Does Ascension NE Wisconsin - St Elizabeth Campus have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Ascension NE Wisconsin - St Elizabeth Campus. In a medical emergency, call 911.

Where is Ascension NE Wisconsin - St Elizabeth Campus?

1506 S Oneida St, Appleton, WI 54915, in Outagamie County, Wisconsin.

What is the phone number of Ascension NE Wisconsin - St Elizabeth Campus?

(920) 738-2000, as listed by Medicare (CMS).

What is the Medicare star rating of Ascension NE Wisconsin - St Elizabeth Campus?

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

Ascension NE Wisconsin - St Elizabeth Campus

Quick answers

Does Ascension NE Wisconsin - St Elizabeth Campus have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ascension NE Wisconsin - St Elizabeth Campus. In a medical emergency, call 911.
Where is Ascension NE Wisconsin - St Elizabeth Campus?: 1506 S Oneida St, Appleton, WI 54915, in Outagamie County, Wisconsin.
What is the phone number of Ascension NE Wisconsin - St Elizabeth Campus?: (920) 738-2000, as listed by Medicare (CMS).
What is the Medicare star rating of Ascension NE Wisconsin - St Elizabeth Campus?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][6][7][8]

Cardiology
Cancer care
Pediatrics
Behavioral health
Radiology
Breast health
Emergency medicine
Trauma care
Heart and vascular health
Medical oncology
Radiation oncology
Gynecologic oncology
Surgical oncology
Palliative medicine
Radiology and imaging
Obstetrics and gynecology (maternity care)
Maternal-fetal medicine
Neonatology (Level III NICU)
Inpatient rehabilitation
Stroke care
Cancer genetics

Conditions treated^[6][7][8][9]

Atrial fibrillation
Congestive heart failure
Structural heart and valve disease
Peripheral artery disease
Coronary artery blockages
High blood pressure
High cholesterol
Irregular heartbeat
Heart attack
Stroke
Ischemic stroke
Concussion
Broken bones
Complex fractures
Spine injury
Brain injury
Severe burns
Severe allergic reactions
Severe skin infections and abscesses
High-risk pregnancy
Multiple pregnancy
Gestational diabetes
Preeclampsia
Congenital abnormalities in babies
Premature birth (before 32 weeks)
Hereditary cancer risk (BRCA1 and BRCA2)

Treatments^{[4][6][7][8][9][10]}

Oral and infusion chemotherapy
Radiation therapy
Palliative care for pain and symptoms
Lymphedema therapy
Cancer rehabilitation
Breast reconstruction options
Genetic risk assessment and counseling
Cancer patient navigation
Cardiac rehabilitation
Anticoagulation clinic
Stroke care (dedicated stroke unit)
Inpatient rehabilitation
Labor, delivery and postpartum care
Neonatal intensive care
Neonatal respiratory support
Breastfeeding support
Childbirth classes
Healing Arts therapy
Spiritual care (chaplains)

Procedures^{[4][6][7][8][9]}

Robotic-assisted minimally invasive procedures
Diagnostic cardiac imaging and tests
X-ray
CT scan
MRI
Ultrasound
3D mammogram
Breast MRI
Low-dose CT lung scan
Laboratory testing
Transabdominal cerclage
Neonatal surgical interventions

Programs and centers^{[4][6][7][8][9][10]}

Birthing Center
Inpatient rehabilitation center
Level III NICU
Maternal-fetal medicine (high-risk pregnancy) program
Primary Stroke Center program
Cancer Center
High-risk breast clinic (BRCA screening)
Cancer patient navigators and financial advocates
Joy - A Hair Studio (for patients with hair loss from treatment)
Heart care with Heart and Vascular Institute of Wisconsin
Children and adolescent inpatient program
Adolescent partial hospitalization behavioral health program
Breastfeeding support
Wound care
Sleep medicine
Chaplain and spiritual care

Emergency care (hospital website)^[4]

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Visiting	Visiting hours 8 a.m.-8 p.m.; check in with a nurse if bringing children under 10; NICU, PICU, ER, L&D and surgery may have extra rules^[11]
Parking	Patient and visitor lots plus a parking ramp on the south side; Breast Center and Children's Health Center visitors enter at Oneida and Seymour^[11]
Interpreters and languages	Free interpreter services 24/7 for language or hearing needs, including Spanish, Hmong and sign language lines^[11]
Patient portal	Ascension patient portal

Recognition^[6][7][8]

Level III Trauma Center
Primary Stroke Center (The Joint Commission)
Level III Neonatal Intensive Care Unit
Commission on Cancer accreditation (Integrated Network Cancer Program, Ascension Wisconsin Cancer Care)

Doctors and clinicians (513)

513 doctors and other clinicians list Ascension NE Wisconsin - St Elizabeth Campus 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 489 more: the button below opens the full list.

Other emergency rooms nearby

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

Thedacare Regional Medical Center - Appleton Inc2.0 mi · Appleton, WI · Acute Care Hospital
Childrens Hospital of Wisconsin Fox Valley7.6 mi · Neenah, WI · Children's Hospital
Thedacare Regional Med Ctr - Neenah7.6 mi · Neenah, WI · Acute Care Hospital
Aurora Medical Ctr Oshkosh18 mi · Oshkosh, WI · Acute Care Hospital
Thedacare Medical Center - New London19 mi · New London, WI · Critical Access Hospital

Other hospitals nearby

Winnebago Mental Health Institute13 mi · Winnebago, WI · 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

Meadowbrook at Appleton0.1 mi · Appleton, WI · 2 of 5 stars
Peabody Manor0.9 mi · Appleton, WI · 2 of 5 stars
Oakridge Gardens Nur Ctr, Inc1.3 mi · Menasha, WI · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Thedacare at Home2.2 mi · Appleton, WI · 4 of 5 stars
Moments Hospice of Appleton6.0 mi · Appleton, WI · 3 of 5 stars
Compassus Neenah7.6 mi · Neenah, WI · 3 of 5 stars

All hospice providers in the state →

Home health agencies

PRN Home Health and Therapy, LLC2.2 mi · Appleton, WI · 4 of 5 stars
Thedacare at Home2.2 mi · Appleton, WI · 3 of 5 stars
Ascension at Home7.6 mi · Neenah, WI

All home health agencies in the state →

Dialysis facilities

FMC Dialysis - Appleton4.9 mi · Appleton, WI · 3 of 5 stars
FMC - Neenah7.6 mi · Neenah, WI · 3 of 5 stars
FMC - Kaukauna9.0 mi · Kaukauna, WI · 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.

Tower Clock Surgery Center Appleton, LLC2.5 mi · Appleton, WI
Pinnacle Cataract & Laser Institute4.9 mi · Appleton, WI
Alexander Eye Surgery Center6.0 mi · Appleton, WI

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

Partnership Community Health Center - Appleton Dental4.3 mi · Appleton, WI · Community health center
Partnership Community Health Center - Medical and Behavioral Care4.3 mi · Appleton, WI · Community health center
Partnership Dental City Center Oshkosh18 mi · Oshkosh, WI · Community health center

Clinics and urgent care

Urgent Care Physcians, Ltd2.2 mi · Appleton, WI · Urgent care center
American Current Care P.A.4.9 mi · Appleton, WI · Urgent care center
Children's Health System6.0 mi · Appleton, WI · Urgent care center

Pharmacies

Ascension Wisconsin Pharmacy, Inc2.2 mi · Appleton, WI · Community/retail pharmacy
Kimberly Hometown Pharmacy LLC2.2 mi · Appleton, WI · Community/retail pharmacy
Paper Valley Pharmacy Inc2.2 mi · Appleton, WI · Community/retail pharmacy

Assisted living nearby

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

Acs Clinical Services LLC Appleton2.2 mi · Appleton, WI
Agape 9 Kingfisher2.2 mi · Appleton, WI
Darboy Assisted Living2.2 mi · Appleton, WI
Heritage Assisted Living2.2 mi · Appleton, WI

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 Ascension NE Wisconsin - St Elizabeth Campus 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	4 of 5 stars
Nurses communicated well	3 of 5 stars
Doctors communicated well	3 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	4 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	69%National average: 72%
Would definitely recommend the hospital	68%National average: 71%
Nurses “always” communicated well	77%National average: 80%
Doctors “always” communicated well	78%National average: 80%
Staff “always” explained medicines before giving them	63%National average: 62%
Were given information about recovery at home	89%National average: 86%
Room and bathroom “always” clean	73%National average: 74%
Area around the room “always” quiet at night	64%National average: 60%
Completed surveys	548Response rate: 35%

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)	0.497No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.27No different from the national benchmark
Surgical site infections after colon surgery	0.5No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.389Better than 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	12.7%
Deaths within 30 days: heart failure patients	12.5%
Deaths within 30 days: pneumonia patients	15.5%
Deaths within 30 days: COPD patients	8.1%
Deaths within 30 days: stroke patients	11.8%
Deaths within 30 days: coronary bypass surgery (CABG)	Too few cases to report
Serious complications (patient safety indicator PSI-90)	1.2No 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	14.7%
Readmitted within 30 days: heart failure	20.3%
Readmitted within 30 days: pneumonia	17.8%
Readmitted within 30 days: COPD	19.2%
Readmitted within 30 days: coronary bypass surgery	11.7%
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.

Average (median) time patients spent in the emergency room before leaving (OP-18b)	143 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	Not reported to Medicare
Sepsis patients who got all the recommended early care (SEP-1)	67%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

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 Appleton Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 85 common services exactly as Ascension NE Wisconsin - St Elizabeth Campus 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: HC PRO OFFICE O/P NEW LOW 30 MIN OR >	$351	$200.07	$85.89 – $233.80
New patient office visit (about 30–44 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $85.89 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $85.89 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $85.89 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $85.89 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $233.80 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $233.80
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$85.89 – $233.80
New patient office visit (about 30–44 minutes): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $85.89 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $85.89 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $85.89 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $85.89 CCHP — 931_CCHP MEWI SEWI 20230101: $201.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $233.80 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $233.80
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: HC PRO OFFICE O/P NEW MOD 45 MIN OR >	$537	$306.09	$140.21 – $357.24
New patient office visit (about 45–59 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $140.21 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $140.21 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $140.21 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $140.21 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $357.24 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $357.24
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$140.21 – $357.24
New patient office visit (about 45–59 minutes): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $140.21 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $140.21 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $140.21 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $140.21 CCHP — 931_CCHP MEWI SEWI 20230101: $306.26 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $357.24 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $357.24
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HC PRO OFFICE O/P NEW HI 60 MIN OR >	$668	$380.76	$190.58 – $451.68
New patient office visit (about 60–74 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $190.58 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $190.58 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $190.58 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $190.58 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $451.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $451.68
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$190.58 – $451.68
New patient office visit (about 60–74 minutes): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $190.58 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $190.58 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $190.58 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $190.58 CCHP — 931_CCHP MEWI SEWI 20230101: $379.86 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $451.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $451.68
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC URGENT CARE LEVEL 3	$369	$210.33	$69.68 – $163.26
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $69.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $69.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $69.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $69.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $163.26 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $163.26
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC OFFICE/OUTPATIENT VISIT EST LEV 3	$336	$191.52	$69.68 – $163.26
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $69.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $69.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $69.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $69.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $163.26 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $163.26
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC PRO OFFICE O/P EST LOW 20 MIN OR >	$237	$135.09	$69.68 – $163.26
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $69.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $69.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $69.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $69.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $163.26 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $163.26
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC URGENT CARE LEVEL 4	$393	$224.01	$102.92 – $237.46
Established patient office visit (about 30–39 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $102.92 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $102.92 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $102.92 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $102.92 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $237.46 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $237.46
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC OFFICE/OUTPATIENT VISIT EST LEV 4	$378	$215.46	$102.92 – $237.46
Established patient office visit (about 30–39 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $102.92 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $102.92 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $102.92 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $102.92 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $237.46 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $237.46
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC PRO OFFICE O/P EST MOD 30 MIN OR >	$351	$200.07	$102.92 – $237.46
Established patient office visit (about 30–39 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $102.92 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $102.92 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $102.92 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $102.92 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $237.46 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $237.46
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: HC PRO OFFICE CONSULT NEW/EST LOW	$441	$251.37	$93.80 – $270.30
Office consultation with a specialist (moderate): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $93.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $93.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $93.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $93.80 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $270.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $270.30
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$93.80 – $270.30
Office consultation with a specialist (moderate): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $93.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $93.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $93.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $93.80 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $270.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $270.30
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: HC PRO OFFICE CONSULT NEW/EST MOD	$655	$373.35	$142.94 – $404.59
Office consultation with a specialist (moderate to high): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $142.94 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $142.94 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $142.94 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $142.94 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $404.59 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $404.59
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$142.94 – $404.59
Office consultation with a specialist (moderate to high): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $142.94 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $142.94 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $142.94 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $142.94 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $404.59 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $404.59
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$99.46 – $290.57
Preventive checkup, new patient, age 18–39: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $99.46 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $99.46 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $99.46 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $99.46 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $290.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $290.57
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$120.71 – $336.42
Preventive checkup, new patient, age 40–64: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $120.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $120.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $120.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $120.71 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $336.42 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $336.42
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HC ER CARE LEVEL III	$1,386	$790.02	$73.88 – $1,333
Emergency room visit (moderate): rates for 9 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $760 ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $1,139 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $73.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $73.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $73.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $73.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $141.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $141.68 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $1,333
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: HC PRO EMERGENCY DEPT VISIT LEVEL 3	$264	$150.48	$73.88 – $141.68
Emergency room visit (moderate): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $73.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $73.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $73.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $73.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $141.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $141.68
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: EMERGENCY DEPT VISIT LOW MDM	Not listed in the file	Not listed in the file	$266.19 – $559
Emergency room visit (moderate): 10 of 17 insurance plan rates ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $760 ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $1,139 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $73.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $73.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $73.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $73.88 CCHP — 931_CCHP MEWI SEWI 20230101: $112.12 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $141.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $141.68 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $266.19
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HC ER CARE LEVEL IV	$2,197	$1,252.29	$125.71 – $1,442
Emergency room visit (moderately high): rates for 7 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $1,442 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $125.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $125.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $125.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $125.71 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $258.63 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $258.63
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: HC PRO EMERGENCY DEPT VISIT LEVEL 4	$493	$281.01	$125.71 – $258.63
Emergency room visit (moderately high): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $125.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $125.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $125.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $125.71 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $258.63 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $258.63
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: EMERGENCY DEPT VISIT MOD MDM	Not listed in the file	Not listed in the file	$409.37 – $859.68
Emergency room visit (moderately high): 10 of 17 insurance plan rates ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $1,442 ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $2,567 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $125.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $125.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $125.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $125.71 CCHP — 931_CCHP MEWI SEWI 20230101: $2,793 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $258.63 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $258.63 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $409.37
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HC SEXUAL ASSAULT FACILITY	$3,434	$1,957.38	$182.14 – $3,383
Emergency room visit (high): rates for 10 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $1,957 ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3,138 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $182.14 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $182.14 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $182.14 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $182.14 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $375.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $375.41 SEHN — 895_SEHN MEWI SEWI 20221001: $3,383 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $3,173
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HC ER CARE LEVEL V	$2,745	$1,564.65	$182.14 – $1,957
Emergency room visit (high): rates for 7 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $1,957 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $182.14 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $182.14 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $182.14 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $182.14 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $375.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $375.41
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: HC PRO EMERGENCY DEPT VISIT LEVEL 5	$725	$413.25	$182.14 – $375.41
Emergency room visit (high): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $182.14 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $182.14 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $182.14 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $182.14 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $375.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $375.41

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: HC BASIC METABOLIC PANEL-CALCIUM, TOTAL	$117	$66.69	$8.88 – $59.96
Basic metabolic panel (blood test): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $12.10 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.67 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.67 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $19.01 SEHN — 895_SEHN MEWI SEWI 20221001: $16.25
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.46 – $17.77
Basic metabolic panel (blood test): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $12.10 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.88 CCHP — 931_CCHP MEWI SEWI 20230101: $28.26 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.67 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.67 CIGNA — 1004_CIGNA 20230701: $32.66 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $8.46
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.46 – $17.77
Basic metabolic panel (blood test): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $8.46 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $17.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $11.84 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $8.46 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $8.88
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: HC COMPREHENSIVE METABOLIC PANEL	$138	$78.66	$11.09 – $74.89
Comprehensive metabolic panel (blood test): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $15.11 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $11.09 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $11.09 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $11.09 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $11.09 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $14.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $14.57 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $23.74 SEHN — 895_SEHN MEWI SEWI 20221001: $20.29
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$10.56 – $22.18
Comprehensive metabolic panel (blood test): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $15.11 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $11.09 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $11.09 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $11.09 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $11.09 CCHP — 931_CCHP MEWI SEWI 20230101: $35.31 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $14.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $14.57 CIGNA — 1004_CIGNA 20230701: $40.76 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $10.56
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$10.56 – $22.18
Comprehensive metabolic panel (blood test): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $10.56 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $22.18 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $14.78 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $10.56 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $11.09
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$47.81 – $100.40
Obstetric blood test panel: 10 of 15 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $68.38 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $50.20 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $50.20 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $50.20 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $50.20 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $65.98 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $65.98 CIGNA — 1004_CIGNA 20230701: $184.55 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $47.81 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $100.40
Obstetric blood test panel CPT 80055 · Inpatient (hospital stay) In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$47.81 – $100.40
Obstetric blood test panel: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $47.81 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $100.40 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $66.93 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $47.81 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $50.20
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: HC LIPID PANEL	$89	$50.73	$14.06 – $44.76
Cholesterol panel (lipid panel): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $19.15 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $14.06 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $14.06 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $14.06 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $14.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $18.48 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $18.48 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $30.10 SEHN — 895_SEHN MEWI SEWI 20221001: $25.72
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$13.39 – $28.12
Cholesterol panel (lipid panel): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $19.15 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $14.06 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $14.06 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $14.06 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $14.06 CCHP — 931_CCHP MEWI SEWI 20230101: $44.76 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $18.48 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $18.48 CIGNA — 1004_CIGNA 20230701: $51.69 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $13.39
Cholesterol panel (lipid panel) CPT 80061 · Inpatient (hospital stay) In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$13.39 – $28.12
Cholesterol panel (lipid panel): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $13.39 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $28.12 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $18.75 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $13.39 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $14.06
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HC RENAL FUNCTION PANEL	$114	$64.98	$9.11 – $61.56
Kidney function panel: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $12.42 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $9.11 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $9.11 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $9.11 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $9.11 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.98 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.98 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $19.52 SEHN — 895_SEHN MEWI SEWI 20221001: $16.67
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.68 – $18.23
Kidney function panel: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $12.42 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $9.11 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $9.11 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $9.11 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $9.11 CCHP — 931_CCHP MEWI SEWI 20230101: $29.01 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.98 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.98 CIGNA — 1004_CIGNA 20230701: $33.50 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $8.68
Kidney function panel CPT 80069 · Inpatient (hospital stay) In the file: RENAL FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.68 – $18.23
Kidney function panel: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $8.68 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $18.23 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $12.15 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $8.68 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $9.11
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HC HEPATIC FUNCTION PANEL	$114	$64.98	$8.58 – $18.36
Liver function panel: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $11.69 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.58 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.58 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.58 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.58 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.27 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.27 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $18.36 SEHN — 895_SEHN MEWI SEWI 20221001: $15.68
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.17 – $17.16
Liver function panel: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $11.69 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.58 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.58 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.58 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.58 CCHP — 931_CCHP MEWI SEWI 20230101: $27.29 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $11.27 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $11.27 CIGNA — 1004_CIGNA 20230701: $31.54 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $8.17
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.17 – $17.16
Liver function panel: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $8.17 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $17.16 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $11.44 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $8.17 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $8.58
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: HC URINALYSIS AUTOMATED W/SCOPE	$32	$18.24	$3.33 – $7.13
Urine test (automated, with microscope): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $4.54 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $3.33 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $3.33 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $3.33 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $3.33 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4.37 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4.37 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $7.13 SEHN — 895_SEHN MEWI SEWI 20221001: $6.07
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.17 – $6.66
Urine test (automated, with microscope): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $4.54 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $3.33 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $3.33 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $3.33 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $3.33 CCHP — 931_CCHP MEWI SEWI 20230101: $10.57 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4.37 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4.37 CIGNA — 1004_CIGNA 20230701: $12.24 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $3.17
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.17 – $6.66
Urine test (automated, with microscope): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $3.17 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $6.66 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $4.44 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $3.17 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $3.33
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: HC URINALYSIS NONAUTOMATED W/O SCOPE-POC	$7	$3.99	$3.65 – $5.74
Urine test (manual, without microscope): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3.65 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $3.65 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $3.65 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $3.65 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $3.65 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4.80 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4.80 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $5.74 SEHN — 895_SEHN MEWI SEWI 20221001: $4.91
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.48 – $7.31
Urine test (manual, without microscope): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3.65 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $3.65 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $3.65 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $3.65 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $3.65 CCHP — 931_CCHP MEWI SEWI 20230101: $8.55 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4.80 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4.80 CIGNA — 1004_CIGNA 20230701: $13.43 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $3.48
Urine test (manual, without microscope) CPT 81002 · Inpatient (hospital stay) In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.48 – $7.31
Urine test (manual, without microscope): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $3.48 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $7.31 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $4.87 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $3.48 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $3.65
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC URINALYSIS AUTOMATED W/O SCOPE - POC	$24	$13.68	$2.36 – $15.91
Urine test (automated, without microscope): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3.21 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2.36 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2.36 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2.36 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2.36 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $3.11 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $3.11 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $5.05 SEHN — 895_SEHN MEWI SEWI 20221001: $4.31
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: HC URINALYSIS AUTOMATED W/O SCOPE	$24	$13.68	$2.36 – $15.91
Urine test (automated, without microscope): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3.21 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2.36 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2.36 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2.36 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2.36 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $3.11 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $3.11 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $5.05 SEHN — 895_SEHN MEWI SEWI 20221001: $4.31
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: URINALYSIS AUTO W/O SCOPE	Not listed in the file	Not listed in the file	$2.25 – $4.73
Urine test (automated, without microscope): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3.21 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2.36 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2.36 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2.36 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2.36 CCHP — 931_CCHP MEWI SEWI 20230101: $7.51 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $3.11 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $3.11 CIGNA — 1004_CIGNA 20230701: $8.69 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $2.25
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HC PSA SCREENING	$114	$64.98	$19.31 – $41.35
PSA (prostate specific antigen) blood test: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $26.31 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $19.31 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $19.31 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $19.31 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $19.31 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $25.38 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $25.38 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $41.35 SEHN — 895_SEHN MEWI SEWI 20221001: $35.33
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL	$37	$21.09	$19.31 – $35.33
PSA (prostate specific antigen) blood test: rates for 8 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $26.31 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $19.31 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $19.31 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $19.31 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $19.31 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $25.38 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $25.38 SEHN — 895_SEHN MEWI SEWI 20221001: $35.33
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$18.39 – $38.62
PSA (prostate specific antigen) blood test: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $26.31 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $19.31 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $19.31 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $19.31 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $19.31 CCHP — 931_CCHP MEWI SEWI 20230101: $61.45 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $25.38 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $25.38 CIGNA — 1004_CIGNA 20230701: $70.99 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $18.39
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HC ASSAY THYROID STIM HORMONE-R	$104	$59.28	$17.64 – $56.13
Thyroid stimulating hormone (TSH) test: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $24.03 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $17.64 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $17.64 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $17.64 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $17.64 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $23.18 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $23.18 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $37.77 SEHN — 895_SEHN MEWI SEWI 20221001: $32.26
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: HC ASSAY THYROID STIM HORMONE	$104	$59.28	$17.64 – $56.13
Thyroid stimulating hormone (TSH) test: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $24.03 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $17.64 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $17.64 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $17.64 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $17.64 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $23.18 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $23.18 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $37.77 SEHN — 895_SEHN MEWI SEWI 20221001: $32.26
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: ASSAY THYROID STIM HORMONE	Not listed in the file	Not listed in the file	$16.80 – $35.28
Thyroid stimulating hormone (TSH) test: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $24.03 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $17.64 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $17.64 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $17.64 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $17.64 CCHP — 931_CCHP MEWI SEWI 20230101: $56.13 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $23.18 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $23.18 CIGNA — 1004_CIGNA 20230701: $64.85 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $16.80
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: HC COMPLETE CBC W/AUTO DIFFERENTIAL WBC	$49	$27.93	$8.16 – $17.47
Complete blood count (CBC) with differential: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $11.12 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.16 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.16 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.16 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.16 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $10.72 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $10.72 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $17.47 SEHN — 895_SEHN MEWI SEWI 20221001: $14.93
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$7.77 – $16.32
Complete blood count (CBC) with differential: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $11.12 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $8.16 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $8.16 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $8.16 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $8.16 CCHP — 931_CCHP MEWI SEWI 20230101: $25.98 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $10.72 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $10.72 CIGNA — 1004_CIGNA 20230701: $29.99 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $7.77
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$7.77 – $16.32
Complete blood count (CBC) with differential: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $7.77 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $16.32 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $10.88 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $7.77 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $8.16
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HC COMPLETE CBC AUTOMATED	$41	$23.37	$6.79 – $14.54
Complete blood count (CBC), automated: rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $9.25 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $6.79 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $6.79 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $6.79 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $6.79 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $8.93 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $8.93 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $14.54 SEHN — 895_SEHN MEWI SEWI 20221001: $12.43
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.47 – $13.59
Complete blood count (CBC), automated: 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $9.25 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $6.79 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $6.79 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $6.79 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $6.79 CCHP — 931_CCHP MEWI SEWI 20230101: $21.60 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $8.93 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $8.93 CIGNA — 1004_CIGNA 20230701: $24.97 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $6.47
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.47 – $13.59
Complete blood count (CBC), automated: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $6.47 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $13.59 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $9.06 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $6.47 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $6.79
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC PROTHROMBIN TIME - POC	$24	$13.68	$4.50 – $13.12
Blood clotting time test (prothrombin time, PT): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $5.63 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $4.50 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $4.50 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $4.50 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $4.50 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5.92 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5.92 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $8.84 SEHN — 895_SEHN MEWI SEWI 20221001: $7.55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: HC PROTHROMBIN TIME	$24	$13.68	$4.50 – $13.12
Blood clotting time test (prothrombin time, PT): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $5.63 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $4.50 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $4.50 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $4.50 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $4.50 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5.92 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5.92 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $8.84 SEHN — 895_SEHN MEWI SEWI 20221001: $7.55
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME	Not listed in the file	Not listed in the file	$4.29 – $9.01
Blood clotting time test (prothrombin time, PT): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $5.63 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $4.50 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $4.50 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $4.50 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $4.50 CCHP — 931_CCHP MEWI SEWI 20230101: $13.12 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5.92 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5.92 CIGNA — 1004_CIGNA 20230701: $16.56 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $4.29
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: HC THROMBOPLASTIN TIME PARTIAL PLASMA OR WB	$40	$22.80	$6.31 – $13.50
Blood clotting test (partial thromboplastin time, PTT): rates for 9 insurance plans ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $8.59 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $6.31 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $6.31 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $6.31 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $6.31 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $8.29 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $8.29 NETWORK HEALTH PLAN — 938_NETWORK HEALTH PLAN MEWI SEWI 20230101: $13.50 SEHN — 895_SEHN MEWI SEWI 20221001: $11.53
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.01 – $12.62
Blood clotting test (partial thromboplastin time, PTT): 10 of 16 insurance plan rates ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $8.59 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $6.31 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $6.31 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $6.31 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $6.31 CCHP — 931_CCHP MEWI SEWI 20230101: $20.05 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $8.29 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $8.29 CIGNA — 1004_CIGNA 20230701: $23.20 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $6.01
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient (hospital stay) In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.01 – $12.62
Blood clotting test (partial thromboplastin time, PTT): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $6.01 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $12.62 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $8.41 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $6.01 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $6.31

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: HC CT HEAD WO CONTRAST	$1,225	$698.25	$42.89 – $294.90
CT scan of the head or brain, without contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $42.89 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $42.89 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $42.89 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $42.89 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $276.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $276.57
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$102.23 – $214.68
CT scan of the head or brain, without contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $42.89 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $42.89 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $42.89 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $42.89 CCHP — 931_CCHP MEWI SEWI 20230101: $391.59 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $276.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $276.57 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $102.23 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $214.68 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $143.12
CT scan of the head or brain, without contrast CPT 70450 · Inpatient (hospital stay) In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$102.23 – $214.68
CT scan of the head or brain, without contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $102.23 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $214.68 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $143.12 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $102.23 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $107.34
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: HC MRI BRAIN W/WO CONTRAST	$2,056	$1,171.92	$115.40 – $1,067.96
MRI of the brain, before and after contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $115.40 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $115.40 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $115.40 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $115.40 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $875.46 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $875.46
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$343.33 – $720.99
MRI of the brain, before and after contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $115.40 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $115.40 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $115.40 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $115.40 CCHP — 931_CCHP MEWI SEWI 20230101: $1,336.86 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $875.46 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $875.46 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $343.33 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $720.99 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $480.66
MRI of the brain, before and after contrast CPT 70553 · Inpatient (hospital stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$343.33 – $720.99
MRI of the brain, before and after contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $343.33 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $720.99 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $480.66 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $343.33 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $360.50
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: HC X-RAY EXAM CHEST 2 VIEWS	$322	$183.54	$11.18 – $78.02
Chest X-ray, 2 views: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $11.18 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $11.18 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $11.18 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $11.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $78.02 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $78.02
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$84.65 – $177.77
Chest X-ray, 2 views: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $11.18 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $11.18 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $11.18 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $11.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $78.02 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $78.02 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $84.65 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $177.77 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $118.51 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $84.65
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$84.65 – $177.77
Chest X-ray, 2 views: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $84.65 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $177.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $118.51 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $84.65 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $88.88
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: HC X-RAY EXAM L-2 SPINE 4/>VWS	$274	$156.18	$13.38 – $115.57
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $13.38 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $13.38 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $13.38 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $13.38 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $115.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $115.57
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$102.23 – $214.68
X-ray of the lower spine, at least 4 views: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $13.38 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $13.38 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $13.38 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $13.38 CCHP — 931_CCHP MEWI SEWI 20230101: $117.13 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $115.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $115.57 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $102.23 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $214.68 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $143.12
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient (hospital stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$102.23 – $214.68
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $102.23 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $214.68 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $143.12 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $102.23 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $107.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HC MRI LUMBAR SPINE WO CONTRAST	$2,547	$1,451.79	$75.07 – $722.71
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $75.07 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $75.07 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $75.07 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $75.07 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $521.52 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $521.52
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$232.38 – $488
MRI of the lower back (lumbar spine), without contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $75.07 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $75.07 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $75.07 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $75.07 CCHP — 931_CCHP MEWI SEWI 20230101: $892.44 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $521.52 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $521.52 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $232.38 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $488 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $325.33
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient (hospital stay) In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$232.38 – $488
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $232.38 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $488 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $325.33 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $232.38 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $244
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HC CT PELVIS W CONTRAST	$752	$428.64	$58.62 – $580.34
CT scan of the pelvis, with contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $58.62 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $58.62 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $58.62 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $58.62 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $580.34 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $580.34
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$171.14 – $359.39
CT scan of the pelvis, with contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $58.62 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $58.62 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $58.62 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $58.62 CCHP — 931_CCHP MEWI SEWI 20230101: $649.54 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $580.34 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $580.34 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $171.14 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $359.39 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $239.60
CT scan of the pelvis, with contrast CPT 72193 · Inpatient (hospital stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$171.14 – $359.39
CT scan of the pelvis, with contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $171.14 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $359.39 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $239.60 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $171.14 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $179.70
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HC MRI JOINT LOWER EXTREMITY WO CONTRAST	$1,626	$926.82	$68.68 – $548.68
MRI of a leg joint (such as the knee), without contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $68.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $68.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $68.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $68.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $548.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $548.68
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI JNT OF LWR EXTRE W/O DYE	Not listed in the file	Not listed in the file	$232.38 – $488
MRI of a leg joint (such as the knee), without contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $68.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $68.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $68.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $68.68 CCHP — 931_CCHP MEWI SEWI 20230101: $658.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $548.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $548.68 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $232.38 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $488 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $325.33
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient (hospital stay) In the file: MRI JNT OF LWR EXTRE W/O DYE	Not listed in the file	Not listed in the file	$232.38 – $488
MRI of a leg joint (such as the knee), without contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $232.38 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $488 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $325.33 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $232.38 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $244
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: HC CT ABDOMEN PELVIS W CONTRAST	$1,418	$808.26	$91.80 – $784.40
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $91.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $91.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $91.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $91.80 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $784.40 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $784.40
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$343.33 – $720.99
CT scan of the abdomen and pelvis, with contrast: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $91.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $91.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $91.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $91.80 CCHP — 931_CCHP MEWI SEWI 20230101: $818.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $784.40 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $784.40 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $343.33 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $720.99 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $480.66
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$343.33 – $720.99
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $343.33 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $720.99 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $480.66 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $343.33 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $360.50
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HC US ABDOMINAL COMPLETE	$752	$428.64	$40.68 – $295.07
Ultrasound of the abdomen, complete: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $40.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $40.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $40.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $40.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $295.07 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $295.07
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$102.23 – $214.68
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $40.68 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $40.68 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $40.68 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $40.68 CCHP — 931_CCHP MEWI SEWI 20230101: $335.12 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $295.07 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $295.07 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $102.23 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $214.68 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $143.12
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$102.23 – $214.68
Ultrasound of the abdomen, complete: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $102.23 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $214.68 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $143.12 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $102.23 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $107.34
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HC US OB 14 WKS / > SINGLE FETUS	$317	$180.69	$50.60 – $245.18
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $50.60 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $50.60 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $50.60 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $50.60 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $245.18 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $245.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$102.23 – $214.68
Pregnancy ultrasound (after the first trimester): 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $50.60 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $50.60 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $50.60 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $50.60 CCHP — 931_CCHP MEWI SEWI 20230101: $353.52 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $336.66 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $336.66 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $102.23 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $214.68 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $143.12
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient (hospital stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$102.23 – $214.68
Pregnancy ultrasound (after the first trimester): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $102.23 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $214.68 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $143.12 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $102.23 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $107.34
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HC US NON-OB TRANSVAGINAL	$289	$164.73	$35.01 – $245.18
Transvaginal ultrasound: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $35.01 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $35.01 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $35.01 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $35.01 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $245.18 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $245.18
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$102.23 – $214.68
Transvaginal ultrasound: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $35.01 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $35.01 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $35.01 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $35.01 CCHP — 931_CCHP MEWI SEWI 20230101: $178.70 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $295.64 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $295.64 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $102.23 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $214.68 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $143.12
Transvaginal ultrasound CPT 76830 · Inpatient (hospital stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$102.23 – $214.68
Transvaginal ultrasound: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $102.23 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $214.68 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $143.12 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $102.23 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $107.34
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD UNI	$1,000	$570	$41.04 – $321.38
Diagnostic mammogram, one breast: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $41.04 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $41.04 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $41.04 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $41.04 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $321.38 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $321.38
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$81.01 – $170.12
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $41.04 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $41.04 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $41.04 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $41.04 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $321.38 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $321.38 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $81.01 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $170.12 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $113.41 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $81.01
Diagnostic mammogram, one breast CPT 77065 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$81.01 – $170.12
Diagnostic mammogram, one breast: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $81.01 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $170.12 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $113.41 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $81.01 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $85.06
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD BI	$1,249	$711.93	$50.39 – $405.50
Diagnostic mammogram, both breasts: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $50.39 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $50.39 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $50.39 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $50.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $405.50 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $405.50
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$103.30 – $216.93
Diagnostic mammogram, both breasts: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $50.39 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $50.39 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $50.39 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $50.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $405.50 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $405.50 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $103.30 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $216.93 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $144.62 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $103.30
Diagnostic mammogram, both breasts CPT 77066 · Inpatient (hospital stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$103.30 – $216.93
Diagnostic mammogram, both breasts: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $103.30 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $216.93 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $144.62 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $103.30 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $108.47
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC SCREEN MAMMO BI INCL CAD	$551	$314.07	$38.46 – $327.96
Screening mammogram, both breasts: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $38.46 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $38.46 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $38.46 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $38.46 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $327.96 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $327.96
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$85.54 – $179.63
Screening mammogram, both breasts: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $38.46 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $38.46 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $38.46 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $38.46 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $327.96 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $327.96 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $85.54 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $179.63 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $119.76 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $85.54
Screening mammogram, both breasts CPT 77067 · Inpatient (hospital stay) In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$85.54 – $179.63
Screening mammogram, both breasts: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $85.54 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $179.63 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $119.76 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $85.54 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $89.82

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$15.15 – $55.09
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $15.15 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $15.15 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $15.15 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $15.15 CCHP — 931_CCHP MEWI SEWI 20230101: $37.14 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $55.09 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $55.09
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: HC LT HEART CATH W/ VENT	$7,820	$4,457.40	$233.20 – $2,963.14
Left heart catheterization (diagnostic): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $233.20 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $233.20 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $233.20 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $233.20 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,963.14 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,963.14
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$233.20 – $2,963.14
Left heart catheterization (diagnostic): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $233.20 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $233.20 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $233.20 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $233.20 CCHP — 931_CCHP MEWI SEWI 20230101: $1,818.57 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,963.14 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,963.14
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · modifier TC In the file: HC LT HEART CATH W/ VENT	$7,820	$4,457.40	$233.20 – $2,963.14
Left heart catheterization (diagnostic): rates for 3 insurance plans CCHP — 931_CCHP MEWI SEWI 20230101: $1,315.68 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,202.61 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,202.61
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: HC COMPLEX EP W/O INDUCTION	$19,606	$11,175.42	$379.88 – $16,158
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $379.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $379.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $379.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $379.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,275.69 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,275.69 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $16,158
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$379.88 – $16,158
Heart rhythm study (electrophysiology evaluation): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $379.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $379.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $379.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $379.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,275.69 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,275.69 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $16,158
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · modifier 26 In the file: HC COMPLEX EP W/O INDUCTION	$19,606	$11,175.42	$379.88 – $16,158
Heart rhythm study (electrophysiology evaluation): rates for 3 insurance plans CCHP — 931_CCHP MEWI SEWI 20230101: $784.19 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,256.08 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,256.08
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: HC ABLATE AF W EP/AR INDUCT	$68,979	$39,318.03	$924.88 – $16,158
Heart rhythm study with ablation for atrial fibrillation: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $924.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $924.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $924.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $924.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $3,954.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $3,954.30 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $16,158
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$924.88 – $16,158
Heart rhythm study with ablation for atrial fibrillation: rates for 8 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $924.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $924.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $924.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $924.88 CCHP — 931_CCHP MEWI SEWI 20230101: $2,154.38 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $3,954.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $3,954.30 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $16,158
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: HC POLYSOMNOGRAM STUDY	$6,229	$3,550.53	$125.71 – $3,687
Sleep study (overnight, in a sleep lab): rates for 8 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $2,887 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $125.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $125.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $125.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $125.71 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,992.51 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,992.51 UNITED HEALTH CARE POS — 985_UNITED HEALTH CARE POS MEWI SEWI 20230401: $3,687
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$978.08 – $2,053.97
Sleep study (overnight, in a sleep lab): 10 of 15 insurance plan rates ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $2,887 ALLIANCE — 885_ALLIANCE MEWI SEWI 20221001: $3,125 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $125.71 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $125.71 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $125.71 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $125.71 CCHP — 931_CCHP MEWI SEWI 20230101: $1,309.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,992.51 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,992.51 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $978.08
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient (hospital stay) In the file: POLYSOM 6/> YRS 4/> PARAM	Not listed in the file	Not listed in the file	$978.08 – $2,053.97
Sleep study (overnight, in a sleep lab): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $978.08 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $2,053.97 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $1,369.31 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $978.08 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $1,026.98

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) In the file: HC PT THERAPEUTIC EXERCISES / 15 MIN	$130	$74.10	$37.41 – $64.83
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $64.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $64.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $64.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $64.83 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $37.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $37.41
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC OT THERAPEUTIC EXERCISES / 15 MIN	$130	$74.10	$37.41 – $64.83
Physical therapy: therapeutic exercise (each 15 minutes): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $64.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $64.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $64.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $64.83 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $37.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $37.41
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: THERAPEUTIC EXERCISES	Not listed in the file	Not listed in the file	$27.97 – $58.74
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $64.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $64.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $64.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $64.83 CCHP — 931_CCHP MEWI SEWI 20230101: $65.82 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $37.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $37.41 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $27.97 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $58.74 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $39.16
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: HC PT EVAL LOW COMPLEX	$269	$153.33	$104.53 – $108.93
Physical therapy evaluation (low complexity): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (low complexity): 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $95.13 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $199.77 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $133.18 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $95.13
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient (hospital stay) In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (low complexity): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $95.13 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $199.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $133.18 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $95.13 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $99.89
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: HC PT EVAL MOD COMPLEX	$323	$184.11	$104.53 – $108.93
Physical therapy evaluation (moderate complexity): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (moderate complexity): 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $95.13 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $199.77 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $133.18 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $95.13
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient (hospital stay) In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (moderate complexity): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $95.13 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $199.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $133.18 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $95.13 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $99.89
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: HC PT EVAL HIGH COMPLEX	$378	$215.46	$104.53 – $108.93
Physical therapy evaluation (high complexity): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (high complexity): 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $108.93 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $108.93 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $108.93 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $108.93 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $104.53 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $104.53 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $95.13 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $199.77 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $133.18 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $95.13
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient (hospital stay) In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$95.13 – $199.77
Physical therapy evaluation (high complexity): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $95.13 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $199.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $133.18 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $95.13 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $99.89
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT PSYTX W PT 30 MIN	$551	$314.07	$74.83 – $232.78
Psychotherapy, 30 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $74.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $74.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $74.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $74.83 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $232.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $232.78
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT PSYTX W/PT 30 MIN	$551	$314.07	$74.83 – $232.78
Psychotherapy, 30 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $74.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $74.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $74.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $74.83 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $232.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $232.78
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: HC AODA OUTPT PSYTX W/PT 30 MIN	$551	$314.07	$74.83 – $232.78
Psychotherapy, 30 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $74.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $74.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $74.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $74.83 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $232.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $232.78
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT PSYTX W PT 45 MIN	$773	$440.61	$99.06 – $309.61
Psychotherapy, 45 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $99.06 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $99.06 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $99.06 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $99.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $309.61 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $309.61
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT PSYTX W/PT 45 MIN	$773	$440.61	$99.06 – $309.61
Psychotherapy, 45 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $99.06 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $99.06 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $99.06 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $99.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $309.61 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $309.61
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: HC AODA OUTPT PSYTX W/PT 45 MIN	$773	$440.61	$99.06 – $309.61
Psychotherapy, 45 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $99.06 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $99.06 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $99.06 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $99.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $309.61 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $309.61
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT PSYTX W PT 60 MIN	$890	$507.30	$146.18 – $464.04
Psychotherapy, 60 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $146.18 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $146.18 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $146.18 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $146.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $464.04 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $464.04
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HC AODA OUTPT PSYTX W/PT 60 MIN	$890	$507.30	$146.18 – $464.04
Psychotherapy, 60 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $146.18 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $146.18 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $146.18 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $146.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $464.04 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $464.04
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: HC MH OUTPT PSYTX W PT 60 MIN	$890	$507.30	$146.18 – $464.04
Psychotherapy, 60 minutes: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $146.18 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $146.18 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $146.18 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $146.18 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $464.04 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $464.04
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT FAMILY PSYTX W/O PT 26-29 M	$1,272	$725.04	$106.57 – $340.30
Family psychotherapy, without the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $106.57 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $106.57 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $106.57 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $106.57 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $340.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $340.30
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 45 MI	$1,272	$725.04	$106.57 – $340.30
Family psychotherapy, without the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $106.57 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $106.57 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $106.57 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $106.57 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $340.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $340.30
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/O PT 60 MI	$1,272	$725.04	$106.57 – $340.30
Family psychotherapy, without the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $106.57 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $106.57 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $106.57 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $106.57 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $340.30 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $340.30
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 26-29 MI	$1,272	$725.04	$111.39 – $352.47
Family psychotherapy, with the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $111.39 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $111.39 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $111.39 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $111.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $352.47 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $352.47
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT FAMILY PSYTX W/ PT 30 MIN	$1,272	$725.04	$111.39 – $352.47
Family psychotherapy, with the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $111.39 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $111.39 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $111.39 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $111.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $352.47 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $352.47
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT FAMILY PSYTX W/ PT 45 MIN	$1,272	$725.04	$111.39 – $352.47
Family psychotherapy, with the patient: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $111.39 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $111.39 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $111.39 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $111.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $352.47 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $352.47
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HC TELEHEALTH AODA OUTPT GROUP PSYCHOTHERAPY 30 MI	$102	$58.14	$26.22 – $92.44
Group psychotherapy: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $26.22 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $26.22 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $26.22 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $26.22 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $92.44 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $92.44
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 90 MIN	$193	$110.01	$26.22 – $92.44
Group psychotherapy: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $26.22 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $26.22 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $26.22 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $26.22 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $92.44 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $92.44
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: HC TELEHEALTH MH OUTPT GROUP PSYCHOTHERAPY 120 MIN	$221	$125.97	$26.22 – $92.44
Group psychotherapy: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $26.22 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $26.22 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $26.22 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $26.22 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $92.44 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $92.44

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: HC PRO EXC BREAST TISSUE 1/> LESN	$2,251	$1,283.07	$426.88 – $1,787.78
Removal of breast growth (open surgery): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $426.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $426.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $426.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $426.88 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,787.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,787.78
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$426.88 – $1,787.78
Removal of breast growth (open surgery): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $426.88 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $426.88 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $426.88 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $426.88 CCHP — 931_CCHP MEWI SEWI 20230101: $1,069.39 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,787.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,787.78
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,315.64 – $40,016
Total hip replacement: rates for 10 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $18,000 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $1,315.64 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $1,315.64 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $1,315.64 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $1,315.64 CCHP — 931_CCHP MEWI SEWI 20230101: $3,094.63 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4,830.15 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4,830.15 CIGNA — 1004_CIGNA 20230701: $40,016 TRILOGY — 1007_TRILOGY MEWI SEWI 20230701: $29,489
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$1,313.97 – $40,016
Total knee replacement: rates for 10 insurance plans ACA — 909_NETWORK HEALTH PLAN ACA MEWI SEWI 20221001: $18,000 ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $1,313.97 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $1,313.97 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $1,313.97 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $1,313.97 CCHP — 931_CCHP MEWI SEWI 20230101: $3,304.10 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $4,825.43 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $4,825.43 CIGNA — 1004_CIGNA 20230701: $40,016 TRILOGY — 1007_TRILOGY MEWI SEWI 20230701: $29,489
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$173.24 – $620.93
Shoulder arthroscopy: shaving of shoulder bone: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $173.24 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $173.24 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $173.24 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $173.24 CCHP — 931_CCHP MEWI SEWI 20230101: $374.59 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $620.93 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $620.93
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$567.30 – $1,936.69
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $567.30 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $567.30 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $567.30 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $567.30 CCHP — 931_CCHP MEWI SEWI 20230101: $1,177.80 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,936.69 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,936.69
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$308.29 – $1,041.64
Removal of tonsils and adenoids (under age 12): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $308.29 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $308.29 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $308.29 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $308.29 CCHP — 931_CCHP MEWI SEWI 20230101: $645.97 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,041.64 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,041.64
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: HC EGD DIAGNOSTIC	$2,787	$1,588.59	$126.80 – $1,017.26
Upper GI endoscopy (diagnostic): rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $126.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $126.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $126.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $126.80 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,017.26 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,017.26
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$901.33 – $1,892.79
Upper GI endoscopy (diagnostic): 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $126.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $126.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $126.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $126.80 CCHP — 931_CCHP MEWI SEWI 20230101: $673.55 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,017.26 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,017.26 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $901.33 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,892.79 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $1,261.86
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient (hospital stay) In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$901.33 – $1,892.79
Upper GI endoscopy (diagnostic): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $901.33 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,892.79 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $1,261.86 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $901.33 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $946.40
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$901.33 – $1,892.79
Upper GI endoscopy with biopsy: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $143.11 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $143.11 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $143.11 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $143.11 CCHP — 931_CCHP MEWI SEWI 20230101: $777.06 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,357.99 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,357.99 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $901.33 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,892.79 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $1,261.86
Upper GI endoscopy with biopsy CPT 43239 · Inpatient (hospital stay) In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$901.33 – $1,892.79
Upper GI endoscopy with biopsy: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $901.33 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,892.79 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $1,261.86 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $901.33 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $946.40
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$876.48 – $1,840.61
Colonoscopy (diagnostic): 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $189.87 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $189.87 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $189.87 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $189.87 CCHP — 931_CCHP MEWI SEWI 20230101: $885.92 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,197.56 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,197.56 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $876.48 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,840.61 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $1,227.07
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$876.48 – $1,840.61
Colonoscopy (diagnostic): rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $876.48 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,840.61 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $1,227.07 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $876.48 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $920.30
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · modifier 53 In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$189.87 – $1,197.56
Colonoscopy (diagnostic): rates for 3 insurance plans CCHP — 931_CCHP MEWI SEWI 20230101: $314.54 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $430.88 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $430.88
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$206.66 – $1,547.70
Colonoscopy with biopsy: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $206.66 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $206.66 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $206.66 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $206.66 CCHP — 931_CCHP MEWI SEWI 20230101: $1,056.64 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,547.70 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,547.70
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$261.49 – $1,614.68
Colonoscopy with removal of polyps (snare): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $261.49 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $261.49 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $261.49 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $261.49 CCHP — 931_CCHP MEWI SEWI 20230101: $1,188.38 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,614.68 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,614.68
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$265.64 – $944.70
Ultrasound of the lower bowel by endoscope: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $265.64 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $265.64 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $265.64 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $265.64 CCHP — 931_CCHP MEWI SEWI 20230101: $644.50 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $944.70 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $944.70
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$665.89 – $2,324.78
Gallbladder removal by laparoscope: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $665.89 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $665.89 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $665.89 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $665.89 CCHP — 931_CCHP MEWI SEWI 20230101: $1,404.42 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $2,324.78 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $2,324.78
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$530.29 – $1,842.90
Groin (inguinal) hernia repair, age 5 or older: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $530.29 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $530.29 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $530.29 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $530.29 CCHP — 931_CCHP MEWI SEWI 20230101: $1,115.19 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,842.90 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,842.90
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$134.49 – $904.09
Prostate biopsy: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $134.49 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $134.49 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $134.49 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $134.49 CCHP — 931_CCHP MEWI SEWI 20230101: $471.15 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $904.09 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $904.09
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,239.73 – $5,277.19
Prostate removal by laparoscope (radical prostatectomy): rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $1,239.73 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $1,239.73 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $1,239.73 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $1,239.73 CCHP — 931_CCHP MEWI SEWI 20230101: $3,707.11 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5,277.19 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5,277.19
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$237.01 – $5,061.75
Hysteroscopy with biopsy of the uterus lining: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $237.01 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $237.01 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $237.01 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $237.01 CCHP — 931_CCHP MEWI SEWI 20230101: $872.12 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5,061.75 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5,061.75
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: HC NJX INTERLAMINAR LMBR/SAC W IMG	$3,415	$1,946.55	$104.29 – $933.45
Spinal injection, lower back (epidural), with imaging guidance: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $104.29 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $104.29 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $104.29 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $104.29 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $933.45 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $933.45
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$665.76 – $1,398.10
Spinal injection, lower back (epidural), with imaging guidance: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $104.29 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $104.29 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $104.29 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $104.29 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $933.45 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $933.45 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $665.76 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,398.10 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $932.06 VETERANS ADMINISTRATION — 916_VETERANS ADMINISTRATION OUTPATIENT MEWI SEWI 20230101: $665.76
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient (hospital stay) In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$665.76 – $1,398.10
Spinal injection, lower back (epidural), with imaging guidance: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $665.76 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,398.10 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $932.06 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $665.76 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $699.05
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: HC INJ AA&/STRD TRANSFORAMINAL EPIDURAL L/S	$2,346	$1,337.22	$117.30 – $862.20
Nerve root injection, lower back, with imaging guidance: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $117.30 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $117.30 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $117.30 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $117.30 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $862.20 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $862.20
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$855.89 – $1,797.37
Nerve root injection, lower back, with imaging guidance: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $117.30 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $117.30 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $117.30 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $117.30 CCHP — 931_CCHP MEWI SEWI 20230101: $508.49 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $862.20 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $862.20 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $855.89 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,797.37 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $1,198.25
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient (hospital stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$855.89 – $1,797.37
Nerve root injection, lower back, with imaging guidance: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $855.89 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,797.37 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $1,198.25 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $855.89 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $898.68
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: HC SONEX CARPAL TUNNEL	$4,535	$2,584.95	$461.42 – $1,563.41
Carpal tunnel release: rates for 6 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $461.42 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $461.42 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $461.42 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $461.42 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,563.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,563.41
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$461.42 – $1,563.41
Carpal tunnel release: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $461.42 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $461.42 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $461.42 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $461.42 CCHP — 931_CCHP MEWI SEWI 20230101: $932.96 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,563.41 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,563.41
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$527.40 – $1,107.54
Laser treatment of clouding after cataract surgery: 10 of 12 insurance plan rates ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $331.10 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $331.10 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $331.10 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $331.10 CCHP — 931_CCHP MEWI SEWI 20230101: $744.15 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,208.81 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,208.81 MEDICARE REPLACEMENT — 914_MEDICARE REPLACEMENT OUTPATIENT MEWI SEWI 20230101: $527.40 MOLINA MARKETPLACE — 911_MOLINA MARKETPLACE OUTPATIENT MEWI SEWI 20230101: $1,107.54 SMARTHEALTH — 964_SMARTHEALTH OUTPATIENT 20230101: $738.36
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient (hospital stay) In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$527.40 – $1,107.54
Laser treatment of clouding after cataract surgery: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $527.40 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $1,107.54 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $738.36 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $527.40 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $553.77
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$574.80 – $1,990.05
Cataract removal with lens implant: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $574.80 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $574.80 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $574.80 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $574.80 CCHP — 931_CCHP MEWI SEWI 20230101: $1,436.46 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $1,990.05 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $1,990.05

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$2,425.82 – $5,571.02
Vaginal delivery, with care before and after: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2,425.82 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2,425.82 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2,425.82 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2,425.82 CCHP — 931_CCHP MEWI SEWI 20230101: $4,492.21 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5,571.02 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5,571.02
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$2,670.36 – $6,132.40
Cesarean delivery (C-section), with care before and after: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2,670.36 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2,670.36 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2,670.36 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2,670.36 CCHP — 931_CCHP MEWI SEWI 20230101: $4,957.96 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $6,132.40 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $6,132.40
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$2,514.83 – $5,810.57
Vaginal delivery after a previous C-section, with care before and after: rates for 7 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $2,514.83 ANTHEM HMO POS — 1000_ANTHEM HMO POS MEWI SEWI 20230401: $2,514.83 ANTHEM PATHWAYS — 946_ANTHEM PATHWAYS MEWI SEWI 20230101: $2,514.83 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $2,514.83 CCHP — 931_CCHP MEWI SEWI 20230101: $4,697.33 CENTIVO NW1 — 892_CENTIVO NW1 MEWI SEWI 20221001: $5,810.57 CENTIVO NW3 — 1013_CENTIVO NW3 MEWI SEWI 20221001: $5,810.57

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$63,910.74 – $134,212.55
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $63,910.74 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $134,212.55 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $89,475.04 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $63,910.74 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $67,106.28
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Outpatient (no overnight stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC	Not listed in the file	Not listed in the file	$171,437.96 – $177,626.40
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 2 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $177,626.40 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $171,437.96
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$12,601.45 – $26,463.05
Hip or knee replacement (major joint of the leg), without major complications: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $12,601.45 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $26,463.05 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $17,642.03 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $12,601.45 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $13,231.52
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Outpatient (no overnight stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC	Not listed in the file	Not listed in the file	$33,645.62 – $34,438.87
Hip or knee replacement (major joint of the leg), without major complications: rates for 2 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $34,438.87 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $33,645.62
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$15,948.94 – $33,492.77
Neck (cervical) spinal fusion, without complications: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $15,948.94 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $33,492.77 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $22,328.52 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $15,948.94 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $16,746.39
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Outpatient (no overnight stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$44,612.69 – $45,033.90
Neck (cervical) spinal fusion, without complications: rates for 2 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $45,033.90 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $44,612.69
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	Not listed in the file	Not listed in the file	$8,105.46 – $17,021.47
Uterus and ovary surgery (not for cancer), without complications: rates for 5 insurance plans MEDICARE REPLACEMENT — 959_MEDICARE REPLACEMENT INPATIENT MEWI SEWI 20230512: $8,105.46 MOLINA MARKETPLACE — 954_MOLINA MARKETPLACE INPATIENT MEWI SEWI 20230512: $17,021.47 SMARTHEALTH — 963_SMARTHEALTH INPATIENT 20231001: $11,347.64 VETERANS ADMINISTRATION — 956_VETERANS ADMINISTRATION INPATIENT MEWI SEWI 20230512: $8,105.46 WELLCARE — 970_MEDICARE ADVANTAGE WELLCARE INPATIENT 20230512: $8,510.73
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Outpatient (no overnight stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$20,600.22 – $21,266.92
Uterus and ovary surgery (not for cancer), without complications: rates for 2 insurance plans ANTHEM BLUE CONNECTION — 999_ANTHEM BLUE CONNECTION MEWI SEWI 20230401: $21,266.92 ANTHEM PPO — 1001_ANTHEM PPO MEWI SEWI 20230401: $20,600.22

Source: Ascension NE Wisconsin - St Elizabeth Campus’s standard charges file (healthcare.ascension.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 1, 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	1506 S Oneida St, Appleton, WI 54915
County	Outagamie County
State	Wisconsin
Phone	(920) 738‑2000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	520009
Name in Medicare records	ASCENSION NE WISCONSIN - ST ELIZABETH CAMPUS
Profile level	Medicare data + hospital website
Official website	healthcare.ascension.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 2026-10-30.

Ascension NE Wisconsin - St. Elizabeth Campus — healthcare.ascension.org
Ascension NE Wisconsin - St. Elizabeth Emergency | Ascension — healthcare.ascension.org
Ascension NE Wisconsin - St. Elizabeth Cancer Center | Ascension — healthcare.ascension.org
Ascension NE Wisconsin - St. Elizabeth Campus Birthing Center | Ascension — healthcare.ascension.org
Ascension NE Wisconsin - St. Elizabeth Cardiology | Ascension — healthcare.ascension.org
Campus amenities | Ascension NE Wisconsin - St. Elizabeth Campus — healthcare.ascension.org
Visitor guidelines | Ascension NE Wisconsin - St. Elizabeth Campus — healthcare.ascension.org