Top 40 services provided by IU HEALTH GOSHEN HOSPITAL
Services CPT Price Est. Cash Price
CT scan of the head or brain without contrast or dye 70450 $1,500.00 $0.00
MRI scan of the brain with and without contrast 70553 $2,200.00 $0.00
X-ray of the chest, 2 views 71046 $300.00 $0.00
X-ray of the lower spine with 4 or more views 72110 $562.00 $0.00
CT scan of the pelvis with contrast or dye 72193 $1,900.00 $0.00
CT scan of the abdomen with contrast or dye 74160 $1,900.00 $0.00
Ultrasound of the abdomen 76700 $1,091.00 $0.00
Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples 76805 $500.00 $0.00
Basic Metabolic Panel 80048 $135.00 $0.00
Comprehensive Metabolic Panel 80053 $235.00 $0.00
Lipid Panel 80061 $78.00 $0.00
Lipid Panel 80061 $124.00 $0.00
Lipid Panel 80061 $190.00 $0.00
Urinalysis, by dipstick or tablet reagent not automated without a microscope 81001 $55.00 $0.00
Urinalysis, by dipstick or tablet reagent not automated without a microscope 81001 $7.00 $0.00
Urinalysis, by dipstick or tablet reagent non-automated with microscopy 81002 $0.00 $0.00
Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage 82550 $39.00 $0.00
Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage 82550 $69.00 $0.00
Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. 84443 $130.00 $0.00
Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks 84484 $130.00 $0.00
Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks 84484 $182.00 $0.00
Complete blood cell count (red cells, white blood cell, platelets), automated test 85025 $69.00 $0.00
Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. 85610 $45.00 $0.00
Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. 85610 $2.00 $0.00
Routine electrocardiogram (EKG) with tracing using at least 12 leads 93005 $278.00 $0.00
Routine electrocardiogram (EKG) with tracing using at least 12 leads 93005 $86.00 $0.00
Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD 94640 $0.00 $0.00
Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD 94640 $55.00 $0.00
Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes 97110 $108.00 $0.00
Training for walking to 1 or more areas for 15 minutes 97116 $108.00 $0.00
Physical therapy evaluation session for 20 minutes 97161 $235.00 $0.00
Office visit for an established patient (moderate severity) typically 15 minutes 99213 $115.00 $0.00
Emergency department visit facility fees for a visit of moderate severity 99283 $700.00 $0.00
Emergency department visit facility fees for a visit of high to moderate severity 99284 $1,000.00 $0.00