Tlh w/t/o 250 g or less cost in Indiana

Tlh w/t/o 250 g or less · CPT 58571

Hospital	City	Cash price	Negotiated range	Payers
Ascension St. Vincent Carmel (St. Vincent Carmel Hospital, Inc.)	Carmel	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Kokomo (St. Joseph Hospital & Health Center, Inc.)	Kokomo	not published	$176.21 – $4,445.47	38
Ascension St. Vincent Evansville (St. Mary's Health, Inc.)	IN 47750\|10388 Warrick Wellness Trail Newburgh	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Clay (St. Vincent Clay Hospital, Inc.)	Brazil	not published	$176.21 – $4,445.47	38
Ascension St. Vincent Fishers (St. Vincent Fishers Hospital, Inc.)	Fishers	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Jennings (St. Vincent Jennings Hospital, Inc.)	Vernon	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Warrick (St. Mary's Warrick Hospital, Inc.)	Boonville	not published	$176.21 – $4,445.47	39
Ascension St. Vincent Williamsport (St. Vincent Williamsport Hospital, Inc.)	Williamsport	not published	$176.21 – $4,445.47	38
Ascension St. Vincent Mercy (St. Vincent Madison County Health System, Inc.)	Elwood	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Heart Center (St. Vincent Heart Center of Indiana, LLC)	Carmel	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Anderson (St. Vincent Anderson Regional Hospital, Inc.)	Anderson	not published	$176.21 – $4,445.47	38
Ascension St. Vincent Randolph (St. Vincent Randolph Hospital, Inc.)	Winchester	not published	$176.21 – $4,445.47	38
Ascension St. Vincent Naab Surgery Center	Indianapolis	not published	$176.21 – $4,445.47	39
Ascension St. Vincent Salem (St. Vincent Salem Hospital, Inc.)	Salem	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Seton (St. Vincent Seton Specialty Hospital, Inc.)	Indianapolis	not published	$228.37 – $4,445.47	38
Ascension St. Vincent Carmel Ambulatory Surgery Center	Carmel	not published	$176.21 – $4,445.47	39