IU Health Jay Hospital — price list
← Hospital overviewVerified from IU Health Jay Hospital’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.
12 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| Amphetamine-Dextroamphet XR Cap 10 mg Outpatient | 52526084 CDM | $45.80 | $20.49 | $17.86 – $44.66 | — | |
| Aripiprazole Tab 10 mg Outpatient | 52527850 CDM | $239 | $107 | $93.33 – $233 | — | |
| Cetirizine Tab 10 mg Outpatient | 52535838 CDM | $18.70 | $8.37 | $7.29 – $18.23 | — | |
| Citalopram Tab 10 mg Outpatient | 52538154 CDM | $18.15 | $8.12 | $7.08 – $17.70 | — | |
| Escitalopram Tab 10 mg Outpatient | 52518537 CDM | $32.80 | $14.67 | $12.79 – $31.98 | — | |
| Ezetimibe Tab 10 mg Outpatient | 52542867 CDM | $92.55 | $41.41 | $36.09 – $90.24 | — | |
| FLUoxetine Cap 10 mg Outpatient | 52521358 CDM | $18.10 | $8.10 | $7.06 – $17.65 | — | |
| Lisinopril Tab 10 mg Outpatient | 52549409 CDM | $9.30 | $4.16 | $3.63 – $9.07 | — | |
| Montelukast Tab 10 mg Outpatient | 52501780 CDM | $41.20 | $18.43 | $16.07 – $40.17 | — | |
| Olanzapine Tab 10 mg Outpatient | 52500691 CDM | $80.30 | $35.93 | $31.32 – $78.29 | — | |
| Pravastatin Tab 10 mg Outpatient | 52555281 CDM | $24.05 | $10.76 | $9.38 – $23.45 | — | |
| Verapamil Inj 10 mg/4 mL (UD) Outpatient | 52553237 CDM | $333 | $149 | $130 – $325 | — |