Does Daviess Community Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Daviess Community Hospital. In a medical emergency, call 911.

Where is Daviess Community Hospital?

1314 E Walnut St, Washington, IN 47501, in Daviess County, Indiana.

What is the phone number of Daviess Community Hospital?

(812) 254-2760, as listed by Medicare (CMS).

What is the Medicare star rating of Daviess Community Hospital?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Daviess Community Hospital — Washington, IN

Quick answers

Does Daviess Community Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Daviess Community Hospital. In a medical emergency, call 911.
Where is Daviess Community Hospital?: 1314 E Walnut St, Washington, IN 47501, in Daviess County, Indiana.
What is the phone number of Daviess Community Hospital?: (812) 254-2760, as listed by Medicare (CMS).
What is the Medicare star rating of Daviess Community Hospital?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[6][8]

Procedures^[6]

Mammography

Emergency care (hospital website)^[8]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visiting hours 8 a.m.-6:30 p.m.; 2 visitors per patient in most units. ER is the only open entrance 5 p.m.-6 a.m^[7]
Parking	Free parking near the main entrance, with accessible spaces^[6]
Patient portal	MyChart

Doctors and clinicians (211)

211 doctors and other clinicians list Daviess Community Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 187 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Good Samaritan Hospital20 mi · Vincennes, IN · Acute Care Hospital
Memorial Hospital and Health Care Center22 mi · Jasper, IN · Acute Care Hospital
Greene County General Hospital26 mi · Linton, IN · Critical Access Hospital
Lawrence County Memorial Hospital29 mi · Lawrenceville, IL · Critical Access Hospital
Gibson General Hospital31 mi · Princeton, IN · Critical Access Hospital

Other hospitals nearby

Mission Behavioral Health Hospital26 mi · Huntingburg, IN · Psychiatric Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Hillside Manor Nursing Home0.4 mi · Washington, IN · 1 of 5 stars
Prairie Village Nursing and Rehabilitation0.5 mi · Washington, IN · 3 of 5 stars
Eastgate Manor Nursing and Rehabilitation0.8 mi · Washington, IN · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Helping Hearts Hospice0.8 mi · Washington, IN
Good Samaritan Hospice18 mi · Vincennes, IN · 4 of 5 stars
Heart to Heart Hospice of Southwest Indiana LLC21 mi · Jasper, IN · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Guardian Angels Home Health Care, Inc12 mi · Bicknell, IN · 2 of 5 stars
Good Samaritan Home Care Services of Vincennes in18 mi · Vincennes, IN · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Vincennes Dialysis18 mi · Vincennes, IN · 2 of 5 stars
DaVita Vincennes Home Dialysis18 mi · Vincennes, IN
DaVita Jasper Dialysis21 mi · Jasper, IN · 4 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Jasper Endoscopy Surgery Center21 mi · Jasper, IN
Saint Charles Surgical Pavillion21 mi · Jasper, IN

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Washington High School0.4 mi · Washington, IN · Community health center
Washington Junior High School0.4 mi · Washington, IN · Community health center
Washington Upper Elementary0.5 mi · Washington, IN · Community health center

Clinics and urgent care

DCH Health Pavilion0.8 mi · Washington, IN · Rural health clinic
DCH Medical Clinic0.8 mi · Washington, IN · Rural health clinic
Good Samaritan Washington Primary Care0.8 mi · Washington, IN · Rural health clinic

Pharmacies

Daviess County Hospital0.8 mi · Washington, IN · Pharmacy
Hook-Superx LLC0.8 mi · Washington, IN · Pharmacy
Wal-Mart Stores East LP0.8 mi · Washington, IN · Community/retail pharmacy

Assisted living nearby

Licensed homes from the official state licence list, by straight-line distance.

Aspen BHC of Washington0.8 mi · Washington, IN

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Daviess Community Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	3 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	5 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	69%National average: 72%
Would definitely recommend the hospital	69%National average: 71%
Nurses “always” communicated well	82%National average: 80%
Doctors “always” communicated well	78%National average: 80%
Staff “always” explained medicines before giving them	58%National average: 62%
Were given information about recovery at home	86%National average: 86%
Room and bathroom “always” clean	82%National average: 74%
Area around the room “always” quiet at night	61%National average: 60%
Completed surveys	153Response rate: 17%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	Not reported to Medicare
Catheter-associated urinary tract infections (CAUTI)	Not reported to Medicare
Surgical site infections after colon surgery	Not reported to Medicare
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	Not reported to Medicare
Clostridioides difficile (C. diff) intestinal infections	0No different from the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	Too few cases to report
Deaths within 30 days: heart failure patients	12.9%
Deaths within 30 days: pneumonia patients	17.4%
Deaths within 30 days: COPD patients	9.2%
Deaths within 30 days: stroke patients	Too few cases to report
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.94No different from the national rate
Complications after hip or knee replacement	Too few cases to report

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	Too few cases to report
Readmitted within 30 days: heart failure	21.8%
Readmitted within 30 days: pneumonia	16.9%
Readmitted within 30 days: COPD	19.6%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	Too few cases to report

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Low (under 20,000)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	119 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	1%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	33%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Indiana Best hospitals in Indiana

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 68 common services exactly as Daviess Community Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	$426	$298.20	$67.80 – $426
New patient office visit (about 30–44 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $340.80 AETNA MCR ADV — AETNA MCR ADV: $426 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $338.63 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $338.63 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $338.63 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $84.75 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $321.72 ANTHEM MCR ADV — ANTHEM MCR ADV: $67.80 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $338.63 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $321.72
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · modifier 95 In the file: New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	$105	$73.50	$52.50 – $102.28
New patient office visit (about 30–44 minutes): 10 of 11 insurance plan rates ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $84.75 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $67.80 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $74.84 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $67.80 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $102.28 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $77.97 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $52.50 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $101.85 SIHO-ALL PLANS — SIHO-ALL PLANS: $94.50 ST. VINCENT HEALTH - ALL PLANS — ST. VINCENT HEALTH - ALL PLANS: $74.58
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$557	$389.90	$111.17 – $557
New patient office visit (about 45–59 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $445.60 AETNA MCR ADV — AETNA MCR ADV: $557 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $442.76 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $442.76 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $442.76 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.96 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $420.65 ANTHEM MCR ADV — ANTHEM MCR ADV: $111.17 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $442.76 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $420.65
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · modifier 95 In the file: New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$269	$188.30	$111.17 – $260.93
New patient office visit (about 45–59 minutes): 10 of 11 insurance plan rates ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.96 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $111.17 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $153.78 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $111.17 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $153.78 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $127.85 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $134.50 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $260.93 SIHO-ALL PLANS — SIHO-ALL PLANS: $242.10 ST. VINCENT HEALTH - ALL PLANS — ST. VINCENT HEALTH - ALL PLANS: $122.29
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	$1,020	$714	$151.85 – $1,020
New patient office visit (about 60–74 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $816 AETNA MCR ADV — AETNA MCR ADV: $1,020 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $810.80 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $810.80 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $810.80 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $189.81 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $770.30 ANTHEM MCR ADV — ANTHEM MCR ADV: $151.85 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $810.80 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $770.30
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · modifier 95 In the file: New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	$351.50	$246.05	$151.85 – $340.96
New patient office visit (about 60–74 minutes): 10 of 11 insurance plan rates ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $189.81 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $151.85 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $202.95 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $151.85 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $165.97 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $174.63 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $175.75 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $340.96 SIHO-ALL PLANS — SIHO-ALL PLANS: $316.35 ST. VINCENT HEALTH - ALL PLANS — ST. VINCENT HEALTH - ALL PLANS: $167.04
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more	$308	$215.60	$55.10 – $308
Established patient office visit (about 20–29 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $246.40 AETNA MCR ADV — AETNA MCR ADV: $308 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $244.83 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $244.83 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $244.83 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $68.88 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $232.60 ANTHEM MCR ADV — ANTHEM MCR ADV: $55.10 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $244.83 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $232.60
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · modifier 95 In the file: Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more	$107	$74.90	$53.50 – $103.79
Established patient office visit (about 20–29 minutes): 10 of 11 insurance plan rates ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $68.88 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $55.10 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $60.62 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $55.10 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $60.62 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $63.37 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $53.50 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $103.79 SIHO-ALL PLANS — SIHO-ALL PLANS: $96.30 ST. VINCENT HEALTH - ALL PLANS — ST. VINCENT HEALTH - ALL PLANS: $60.61
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$368	$257.60	$80.95 – $368
Established patient office visit (about 30–39 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $294.40 AETNA MCR ADV — AETNA MCR ADV: $368 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $292.52 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $292.52 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $292.52 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $101.19 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $277.91 ANTHEM MCR ADV — ANTHEM MCR ADV: $80.95 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $292.52 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $277.91
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · modifier 95 In the file: Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$165	$115.50	$80.95 – $160.05
Established patient office visit (about 30–39 minutes): 10 of 11 insurance plan rates ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $101.19 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $80.95 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $89.21 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $80.95 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $89.21 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $93.09 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $82.50 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $160.05 SIHO-ALL PLANS — SIHO-ALL PLANS: $148.50 ST. VINCENT HEALTH - ALL PLANS — ST. VINCENT HEALTH - ALL PLANS: $89.05
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with low level of medical decision making, if using time, 30 minutes or more	$225.50	$157.85	$112.75 – $225.50
Office consultation with a specialist (moderate): rates for 6 insurance plans CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $225.50 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $225.50 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $112.75 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $218.74 SIHO-ALL PLANS — SIHO-ALL PLANS: $202.95 UHC - ALL PLANS — UHC - ALL PLANS: $135.30
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: Office or other outpatient consultation with moderate level of medical decision making, if using time, 40 minutes or more	$344.50	$241.15	$172.25 – $344.50
Office consultation with a specialist (moderate to high): rates for 6 insurance plans CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $344.50 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $344.50 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $172.25 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $334.17 SIHO-ALL PLANS — SIHO-ALL PLANS: $310.05 UHC - ALL PLANS — UHC - ALL PLANS: $206.70
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: Emergency department visit with low level of medical decision making	$955	$668.50	$288.81 – $955
Emergency room visit (moderate): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $764 AETNA MCR ADV — AETNA MCR ADV: $955 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $759.13 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $759.13 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $759.13 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $361.02 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $721.22 ANTHEM MCR ADV — ANTHEM MCR ADV: $288.81 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $759.13 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $721.22
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency department visit with low level of medical decision making	$743	$520.10	$64.70 – $720.71
Emergency room visit (moderate): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $65.36 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $81.70 ANTHEM MCR ADV — ANTHEM MCR ADV: $65.36 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $65.36 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $64.70 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $65.36 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $64.70 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $75.16 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $125.49 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $371.50
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · modifier 25 In the file: Emergency department visit with low level of medical decision making	$929.50	$650.65	$288.81 – $929.50
Emergency room visit (moderate): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $743.60 AETNA MCR ADV — AETNA MCR ADV: $929.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $738.86 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $738.86 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $738.86 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $361.02 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $701.96 ANTHEM MCR ADV — ANTHEM MCR ADV: $288.81 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $738.86 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $701.96
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: Emergency department visit with moderate level of medical decision making	$1,432.50	$1,002.75	$441.47 – $1,432.50
Emergency room visit (moderately high): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,146 AETNA MCR ADV — AETNA MCR ADV: $1,432.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,138.69 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,138.69 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,138.69 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $551.84 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,081.82 ANTHEM MCR ADV — ANTHEM MCR ADV: $441.47 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,138.69 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,081.82
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency department visit with moderate level of medical decision making	$1,061	$742.70	$110.18 – $1,029.17
Emergency room visit (moderately high): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $111.13 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.91 ANTHEM MCR ADV — ANTHEM MCR ADV: $111.13 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $111.13 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $110.18 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $111.13 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $110.18 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $127.80 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $213.37 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $530.50
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient · modifier 25 In the file: Emergency department visit with moderate level of medical decision making	$1,397.50	$978.25	$441.47 – $1,397.50
Emergency room visit (moderately high): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,118 AETNA MCR ADV — AETNA MCR ADV: $1,397.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,110.87 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,110.87 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,110.87 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $551.84 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,055.39 ANTHEM MCR ADV — ANTHEM MCR ADV: $441.47 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,110.87 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,055.39
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: Emergency department visit with high level of medical decision making	$2,122	$1,485.40	$630.08 – $2,122
Emergency room visit (high): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,697.60 AETNA MCR ADV — AETNA MCR ADV: $2,122 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,686.78 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,686.78 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,686.78 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $787.60 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,602.53 ANTHEM MCR ADV — ANTHEM MCR ADV: $630.08 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,686.78 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,602.53
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency department visit with high level of medical decision making	$1,857	$1,299.90	$159.69 – $1,801.29
Emergency room visit (high): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $161.52 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $201.90 ANTHEM MCR ADV — ANTHEM MCR ADV: $161.52 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $161.52 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $159.69 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $161.52 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $159.69 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $185.75 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $310.12 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $928.50
Emergency room visit (high) CPT 99285 · Inpatient or outpatient · modifier 25 In the file: Emergency department visit with high level of medical decision making	$2,044.50	$1,431.15	$630.08 – $2,044.50
Emergency room visit (high): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,635.60 AETNA MCR ADV — AETNA MCR ADV: $2,044.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,625.17 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,625.17 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,625.17 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $787.60 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,544.01 ANTHEM MCR ADV — ANTHEM MCR ADV: $630.08 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,625.17 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,544.01

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Blood test, basic group of blood chemicals (Calcium, total)	$82	$57.40	$6.94 – $82
Basic metabolic panel (blood test): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $65.60 AETNA MCR ADV — AETNA MCR ADV: $82 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $65.18 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $65.18 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $65.18 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $10.58 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $61.93 ANTHEM MCR ADV — ANTHEM MCR ADV: $8.46 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $65.18 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $61.93
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Blood test, comprehensive group of blood chemicals	$43.50	$30.45	$4.59 – $43.50
Comprehensive metabolic panel (blood test): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $34.80 AETNA MCR ADV — AETNA MCR ADV: $43.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $34.58 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $34.58 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $34.58 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $13.20 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $32.85 ANTHEM MCR ADV — ANTHEM MCR ADV: $10.56 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $34.58 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $32.85
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric blood test panel	$119	$83.30	$47.81 – $119
Obstetric blood test panel: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $95.20 AETNA MCR ADV — AETNA MCR ADV: $119 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $94.59 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $94.59 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $94.59 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $59.76 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $89.87 ANTHEM MCR ADV — ANTHEM MCR ADV: $47.81 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $94.59 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $89.87
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Blood test, lipids (cholesterol and triglycerides)	$76.50	$53.55	$10.24 – $76.50
Cholesterol panel (lipid panel): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $61.20 AETNA MCR ADV — AETNA MCR ADV: $76.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $60.81 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $60.81 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $60.81 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $16.74 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $57.77 ANTHEM MCR ADV — ANTHEM MCR ADV: $13.39 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $60.81 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $57.77
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Kidney function blood test panel	$58.50	$40.95	$5.08 – $58.50
Kidney function panel: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $46.80 AETNA MCR ADV — AETNA MCR ADV: $58.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $46.50 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $46.50 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $46.50 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $10.85 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $44.18 ANTHEM MCR ADV — ANTHEM MCR ADV: $8.68 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $46.50 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $44.18
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Liver function blood test panel	$70.50	$49.35	$5.76 – $70.50
Liver function panel: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $56.40 AETNA MCR ADV — AETNA MCR ADV: $70.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $56.04 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $56.04 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $56.04 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $10.21 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $53.24 ANTHEM MCR ADV — ANTHEM MCR ADV: $8.17 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $56.04 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $53.24
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Manual urinalysis test with examination using microscope, automated	$50.50	$35.35	$1.60 – $50.50
Urine test (automated, with microscope): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $40.40 AETNA MCR ADV — AETNA MCR ADV: $50.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $40.14 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $40.14 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $40.14 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $3.96 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $38.14 ANTHEM MCR ADV — ANTHEM MCR ADV: $3.17 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $40.14 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $38.14
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urinalysis, manual test	$17	$11.90	$0.59 – $17
Urine test (manual, without microscope): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $13.60 AETNA MCR ADV — AETNA MCR ADV: $17 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $13.51 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $13.51 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $13.51 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $4.35 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $12.84 ANTHEM MCR ADV — ANTHEM MCR ADV: $3.48 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $13.51 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $12.84
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Automated urinalysis test	$32	$22.40	$0.72 – $32
Urine test (automated, without microscope): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $25.60 AETNA MCR ADV — AETNA MCR ADV: $32 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $25.44 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $25.44 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $25.44 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $2.81 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $24.17 ANTHEM MCR ADV — ANTHEM MCR ADV: $2.25 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $25.44 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $24.17
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA (prostate specific antigen) measurement, total	$87	$60.90	$16 – $87
PSA (prostate specific antigen) blood test: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $69.60 AETNA MCR ADV — AETNA MCR ADV: $87 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $69.16 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $69.16 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $69.16 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $22.99 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $65.70 ANTHEM MCR ADV — ANTHEM MCR ADV: $18.39 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $69.16 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $65.70
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Blood test, thyroid stimulating hormone (TSH)	$29	$20.30	$4.87 – $32.26
Thyroid stimulating hormone (TSH) test: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $23.20 AETNA MCR ADV — AETNA MCR ADV: $29 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $23.05 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $23.05 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $23.05 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $21 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $21.90 ANTHEM MCR ADV — ANTHEM MCR ADV: $16.80 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $23.05 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $21.90
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	$72.50	$50.75	$5.63 – $72.50
Complete blood count (CBC) with differential: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $58 AETNA MCR ADV — AETNA MCR ADV: $72.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $57.63 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $57.63 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $57.63 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $9.71 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $54.75 ANTHEM MCR ADV — ANTHEM MCR ADV: $7.77 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $57.63 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $54.75
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Complete blood cell count (red cells, white blood cell, platelets), automated test	$226	$158.20	$6.47 – $226
Complete blood count (CBC), automated: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $180.80 AETNA MCR ADV — AETNA MCR ADV: $226 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $179.65 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $179.65 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $179.65 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $8.09 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $170.68 ANTHEM MCR ADV — ANTHEM MCR ADV: $6.47 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $179.65 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $170.68
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Blood test, clotting time	$42	$29.40	$1.80 – $42
Blood clotting time test (prothrombin time, PT): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $33.60 AETNA MCR ADV — AETNA MCR ADV: $42 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $33.39 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $33.39 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $33.39 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $5.36 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $31.72 ANTHEM MCR ADV — ANTHEM MCR ADV: $4.29 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $33.39 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $31.72
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Coagulation assessment blood test, plasma or whole blood	$66.50	$46.55	$4 – $66.50
Blood clotting test (partial thromboplastin time, PTT): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $53.20 AETNA MCR ADV — AETNA MCR ADV: $66.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $52.86 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $52.86 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $52.86 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $7.51 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $50.22 ANTHEM MCR ADV — ANTHEM MCR ADV: $6.01 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $52.86 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $50.22

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT scan head or brain without contrast	$1,515.50	$1,060.85	$56.64 – $1,515.50
CT scan of the head or brain, without contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,212.40 AETNA MCR ADV — AETNA MCR ADV: $1,515.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,303 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,303 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,303 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,238 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,303 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,238
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · modifier 26 In the file: CT scan head or brain without contrast	$98.50	$68.95	$37.82 – $98.36
CT scan of the head or brain, without contrast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $37.82 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $47.28 ANTHEM MCR ADV — ANTHEM MCR ADV: $37.82 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $37.82 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $98.36 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $37.82 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $98.36 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $37.82 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $72.61 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $49.25
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI scan of brain before and after contrast	$3,504	$2,452.80	$193.88 – $3,504
MRI of the brain, before and after contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,803.20 AETNA MCR ADV — AETNA MCR ADV: $3,504 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,956 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,956 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,956 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $461.39 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,858 ANTHEM MCR ADV — ANTHEM MCR ADV: $369.11 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,956 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,858
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 52 In the file: MRI scan of brain before and after contrast	$3,504	$2,452.80	$193.88 – $3,504
MRI of the brain, before and after contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,803.20 AETNA MCR ADV — AETNA MCR ADV: $3,504 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,956 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,956 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,956 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $461.39 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,858 ANTHEM MCR ADV — ANTHEM MCR ADV: $369.11 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,956 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,858
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 26 In the file: MRI scan of brain before and after contrast	$251.50	$176.05	$101.05 – $293.10
MRI of the brain, before and after contrast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $101.05 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $126.31 ANTHEM MCR ADV — ANTHEM MCR ADV: $101.05 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $101.05 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $293.10 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $101.05 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $293.10 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $101.05 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $194.02 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $125.75
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-ray of chest, 2 views	$330	$231	$62.12 – $330
Chest X-ray, 2 views: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $264 AETNA MCR ADV — AETNA MCR ADV: $330 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $262.32 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $262.32 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $262.32 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $115.09 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $249.22 ANTHEM MCR ADV — ANTHEM MCR ADV: $92.07 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $262.32 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $249.22
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier PO In the file: X-ray of chest, 2 views	$330	$231	$62.12 – $330
Chest X-ray, 2 views: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $264 AETNA MCR ADV — AETNA MCR ADV: $330 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $262.32 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $262.32 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $262.32 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $115.09 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $249.22 ANTHEM MCR ADV — ANTHEM MCR ADV: $92.07 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $262.32 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $249.22
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier 26 In the file: X-ray of chest, 2 views	$26	$18.20	$9.65 – $30.39
Chest X-ray, 2 views: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $9.65 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $12.06 ANTHEM MCR ADV — ANTHEM MCR ADV: $9.65 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $9.65 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $30.39 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $9.65 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $30.39 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $9.65 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $18.53 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $13
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-ray of lower and sacral spine, minimum of 4 views	$621.50	$435.05	$23.45 – $621.50
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $497.20 AETNA MCR ADV — AETNA MCR ADV: $621.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $494.03 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $494.03 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $494.03 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $469.36 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $494.03 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $469.36
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier PO In the file: X-ray of lower and sacral spine, minimum of 4 views	$621.50	$435.05	$23.45 – $621.50
X-ray of the lower spine, at least 4 views: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $497.20 AETNA MCR ADV — AETNA MCR ADV: $621.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $494.03 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $494.03 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $494.03 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $469.36 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $494.03 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $469.36
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier 26 In the file: X-ray of lower and sacral spine, minimum of 4 views	$31	$21.70	$12.08 – $46.90
X-ray of the lower spine, at least 4 views: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $12.08 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $15.10 ANTHEM MCR ADV — ANTHEM MCR ADV: $12.08 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $12.08 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $46.90 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $12.08 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $46.90 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $12.08 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $23.19 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $15.50
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI scan of lower spinal canal without contrast	$2,570	$1,799	$117.33 – $2,570
MRI of the lower back (lumbar spine), without contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,056 AETNA MCR ADV — AETNA MCR ADV: $2,570 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,956 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,956 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,956 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $315.55 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,858 ANTHEM MCR ADV — ANTHEM MCR ADV: $252.44 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,956 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,858
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier 26 In the file: MRI scan of lower spinal canal without contrast	$172.50	$120.75	$65.81 – $176.03
MRI of the lower back (lumbar spine), without contrast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $65.81 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $82.26 ANTHEM MCR ADV — ANTHEM MCR ADV: $65.81 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $65.81 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $176.03 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $65.81 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $176.03 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $65.81 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $126.36 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $86.25
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT scan of pelvis with contrast	$1,735	$1,214.50	$123.28 – $1,735
CT scan of the pelvis, with contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,388 AETNA MCR ADV — AETNA MCR ADV: $1,735 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,303 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,303 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,303 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $231.97 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,238 ANTHEM MCR ADV — ANTHEM MCR ADV: $185.58 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,303 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,238
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier LT In the file: MRI scan of leg joint without contrast	$2,575.50	$1,802.85	$129.47 – $2,575.50
MRI of a leg joint (such as the knee), without contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,060.40 AETNA MCR ADV — AETNA MCR ADV: $2,575.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,956 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,956 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,956 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $315.55 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,858 ANTHEM MCR ADV — ANTHEM MCR ADV: $252.44 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,956 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,858
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier RT In the file: MRI scan of leg joint without contrast	$2,575.50	$1,802.85	$129.47 – $2,575.50
MRI of a leg joint (such as the knee), without contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,060.40 AETNA MCR ADV — AETNA MCR ADV: $2,575.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,956 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,956 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,956 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $315.55 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,858 ANTHEM MCR ADV — ANTHEM MCR ADV: $252.44 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,956 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,858
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier 26 \| LT In the file: MRI scan of leg joint without contrast	$157.50	$110.25	$60.40 – $186.74
MRI of a leg joint (such as the knee), without contrast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $60.40 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $75.50 ANTHEM MCR ADV — ANTHEM MCR ADV: $60.40 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $60.40 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $186.74 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $60.40 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $186.74 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $60.40 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $115.97 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $78.75
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT scan of abdomen and pelvis with contrast	$3,729.50	$2,610.65	$162.17 – $3,729.50
CT scan of the abdomen and pelvis, with contrast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,983.60 AETNA MCR ADV — AETNA MCR ADV: $3,729.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,303 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,303 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,303 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $461.39 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,238 ANTHEM MCR ADV — ANTHEM MCR ADV: $369.11 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,303 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,238
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · modifier 26 In the file: CT scan of abdomen and pelvis with contrast	$210.50	$147.35	$80.41 – $276.97
CT scan of the abdomen and pelvis, with contrast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $80.41 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $100.51 ANTHEM MCR ADV — ANTHEM MCR ADV: $80.41 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $80.41 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $276.97 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $80.41 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $276.97 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $80.41 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $154.39 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $105.25
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Complete ultrasound scan of abdomen	$1,121	$784.70	$70.27 – $1,121
Ultrasound of the abdomen, complete: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $896.80 AETNA MCR ADV — AETNA MCR ADV: $1,121 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $891.08 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $891.08 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $891.08 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $846.58 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $891.08 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $846.58
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · modifier 26 In the file: Complete ultrasound scan of abdomen	$88.75	$62.13	$36.02 – $104.38
Ultrasound of the abdomen, complete: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $36.02 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $45.03 ANTHEM MCR ADV — ANTHEM MCR ADV: $36.02 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $36.02 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $104.38 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $36.02 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $104.38 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $36.02 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $69.16 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $44.38
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus	$797	$557.90	$67.54 – $797
Pregnancy ultrasound (after the first trimester): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $637.60 AETNA MCR ADV — AETNA MCR ADV: $797 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $633.54 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $633.54 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $633.54 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $601.89 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $633.54 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $601.89
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina	$686.50	$480.55	$64.08 – $686.50
Transvaginal ultrasound: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $549.20 AETNA MCR ADV — AETNA MCR ADV: $686.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $545.70 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $545.70 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $545.70 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $138.26 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $518.44 ANTHEM MCR ADV — ANTHEM MCR ADV: $110.61 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $545.70 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $518.44
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier RT In the file: Diagnostic mammography of 1 breast	$455	$318.50	$65.56 – $455
Diagnostic mammogram, one breast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $364 AETNA MCR ADV — AETNA MCR ADV: $455 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $259 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $259 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $259 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $144.89 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $246 ANTHEM MCR ADV — ANTHEM MCR ADV: $115.91 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $259 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $246
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier LT In the file: Diagnostic mammography of 1 breast	$455	$318.50	$65.56 – $455
Diagnostic mammogram, one breast: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $364 AETNA MCR ADV — AETNA MCR ADV: $455 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $259 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $259 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $259 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $144.89 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $246 ANTHEM MCR ADV — ANTHEM MCR ADV: $115.91 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $259 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $246
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier 26 \| RT In the file: Diagnostic mammography of 1 breast	$80	$56	$36.18 – $113.63
Diagnostic mammogram, one breast: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $36.18 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $45.23 ANTHEM MCR ADV — ANTHEM MCR ADV: $36.18 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $36.18 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $113.63 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $36.18 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $113.63 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $36.18 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $69.47 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $40
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic mammography of both breasts	$582.50	$407.75	$83.89 – $582.50
Diagnostic mammogram, both breasts: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $466 AETNA MCR ADV — AETNA MCR ADV: $582.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $259 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $259 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $259 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $183.43 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $246 ANTHEM MCR ADV — ANTHEM MCR ADV: $146.74 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $259 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $246
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening mammography	$469.50	$328.65	$69.28 – $469.50
Screening mammogram, both breasts: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $375.60 AETNA MCR ADV — AETNA MCR ADV: $469.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $259 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $259 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $259 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $147.64 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $246 ANTHEM MCR ADV — ANTHEM MCR ADV: $118.11 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $259 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $246
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52 In the file: Screening mammography	$469.50	$328.65	$69.28 – $469.50
Screening mammogram, both breasts: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $375.60 AETNA MCR ADV — AETNA MCR ADV: $469.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $259 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $259 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $259 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $147.64 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $246 ANTHEM MCR ADV — ANTHEM MCR ADV: $118.11 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $259 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $246
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 26 In the file: Screening mammography	$75.50	$52.85	$33.73 – $116.03
Screening mammogram, both breasts: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $33.73 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $42.16 ANTHEM MCR ADV — ANTHEM MCR ADV: $33.73 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $33.73 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $116.03 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $33.73 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $116.03 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $33.73 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $64.76 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $37.75

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Sleep study in sleep lab (6 years or older)	$3,484	$2,438.80	$908.56 – $3,484
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,787.20 AETNA MCR ADV — AETNA MCR ADV: $3,484 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $2,769.43 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $2,769.43 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $2,769.43 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,135.70 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $2,631.12 ANTHEM MCR ADV — ANTHEM MCR ADV: $908.56 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $2,769.43 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $2,631.12
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · modifier 52 In the file: Sleep study in sleep lab (6 years or older)	$3,484	$2,438.80	$908.56 – $3,484
Sleep study (overnight, in a sleep lab): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $2,787.20 AETNA MCR ADV — AETNA MCR ADV: $3,484 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $2,769.43 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $2,769.43 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $2,769.43 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,135.70 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $2,631.12 ANTHEM MCR ADV — ANTHEM MCR ADV: $908.56 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $2,769.43 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $2,631.12
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · modifier 26 In the file: Sleep study in sleep lab (6 years or older)	$583.50	$408.45	$115.18 – $566
Sleep study (overnight, in a sleep lab): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $115.18 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $143.98 ANTHEM MCR ADV — ANTHEM MCR ADV: $115.18 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $115.18 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $563.89 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $115.18 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $563.89 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $132.46 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $221.15 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $291.75

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GP In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$143	$100.10	$27.89 – $150
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $143 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $113.67 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $113.67 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $113.67 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $34.86 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $107.99 ANTHEM MCR ADV — ANTHEM MCR ADV: $27.89 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $113.67 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $107.99
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier CQ In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$143	$100.10	$27.89 – $150
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $143 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $113.67 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $113.67 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $113.67 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $34.86 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $107.99 ANTHEM MCR ADV — ANTHEM MCR ADV: $27.89 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $113.67 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $107.99
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GO In the file: Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes	$143	$100.10	$27.89 – $150
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $143 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $113.67 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $113.67 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $113.67 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $34.86 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $107.99 ANTHEM MCR ADV — ANTHEM MCR ADV: $27.89 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $113.67 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $107.99
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 20 minutes	$308	$215.60	$94.33 – $308
Physical therapy evaluation (low complexity): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $308 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $244.83 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $244.83 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $244.83 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $117.91 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $232.60 ANTHEM MCR ADV — ANTHEM MCR ADV: $94.33 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $244.83 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $232.60
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 30 minutes	$331.50	$232.05	$94.33 – $331.50
Physical therapy evaluation (moderate complexity): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $331.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $263.51 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $263.51 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $263.51 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $117.91 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $250.35 ANTHEM MCR ADV — ANTHEM MCR ADV: $94.33 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $263.51 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $250.35
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: Evaluation for physical therapy, typically 45 minutes	$463.50	$324.45	$94.33 – $463.50
Physical therapy evaluation (high complexity): 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $150 AETNA MCR ADV — AETNA MCR ADV: $463.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $368.44 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $368.44 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $368.44 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $117.91 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $350.04 ANTHEM MCR ADV — ANTHEM MCR ADV: $94.33 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $368.44 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $350.04
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 minutes	$140.50	$98.35	$68.99 – $136.29
Psychotherapy, 30 minutes: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $250.40 AETNA MCR ADV — AETNA MCR ADV: $68.99 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $248.80 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $248.80 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $248.80 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $86.24 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $236.38 ANTHEM MCR ADV — ANTHEM MCR ADV: $68.99 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $248.80 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $68.99
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · modifier AJ In the file: Psychotherapy, 30 minutes	$132.50	$92.75	$66.25 – $132.46
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $68.99 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $86.24 ANTHEM MCR ADV — ANTHEM MCR ADV: $68.99 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $68.99 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $76.90 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $68.99 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $67.65 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $79.34 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $132.46 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $66.25
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) · modifier 95 In the file: Psychotherapy, 30 minutes	$134.50	$94.15	$67.25 – $132.46
Psychotherapy, 30 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $68.99 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $86.24 ANTHEM MCR ADV — ANTHEM MCR ADV: $68.99 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $68.99 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $76.90 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $68.99 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $76.90 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $79.34 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $132.46 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $67.25
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 minutes	$181.50	$127.05	$90.75 – $360.56
Psychotherapy, 45 minutes: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $145.20 AETNA MCR ADV — AETNA MCR ADV: $181.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $144.27 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $144.27 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $144.27 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $234.74 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $137.07 ANTHEM MCR ADV — ANTHEM MCR ADV: $187.79 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $144.27 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $137.07
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · modifier AJ In the file: Psychotherapy, 45 minutes	$173.50	$121.45	$86.75 – $174.89
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $91.09 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $113.86 ANTHEM MCR ADV — ANTHEM MCR ADV: $91.09 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $91.09 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $101.51 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $91.09 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $101.51 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $104.75 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $174.89 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $86.75
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) · modifier 95 In the file: Psychotherapy, 45 minutes	$179.50	$125.65	$89.75 – $174.89
Psychotherapy, 45 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $91.09 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $113.86 ANTHEM MCR ADV — ANTHEM MCR ADV: $91.09 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $91.09 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $101.51 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $91.09 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $101.51 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $104.75 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $174.89 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $89.75
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 1 hour	$267.50	$187.25	$133.75 – $360.56
Psychotherapy, 60 minutes: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $214 AETNA MCR ADV — AETNA MCR ADV: $267.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $212.64 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $212.64 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $212.64 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $234.74 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $202.02 ANTHEM MCR ADV — ANTHEM MCR ADV: $187.79 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $212.64 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $202.02
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · modifier AJ In the file: Psychotherapy, 1 hour	$260.50	$182.35	$130.25 – $257.89
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $134.32 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $167.90 ANTHEM MCR ADV — ANTHEM MCR ADV: $134.32 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $134.32 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $150.29 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $134.32 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $150.29 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $154.47 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $257.89 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $130.25
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) · modifier 95 In the file: Psychotherapy, 1 hour	$268	$187.60	$134 – $259.96
Psychotherapy, 60 minutes: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $134.32 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $167.90 ANTHEM MCR ADV — ANTHEM MCR ADV: $134.32 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $134.32 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $150.29 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $134.32 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $150.29 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $154.47 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $257.89 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $134
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psychotherapy without patient, 50 minutes	$238	$166.60	$96.45 – $230.86
Family psychotherapy, without the patient: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $227.60 AETNA MCR ADV — AETNA MCR ADV: $98.20 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $226.15 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $226.15 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $226.15 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $122.75 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $214.85 ANTHEM MCR ADV — ANTHEM MCR ADV: $98.20 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $226.15 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $98.20
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) · modifier 95 In the file: Family psychotherapy without patient, 50 minutes	$216.50	$151.55	$96.75 – $210.01
Family psychotherapy, without the patient: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $98.20 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $122.75 ANTHEM MCR ADV — ANTHEM MCR ADV: $98.20 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $98.20 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $96.75 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $98.20 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $96.75 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $112.93 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $188.54 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $108.25
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psychotherapy with patient, 50 minutes	$216.50	$151.55	$100.61 – $210.01
Family psychotherapy, with the patient: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $250.40 AETNA MCR ADV — AETNA MCR ADV: $102.04 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $248.80 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $248.80 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $248.80 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $127.55 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $236.38 ANTHEM MCR ADV — ANTHEM MCR ADV: $102.04 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $248.80 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $102.04
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · modifier AJ In the file: Family psychotherapy with patient, 50 minutes	$313	$219.10	$156.50 – $360.56
Family psychotherapy, with the patient: 10 of 19 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $250.40 AETNA MCR ADV — AETNA MCR ADV: $313 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $248.80 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $248.80 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $248.80 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $234.74 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $236.38 ANTHEM MCR ADV — ANTHEM MCR ADV: $187.79 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $248.80 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $236.38
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) · modifier 95 In the file: Family psychotherapy with patient, 50 minutes	$225	$157.50	$100.61 – $218.25
Family psychotherapy, with the patient: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $102.04 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $127.55 ANTHEM MCR ADV — ANTHEM MCR ADV: $102.04 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $102.04 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $100.61 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $102.04 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $100.61 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $117.35 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $195.92 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $112.50
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy	$152.50	$106.75	$76.25 – $206.37
Group psychotherapy: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $122 AETNA MCR ADV — AETNA MCR ADV: $152.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $121.22 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $121.22 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $121.22 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $134.35 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $115.17 ANTHEM MCR ADV — ANTHEM MCR ADV: $107.48 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $121.22 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $115.17
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) · modifier AJ In the file: Group psychotherapy	$152.50	$106.75	$76.25 – $206.37
Group psychotherapy: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $122 AETNA MCR ADV — AETNA MCR ADV: $152.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $121.22 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $121.22 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $121.22 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $134.35 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $115.17 ANTHEM MCR ADV — ANTHEM MCR ADV: $107.48 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $121.22 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $115.17

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Removal of growth and tissue of breast, duct, or nipple	$819.50	$573.65	$370.76 – $794.92
Removal of breast growth (open surgery): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $370.76 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $463.45 ANTHEM MCR ADV — ANTHEM MCR ADV: $370.76 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $370.76 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $464.91 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $370.76 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $464.91 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $426.37 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $711.86 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $409.75
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Replacement of thigh bone and hip joint with prosthesis	$2,528.50	$1,769.95	$1,064.13 – $2,575.19
Total hip replacement: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $1,064.13 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,330.16 ANTHEM MCR ADV — ANTHEM MCR ADV: $1,064.13 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,064.13 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $1,154.08 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $1,064.13 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $1,154.08 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $1,223.75 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $2,043.13 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $1,264.25
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · modifier AS In the file: Replacement of thigh bone and hip joint with prosthesis	$1,580.50	$1,106.35	$790.25 – $2,575.19
Total hip replacement: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $1,064.13 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,330.16 ANTHEM MCR ADV — ANTHEM MCR ADV: $1,064.13 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,064.13 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $1,154.08 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $1,064.13 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $1,154.08 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $1,223.75 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $2,043.13 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $790.25
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Replacement of knee joint, both sides of knee	$2,526.50	$1,768.55	$1,062.09 – $2,570.26
Total knee replacement: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $1,062.09 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,327.61 ANTHEM MCR ADV — ANTHEM MCR ADV: $1,062.09 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,062.09 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $1,152.73 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $1,062.09 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $1,152.73 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $1,221.40 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $2,039.21 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $1,263.25
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · modifier AS In the file: Replacement of knee joint, both sides of knee	$1,579	$1,105.30	$789.50 – $2,570.26
Total knee replacement: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $1,062.09 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,327.61 ANTHEM MCR ADV — ANTHEM MCR ADV: $1,062.09 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,062.09 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $1,152.73 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $1,062.09 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $1,152.73 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $1,221.40 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $2,039.21 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $789.50
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: Shaving of part of shoulder bone and repair of ligament using an endoscope	$340.50	$238.35	$135.46 – $330.29
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $135.46 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $169.33 ANTHEM MCR ADV — ANTHEM MCR ADV: $135.46 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $135.46 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $152.82 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $135.46 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $152.82 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $155.78 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $260.08 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $170.25
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · modifier AS In the file: Shaving of part of shoulder bone and repair of ligament using an endoscope	$212.50	$148.75	$106.25 – $327.81
Shoulder arthroscopy: shaving of shoulder bone: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $135.46 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $169.33 ANTHEM MCR ADV — ANTHEM MCR ADV: $135.46 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $135.46 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $152.82 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $135.46 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $152.82 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $155.78 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $260.08 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $106.25
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Removal of knee cartilage using an endoscope	$1,072.50	$750.75	$474.14 – $1,147.42
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $474.14 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $592.68 ANTHEM MCR ADV — ANTHEM MCR ADV: $474.14 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $474.14 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $494.35 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $474.14 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $494.35 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $545.26 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $910.35 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $536.25
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · modifier AS In the file: Removal of knee cartilage using an endoscope	$670	$469	$335 – $1,147.42
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $474.14 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $592.68 ANTHEM MCR ADV — ANTHEM MCR ADV: $474.14 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $474.14 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $494.35 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $474.14 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $494.35 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $545.26 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $910.35 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $335
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$245	$171.50	$103.93 – $256.15
Upper GI endoscopy (diagnostic): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $103.93 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $129.91 ANTHEM MCR ADV — ANTHEM MCR ADV: $103.93 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $103.93 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $256.15 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $103.93 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $256.15 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $119.52 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $199.55 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $122.50
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	$276	$193.20	$116.27 – $331.18
Upper GI endoscopy with biopsy: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $116.27 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $145.34 ANTHEM MCR ADV — ANTHEM MCR ADV: $116.27 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $116.27 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $124.21 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $116.27 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $331.18 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $133.71 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $223.24 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $138
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Diagnostic exam of large bowel using a flexible endoscope	$368.50	$257.95	$154.36 – $357.45
Colonoscopy (diagnostic): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $154.36 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $192.95 ANTHEM MCR ADV — ANTHEM MCR ADV: $154.36 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $154.36 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $165.58 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $154.36 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $165.58 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $177.51 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $296.37 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $184.25
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Biopsy of large bowel using a flexible endoscope	$400.50	$280.35	$167 – $388.49
Colonoscopy with biopsy: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $167 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $208.75 ANTHEM MCR ADV — ANTHEM MCR ADV: $167 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $167 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $180.09 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $167 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $384.68 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $192.05 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $320.64 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $200.25
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Removal of polyps or growths of large bowel using an endoscope with mechanical snare	$509	$356.30	$210.50 – $493.73
Colonoscopy with removal of polyps (snare): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $210.50 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $263.13 ANTHEM MCR ADV — ANTHEM MCR ADV: $210.50 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $210.50 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $405.04 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $210.50 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $405.04 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $242.08 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $404.16 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $254.50
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Removal of gallbladder using an endoscope	$1,299.50	$909.65	$571.38 – $1,260.52
Gallbladder removal by laparoscope: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $571.38 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $714.23 ANTHEM MCR ADV — ANTHEM MCR ADV: $571.38 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $571.38 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $587.64 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $571.38 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $587.64 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $657.09 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $1,097.05 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $649.75
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair of groin hernia (5 years or older)	$1,030.50	$721.35	$459.67 – $999.59
Groin (inguinal) hernia repair, age 5 or older: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $459.67 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $574.59 ANTHEM MCR ADV — ANTHEM MCR ADV: $459.67 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $459.67 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $467.34 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $459.67 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $467.34 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $528.62 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $882.57 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $515.25
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy of prostate gland	$259	$181.30	$129.50 – $251.23
Prostate biopsy: rates for 6 insurance plans CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $217.24 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $217.24 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $129.50 SAGAMORE VALLEY-ALL PLANS — SAGAMORE VALLEY-ALL PLANS: $251.23 SIHO-ALL PLANS — SIHO-ALL PLANS: $233.10 UHC - ALL PLANS — UHC - ALL PLANS: $155.40
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: Surgical removal of prostate and surrounding lymph nodes using an endoscope	$2,364.50	$1,655.15	$1,014.59 – $2,293.57
Prostate removal by laparoscope (radical prostatectomy): 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $1,014.59 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,268.24 ANTHEM MCR ADV — ANTHEM MCR ADV: $1,014.59 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,014.59 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $1,084.42 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $1,014.59 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $1,084.42 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $1,166.78 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $1,948.01 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $1,182.25
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection of substance into lower spine canal using imaging guidance	$1,537	$1,075.90	$507.19 – $1,537
Spinal injection, lower back (epidural), with imaging guidance: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,229.60 AETNA MCR ADV — AETNA MCR ADV: $1,537 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,221.76 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,221.76 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,221.76 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $933.54 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,160.74 ANTHEM MCR ADV — ANTHEM MCR ADV: $746.83 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,221.76 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,160.74
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level	$1,956.50	$1,369.55	$935.78 – $1,956.50
Nerve root injection, lower back, with imaging guidance: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $1,565.20 AETNA MCR ADV — AETNA MCR ADV: $1,956.50 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $1,555.22 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $1,555.22 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $1,555.22 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $1,169.73 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $1,477.55 ANTHEM MCR ADV — ANTHEM MCR ADV: $935.78 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $1,555.22 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $1,477.55
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Release and/or relocation of hand nerve	$862	$603.40	$389.54 – $836.14
Carpal tunnel release: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $389.54 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $486.93 ANTHEM MCR ADV — ANTHEM MCR ADV: $389.54 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $389.54 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $407.72 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $389.54 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $400.86 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $447.97 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $747.92 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $431
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier AS In the file: Release and/or relocation of hand nerve	$539	$377.30	$269.50 – $747.92
Carpal tunnel release: 10 of 14 insurance plan rates AETNA MCR ADV — AETNA MCR ADV: $389.54 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $486.93 ANTHEM MCR ADV — ANTHEM MCR ADV: $389.54 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $389.54 CARESOURCE MCAID-ALL PLANS — CARESOURCE MCAID-ALL PLANS: $407.72 ENCORE PPO-ALL PLANS — ENCORE PPO-ALL PLANS: $389.54 HOOSIER HEALTHWISE MCAID-ALL PLANS — HOOSIER HEALTHWISE MCAID-ALL PLANS: $400.86 HUMANA CHOICECARE-ALL PLANS — HUMANA CHOICECARE-ALL PLANS: $447.97 MDWISE MARKETPLACE-ALL PLANS — MDWISE MARKETPLACE-ALL PLANS: $747.92 PATOKA VALLEY-ALL PLANS — PATOKA VALLEY-ALL PLANS: $269.50

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	$20,249.47	$14,174.63	$5,805.52 – $19,641.98
Uterus and ovary surgery (not for cancer), without complications: 10 of 20 insurance plan rates AETNA - ALL OTHER PLANS — AETNA - ALL OTHER PLANS: $16,199.57 AETNA MCR ADV — AETNA MCR ADV: $9,653.99 ANTHEM BLUE ACCESS PPO — ANTHEM BLUE ACCESS PPO: $17,799.08 ANTHEM BLUE PREF HMO — ANTHEM BLUE PREF HMO: $17,799.08 ANTHEM BLUE TRAD - ALL OTHER PLANS — ANTHEM BLUE TRAD - ALL OTHER PLANS: $17,799.08 ANTHEM ESSENTIAL — ANTHEM ESSENTIAL: $12,067.48 ANTHEM HEALTHSYNC — ANTHEM HEALTHSYNC: $16,909.50 ANTHEM MCR ADV — ANTHEM MCR ADV: $9,653.99 ANTHEM PATH HMO/POS — ANTHEM PATH HMO/POS: $17,799.08 ANTHEM PATH X HMO/POS — ANTHEM PATH X HMO/POS: $16,909.50

Source: Daviess Community Hospital’s standard charges file (apps.para-hcfs.com, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on August 18, 2026; retrieved November 5, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	1314 E Walnut St, Washington, IN 47501
County	Daviess County
State	Indiana
Phone	(812) 254‑2760
Emergency services	Yes
Ownership	Government - Local
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	150061
Name in Medicare records	DAVIESS COMMUNITY HOSPITAL
Profile level	Medicare data + hospital website
Official website	dchosp.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-11-02.

Daviess Community Hospital | Daviess Community Hospital — dchosp.org
Visiting Hours | Daviess County Hospital — dchosp.org
24/7 Emergency Care | Daviess Community Hospital ER & EMS — dchosp.org

Daviess Community Hospital

Summary

Profile from official sources

At a glance