Memorial Hospital of South Bend — price list
← Hospital overviewVerified from Memorial Hospital of South Bend’s published price file
Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
417 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 84140 PREGNENOLONE LAB Inpatient | 84140 CPT | $268 | $174 | $53.60 – $220 | — | |
| 84154 ASSAY OF PSA FREE Inpatient | 84154 CPT | $387 | $252 | $77.40 – $317 | — | |
| 84155 ASSAY OF PROTEIN SERUM Inpatient | 84155 CPT | $79.00 | $51.35 | $15.80 – $64.78 | — | |
| 84202 ASSAY RBC PROTOPORPHYRIN Inpatient | 84202 CPT | $294 | $191 | $58.80 – $241 | — | |
| 84244 ASSAY OF RENIN Inpatient | 84244 CPT | $462 | $300 | $92.40 – $379 | — | |
| 84392 ASSAY OF URINE SULFATE Inpatient | 84392 CPT | $100 | $65.00 | $20.00 – $82.00 | — | |
| 84394 Test for total Tau protein Inpatient | 84394 CPT | $648 | $421 | $130 – $531 | — | |
| 84402 ASSAY OF FREE TESTOSTERONE Inpatient | 84402 CPT | $539 | $350 | $108 – $442 | — | |
| 84403 ASSAY OF TOTAL TESTOSTERONE Inpatient | 84403 CPT | $513 | $333 | $103 – $421 | — | |
| 84478 ASSAY OF TRIGLYCERIDES Inpatient | 84478 CPT | $133 | $86.45 | $26.60 – $109 | — | |
| 84560 ASSAY OF URINE/URIC ACID Inpatient | 84560 CPT | $105 | $68.25 | $21.00 – $86.10 | — | |
| 84702 CHORIONIC GONADOTROPIN TEST Inpatient | 84702 CPT | $130 | $84.50 | $26.00 – $107 | — | |
| 84999 CLINICAL CHEMISTRY TEST Inpatient | 84999 CPT | $76.00 | $49.40 | $15.20 – $62.32 | — | |
| 85384 Fibrinogen Activity Inpatient | 85384 CPT | $171 | $111 | $34.20 – $140 | — | |
| 85390 Fibrinolysis Inpatient | 85390 CPT | $75.00 | $48.75 | $15.00 – $61.50 | — | |
| 85597 PHOSPHOLIPID PLTLT NEUTRALIZ Inpatient | 85597 CPT | $226 | $147 | $45.20 – $185 | — | |
| 85999 Prothrombotic State Inpatient | 85999 CPT | $49.00 | $31.85 | $9.80 – $40.18 | — | |
| ACNE-MARSUPIALIZAT MULTIPLE MILIA Inpatient | 10040 CPT | $261 | $170 | $52.20 – $214 | — | |
| Allergen Food, Gluten F079-IgE Inpatient | 86003 CPT | $109 | $70.85 | $21.80 – $89.38 | — | |
| Allergen Mold/Microorganism, Candida albicans (yeast) IgG Inpatient | 86001 CPT | $103 | $66.95 | $20.60 – $84.46 | — | |
| AXLE FEMUR DISTAL SM GMRS Inpatient | C1776 CPT | $5,902 | $3,836 | $1,180 – $4,840 | — | |
| BASEPLATE HALF WEDGE Inpatient | C1776 CPT | $10,725 | $6,971 | $2,145 – $8,795 | — | |
| BASEPLATE TIBIAL S2 MRH Inpatient | C1776 CPT | $19,005 | $12,353 | $3,801 – $15,584 | — | |
| BEARING TIBIAL PERSONA VIVACIT-E 10MM 8-11/GH Inpatient | C1776 CPT | $4,485 | $2,915 | $897 – $3,678 | — | |
| Bill Only 84479 T3 Uptake Inpatient | 84479 CPT | $98.00 | $63.70 | $19.60 – $80.36 | — | |
| Blood Patch Charge Inpatient | 621811117 CDM | $790 | $514 | $158 – $648 | — | |
| BONE GRAFT 10CC PRO-DENSE INJECTABLE Inpatient | 625133739 CDM | $15,384 | $10,000 | $3,077 – $12,615 | — | |
| BONE GRAFT FIBULA SHAFT Inpatient | 625133178 CDM | $4,579 | $2,976 | $916 – $3,755 | — | |
| Bravo Interpretation Inpatient | 91035 CPT | $1,295 | $842 | $259 – $1,062 | — | |
| Bronchoscopy - GI Inpatient | 621525970 CDM | $6,425 | $4,176 | $1,285 – $5,269 | — |