Does Ascension Providence have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Ascension Providence. In a medical emergency, call 911.

Where is Ascension Providence?

6901 Medical Parkway, Waco, TX 76712, in McLennan County, Texas.

What is the phone number of Ascension Providence?

(254) 751-4000, as listed by Medicare (CMS).

What is the Medicare star rating of Ascension Providence?

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

Ascension Providence — Waco, TX

Quick answers

Does Ascension Providence have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ascension Providence. In a medical emergency, call 911.
Where is Ascension Providence?: 6901 Medical Parkway, Waco, TX 76712, in McLennan County, Texas.
What is the phone number of Ascension Providence?: (254) 751-4000, as listed by Medicare (CMS).
What is the Medicare star rating of Ascension Providence?: 2 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Heart and vascular health
Neurosurgery
Orthopedics
Women's health
Maternity services
Cancer care
Stroke care
Imaging
Rehabilitation services
Emergency care

Conditions treated^[4]

Heart failure

Procedures^[4]

Minimally invasive robotic and image-guided surgery

Programs and centers^[4]

Inpatient rehabilitation
Women's and Newborn Center
Commission on Cancer accredited cancer program

Emergency care (hospital website)^[4][5]

Emergency room	Yes
Open 24/7	Yes
Stroke designation	Primary Stroke Center (The Joint Commission); Level II Stroke Center (State of Texas)

Visiting and practical information

Interpreters and languages	Language assistance pages offered in Spanish, Arabic, Polish, Haitian Creole, Vietnamese and more^[4]
Patient portal	Patient Portal

Recognition^[4]

Commission on Cancer accredited cancer program
AHA Get With The Guidelines 2026: Target Ablation Honor Roll
AHA Get With The Guidelines 2026: CAD STEMI Gold Plus with Target Type 2 Diabetes Honor Roll
AHA Get With The Guidelines 2026: CAD NSTEMI Bronze

Doctors and clinicians (465)

465 doctors and other clinicians list Ascension Providence 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

Doctors with a page on this site (465)

Aadil Kaisani, DOInternal Medicine
Aaron Jackson, MDDiagnostic Radiology
Aaron Kolar, DOGeneral Practice
Abdul Keylani, MDInterventional Cardiology
Adam D. Flowers, MDFamily Practice
Adam Jantz, MDFamily Practice
Adam M. Borowski, MDDiagnostic Radiology
Adam M. Falcone, MDCardiovascular Disease (Cardiology)
Adam Spjute, MDAnesthesiology
Adrian Dirk, MDFamily Practice
Alan G. Sims, AAAnesthesiology Assistant
Ali A. Marashi, NPNurse Practitioner
Allison Achilefu, MDFamily Practice
Alyson J. Brzezinski, NPNurse Practitioner
Amanda Brokke, CNACertified Registered Nurse Anesthetist (CRNA)
Amber R. Koonce, PAPhysician Assistant
Amy G. Mercer, NPNurse Practitioner
Amy Lobrano, MDGastroenterology
Amy R. McCourt, MDDiagnostic Radiology
Anas Elkheder, MDInternal Medicine
Andrew Anyadiegwu, MDPulmonary Disease
Andrew B. Dossett, MDOrthopedic Surgery
Andrew K. Day, MDInterventional Cardiology
Andrew L. De Jong, MDOtolaryngology

And 441 more: the button below opens the full list.

Other emergency rooms nearby

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

Baylor Scott & White Medical Center Hillcrest3.8 mi · Waco, TX · Acute Care Hospital
Falls Community Hospital and Clinic23 mi · Marlin, TX · Rural Emergency Hospital
Temple VA Medical Center (VA Central Texas Healthcare System)28 mi · Temple, TX · Federal/VA Acute Care Hospital
Goodall Witcher Hospital30 mi · Clifton, TX · Critical Access Hospital
Darnall AMC (FT Cavazos)32 mi · Fort Cavazos, TX · Military Hospital (Department of Defense)

Other hospitals nearby

Oceans Behavioral Hospital of Waco2.8 mi · Waco, TX · Psychiatric Hospital
Encompass Health Rehabilitation Hospital of Waco7.8 mi · Robinson, TX · Inpatient Rehabilitation 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

Greenview Nursing and Rehabilitation0.3 mi · Waco, TX · 1 of 5 stars
Woodway Rehabilitation and Healthcare Center0.9 mi · Waco, TX · 2 of 5 stars
Avir at Jeffrey Place1.1 mi · Waco, TX · 2 of 5 stars

All nursing homes in the state →

Hospice providers

Alamo Hospice of Waco1.7 mi · Waco, TX
Compassus - Central Texas1.7 mi · Waco, TX
Gentiva1.7 mi · Waco, TX

All hospice providers in the state →

Home health agencies

Ascension at Home1.7 mi · Waco, TX · 3 of 5 stars
Bluebonnet Health Services of Waco1.7 mi · Waco, TX
Centerwell Home Health1.7 mi · Waco, TX · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

FMC Dialysis Services Waco West3.8 mi · Waco, TX · 3 of 5 stars
FMC Greenway Kidney Center3.8 mi · Waco, TX · 4 of 5 stars
Fresenius Medical Care Brazos7.8 mi · Waco, TX · 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.

Fish Pond Surgery Center LLC1.7 mi · Waco, TX
Heart of Texas Surgery Center PLLC3.8 mi · Woodway, TX
Waco Cardiology Cath Lab & Surgery Center3.8 mi · Waco, TX

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

Waco Family Medicine - West Waco0.3 mi · Woodway, TX · Community health center
Waco Family Medicine - Tennyson0.6 mi · Waco, TX · Community health center
Waco Family Medicine - Parkdale0.7 mi · Waco, TX · Community health center

Clinics and urgent care

American Current Care P.A.1.7 mi · Waco, TX · Urgent care center
The Seton Cove3.8 mi · Waco, TX · Urgent care center
The Seton Cove4.5 mi · Hewitt, TX · Urgent care center

Pharmacies

Albertsons LLC1.7 mi · Waco, TX · Community/retail pharmacy
Baylor Scott & White Health Enterprises, Inc.1.7 mi · Waco, TX · Community/retail pharmacy
Gibson Sales LP1.7 mi · Waco, TX · Community/retail pharmacy

Assisted living nearby

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

Residency at Ridgewood1.7 mi · Waco, TX
The Delaney at Lake Waco1.7 mi · Waco, TX
Waco TX Arbor House, LP2.7 mi · Waco, TX
Lynridge of Waco Assisted Living and Memory Care3.8 mi · Waco, TX

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 Providence 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	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	70%National average: 72%
Would definitely recommend the hospital	69%National average: 71%
Nurses “always” communicated well	75%National average: 80%
Doctors “always” communicated well	79%National average: 80%
Staff “always” explained medicines before giving them	59%National average: 62%
Were given information about recovery at home	86%National average: 86%
Room and bathroom “always” clean	67%National average: 74%
Area around the room “always” quiet at night	60%National average: 60%
Completed surveys	375Response rate: 16%

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)	0.306No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.648No different from the national benchmark
Surgical site infections after colon surgery	0.463No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0.274No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.13Better 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	11.8%
Deaths within 30 days: heart failure patients	13.8%
Deaths within 30 days: pneumonia patients	16.8%
Deaths within 30 days: COPD patients	8.1%
Deaths within 30 days: stroke patients	14.9%
Deaths within 30 days: coronary bypass surgery (CABG)	2.3%
Serious complications (patient safety indicator PSI-90)	1.12No different from the national rate
Complications after hip or knee replacement	4.2%

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	14.1%
Readmitted within 30 days: heart failure	21.4%
Readmitted within 30 days: pneumonia	18%
Readmitted within 30 days: COPD	19.5%
Readmitted within 30 days: coronary bypass surgery	12.5%
Readmitted within 30 days: hip or knee replacement	5.3%

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)	223 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)	41%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 Waco Best hospitals in Texas

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 Providence 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: 99203-OFF/OUTPT NEW LOW 30 MIN	$493.75	$177.75	$128.61 – $191.38
New patient office visit (about 30–44 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $161.16 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $173.56 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $128.61 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $191.38
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: O/P VISIT - NEW PT - INTER	$543.25	$195.57	$128.61 – $161.16
New patient office visit (about 30–44 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $161.16 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $128.61
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: NEW PT VISIT INTERMEDIATE	$543.25	$195.57	$128.61 – $161.16
New patient office visit (about 30–44 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $161.16 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $128.61
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: 99204-OFF/OUTPT NEW MOD 45 MIN	$638.25	$229.77	$217.75 – $324.01
New patient office visit (about 45–59 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $272.85 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $293.84 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $217.75 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $324.01
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: O/P VISIT - NEW PT - EXTENDED	$638.25	$229.77	$217.75 – $272.85
New patient office visit (about 45–59 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $272.85 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $217.75
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: NEW PT VISIT EXTENDED	$638.25	$229.77	$217.75 – $272.85
New patient office visit (about 45–59 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $272.85 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $217.75
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: 99205-OFF/OUTPT NEW HI 60 MIN	$760.75	$273.87	$284.17 – $422.84
New patient office visit (about 60–74 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $356.08 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $383.47 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $284.17 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $422.84
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: O/P VISIT - COMPLEX	$760.75	$273.87	$284.17 – $356.08
New patient office visit (about 60–74 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $356.08 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $284.17
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: NEW PT VISIT COMPLEX	$760.75	$273.87	$284.17 – $356.08
New patient office visit (about 60–74 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $356.08 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $284.17
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: 99213-OFF/OUTPT EST LOW 20 MIN	$530.25	$190.89	$86.15 – $128.19
Established patient office visit (about 20–29 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $107.95 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $116.26 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $86.15 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $128.19
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: VISIT - EST - INTERMEDIATE	$583.25	$209.97	$86.15 – $107.95
Established patient office visit (about 20–29 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $107.95 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $86.15
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: EST PT VISIT INTERMEDIATE	$530.25	$190.89	$86.15 – $107.95
Established patient office visit (about 20–29 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $107.95 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $86.15
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: 99214-OFF/OUTPT EST MOD 30 MIN	$606	$218.16	$132.81 – $197.62
Established patient office visit (about 30–39 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $166.42 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $179.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $132.81 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $197.62
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: VISIT - EST - EXTENDED	$666.50	$239.94	$132.81 – $166.42
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $166.42 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $132.81
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: VISIT PT EST EXTENDED	$666.50	$239.94	$132.81 – $166.42
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $166.42 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $132.81
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	$161.53 – $240.36
Office consultation with a specialist (moderate): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $202.40 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $217.97 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $161.53 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $240.36
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	$259.63 – $386.33
Office consultation with a specialist (moderate to high): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $325.33 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $350.36 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $259.63 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $386.33
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	$165.12 – $245.69
Preventive checkup, new patient, age 18–39: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $206.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $222.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $165.12 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $245.69
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	$201 – $299.09
Preventive checkup, new patient, age 40–64: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $251.87 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $271.24 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $201 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $299.09
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: CPER INTERMEDIATE	$1,087.25	$391.41	$21.40 – $1,087.25
Emergency room visit (moderate): 10 of 14 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $475.71 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $21.40 CIGNA — 930_CIGNA 20250701: $1,009 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,087.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $21.40 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $51.36 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $28.96 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $28.96 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $23.24 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $21.40
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: E/D LEVEL 3 INTERMEDIATE	$1,087.25	$391.41	$21.40 – $1,100
Emergency room visit (moderate): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $475.71 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $21.40 CIGNA — 930_CIGNA 20250701: $1,009 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $21.40 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $51.36 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $28.96 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $28.96 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $23.24 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $21.40 UHC — 943_UNITED HEALTHCARE 20250701: $1,058
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: MEC LEVEL 3 INTERMEDIATE	$1,087.25	$391.41	$21.40 – $1,087.25
Emergency room visit (moderate): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $475.71 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $21.40 CIGNA — 930_CIGNA 20250701: $1,009 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $21.40 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $51.36 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $28.96 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $28.96 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $23.24 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $21.40 UHC — 943_UNITED HEALTHCARE 20250701: $1,058
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: E/D LEVEL 4 EXTENDED	$1,860.75	$669.87	$174.17 – $2,160
Emergency room visit (moderately high): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $749.31 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $868.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $202.18 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $202.18 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $174.17 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $202.18 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $202.18 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $174.17 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $174.17 UHC — 943_UNITED HEALTHCARE 20250701: $1,287
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: CPER EXTENDED	$1,860.75	$669.87	$174.17 – $1,944
Emergency room visit (moderately high): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $749.31 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $868.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $202.18 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $174.17 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $202.18 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $174.17 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $174.17 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $202.18 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $174.17 UHC — 943_UNITED HEALTHCARE 20250701: $1,287
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: MEC LEVEL 4 EXTENDED	$2,160	$777.60	$174.17 – $1,944
Emergency room visit (moderately high): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $749.31 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $868.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $202.18 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $174.17 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $202.18 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $202.18 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $174.17 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $202.18 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $174.17 UHC — 943_UNITED HEALTHCARE 20250701: $1,287
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: CPER COMPREHENSIVE	$2,508	$902.88	$234.75 – $2,508
Emergency room visit (high): 10 of 14 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,074.61 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,246.14 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $234.75 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $2,508 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $234.75 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $333.22 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $234.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $234.75 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $234.75 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $234.75
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: E/D LEVEL 5 COMPREHENSIVE	$2,508	$902.88	$234.75 – $3,204
Emergency room visit (high): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,074.61 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,246.14 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $333.22 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $333.22 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $333.22 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $234.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $333.22 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $234.75 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $333.22 UHC — 943_UNITED HEALTHCARE 20250701: $1,500
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: MEC LEVEL 5 COMPREHENSIVE	$3,560	$1,281.60	$234.75 – $3,560
Emergency room visit (high): 10 of 13 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,074.61 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,246.14 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $333.22 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $234.75 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $234.75 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $234.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $333.22 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $234.75 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $234.75 UHC — 943_UNITED HEALTHCARE 20250701: $1,500

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: BASIC METABOLIC	$266.75	$96.03	$7.11 – $37.31
Basic metabolic panel (blood test): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $19.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $34.18 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $15.82 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $37.31 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $7.11 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $19.30 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $20.69 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $7.11 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $7.11 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $7.11
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: BASIC METABOLIC	$266.75	$96.03	$7.11 – $37.31
Basic metabolic panel (blood test): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $7.11 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $7.11 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $7.11 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $7.11 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $7.11 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $7.11 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $7.11 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $7.11 UHC STAR — 929_UHC STAR INPATIENT 20250701: $7.11 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $7.11
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 – $12.69
Basic metabolic panel (blood test): 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.63 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $8.46 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $19.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $34.18 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $15.82 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $37.31 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $7.11 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $19.30 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $20.69 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $12.69
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREHENSIVE METABOLIC	$320.50	$115.38	$8.87 – $46.57
Comprehensive metabolic panel (blood test): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $24.60 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $42.66 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $19.75 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $46.57 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $8.87 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $24.09 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $25.84 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $8.87 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $8.87 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $8.87
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMPREHENSIVE METABOLIC	$320.50	$115.38	$8.87 – $46.57
Comprehensive metabolic panel (blood test): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $8.87 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $8.87 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $8.87 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $8.87 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $8.87 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $8.87 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $8.87 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $8.87 UHC STAR — 929_UHC STAR INPATIENT 20250701: $8.87 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $8.87
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 – $15.84
Comprehensive metabolic panel (blood test): 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $10.77 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $10.56 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $24.60 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $42.66 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $19.75 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $46.57 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $8.87 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $24.09 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $25.84 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $15.84
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 – $71.72
Obstetric blood test panel: 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $48.77 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $47.81 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $111.40 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.15 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $89.41 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $210.84 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $71.72 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $47.81 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $66.93 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $71.72
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 – $71.72
Obstetric blood test panel: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $48.77 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $47.81 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $47.81 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $66.93 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $71.72 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $49.24 TRICARE — 986_TRICARE INPATIENT 20251001: $47.81 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $48.77 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $47.81 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $47.81
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID SCREEN	$253	$91.08	$11.25 – $59.05
Cholesterol panel (lipid panel): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $31.20 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $54.10 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $25.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $59.05 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $11.25 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $29.10 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $32.75 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $11.25 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $11.25 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $11.25
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: NMR LIPOPROFILE+LIPIDS 80061	$160.75	$57.87	$11.25 – $59.05
Cholesterol panel (lipid panel): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $31.20 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $54.10 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $25.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $59.05 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $11.25 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $29.10 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $32.75 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $11.25 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $11.25 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $11.25
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID SCREEN	$265.75	$95.67	$11.25 – $59.05
Cholesterol panel (lipid panel): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $11.25 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $11.25 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $11.25 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $11.25 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $11.25 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $11.25 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $11.25 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $11.25 UHC STAR — 929_UHC STAR INPATIENT 20250701: $11.25 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $11.25
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION	$262.50	$94.50	$7.29 – $38.28
Kidney function panel: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $20.22 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $35.07 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $16.23 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $38.28 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $7.29 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $18.85 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $21.22 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $7.29 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $7.29 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $7.29
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL FUNCTION	$262.50	$94.50	$7.29 – $38.28
Kidney function panel: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $7.29 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $7.29 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $7.29 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $7.29 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $7.29 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $7.29 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $7.29 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $7.29 UHC STAR — 929_UHC STAR INPATIENT 20250701: $7.29 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $7.29
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 – $13.02
Kidney function panel: 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.85 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $8.68 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $20.22 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $35.07 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $16.23 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $38.28 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $7.29 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $18.85 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $21.22 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $13.02
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION	$124.75	$44.91	$6.86 – $36.03
Liver function panel: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $19.04 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $33.01 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $15.28 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $36.03 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $6.86 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $17.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $19.98 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $6.86 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $6.86 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $6.86
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION	$131	$47.16	$6.86 – $36.03
Liver function panel: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $6.86 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $6.86 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $6.86 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $6.86 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $6.86 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $6.86 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $6.86 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $6.86 UHC STAR — 929_UHC STAR INPATIENT 20250701: $6.86 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $6.86
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 – $12.25
Liver function panel: 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $8.33 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $8.17 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $19.04 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $33.01 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $15.28 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $36.03 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $6.86 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $17.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $19.98 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $12.25
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: URINALYSIS	$93.50	$33.66	$2.66 – $13.98
Urine test (automated, with microscope): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $7.39 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $12.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $5.93 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $13.98 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $2.66 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $6.89 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7.75 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $2.66 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $2.66 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $2.66
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS	$93.50	$33.66	$2.66 – $13.98
Urine test (automated, with microscope): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $2.66 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $2.66 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $2.66 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $2.66 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $2.66 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $2.66 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $2.66 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $2.66 UHC STAR — 929_UHC STAR INPATIENT 20250701: $2.66 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $2.66
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 – $4.75
Urine test (automated, with microscope): 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $3.23 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $3.17 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $7.39 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $12.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $5.93 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $13.98 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $2.66 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $6.89 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7.75 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $4.75
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: SPECIFIC GRAV URINE	$46.25	$16.65	$2.92 – $15.35
Urine test (manual, without microscope): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $8.11 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.06 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $6.51 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $15.35 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $2.92 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $5.55 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $6.24 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $2.92 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $2.92 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $2.92
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: PH URINE	$46.25	$16.65	$2.92 – $15.35
Urine test (manual, without microscope): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $8.11 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.06 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $6.51 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $15.35 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $2.92 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $5.55 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $6.24 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $2.92 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $2.92 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $2.92
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINALYSIS DIP PROTEIN/GLUCOSE	$46.25	$16.65	$2.92 – $15.35
Urine test (manual, without microscope): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $8.11 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.06 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $6.51 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $15.35 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $2.92 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $5.55 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $6.24 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $2.92 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $2.92 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $2.92
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: PROTEIN URINE	$38.25	$13.77	$1.89 – $9.92
Urine test (automated, without microscope): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $5.24 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $9.09 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $4.21 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $9.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1.89 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $4.88 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $5.49 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $1.89 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $1.89 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $1.89
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: PROTEIN URINE	$38.25	$13.77	$1.89 – $9.92
Urine test (automated, without microscope): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $1.89 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $1.89 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $1.89 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $1.89 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $1.89 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $1.89 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $1.89 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $1.89 UHC STAR — 929_UHC STAR INPATIENT 20250701: $1.89 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $1.89
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 – $3.38
Urine test (automated, without microscope): 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $2.29 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $2.25 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $5.24 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $9.09 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $4.21 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $9.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1.89 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $4.88 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $5.49 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $3.38
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA (DIAGNOSTIC)	$152.50	$54.90	$15.45 – $81.10
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $42.85 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $74.30 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $34.39 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $81.10 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $15.45 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $39.94 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $44.96 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $15.45 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $15.45 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $15.45
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA - ULTRA SENSITIVE	$168.25	$60.57	$15.45 – $81.10
PSA (prostate specific antigen) blood test: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $42.85 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $74.30 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $34.39 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $81.10 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $15.45 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $39.94 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $44.96 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $15.45 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $15.45 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $15.45
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: PSA (DIAGNOSTIC)	$160.25	$57.69	$15.45 – $81.10
PSA (prostate specific antigen) blood test: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $15.45 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $15.45 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $15.45 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $15.45 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $15.45 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $15.45 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $15.45 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $15.45 UHC STAR — 929_UHC STAR INPATIENT 20250701: $15.45 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $15.45
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH	$194.25	$69.93	$7.58 – $74.09
Thyroid stimulating hormone (TSH) test: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $39.14 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $67.87 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $31.42 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $74.09 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $14.11 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $38.28 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $41.83 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $14.11 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $14.11 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $14.11
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: TSH	$204	$73.44	$7.58 – $74.09
Thyroid stimulating hormone (TSH) test: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $7.58 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $7.58 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $7.58 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $7.58 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $7.58 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $7.58 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $7.58 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $7.58 UHC STAR — 929_UHC STAR INPATIENT 20250701: $7.58 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $7.58
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 – $25.20
Thyroid stimulating hormone (TSH) test: 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $17.14 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $16.80 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $39.14 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $67.87 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $31.42 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $74.09 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $14.11 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $38.28 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $41.83 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $25.20
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC WITH DIFF	$122.50	$44.10	$1.99 – $34.27
Complete blood count (CBC) with differential: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $18.10 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $31.39 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $14.53 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $34.27 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $6.53 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $17.72 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $19 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $6.53 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $6.53 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $6.53
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: CBC WITH DIFF	$122.50	$44.10	$1.99 – $34.27
Complete blood count (CBC) with differential: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $1.99 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $1.99 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $1.99 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $1.99 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $1.99 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $1.99 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $1.99 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $1.99 UHC STAR — 929_UHC STAR INPATIENT 20250701: $1.99 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $1.99
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 – $11.65
Complete blood count (CBC) with differential: 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $7.93 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $7.77 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $18.10 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $31.39 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $14.53 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $34.27 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $6.53 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $17.72 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $19 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $11.65
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC NO DIFF	$84.25	$30.33	$1.99 – $28.53
Complete blood count (CBC), automated: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $15.08 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $26.14 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $12.10 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $28.53 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $5.43 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $14.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $15.81 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $5.43 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $5.43 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $5.43
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: CBC NO DIFF	$84.25	$30.33	$1.99 – $28.53
Complete blood count (CBC), automated: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $1.99 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $1.99 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $1.99 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $1.99 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $1.99 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $1.99 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $1.99 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $1.99 UHC STAR — 929_UHC STAR INPATIENT 20250701: $1.99 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $1.99
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 – $9.71
Complete blood count (CBC), automated: 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $6.60 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $6.47 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $15.08 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $26.14 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $12.10 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $28.53 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $5.43 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $14.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $15.81 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $9.71
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PT INHIBITOR SCREEN	$66.25	$23.85	$3.60 – $18.92
Blood clotting time test (prothrombin time, PT): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $10 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $17.33 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $8.02 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $18.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $3.60 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $8.95 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $9.78 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $3.60 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $3.60 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $3.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTIME	$117.75	$42.39	$3.60 – $18.92
Blood clotting time test (prothrombin time, PT): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $10 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $17.33 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $8.02 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $18.92 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $3.60 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $8.95 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $9.78 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $3.60 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $3.60 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $3.60
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PT INHIBITOR SCREEN	$63	$22.68	$3.60 – $18.92
Blood clotting time test (prothrombin time, PT): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $15.10 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $15.10 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $15.10 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $15.10 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $15.10 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $15.10 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $15.10 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $15.10 UHC STAR — 929_UHC STAR INPATIENT 20250701: $15.10 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $15.10
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT	$136.25	$49.05	$5.05 – $26.50
Blood clotting test (partial thromboplastin time, PTT): 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $14 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $24.28 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $11.24 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $26.50 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $5.05 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $13.03 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $14.66 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $5.05 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $5.05 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $5.05
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: PTT	$143	$51.48	$5.05 – $26.50
Blood clotting test (partial thromboplastin time, PTT): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $5.75 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $5.75 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $5.75 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $5.75 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $5.75 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $5.75 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $5.75 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $5.75 UHC STAR — 929_UHC STAR INPATIENT 20250701: $5.75 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $5.75
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 – $9.02
Blood clotting test (partial thromboplastin time, PTT): 10 of 28 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $6.13 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $6.01 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $14 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $24.28 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $11.24 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $26.50 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $5.05 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $13.03 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $14.66 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $9.02

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: OR OPERATIVE CT HEAD	$1,839.25	$662.13	$106.88 – $618.68
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $236.49 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $554.80 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $618.68 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $1,100.81 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $106.88 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $106.88 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $106.88
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD OR BRAIN W/O CONTRAST	$1,839.25	$662.13	$106.88 – $1,048.37
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $236.49 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $554.80 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $618.68 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $1,048.37 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $106.88 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $106.88 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $106.88
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: HEAD SCAN NON-CONTRASTEIM	$1,839.25	$662.13	$106.88 – $1,100.81
CT scan of the head or brain, without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $236.49 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $554.80 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $618.68 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $1,100.81 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $106.88 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $106.88 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $106.88
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN WO/W CONTRAST	$3,688	$1,327.68	$332.80 – $2,107.81
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $332.80 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $332.80 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $332.80 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $332.80 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $332.80 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $332.80
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN TRIGEM NEURAL W W/O	$4,056.75	$1,460.43	$332.80 – $2,107.81
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $332.80 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $332.80 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $332.80 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $332.80 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $332.80 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $332.80
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN BOTH STEALTH MARKERS	$4,056.75	$1,460.43	$332.80 – $2,107.81
MRI of the brain, before and after contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $332.80 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $332.80 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $332.80 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $332.80 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $332.80 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $332.80
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST 2 VIEW E1D	$413.25	$148.77	$28.74 – $235.55
Chest X-ray, 2 views: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $167.60 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $177.18 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $134.08 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $195.53 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $33.75 CIGNA — 930_CIGNA 20250701: $235.55 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $33.75 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $33.75 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $33.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $33.75
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: XR CHEST DECUBITUS BILAT	$413.25	$148.77	$28.74 – $235.55
Chest X-ray, 2 views: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $167.60 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $177.18 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $134.08 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $195.53 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $33.75 CIGNA — 930_CIGNA 20250701: $235.55 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $33.75 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $33.75 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $33.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $33.75
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: XR CHEST 2 VIEWS	$413.25	$148.77	$28.74 – $235.55
Chest X-ray, 2 views: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $167.60 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $177.18 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $134.08 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $195.53 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $33.75 CIGNA — 930_CIGNA 20250701: $235.55 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $33.75 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $33.75 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $33.75 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $33.75
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: LUMBAR W/OBLIQUES 5 V E4H	$657	$236.52	$46.11 – $374.49
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $235.37 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $248.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $188.30 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $274.60 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $51.45 CIGNA — 930_CIGNA 20250701: $374.49 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $75.20 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $84.63 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $51.45 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $51.45
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR SPINE LUMBOSACRAL MINIMUM 4	$657	$236.52	$46.11 – $374.49
X-ray of the lower spine, at least 4 views: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $235.37 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $248.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $188.30 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $274.60 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $51.45 CIGNA — 930_CIGNA 20250701: $374.49 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $75.20 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $84.63 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $51.45 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $51.45
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: LUMBAR W/OBLIQUES 5 V E4H	$657	$236.52	$46.11 – $374.49
X-ray of the lower spine, at least 4 views: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $46.11 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $46.11 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $46.11 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $46.11 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $46.11 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $46.11 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $46.11 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $46.11 UHC STAR — 929_UHC STAR INPATIENT 20250701: $46.11 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $46.11
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR W/O CONTRAST	$2,665.50	$959.58	$199.14 – $1,319.12
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $199.14 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $199.14 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $199.14 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $199.14 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $199.14 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $199.14
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI THORACOLUMBAR W/O	$2,423.25	$872.37	$199.14 – $1,319.12
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $199.14 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $199.14 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $199.14 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $199.14 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $199.14 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $199.14
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR W/O	$2,423.25	$872.37	$199.14 – $1,319.12
MRI of the lower back (lumbar spine), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $199.14 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $199.14 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $199.14 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $199.14 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $199.14 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $199.14
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/ CONTRAST	$1,252.50	$450.90	$180.34 – $1,005.85
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $384.48 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $901.99 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,005.85 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $180.34 CIGNA — 930_CIGNA 20250701: $713.92 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $180.34 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $180.34 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $180.34 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $180.34 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $180.34
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: PELVIS CONTRAST EIM	$1,315.25	$473.49	$180.34 – $1,005.85
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $384.48 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $901.99 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,005.85 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $180.34 CIGNA — 930_CIGNA 20250701: $749.69 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $180.34 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $180.34 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $180.34 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $180.34 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $180.34
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: *CT PELVIS W CONTRAST-2	$1,315.25	$473.49	$180.34 – $1,005.85
CT scan of the pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $384.48 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $901.99 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,005.85 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $180.34 CIGNA — 930_CIGNA 20250701: $749.69 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $180.34 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $180.34 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $180.34 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $180.34 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $180.34
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI LOW EXT JOINT W/O CONTRAST	$2,423.25	$872.37	$210.84 – $1,319.12
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $210.84 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $210.84 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $210.84 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $210.84 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $210.84 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $210.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI ANKLE RIGHT W/O	$2,665.50	$959.58	$210.84 – $1,319.12
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $210.84 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $210.84 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $210.84 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $210.84 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $210.84 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $210.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI HIP LEFT W/O	$2,423.25	$872.37	$210.84 – $1,319.12
MRI of a leg joint (such as the knee), without contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $491.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,153.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,286.38 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $210.84 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,319.12 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $210.84 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $210.84 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $210.84 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $210.84 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $210.84
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: *CT ABD/PELVIS W CONTRAST(2)	$5,265.25	$1,895.49	$252.74 – $3,001.19
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $318.09 CIGNA — 930_CIGNA 20250701: $3,001.19 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $318.09 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $318.09 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $318.09 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $318.09 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $318.09
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABDOMEN/PELVIS W CONTRAST	$5,265.25	$1,895.49	$252.74 – $3,001.19
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $318.09 CIGNA — 930_CIGNA 20250701: $3,001.19 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $318.09 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $318.09 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $318.09 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $318.09 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $318.09
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD/PELV PEDI APPENDICITIS	$5,265.25	$1,895.49	$252.74 – $2,858.26
CT scan of the abdomen and pelvis, with contrast: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $805.70 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,890.16 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $2,107.81 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $318.09 CIGNA — 930_CIGNA 20250701: $2,858.26 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $318.09 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $318.09 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $318.09 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $318.09 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $318.09
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN COMPLETE	$1,000.25	$360.09	$106.88 – $570.14
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $235.37 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $248.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $188.30 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $274.60 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $570.14 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $267.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $292.57 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: ABDOM COMP Q70	$1,000.25	$360.09	$106.88 – $627.14
Ultrasound of the abdomen, complete: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $235.37 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $248.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $188.30 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $274.60 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $627.14 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $267.75 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $292.57 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US ABDOMEN COMPLETE	$1,000.25	$360.09	$106.88 – $570.14
Ultrasound of the abdomen, complete: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $114.46 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $114.46 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $114.46 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $114.46 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $114.46 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $114.46 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $114.46 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $114.46 UHC STAR — 929_UHC STAR INPATIENT 20250701: $114.46 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $114.46
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREGNANCY > 14 WEEKS	$798.25	$287.37	$106.88 – $455
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $192.23 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $203.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $153.79 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $224.27 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $455 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $171.72 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $193.27 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US OB>=14 WKS,SINGLE FETUS	$725.75	$261.27	$106.88 – $455
Pregnancy ultrasound (after the first trimester): 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $192.23 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $203.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $153.79 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $224.27 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $455 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $171.72 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $193.27 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: US PREGNANCY > 14 WEEKS	$798.25	$287.37	$106.88 – $455
Pregnancy ultrasound (after the first trimester): 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $114.46 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $114.46 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $114.46 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $114.46 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $114.46 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $114.46 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $114.46 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $114.46 UHC STAR — 929_UHC STAR INPATIENT 20250701: $114.46 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $114.46
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US TRANSVAGINAL	$737.75	$265.59	$106.88 – $382.33
Transvaginal ultrasound: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $185.43 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $196.03 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $148.34 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $216.34 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $382.33 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $215.12 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $141.36 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: TRANSVAGINAL ULTRASOUND	$670.75	$241.47	$106.88 – $420.52
Transvaginal ultrasound: 10 of 18 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $185.43 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $196.03 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $148.34 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $216.34 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $106.88 CIGNA — 930_CIGNA 20250701: $420.52 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $215.12 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $141.36 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $106.88 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $106.88
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: US TRANSVAGINAL	$670.75	$241.47	$106.88 – $382.33
Transvaginal ultrasound: 10 of 12 insurance plan rates BCBS STAR — 974_BCBS STAR INPATIENT 20240901: $114.46 MCLENNAN COUNTY INDIGENT — 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601: $114.46 MEDICAID REPLACEMENT 100% — 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901: $114.46 MOLINA MEDICAID REPLACEMENT CHIP — 891_MOLINA CHIP INPATIENT 20240901: $114.46 SUPERIOR CHIP/CHIP PERINATE — 898_SUPERIOR CHIP INPATIENT 20240901: $114.46 SUPERIOR STAR — 817_SUPERIOR STAR INPATIENT 20240901: $114.46 SUPERIOR STAR PLUS — 856_SUPERIOR STAR PLUS INPATIENT 20240901: $114.46 SWHP RIGHTCARE STAR — 818_SWHP RIGHTCARE STAR INPATIENT 20240901: $114.46 UHC STAR — 929_UHC STAR INPATIENT 20250701: $114.46 UHC STAR KIDS — 894_UHC STAR KIDS INPATIENT 20240901: $114.46
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: POST US BX/NEEDLE LOC MAM RT	$329.50	$118.62	$158.03 – $230.45
Diagnostic mammogram, one breast: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $197.53 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $208.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $158.03 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $230.45 CIGNA — 930_CIGNA 20250701: $187.81
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: POST US BX/NEEDLE LOC MAM LT	$329.50	$118.62	$158.03 – $230.45
Diagnostic mammogram, one breast: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $197.53 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $208.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $158.03 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $230.45 CIGNA — 930_CIGNA 20250701: $187.81
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC W/CAD LEFT	$329.50	$118.62	$158.03 – $230.45
Diagnostic mammogram, one breast: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $197.53 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $208.81 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $158.03 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $230.45 CIGNA — 930_CIGNA 20250701: $187.81
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: POST US BX/LOC DIAG MAM BI	$552.25	$198.81	$94.30 – $314.78
Diagnostic mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $252.78 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $267.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $202.23 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $294.91 CIGNA — 930_CIGNA 20250701: $314.78
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: POST BX/NEEDLE LOC DIAG MAM BI	$552.25	$198.81	$94.30 – $314.78
Diagnostic mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $252.78 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $267.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $202.23 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $294.91 CIGNA — 930_CIGNA 20250701: $314.78
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAGNOSTIC W/CAD BILAT	$552.25	$198.81	$94.30 – $314.78
Diagnostic mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $252.78 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $267.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $202.23 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $294.91 CIGNA — 930_CIGNA 20250701: $314.78
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCREENING MAMMO UNI RT	$362.50	$130.50	$78.03 – $243.70
Screening mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $208.89 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $220.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $167.12 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $243.70 CIGNA — 930_CIGNA 20250701: $206.63
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCREENING MAMMO UNI LT	$362.50	$130.50	$78.03 – $243.70
Screening mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $208.89 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $220.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $167.12 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $243.70 CIGNA — 930_CIGNA 20250701: $206.63
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCREENING IMPLANT UNI LT	$329.50	$118.62	$78.03 – $243.70
Screening mammogram, both breasts: rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $208.89 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $220.82 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $167.12 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $243.70 CIGNA — 930_CIGNA 20250701: $187.81

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	$32.35 – $76.29
Electrocardiogram (ECG/EKG) with reading: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $40.31 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $69.89 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $32.35 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $76.29
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: 93452-LHC, LV	$10,420	$3,751.20	$2,400 – $4,177.77
Left heart catheterization (diagnostic): rates for 3 insurance plans FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $2,400 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $3,603.61 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $4,177.77
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	$2,142 – $5,443.40
Left heart catheterization (diagnostic): rates for 8 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $5,186.91 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $4,702.42 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $4,132.56 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $5,443.40 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $2,400 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $3,603.61 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $4,177.77 HUMANA — 644_HUMANA HMO PPO 20230701: $2,142
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: 93619-COMP EPS W/O INDUCTION	$25,266.25	$9,095.85	$9,770.04 – $14,537.70
Heart rhythm study (electrophysiology evaluation): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $12,242.28 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $13,183.99 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $9,770.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $14,537.70
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	$9,770.04 – $14,537.70
Heart rhythm study (electrophysiology evaluation): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $12,242.28 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $13,183.99 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $9,770.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $14,537.70
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: 93656 COMP EPS TRANSEPTL A FIB	$86,367.50	$31,092.30	$33,921.73 – $50,475.12
Heart rhythm study with ablation for atrial fibrillation: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $42,505.36 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $45,775 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $33,921.73 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $50,475.12
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	$7,649 – $50,475.12
Heart rhythm study with ablation for atrial fibrillation: rates for 6 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $42,505.36 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $45,775 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $33,921.73 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $50,475.12 CIGNA — 930_CIGNA 20250701: $21,702 HUMANA — 644_HUMANA HMO PPO 20230701: $7,649
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: 6 AND OLDER PSG	$7,455.75	$2,684.07	$831.54 – $2,940
Sleep study (overnight, in a sleep lab): rates for 5 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,041.96 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,122.11 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $831.54 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,237.32 UHC — 943_UNITED HEALTHCARE 20250701: $2,940
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	$997.12 – $1,495.68
Sleep study (overnight, in a sleep lab): 10 of 16 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $1,017.06 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $997.12 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,041.96 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,122.11 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $831.54 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,237.32 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $1,495.68 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $997.12 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $1,395.97 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $1,495.68
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	$997.12 – $1,495.68
Sleep study (overnight, in a sleep lab): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $1,017.06 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $997.12 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $997.12 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $1,395.97 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $1,495.68 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $1,027.03 TRICARE — 986_TRICARE INPATIENT 20251001: $997.12 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $1,017.06 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $997.12 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $997.12

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: THERAPEUTIC EXERCISE PT	$123.25	$44.37	$52.04 – $77.43
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $65.21 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $70.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $52.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $77.43
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: OT - THER EX	$123.25	$44.37	$52.04 – $77.43
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $65.21 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $70.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $52.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $77.43
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: THER EX	$123.25	$44.37	$52.04 – $77.43
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $65.21 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $70.22 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $52.04 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $77.43
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVAL LOW COMPLEXITY 20 MIN	$369.50	$133.02	$143.57 – $213.63
Physical therapy evaluation (low complexity): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63
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	$95.34 – $143.01
Physical therapy evaluation (low complexity): 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $95.34 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $143.01 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $95.34 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $133.48 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $143.01
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	$95.34 – $143.01
Physical therapy evaluation (low complexity): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $95.34 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $95.34 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $133.48 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $143.01 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $98.20 TRICARE — 986_TRICARE INPATIENT 20251001: $95.34 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $97.25 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $95.34 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $95.34
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVAL MOD COMPLEXITY 30 MIN	$430.50	$154.98	$143.57 – $213.63
Physical therapy evaluation (moderate complexity): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63
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	$95.34 – $143.01
Physical therapy evaluation (moderate complexity): 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $95.34 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $143.01 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $95.34 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $133.48 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $143.01
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	$95.34 – $143.01
Physical therapy evaluation (moderate complexity): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $95.34 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $95.34 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $133.48 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $143.01 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $98.20 TRICARE — 986_TRICARE INPATIENT 20251001: $95.34 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $97.25 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $95.34 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $95.34
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVAL HIGH COMPLEXITY 45 MIN	$492.25	$177.21	$143.57 – $213.63
Physical therapy evaluation (high complexity): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63
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	$95.34 – $143.01
Physical therapy evaluation (high complexity): 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $95.34 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $179.90 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $193.74 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $143.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $213.63 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $143.01 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $95.34 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $133.48 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $143.01
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	$95.34 – $143.01
Physical therapy evaluation (high complexity): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $97.25 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $95.34 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $95.34 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $133.48 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $143.01 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $98.20 TRICARE — 986_TRICARE INPATIENT 20251001: $95.34 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $97.25 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $95.34 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $95.34
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 30 minutes: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $157.47 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $236.20 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $157.47 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $220.46 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $236.20 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $162.19 TRICARE — 877_TRICARE OUTPATIENT 20250101: $157.47 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $160.62 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $157.47
Psychotherapy, 30 minutes CPT 90832 · Inpatient (hospital stay) In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 30 minutes: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $157.47 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $157.47 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $220.46 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $236.20 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $162.19 TRICARE — 986_TRICARE INPATIENT 20251001: $157.47 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $160.62 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $157.47 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $157.47
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 45 minutes: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $157.47 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $236.20 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $157.47 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $220.46 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $236.20 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $162.19 TRICARE — 877_TRICARE OUTPATIENT 20250101: $157.47 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $160.62 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $157.47
Psychotherapy, 45 minutes CPT 90834 · Inpatient (hospital stay) In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 45 minutes: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $157.47 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $157.47 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $220.46 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $236.20 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $162.19 TRICARE — 986_TRICARE INPATIENT 20251001: $157.47 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $160.62 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $157.47 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $157.47
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 60 minutes: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $157.47 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $236.20 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $157.47 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $220.46 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $236.20 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $162.19 TRICARE — 877_TRICARE OUTPATIENT 20250101: $157.47 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $160.62 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $157.47
Psychotherapy, 60 minutes CPT 90837 · Inpatient (hospital stay) In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$157.47 – $236.20
Psychotherapy, 60 minutes: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $157.47 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $157.47 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $220.46 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $236.20 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $162.19 TRICARE — 986_TRICARE INPATIENT 20251001: $157.47 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $160.62 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $157.47 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $157.47
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$157.47 – $236.20
Family psychotherapy, without the patient: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $157.47 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $236.20 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $157.47 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $220.46 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $236.20 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $162.19 TRICARE — 877_TRICARE OUTPATIENT 20250101: $157.47 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $160.62 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $157.47
Family psychotherapy, without the patient CPT 90846 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$157.47 – $236.20
Family psychotherapy, without the patient: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $157.47 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $157.47 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $220.46 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $236.20 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $162.19 TRICARE — 986_TRICARE INPATIENT 20251001: $157.47 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $160.62 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $157.47 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $157.47
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$157.47 – $236.20
Family psychotherapy, with the patient: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $157.47 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $236.20 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $157.47 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $220.46 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $236.20 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $162.19 TRICARE — 877_TRICARE OUTPATIENT 20250101: $157.47 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $160.62 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $157.47
Family psychotherapy, with the patient CPT 90847 · Inpatient (hospital stay) In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$157.47 – $236.20
Family psychotherapy, with the patient: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $160.62 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $157.47 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $157.47 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $220.46 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $236.20 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $162.19 TRICARE — 986_TRICARE INPATIENT 20251001: $157.47 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $160.62 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $157.47 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $157.47
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$90.66 – $135.99
Group psychotherapy: 10 of 11 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $92.47 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $90.66 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $135.99 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $90.66 SMARTHEALTH — 875_SMARTHEALTH OUTPATIENT 20250101: $126.92 SUPERIOR AMBETTER — 876_SUPERIOR AMBETTER OUTPATIENT 20250101: $135.99 SWHP MEDICARE REPLACEMENT — 882_MEDICARE ADVANTAGE SCOTT AND WHITE OUTPATIENT 20250101: $93.38 TRICARE — 877_TRICARE OUTPATIENT 20250101: $90.66 UHC MEDICARE REPLACEMENT — 883_MEDICARE ADVANTAGE UNITED HEALTHCARE OUTPATIENT 20250101: $92.47 VA — 887_VETERANS ADMINISTRATION OUTPATIENT 20250101: $90.66
Group psychotherapy CPT 90853 · Inpatient (hospital stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$90.66 – $135.99
Group psychotherapy: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $92.47 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $90.66 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $90.66 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $126.92 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $135.99 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $93.38 TRICARE — 986_TRICARE INPATIENT 20251001: $90.66 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $92.47 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $90.66 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $90.66

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$859.35 – $5,725.85
Removal of breast growth (open surgery): 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $3,029.55 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $5,150.23 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $2,423.73 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $5,725.85 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $963.66 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $859.35 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $963.66 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $963.66 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $963.66 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $963.66
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	$9,520.93 – $22,492.34
Total hip replacement: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $11,900.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $20,231.21 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $9,520.93 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $22,492.34
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	$9,520.93 – $22,492.34
Total knee replacement: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $11,900.71 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $20,231.21 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $9,520.93 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $22,492.34
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	$859.35
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $859.35
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	$1,061.55 – $5,173.78
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,737.45 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $4,653.66 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $2,190.05 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $5,173.78 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1,088.27 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,061.55 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $1,088.27 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $1,088.27 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $1,088.27 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $1,088.27
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	$859.35 – $9,167.50
Removal of tonsils and adenoids (under age 12): 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $4,850.53 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $8,245.90 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $3,880.57 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $9,167.50 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1,954.22 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $859.35 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $1,954.22 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $1,954.22 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $1,954.22 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $1,954.22
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	$918.88 – $1,378.32
Upper GI endoscopy (diagnostic): 10 of 27 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $937.26 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $918.88 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $785.92 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,336.06 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $628.76 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,485.39 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $334.95 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $556.05 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $1,378.32 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $334.95
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	$918.88 – $1,378.32
Upper GI endoscopy (diagnostic): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $937.26 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $918.88 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $918.88 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $1,286.43 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $1,378.32 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $946.45 TRICARE — 986_TRICARE INPATIENT 20251001: $918.88 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $937.26 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $918.88 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $918.88
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	$918.88 – $1,378.32
Upper GI endoscopy with biopsy: 10 of 27 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $937.26 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $918.88 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $785.92 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,336.06 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $628.76 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,485.39 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $334.95 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $1,378.32 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $334.95
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	$918.88 – $1,378.32
Upper GI endoscopy with biopsy: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $937.26 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $918.88 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $918.88 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $1,286.43 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $1,378.32 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $946.45 TRICARE — 986_TRICARE INPATIENT 20251001: $918.88 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $937.26 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $918.88 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $918.88
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$893.55 – $1,340.32
Colonoscopy (diagnostic): 10 of 27 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $911.42 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $893.55 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $763.88 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,298.60 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $611.13 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,443.73 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $328.50 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $1,340.32 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $328.50
Colonoscopy (diagnostic) CPT 45378 · Inpatient (hospital stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$893.55 – $1,340.32
Colonoscopy (diagnostic): rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $911.42 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $893.55 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $893.55 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $1,250.97 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $1,340.32 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $920.36 TRICARE — 986_TRICARE INPATIENT 20251001: $893.55 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $911.42 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $893.55 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $893.55
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	$429.26 – $1,897.98
Colonoscopy with biopsy: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,004.22 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,707.17 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $803.41 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,897.98 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $429.26 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $429.26 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $429.26 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $429.26 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $429.26
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	$429.26 – $1,897.98
Colonoscopy with removal of polyps (snare): 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,004.22 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,707.17 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $803.41 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,897.98 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $429.26 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $429.26 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $429.26 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $429.26 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $429.26
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	$429.26 – $1,897.98
Ultrasound of the lower bowel by endoscope: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,004.22 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,707.17 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $803.41 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,897.98 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $429.26 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $429.26 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $429.26 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $429.26 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $429.26
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	$1,888.85 – $9,836
Gallbladder removal by laparoscope: 10 of 21 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $5,546 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $5,836 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $5,546 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $6,485 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1,888.85 CIGNA — 930_CIGNA 20250701: $9,836 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $3,390 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $5,333.35 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $5,901.09 HUMANA — 644_HUMANA HMO PPO 20230701: $3,705
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	$1,061.55 – $5,876.65
Groin (inguinal) hernia repair, age 5 or older: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $3,109.34 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $5,285.88 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $2,487.56 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $5,876.65 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1,151.54 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $1,061.55 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $1,151.54 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $1,151.54 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $1,151.54 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $1,151.54
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY PROSTATE	$1,512.50	$544.50	$652.80 – $1,417.29
Prostate biopsy: 10 of 14 insurance plan rates BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,417.29 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $652.80 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $1,058.75 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $652.80 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $652.80 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $652.80 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $652.80 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $652.80 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $652.80
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$652.80 – $3,348.23
Prostate biopsy: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,771.55 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,011.64 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,417.29 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $3,348.23 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $652.80 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $652.80 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $652.80 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $652.80 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $652.80
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	$6,730.74 – $15,900.78
Prostate removal by laparoscope (radical prostatectomy): rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $8,413.11 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14,302.29 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $6,730.74 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $15,900.78
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	$859.35 – $4,721.41
Hysteroscopy with biopsy of the uterus lining: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,498.10 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $4,246.77 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,998.56 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $4,721.41 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $1,063.52 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $859.35 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $1,063.52 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $1,063.52 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $1,063.52 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $1,063.52
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: 62323-INJ EPIDRL L/S SPI W/IMG	$2,160.50	$777.78	$262.86 – $1,512.35
Spinal injection, lower back (epidural), with imaging guidance: 10 of 12 insurance plan rates BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $262.86 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $1,512.35 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $262.86 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $262.86 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $262.86 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $262.86 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $262.86 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $262.86 UHC STAR — 928_UHC STAR OUTPATIENT 20250701: $262.86 UHC STAR KIDS — 909_UHC STAR KIDS OUTPATIENT 20241201: $262.86
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: EPI L/SACRAL INJ - P	$2,160.50	$777.78	$262.86 – $1,512.35
Spinal injection, lower back (epidural), with imaging guidance: 10 of 12 insurance plan rates BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $262.86 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $1,512.35 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $262.86 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $262.86 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $262.86 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $262.86 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $262.86 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $262.86 UHC STAR — 928_UHC STAR OUTPATIENT 20250701: $262.86 UHC STAR KIDS — 909_UHC STAR KIDS OUTPATIENT 20241201: $262.86
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	$678.73 – $1,018.10
Spinal injection, lower back (epidural), with imaging guidance: 10 of 26 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $692.30 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $678.73 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $625.05 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,062.59 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $500.06 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,181.34 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $262.86 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $1,018.10 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $262.86 MEDICARE ADVANTAGE 100 PERCENT — 879_MEDICARE ADVANTAGE 100% OUTPATIENT 20250101: $678.73
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: 64483-INJ AA&/STTFEPI L/S1L BI	$4,460.75	$1,605.87	$340.77 – $3,122.53
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $812.05 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,380.48 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $649.67 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,534.77 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $340.77 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $556.05 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $3,122.53 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $340.77 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $340.77 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $340.77
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NERVE BLOCK VERTEBRAL	$1,907.25	$686.61	$340.77 – $1,534.77
Nerve root injection, lower back, with imaging guidance: 10 of 17 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $812.05 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,380.48 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $649.67 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $1,534.77 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $340.77 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $556.05 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $1,335.08 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $340.77 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $340.77 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $340.77
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: 64483-INJ AA&/STR TFEPI L/S 1L	$1,907.25	$686.61	$340.77 – $1,335.08
Nerve root injection, lower back, with imaging guidance: 10 of 13 insurance plan rates BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $340.77 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $556.05 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $1,335.08 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $340.77 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $340.77 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $340.77 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $340.77 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $340.77 SWHP RIGHTCARE STAR — 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201: $340.77 UHC STAR — 928_UHC STAR OUTPATIENT 20250701: $340.77
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	$659.94 – $3,249.57
Carpal tunnel release: 10 of 16 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $1,719.35 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,922.89 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,375.53 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $3,249.57 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $659.94 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $659.94 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $659.94 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $659.94 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $659.94
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	$537.67 – $806.50
Laser treatment of clouding after cataract surgery: 10 of 27 insurance plan rates AETNA MEDICARE REPLACEMENT — 880_MEDICARE ADVANTAGE AETNA OUTPATIENT 20250101: $548.42 ASCENSION COMPLETE MEDICARE REPLACEMENT — 920_MEDICARE ADVANTAGE ASCENSION COMPLETE OUTPATIENT 2025010: $537.67 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $506.93 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $861.78 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $405.56 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $958.10 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $208.33 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $758.25 GREEN IMAGING — 932_GREEN IMAGING OUTPATIENT 20250101: $806.50 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $208.33
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	$537.67 – $806.50
Laser treatment of clouding after cataract surgery: rates for 10 insurance plans AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $548.42 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $537.67 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $537.67 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $752.74 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $806.50 SWHP MEDICARE REPLACEMENT — 990_MEDICARE ADVANTAGE SCOTT AND WHITE INPATIENT 20251001: $553.80 TRICARE — 986_TRICARE INPATIENT 20251001: $537.67 UHC MEDICARE REPLACEMENT — 991_MEDICARE ADVANTAGE UNITED HEALTHCARE INPATIENT 20251001: $548.42 VA — 992_VETERANS ADMINISTRATION INPATIENT 20251001: $537.67 WELLCARE ALLWELL MEDICARE ADVANTAGE — 994_WELLCARE ALLWELL MEDICARE ADVANTAGE INPATIENT 20251001: $537.67
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	$849.94 – $3,821.32
Cataract removal with lens implant: 10 of 15 insurance plan rates BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,021.86 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,437.16 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,617.55 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $3,821.32 BCBS STAR — 975_BCBS STAR OUTPATIENT 20241201: $849.94 MEDICAID REPLACEMENT 100% — 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201: $849.94 MOLINA MEDICAID REPLACEMENT CHIP — 908_MOLINA CHIP OUTPATIENT 20241201: $849.94 SUPERIOR CHIP/CHIP PERINATE — 910_SUPERIOR CHIP OUTPATIENT 20241201: $849.94 SUPERIOR STAR — 904_SUPERIOR STAR OUTPATIENT 20241201: $849.94 SUPERIOR STAR PLUS — 907_SUPERIOR STAR PLUS OUTPATIENT 20241201: $849.94

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	$1,742.34 – $4,116.12
Vaginal delivery, with care before and after: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,177.84 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,702.33 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,742.34 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $4,116.12
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	$1,931.77 – $4,563.63
Cesarean delivery (C-section), with care before and after: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,414.62 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $4,104.85 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,931.77 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $4,563.63
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	$1,828.26 – $4,319.10
Vaginal delivery after a previous C-section, with care before and after: rates for 4 insurance plans BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $2,285.24 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,884.91 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $1,828.26 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $4,319.10

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	$61,272.51 – $91,908.76
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 23 insurance plan rates AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $62,497.96 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $61,272.51 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $57,921 BCBS ESSENTIALS HMO — 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $67,136 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $46,336 BCBS PPO — 869_BLUE CROSS BLUE SHIELD PPO 20250101: $74,595 BCBS TRADITIONAL — 516_BLUE CROSS BLUE SHIELD TRADITIONAL 20210815: $61,090 CIGNA — 930_CIGNA 20250701: $73,165 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $50,589 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7,195.69
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	$12,081.26 – $18,121.89
Hip or knee replacement (major joint of the leg), without major complications: 10 of 18 insurance plan rates AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $12,322.89 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $12,081.26 BCBS ADVANTAGE HMO — 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101: $25,654 BCBS MYBLUEHEALTH — 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101: $20,523 BCBS TRADITIONAL — 516_BLUE CROSS BLUE SHIELD TRADITIONAL 20210815: $27,018 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $10,618 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7,195.69 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $7,529.18 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $12,081.26 PHCS — 376_PHCS 20191001: $1,210
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	$15,290.57 – $22,935.85
Neck (cervical) spinal fusion, without complications: 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $15,596.38 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $15,290.57 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $10,482 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7,195.69 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $7,529.18 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $15,290.57 PHCS — 376_PHCS 20191001: $1,210 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $21,406.80 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $22,935.85 SWHP MANAGED CARE — 841_SCOTT & WHITE HEALTH PLAN 20241001: $6,439.43
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	$7,770.86 – $11,656.29
Uterus and ovary surgery (not for cancer), without complications: 10 of 15 insurance plan rates AETNA MEDICARE REPLACEMENT — 989_MEDICARE ADVANTAGE AETNA INPATIENT 20251001: $7,926.28 ASCENSION COMPLETE MEDICARE REPLACEMENT — 995_MEDICARE ADVANTAGE ASCENSION COMPLETE INPATIENT 20251001: $7,770.86 FIRSTCARE FOCUS NETWORK — 130_FIRSTCARE FOCUS NETWORK 20131001: $4,582 FIRSTCARE HMO — 839_FIRSTCARE HMO 20241001: $7,195.69 FIRSTCARE PPO — 840_FIRSTCARE PPO 20241001: $7,529.18 MEDICARE ADVANTAGE 100 PERCENT — 988_MEDICARE ADVANTAGE 100% INPATIENT 20251001: $7,770.86 PHCS — 376_PHCS 20191001: $1,210 SMARTHEALTH — 984_SMARTHEALTH INPATIENT 20251001: $10,879.20 SUPERIOR AMBETTER — 985_SUPERIOR AMBETTER INPATIENT 20251001: $11,656.29 SWHP MANAGED CARE — 841_SCOTT & WHITE HEALTH PLAN 20241001: $6,439.43

Source: Ascension Providence’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	6901 Medical Parkway, Waco, TX 76712
County	McLennan County
State	Texas
Phone	(254) 751‑4000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	2 of 5 stars
CMS Certification Number	450042
Name in Medicare records	ASCENSION PROVIDENCE
Profile level	Medicare data + hospital website
Name on the hospital’s website	Ascension Providence Hospital
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 Providence Hospital — healthcare.ascension.org
Ascension Providence Emergency — healthcare.ascension.org

Ascension Providence

Summary

Profile from official sources

At a glance