$1,524.83	$449.06–$1,494.33	—	25%
First repair of a small front abdominal hernia (e.g. umbilical), under 3 cm CPT 49591 Initial repair of sliding hernia of abdomen, less than 3 cm in length	$539.25	$719.00	$247.79–$539.25	93% below	25%
Flexible sigmoidoscopy, diagnostic (lower colon only) CPT 45330 Diagnostic exam of lower portion of large bowel using a flexible endoscope	$333.13	$444.17	$43.57–$310.92	84% below	25%
Gallbladder removal, laparoscopic CPT 47562 Removal of gallbladder using an endoscope	$499.15	$665.53	$196.00–$652.22	97% below	25%
Gallbladder removal, laparoscopic inpatient CPT 47562 Removal of gallbladder using an endoscope	$499.15	$665.53	$196.00–$652.22	—	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery CPT 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope	$499.15	$665.53	$196.00–$652.22	97% below	25%
Gallbladder removal, laparoscopic, with X-ray of the bile ducts during surgery inpatient CPT 47563 Removal of gallbladder with X-ray study of bile ducts using an endoscope	$499.15	$665.53	$196.00–$652.22	—	25%
Hammertoe correction surgery CPT 28285 Correction of toe joint deformity	$675.00	$900.00	$302.68–$906.56	93% below	25%
Hemorrhoid banding (rubber band ligation) CPT 46221 Removal of external hemorrhoids by rubber banding	$465.00	$620.00	$159.00–$477.20	79% below	25%
Hemorrhoidectomy (internal and external), one area CPT 46255 Removal of single external and internal hemorrhoid group	$1,748.66	$2,331.54	$686.64–$2,284.91	64% below	25%
Hemorrhoidectomy (internal and external), one area inpatient CPT 46255 Removal of single external and internal hemorrhoid group	$1,748.66	$2,331.54	$686.64–$2,284.91	—	25%
Hip replacement after an earlier hip surgery (conversion to total hip) CPT 27132 Total hip replacement after previous hip surgery	$1,171.85	$1,562.47	$781.24–$2,771.90	95% below	25%
Hysterosalpingogram (HSG): contrast injection to check the fallopian tubes CPT 58340 Insertion of tube and introduction of contrast for X-ray of uterus and fallopian tubes	$702.75	$937.00	$42.06–$655.90	143% above	25%
Hysteroscopy with uterine lining sampling and/or polyp removal CPT 58558 Biopsy of lining of uterus and/or removal of polyp using an endoscope	$750.00	$1,000.00	$164.26–$2,059.97	88% below	25%
IUD insertion (the device itself billed separately) CPT 58300 Insertion of IUD for pregnancy prevention	$152.25	$203.00	$40.60–$181.41	96% below	25%
Incision and drainage of a simple or single skin abscess CPT 10060 Simple or single drainage of skin abscess	$1,232.04	$1,642.72	$483.78–$1,609.87	151% above	25%
Inguinal (groin) hernia repair, age 5 or older CPT 49505 Repair of groin hernia (5 years or older)	$562.61	$750.15	$375.08–$864.58	94% below	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament	$948.75	$1,265.00	$27.34–$885.50	72% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) CPT 20550 Injection into tendon or ligament	$2,061.04	$2,748.05	$809.30–$2,693.09	274% above	25%
Injection into a tendon sheath or ligament (for example trigger finger) inpatient CPT 20550 Injection into tendon or ligament	$2,061.04	$2,748.05	$809.30–$2,693.09	—	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration and/or injection of fluid from large joint	$82.49	$109.99	$32.02–$108.43	81% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 Aspiration and/or injection of fluid from large joint	$483.05	$644.07	$189.68–$631.19	13% above	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Aspiration and/or injection of fluid from large joint	$209.99	$279.98	$82.45–$274.38	51% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound one side CPT 20610 Aspiration and/or injection of fluid from large joint	$209.99	$279.98	$82.45–$274.38	51% below	25%
Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound inpatient CPT 20610 Aspiration and/or injection of fluid from large joint	$483.05	$644.07	$189.68–$631.19	—	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion of drug delivery implant into tissue	$416.63	$555.50	$43.84–$388.85	72% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant CPT 11981 Insertion of drug delivery implant into tissue	$983.19	$1,310.92	$386.07–$1,284.70	34% below	25%
Insertion of a drug-delivery implant, such as the arm birth control implant inpatient CPT 11981 Insertion of drug delivery implant into tissue	$983.19	$1,310.92	$386.07–$1,284.70	—	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint	$61.28	$81.71	$26.24–$92.12	86% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 Aspiration and/or injection of fluid from medium joint	$223.82	$298.43	$87.89–$292.46	50% below	25%
Joint injection or drainage, medium joint (wrist, elbow, ankle) inpatient CPT 20605 Aspiration and/or injection of fluid from medium joint	$223.82	$298.43	$87.89–$292.46	—	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint	$220.77	$294.36	$86.69–$288.47	25% below	25%
Joint injection or drainage, small joint (fingers, toes) CPT 20600 Aspiration and/or injection of fluid from small joint	$231.04	$308.05	$25.66–$215.64	21% below	25%
Joint injection or drainage, small joint (fingers, toes) inpatient CPT 20600 Aspiration and/or injection of fluid from small joint	$220.77	$294.36	$86.69–$288.47	—	25%
Knee arthroscopy with meniscus repair (one side of the knee) CPT 29882 Repair of inside or outside knee joint cartilage using an endoscope	$1,440.00	$1,920.00	$513.76–$1,344.00	87% below	25%
Knee arthroscopy with meniscus trim CPT 29881 Removal of knee cartilage using an endoscope	$1,335.00	$1,780.00	$412.50–$1,246.00	83% below	25%
Knee arthroscopy with removal of both torn meniscus parts CPT 29880 Removal of both knee cartilages using an endoscope	$1,221.75	$1,629.00	$426.38–$1,140.30	83% below	25%
Knee arthroscopy with smoothing of damaged cartilage (chondroplasty) CPT 29877 Removal or shaving of knee joint cartilage using an endoscope	$2,858.25	$3,811.00	$469.18–$2,667.70	56% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) CPT 44970 Removal of appendix using an endoscope	$830.85	$1,107.80	$326.25–$1,085.64	94% below	25%
Laparoscopic appendectomy (appendix removal through small cuts) inpatient CPT 44970 Removal of appendix using an endoscope	$830.85	$1,107.80	$326.25–$1,085.64	—	25%
Laparoscopic fundoplication (anti-reflux surgery) CPT 43280 Strengthening of muscle between esophagus and stomach by wrapping part of stomach around esophagus using an endoscope	$606.00	$808.00	$237.96–$791.84	97% below	25%
Laparoscopic inguinal (groin) hernia repair, first repair on that side CPT 49650 Repair of groin hernia using an endoscope	$1,412.74	$1,883.65	$334.37–$1,318.56	91% below	25%
Laparoscopic inguinal (groin) hernia repair, recurrent hernia CPT 49651 Repair of recurrent groin hernia using an endoscope	$1,125.00	$1,500.00	$433.44–$1,050.00	93% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	$576.44	$768.59	$226.35–$753.22	12% below	25%
Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs inpatient CPT 12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	$576.44	$768.59	$226.35–$753.22	—	25%
Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance	$875.60	$1,167.46	$63.00–$817.22	32% below	25%
Lower-back epidural injection, without imaging guidance CPT 62322 Injection of substance into lower spine canal	$1,114.50	$1,486.00	$61.08–$1,040.20	20% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less	$95.06	$126.74	$62.14–$212.67	95% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm CPT 11400 Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less	$246.35	$328.47	$96.73–$321.90	87% below	25%
Mole or benign skin lesion removal (excision), body, arms or legs, up to 0.5 cm inpatient CPT 11400 Removal of noncancer skin growth of body, arms, or legs, 0.5 cm or less	$246.35	$328.47	$96.73–$321.90	—	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	$83.58	$111.44	$55.72–$237.35	82% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm CPT 11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	$371.94	$495.92	$146.05–$486.00	22% below	25%
Mole or benign skin lesion removal (excision), face, ears, eyelids, nose or lips, up to 0.5 cm inpatient CPT 11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	$371.94	$495.92	$146.05–$486.00	—	25%
Nail removal (partial or complete), one nail CPT 11730 Simple separation of fingernail or toenail from nail bed, first nail	$155.20	$206.93	$40.46–$191.50	61% below	25%
Occipital nerve block (injection for headaches) CPT 64405 Injection of anesthetic agent and/or steroid into upper neck and back of head nerve	$2,214.00	$2,952.00	$36.44–$2,066.40	269% above	25%
Paracentesis with imaging guidance CPT 49083 Drainage of fluid from abdominal cavity using imaging guidance	$223.61	$298.14	$76.33–$476.94	84% below	25%
Partial knee replacement (one compartment) CPT 27446 Replacement of knee joint on side of knee	$1,920.00	$2,560.00	$834.95–$1,913.11	90% below	25%
Permanent removal of a nail and nail root (partial or complete) CPT 11750 Permanent removal fingernail or toenail	$104.67	$139.56	$41.10–$136.77	85% below	25%
Permanent removal of a nail and nail root (partial or complete) inpatient CPT 11750 Permanent removal fingernail or toenail	$104.67	$139.56	$41.10–$136.77	—	25%
Prostate biopsy CPT 55700 Biopsy of prostate gland	$850.18	$1,133.57	$333.84–$1,110.90	75% below	25%
Prostate biopsy inpatient CPT 55700 Biopsy of prostate gland	$850.18	$1,133.57	$333.84–$1,110.90	—	25%
Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple	$86.47	$115.29	$57.65–$252.81	83% below	25%
Removal of a foreign object under the skin, simple CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple	$325.26	$433.68	$127.72–$425.01	36% below	25%
Removal of a foreign object under the skin, simple inpatient CPT 10120 Removal of foreign body from tissue, accessed beneath the skin, simple	$325.26	$433.68	$127.72–$425.01	—	25%
Removal of one lobe of the thyroid (lobectomy) CPT 60220 Removal of thyroid lobe on side of neck	$1,585.50	$2,114.00	$512.24–$1,479.80	83% below	25%
Screening colonoscopy for a person at average risk (Medicare code) HCPCS G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK	$677.96	$903.95	$154.52–$632.77	64% below	25%
Screening colonoscopy, high risk of colorectal cancer (Medicare code) HCPCS G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK	$674.93	$899.91	$154.36–$629.94	61% below	25%
Septoplasty to straighten the nasal septum CPT 30520 Reshaping of nasal cartilage	$3,000.00	$4,000.00	$496.12–$2,800.00	69% below	25%
Short arm cast (elbow to hand) CPT 29075 Application of elbow to finger cast	$2,967.13	$3,956.17	$47.21–$2,769.32	670% above	25%
Short arm splint (forearm and hand) CPT 29125 Application of nonmoveable forearm to hand splint	$1,441.50	$1,922.00	$33.02–$1,345.40	635% above	25%
Short leg cast (below the knee) CPT 29405 Application of short leg cast	$115.90	$154.53	$44.97–$138.27	69% below	25%
Short leg cast (below the knee) CPT 29405 Application of short leg cast	$305.93	$407.91	$120.13–$399.75	19% below	25%
Short leg cast (below the knee) inpatient CPT 29405 Application of short leg cast	$305.93	$407.91	$120.13–$399.75	—	25%
Short leg splint (calf to foot) CPT 29515 Application of short leg splint from calf to foot	$603.82	$805.09	$237.10–$788.99	143% above	25%
Short leg splint (calf to foot) inpatient CPT 29515 Application of short leg splint from calf to foot	$603.82	$805.09	$237.10–$788.99	—	25%
Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.5 cm or less	$1,012.78	$1,350.37	$34.99–$945.26	127% above	25%
Skin biopsy, punch, one lesion CPT 11104 Punch biopsy, first skin growth	$45.30	$60.40	$30.20–$204.85	90% below	25%
Skin cancer removal (excision), body, arms or legs, up to 0.5 cm CPT 11600 Removal of cancer skin growth of body, arms, or legs, 0.5 cm or less	$450.00	$600.00	$88.23–$420.00	1% above	25%
Skin tag removal, up to 15 tags CPT 11200 Removal of skin tag, 1-15 skin tags	$56.25	$75.00	$37.50–$155.67	80% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test	$890.06	$1,186.75	$349.50–$1,163.02	13% below	25%
Spinal tap (lumbar puncture), diagnostic CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test	$2,608.49	$3,477.99	$1,024.27–$3,408.43	154% above	25%
Spinal tap (lumbar puncture), diagnostic inpatient CPT 62270 Removal of cerebrospinal fluid with lower back spinal tap for diagnostic test	$2,608.49	$3,477.99	$1,024.27–$3,408.43	—	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm	$483.29	$644.38	$45.61–$451.07	20% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm	$547.46	$729.94	$214.97–$715.34	35% above	25%
Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs inpatient CPT 12002 Simple repair of surface wound of scalp, neck, underarms, trunk, arms, or legs, 2.6-7.5 cm	$547.46	$729.94	$214.97–$715.34	—	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	$93.78	$125.04	$43.17–$197.34	78% below	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	$674.69	$899.58	$264.93–$881.59	56% above	25%
Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair inpatient CPT 12011 Simple repair of surface wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	$674.69	$899.58	$264.93–$881.59	—	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Biopsy of related skin growth, first growth	$327.00	$436.00	$24.83–$305.20	22% below	25%
Tangential (shave-style) skin biopsy, one lesion CPT 11102 Biopsy of related skin growth, first growth	$1,264.31	$1,685.74	$496.45–$1,652.03	202% above	25%
Tangential (shave-style) skin biopsy, one lesion inpatient CPT 11102 Biopsy of related skin growth, first growth	$1,264.31	$1,685.74	$496.45–$1,652.03	—	25%
Thoracentesis with imaging guidance CPT 32555 Aspiration of fluid from chest cavity using imaging guidance	$579.39	$772.52	$77.56–$825.10	48% below	25%
Thoracentesis with imaging guidance CPT 32555 Aspiration of fluid from chest cavity using imaging guidance	$2,943.67	$3,924.89	$1,155.88–$3,846.39	166% above	25%
Thoracentesis with imaging guidance inpatient CPT 32555 Aspiration of fluid from chest cavity using imaging guidance	$2,943.67	$3,924.89	$1,155.88–$3,846.39	—	25%
Tonsil and adenoid removal, age 12 or older CPT 42821 Removal of tonsils and adenoid glands (12 years or older)	$384.75	$513.00	$220.74–$515.33	92% below	25%
Tonsil and adenoid removal, child under 12 CPT 42820 Removal of tonsils and adenoid glands (younger than 12 years)	$330.00	$440.00	$211.54–$494.24	94% below	25%
Tonsil removal (tonsillectomy) only, age 12 or older CPT 42826 Removal of tonsils (12 years or older)	$352.50	$470.00	$187.65–$434.48	94% below	25%
Total hip replacement CPT 27130 Replacement of thigh bone and hip joint with prosthesis	$1,758.16	$2,344.21	$925.79–$2,135.05	94% below	25%
Total knee replacement CPT 27447 Replacement of knee joint, both sides of knee	$2,911.07	$3,881.43	$924.02–$2,717.00	87% below	25%
Total thyroid removal (thyroidectomy) CPT 60240 Removal of thyroid	$1,770.28	$2,360.37	$661.40–$1,652.26	85% below	25%
Trigger finger release surgery CPT 26055 Incision of tendon covering of finger	$2,394.46	$3,192.61	$230.92–$2,234.83	36% below	25%
Trigger point injections, 1 or 2 muscles CPT 20552 Injection of trigger points, 1-2 muscles	$1,002.17	$1,336.23	$29.28–$935.36	71% above	25%
Tubal ligation, laparoscopic (tubes sealed by cautery) CPT 58670 Destruction of fallopian tubes using an endoscope	$335.57	$447.43	$223.72–$620.48	97% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Biopsy of breast and placement of locating device using ultrasound, first growth	$1,775.47	$2,367.29	$697.17–$2,319.94	23% below	25%
Ultrasound-guided breast needle biopsy with marker clip, first lesion one side CPT 19083 Biopsy of breast and placement of locating device using ultrasound, first growth	$1,775.47	$2,367.29	$697.17–$2,319.94	23% below	25%
Upper endoscopy (EGD) with balloon widening of the esophagus CPT 43249 Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm	$329.25	$439.00	$111.58–$1,694.09	89% below	25%
Upper endoscopy (EGD) with biopsy CPT 43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$632.25	$843.00	$101.15–$612.69	79% below	25%
Upper endoscopy (EGD) with polyp removal by snare CPT 43251 Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare	$351.00	$468.00	$141.71–$803.31	91% below	25%
Upper endoscopy (EGD) with widening of the esophagus over a guide wire CPT 43248 Insertion of guide wire with dilation of esophagus using a flexible endoscope	$916.50	$1,222.00	$121.00–$855.40	66% below	25%
Upper endoscopy (EGD), diagnostic CPT 43235 Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$668.25	$891.00	$90.42–$623.70	69% below	25%
Vasectomy, one or both sides, including follow-up semen testing CPT 55250 Removal of sperm duct	$973.39	$1,297.85	$177.50–$908.50	42% below	25%
Wart removal, up to 14 warts CPT 17110 Destruction of skin growth, 1-14 growths	$127.50	$170.00	$50.92–$189.29	57% below	25%
Wart removal, up to 14 warts CPT 17110 Destruction of skin growth, 1-14 growths	$209.33	$279.10	$82.20–$273.52	29% below	25%
Wart removal, up to 14 warts inpatient CPT 17110 Destruction of skin growth, 1-14 growths	$209.33	$279.10	$82.20–$273.52	—	25%
Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 Removal of skin and tissue, 20.0 sq cm or less	$106.27	$141.69	$41.73–$138.86	86% below	25%
Wound debridement, skin and tissue under it, first 20 sq cm inpatient CPT 11042 Removal of skin and tissue, 20.0 sq cm or less	$106.27	$141.69	$41.73–$138.86	—	25%
Wrist fracture surgery (plate and screws), distal radius CPT 25607 Treatment of broken forearm bone on thumb side of wrist, above wrist, with placement of stabilizing device	$649.52	$866.03	$433.02–$1,257.01	92% below	25%

Doctor visits and therapy

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
Breathing treatment (nebulizer or inhaler) for airway obstruction CPT 94640 Inhalation treatment for airway obstruction or sputum production	$265.63	$354.17	$104.30–$347.09	135% above	25%
Chemotherapy IV infusion, first hour CPT 96413 Administration of chemotherapy into vein, 1 hour or less	$227.26	$303.01	$89.24–$296.95	66% below	25%
Comprehensive hearing test: tone and speech audiometry, both ears CPT 92557 Comprehensive hearing and speech recognition test	$179.44	$239.25	$70.46–$234.47	7% below	25%
Critical care, first 30 to 74 minutes CPT 99291 Critical care, first 30-74 minutes	$342.75	$457.00	$153.64–$421.68	83% below	25%
Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 Routine electrocardiogram (ECG) using at least 12 leads with tracing	$85.36	$113.81	$5.52–$79.67	58% below	25%
Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 Emergency department visit for problem that may not require health care professional	$118.50	$158.00	$8.34–$110.60	40% below	25%
Emergency room visit, level 2 of 5, straightforward problem CPT 99282 Emergency department visit with straightforward medical decision making	$157.56	$210.08	$30.10–$147.06	61% below	25%
Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 Emergency department visit with low level of medical decision making	$206.04	$274.72	$51.62–$192.30	70% below	25%
Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 Emergency department visit with moderate level of medical decision making	$266.91	$355.88	$87.24–$250.00	77% below	25%
Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 Emergency department visit with high level of medical decision making	$206.15	$274.87	$126.69–$252.81	88% below	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG)	$2,378.75	$3,171.66	$934.05–$3,108.23	202% above	25%
Exercise stress test, tracing only, the hospital charge CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG)	$2,511.29	$3,348.39	$986.10–$3,281.42	219% above	25%
Exercise stress test, tracing only, the hospital charge inpatient CPT 93017 Exercise or drug-induced heart stress test with electrocardiogram (ECG)	$2,378.75	$3,171.66	$934.05–$3,108.23	—	25%
Family therapy without the patient, 50 minutes CPT 90846 Family psychotherapy without patient, 50 minutes	$155.96	$207.94	$61.24–$203.78	24% below	25%
Group psychotherapy session CPT 90853 Group psychotherapy	$445.65	$594.20	$174.99–$582.32	101% above	25%
IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 Infusion into a vein for hydration, 31-60 minutes	$629.05	$838.73	$247.01–$821.96	60% above	25%
IV infusion of a medicine, first hour CPT 96365 Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less	$346.35	$461.80	$136.00–$452.56	14% below	25%
IV push of a medicine, first drug CPT 96374 Injection of drug or substance into vein	$102.08	$136.11	$40.08–$133.39	49% below	25%
Injection under the skin or into a muscle, for treatment or testing CPT 96372 Injection of drug or substance under skin or into muscle	$223.36	$297.81	$87.71–$291.85	112% above	25%
Nerve conduction study, 7 or 8 nerve studies CPT 95910 Nerve conduction, 7-8 studies	$326.64	$435.52	$128.26–$426.81	61% below	25%
New patient office visit, about 30 minutes CPT 99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	$59.25	$79.00	$55.30–$148.31	67% below	25%
New patient office visit, about 45 minutes CPT 99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$31.06	$41.41	$28.99–$222.98	85% below	25%
New patient office visit, about 60 minutes CPT 99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	$216.23	$288.30	$84.90–$282.53	20% below	25%
New patient office visit, straightforward problem or 15+ minutes CPT 99202 New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more	$20.29	$27.05	$18.94–$95.38	85% below	25%
Nutrition counseling (medical nutrition therapy), first visit, 15 minutes CPT 97802 Therapy procedure for nutrition management, each 15 minutes	$133.64	$178.19	$52.48–$174.63	291% above	25%
Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 Therapy procedure using manual technique, each 15 minutes	$801.34	$1,068.45	$314.66–$1,047.08	866% above	25%
Preventive checkup, new patient aged 18–39 CPT 99385 Initial new patient preventive medicine evaluation (18-39 years)	$116.21	$154.94	$30.99–$173.01	33% below	25%
Preventive checkup, new patient aged 40–64 CPT 99386 Initial new patient preventive medicine evaluation (40-64 years)	$170.09	$226.79	$45.36–$199.62	13% below	25%
Preventive checkup, new patient aged 65 or older CPT 99387 Initial new patient preventive medicine evaluation (65 years or older)	$76.51	$102.01	$20.40–$216.89	66% below	25%
Preventive checkup, returning patient aged 18–39 CPT 99395 Established patient periodic preventive medicine examination (18-39 years)	$80.25	$107.00	$21.40–$156.17	42% below	25%
Preventive checkup, returning patient aged 40–64 CPT 99396 Established patient periodic preventive medicine examination (40-64 years)	$132.00	$176.00	$35.20–$166.03	at median	25%
Preventive checkup, returning patient aged 65 or older CPT 99397 Established patient periodic preventive medicine examination (65 year old or older)	$191.25	$255.00	$51.00–$178.93	3% above	25%
Psychiatric evaluation with medical services CPT 90792 Psychiatric diagnostic evaluation with medical services	$661.87	$882.49	$259.89–$864.84	247% above	25%
Psychotherapy for crisis, first 60 minutes CPT 90839 Psychotherapy for crisis, first hour	$83.25	$111.00	$32.69–$108.78	18% below	25%
Psychotherapy session, 30 minutes CPT 90832 Psychotherapy, 30 minutes	$66.17	$88.22	$25.98–$86.46	33% below	25%
Psychotherapy session, 45 minutes CPT 90834 Psychotherapy, 45 minutes	$162.14	$216.18	$63.67–$211.86	at median	25%
Psychotherapy session, 60 minutes CPT 90837 Psychotherapy, 1 hour	$63.75	$85.00	$59.50–$202.89	71% below	25%
Quit-smoking counseling, 3 to 10 minutes CPT 99406 Smoking and tobacco use intermediate counseling, 3-10 minutes	$80.75	$107.67	$8.87–$75.37	169% above	25%
Returning patient office visit, high complexity or 40+ minutes CPT 99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	$67.32	$89.76	$26.43–$87.96	55% below	25%
Returning patient office visit, low complexity or 20+ minutes CPT 99213 Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more	$307.84	$410.45	$120.88–$402.24	229% above	25%
Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$77.28	$103.04	$30.35–$100.98	30% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	$43.65	$58.20	$25.57–$75.05	17% below	25%
Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	$322.21	$429.61	$126.52–$421.02	516% above	25%
Returning patient office visit, straightforward problem or 10+ minutes inpatient CPT 99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	$322.21	$429.61	$126.52–$421.02	—	25%
Specialist consultation, low complexity or 30+ minutes CPT 99243 Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more	$173.94	$231.92	$46.38–$162.34	21% below	25%
Specialist consultation, moderate complexity or 40+ minutes CPT 99244 Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more	$251.98	$335.97	$67.19–$235.18	at median	25%
Speech therapy session, individual CPT 92507 Treatment of speech, language, voice, communication, and/or hearing processing disorder	$146.72	$195.62	$57.61–$191.71	4% above	25%
Spirometry (breathing test) CPT 94010 Test to measure expiratory airflow and volume	$413.93	$551.90	$162.53–$540.86	57% above	25%
Spirometry before and after a bronchodilator CPT 94060 Test to measure expiratory airflow and volume changes before and after medication administration	$2,233.92	$2,978.56	$877.19–$2,918.99	294% above	25%
Therapeutic phlebotomy (removing blood as treatment) CPT 99195 Drawing of blood for a medical problem	$84.96	$113.28	$17.10–$121.89	60% below	25%
Treadmill or drug stress test with ECG, supervision and report CPT 93015 Exercise or drug-induced heart stress test with electrocardiogram (ECG) with supervision and review by physician	$669.75	$893.00	$60.30–$625.10	at median	25%

Vaccines

Procedure	Cash price	List price	Insurers pay	vs Indiana	Off list
COVID-19 vaccine (Moderna), age 12 and older CPT 91322 Severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use	$101.18	$134.90	$26.98–$101.18	59% below	25%
COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 Severe acute respiratory syndrome coronavirus 2 (COVID-19) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use	$153.15	$204.20	$40.84–$153.15	54% below	25%
Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 Varicella vaccine	$217.45	$289.93	$85.38–$284.13	47% below	25%
DTaP and polio booster for ages 4 to 6 (Kinrix, Quadracel) CPT 90696 Diphtheria, tetanus, acellular pertussis, and polio vaccine	$78.48	$104.64	$30.82–$102.55	40% below	25%
DTaP vaccine (diphtheria, tetanus and whooping cough), under age 7 CPT 90700 Diphtheria, tetanus, and acellular pertussis vaccine (younger than 7 years)	$67.50	$90.00	$26.51–$88.20	14% below	25%
DTaP, hepatitis B and polio combination vaccine (Pediarix) CPT 90723 Diphtheria, tetanus, acellular pertussis, hepatitis B, and polio vaccine	$636.30	$848.40	$249.85–$831.43	252% above	25%
DTaP, polio and Hib combination vaccine (Pentacel) CPT 90698 Diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b vaccine	$591.61	$788.81	$232.30–$773.03	149% above	25%
DTaP, polio, Hib and hepatitis B combination vaccine (Vaxelis) CPT 90697 Diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccine	$616.80	$822.40	$242.20–$805.95	49% above	25%
Flu shot, recombinant, egg-free (Flublok) CPT 90673 Influenza vaccine, trivalent derived from recombinant DNA	$42.73	$56.97	$16.78–$55.83	12% above	25%
Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 Influenza vaccine, trivalent, split virus, preservative-free, 0.5 mL dosage	$89.42	$119.23	$35.11–$116.85	124% above	25%
HPV vaccine, 9-valent (Gardasil 9) CPT 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent	$193.39	$257.85	$75.94–$252.69	69% below	25%
Hepatitis A vaccine, adult dose CPT 90632 Hepatitis A vaccine adult dosage	$30.60	$40.80	$12.02–$39.98	82% below	25%
Hepatitis A vaccine, child and teen dose (2-dose schedule) CPT 90633 Hepatitis A vaccine pediatric or adolescent dosage	$11.25	$15.00	$10.50–$82.87	86% below	25%
Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 Hepatitis B vaccine, adult dosage (3 dose schedule)	$436.49	$581.98	$171.39–$570.34	148% above	25%
Hib vaccine (Haemophilus influenzae type b), 3-dose schedule (PedvaxHIB) CPT 90647 Haemophilus influenzae type b vaccine, PRP-OMP conjugate	$30.60	$40.80	$12.02–$39.98	53% below	25%
Hib vaccine (Haemophilus influenzae type b), 4-dose schedule (ActHIB, Hiberix) CPT 90648 Haemophilus influenzae type b vaccine, PRP-T conjugate	$309.00	$412.00	$121.33–$403.76	533% above	25%
MMRV vaccine (measles, mumps, rubella and chickenpox), live (ProQuad) CPT 90710 Measles, mumps, rubella, and varicella vaccine	$143.08	$190.77	$56.18–$186.95	66% below	25%
Meningococcal ACWY (MenACWY) vaccine CPT 90734 Meningococcal vaccine, serogroups A, C, W, Y, diphtheria toxoid carrier vaccine	$121.58	$162.10	$47.74–$158.86	63% below	25%
Pneumonia vaccine, 13-valent conjugate (Prevnar 13) CPT 90670 Pneumococcal vaccine, 13-valent	$652.80	$870.40	$256.33–$852.99	45% above	25%
Pneumonia vaccine, 15-valent conjugate (Vaxneuvance) CPT 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use	$652.79	$870.38	$256.33–$852.97	29% above	25%
Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 Pneumococcal vaccine, 23-valent	$54.02	$72.02	$21.21–$70.58	72% below	25%
Polio vaccine, inactivated (IPV) CPT 90713 Poliovirus vaccine	$381.19	$508.25	$149.68–$498.09	199% above	25%
RSV antibody shot for infants and toddlers, larger dose (1 mL, 100 mg) CPT 90381 Respiratory syncytial virus antibody, 1.0 mL dosage for injection into muscle	$724.44	$965.92	$284.46–$946.60	36% below	25%
RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 Respiratory syncytial virus antibody, 0.5 mL dosage for injection into muscle	$500.71	$667.61	$196.61–$654.26	56% below	25%
Rabies vaccine, one dose CPT 90675 Rabies vaccine for injection into muscle	$438.64	$584.85	$172.24–$573.15	46% below	25%
Rotavirus vaccine, oral, 2-dose schedule (Rotarix) CPT 90681 Rotavirus vaccine, human, attenuated	$42.73	$56.97	$16.78–$55.83	69% below	25%
Rotavirus vaccine, oral, 3-dose schedule (RotaTeq) CPT 90680 Rotavirus vaccine, pentavalent	$42.73	$56.97	$16.78–$55.83	78% below	25%
Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 Shingles vaccine for injection into muscle	$179.36	$239.14	$70.43–$234.36	54% below	25%
Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Diphtheria and tetanus vaccine (7 years or older)	$268.92	$358.56	$105.60–$351.39	135% above	25%
Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older)	$82.64	$110.18	$32.45–$107.98	33% below	25%
Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 Administration of vaccine	$82.04	$109.38	$32.21–$107.19	26% above	25%
Vaccine administration fee, each additional vaccine at the same visit CPT 90472 Administration of vaccine, each additional vaccine	$30.60	$40.80	$12.02–$39.98	23% below	25%

Source file: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRMHRUSHVILLEIN&type=CDMWithoutLabel&fileType=CSV