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Witham Health Services

Lebanon, IN · CMS ID: 150104

This hospital has pricing data for 43 procedures ranging from $35 to $4,985.

Procedures (43)

C-Section Delivery

59510
Cash Price
(No Insurance)
$2,615
Gross Charge
$3,735
Insurance Negotiated Rates
Blue Cross Blue Shield$201

Cataract Surgery

66984
Cash Price
(No Insurance)
$103
Gross Charge
$147
Insurance Negotiated Rates
Blue Cross Blue Shield$91

Chest X-Ray 1 View

71045
Cash Price
(No Insurance)
$412
Gross Charge
$589
Insurance Negotiated Rates
Blue Cross Blue Shield$62

Chest X-Ray 2 Views

71046
Cash Price
(No Insurance)
$60
Gross Charge
$85
Insurance Negotiated Rates
Blue Cross Blue Shield$53

Colonoscopy Diagnostic

45378
Cash Price
(No Insurance)
$349
Gross Charge
$498
Insurance Negotiated Rates
Blue Cross Blue Shield$309

Colonoscopy with Biopsy

45380
Cash Price
(No Insurance)
$978
Gross Charge
$1,397
Insurance Negotiated Rates
Blue Cross Blue Shield$866

Colonoscopy with Polyp Removal

45385
Cash Price
(No Insurance)
$1,040
Gross Charge
$1,486
Insurance Negotiated Rates
Blue Cross Blue Shield$921

Complete Blood Count (CBC)

85025
Cash Price
(No Insurance)
$35
Gross Charge
$50
Insurance Negotiated Rates
Blue Cross Blue Shield$8

Comprehensive Metabolic Panel

80053
Cash Price
(No Insurance)
$65
Gross Charge
$93
Insurance Negotiated Rates
Blue Cross Blue Shield$11

CT Abdomen/Pelvis with Contrast

74177
Cash Price
(No Insurance)
$4,578
Gross Charge
$6,540
Insurance Negotiated Rates
Blue Cross Blue Shield$162

CT Abdomen/Pelvis without Contrast

74176
Cash Price
(No Insurance)
$3,359
Gross Charge
$4,799
Insurance Negotiated Rates
Blue Cross Blue Shield$90

CT Chest Low Dose

71271
Cash Price
(No Insurance)
$225
Gross Charge
$321
Insurance Negotiated Rates
Blue Cross Blue Shield$81

CT Chest with Contrast

71260
Cash Price
(No Insurance)
$2,178
Gross Charge
$3,111
Insurance Negotiated Rates
Blue Cross Blue Shield$123

ER Visit Level 3

99283
Cash Price
(No Insurance)
$130
Gross Charge
$186
Insurance Negotiated Rates
Encore-All Plans$48

ER Visit Level 4

99284
Cash Price
(No Insurance)
$216
Gross Charge
$309
Insurance Negotiated Rates
Encore-All Plans$48

ER Visit Level 5

99285
Cash Price
(No Insurance)
$264
Gross Charge
$377
Insurance Negotiated Rates
Encore-All Plans$48

Fetal Non-Stress Test

59025
Cash Price
(No Insurance)
$76
Gross Charge
$109
Insurance Negotiated Rates
Blue Cross Blue Shield$68

Hemoglobin A1C

83036
Cash Price
(No Insurance)
$41
Gross Charge
$58
Insurance Negotiated Rates
Blue Cross Blue Shield$10

Hip Replacement

27130
Cash Price
(No Insurance)
$1,371
Gross Charge
$1,959
Insurance Negotiated Rates
Blue Cross Blue Shield$195

Knee Arthroscopy

29881
Cash Price
(No Insurance)
$580
Gross Charge
$828
Insurance Negotiated Rates
Blue Cross Blue Shield$82

Knee Replacement

27447
Cash Price
(No Insurance)
$1,369
Gross Charge
$1,956
Insurance Negotiated Rates
Blue Cross Blue Shield$195

Knee X-Ray

73560
Cash Price
(No Insurance)
$232
Gross Charge
$331
Insurance Negotiated Rates
Blue Cross Blue Shield$3

Laparoscopic Cholecystectomy

47562
Cash Price
(No Insurance)
$385
Gross Charge
$550
Insurance Negotiated Rates
Blue Cross Blue Shield$341

Lipid Panel

80061
Cash Price
(No Insurance)
$41
Gross Charge
$58
Insurance Negotiated Rates
Blue Cross Blue Shield$13

Mammogram Diagnostic

77066
Cash Price
(No Insurance)
$648
Gross Charge
$925
Insurance Negotiated Rates
Blue Cross Blue Shield$84

Mammogram Screening

77067
Cash Price
(No Insurance)
$344
Gross Charge
$492
Insurance Negotiated Rates
Blue Cross Blue Shield$69

MRI Brain

70551
Cash Price
(No Insurance)
$2,419
Gross Charge
$3,455
Insurance Negotiated Rates
Blue Cross Blue Shield$119

MRI Brain with Contrast

70553
Cash Price
(No Insurance)
$473
Gross Charge
$675
Insurance Negotiated Rates
Blue Cross Blue Shield$119

MRI Cervical Spine

72141
Cash Price
(No Insurance)
$2,493
Gross Charge
$3,561
Insurance Negotiated Rates
Blue Cross Blue Shield$117

MRI Knee

73721
Cash Price
(No Insurance)
$2,493
Gross Charge
$3,561
Insurance Negotiated Rates
Blue Cross Blue Shield$129

MRI Lumbar Spine

72148
Cash Price
(No Insurance)
$2,377
Gross Charge
$3,396
Insurance Negotiated Rates
Blue Cross Blue Shield$117

MRI Shoulder

73221
Cash Price
(No Insurance)
$4,985
Gross Charge
$7,122
Insurance Negotiated Rates
Blue Cross Blue Shield$48

Office Visit Level 3

99213
Cash Price
(No Insurance)
$166
Gross Charge
$237
Insurance Negotiated Rates
Blue Cross Blue Shield$30

Office Visit Level 4

99214
Cash Price
(No Insurance)
$121
Gross Charge
$173
Insurance Negotiated Rates
Aetna$70

Shoulder X-Ray

73030
Cash Price
(No Insurance)
$286
Gross Charge
$408
Insurance Negotiated Rates
Blue Cross Blue Shield$15

TSH (Thyroid)

84443
Cash Price
(No Insurance)
$65
Gross Charge
$93
Insurance Negotiated Rates
Blue Cross Blue Shield$17

Ultrasound Abdomen

76700
Cash Price
(No Insurance)
$1,061
Gross Charge
$1,516
Insurance Negotiated Rates
Blue Cross Blue Shield$1

Ultrasound Pelvis

76856
Cash Price
(No Insurance)
$368
Gross Charge
$526
Insurance Negotiated Rates
Blue Cross Blue Shield$24

Ultrasound Transvaginal

76830
Cash Price
(No Insurance)
$401
Gross Charge
$573
Insurance Negotiated Rates
Blue Cross Blue Shield$64

Upper Endoscopy Diagnostic

43235
Cash Price
(No Insurance)
$579
Gross Charge
$827
Insurance Negotiated Rates
Blue Cross Blue Shield$513

Upper Endoscopy with Biopsy

43239
Cash Price
(No Insurance)
$669
Gross Charge
$955
Insurance Negotiated Rates
Blue Cross Blue Shield$592

Urinalysis

81001
Cash Price
(No Insurance)
$131
Gross Charge
$187
Insurance Negotiated Rates
Blue Cross Blue Shield$3

Vaginal Delivery

59400
Cash Price
(No Insurance)
$2,242
Gross Charge
$3,203
Insurance Negotiated Rates
Blue Cross Blue Shield$91