Where is Ascension Sacred Heart Rehabilitation Hospital?

13111 N Port Washington Rd Second Floor, Mequon, WI 53097, in Ozaukee County, Wisconsin.

What is the phone number of Ascension Sacred Heart Rehabilitation Hospital?

(262) 292-0400, as listed by Medicare (CMS).

Ascension Sacred Heart Rehabilitation Hospital

Quick answers

Where is Ascension Sacred Heart Rehabilitation Hospital?: 13111 N Port Washington Rd Second Floor, Mequon, WI 53097, in Ozaukee County, Wisconsin.
What is the phone number of Ascension Sacred Heart Rehabilitation Hospital?: (262) 292-0400, as listed by Medicare (CMS).

Specialties and care areas^[4]

Inpatient rehabilitation
Physical therapy
Occupational therapy
Speech therapy
Physical medicine and rehabilitation (physiatry)
Rehabilitation nursing

Conditions treated^[4]

Acquired and traumatic brain injury
Amputation
Complex medical conditions
Coma or loss of consciousness
Spine surgery or spinal cord injury
Stroke or neurologic disorder
Swallowing problems
Concussion

Treatments^[4]

One-on-one therapy with individualized plan
Community re-entry therapy and home assessments
Neurological rehabilitation (outpatient)
Brain injury day treatment

Programs and centers^[4]

Inpatient rehabilitation facility (IRF)

Nearest emergency rooms

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

Aurora Medical Center5.5 mi · Grafton, WI · Acute Care Hospital
Ascension Wisconsin Hosp Menomonee Falls Campus9.7 mi · Menomonee Falls, WI · Acute Care Hospital
Community Memorial Hospital12 mi · Menomonee Falls, WI · Acute Care Hospital
Ascension SE Wisconsin Hospital13 mi · Milwaukee, WI · Acute Care Hospital
Ascension Columbia St Marys Hospital Milwaukee13 mi · Milwaukee, WI · Acute Care Hospital

Other hospitals nearby

Orthopaedic Hospital of Wisconsin12 mi · Glendale, WI · Acute Care 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

Newcastle Place2.5 mi · Mequon, WI · 4 of 5 stars
Avina of Milwaukee6.0 mi · Milwaukee, WI · 1 of 5 stars
Amethyst Health of Brown Deer6.9 mi · Milwaukee, WI · 1 of 5 stars

All nursing homes in the state →

Hospice providers

North Shore at Home6.5 mi · Glendale, WI
Horizon Homecare and Hospice8.5 mi · Milwaukee, WI · 3 of 5 stars
Vitas Healthcare Corp Midwest8.5 mi · Milwaukee, WI · 3 of 5 stars

All hospice providers in the state →

Home health agencies

Miracle Home Health of Wisconsin6.5 mi · Glendale, WI · 2 of 5 stars
Atlantic Home Health Care7.1 mi · Brown Deer, WI
Horizon Home Care and Hospice8.5 mi · Milwaukee, WI · 4 of 5 stars

All home health agencies in the state →

Dialysis facilities

DaVita Cedarburg Dialysis7.0 mi · Cedarburg, WI · 2 of 5 stars
DaVita Mill Street Home Training (PD)7.0 mi · Cedarburg, WI · 3 of 5 stars
DaVita Brown Deer Dialysis7.1 mi · Milwaukee, WI · 3 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.

East Mequon Surgery Ctr2.9 mi · Mequon, WI
Ozaukee Surgery Center, LLC2.9 mi · Mequon, WI
PMTC Surgery Ctr7.1 mi · Milwaukee, WI

All outpatient surgery centers in the state →

Community care nearby

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

Community health centers

Isaac Coggs Heritage Health Ctr10 mi · Milwaukee, WI · Community health center
C. H. Mason Health Clinic10 mi · Milwaukee, WI · Community health center
Outreach Community Health Centers, Incorporated11 mi · Milwaukee, WI · Community health center

Clinics and urgent care

Oasis Health Care LLC5.5 mi · Grafton, WI · Urgent care center
Children's Health System7.1 mi · Milwaukee, WI · Urgent care center
Omni Family Medical Clinic Urgent Care, S.C.7.1 mi · Milwaukee, WI · Urgent care center

Pharmacies

Aurora Pharmacy Inc2.9 mi · Mequon, WI · Clinic pharmacy
Froedtert Health Pharmacy LLC2.9 mi · Mequon, WI · Community/retail pharmacy
Froedtert Memorial Lutheran Hospital, Inc.2.9 mi · Mequon, WI · Community/retail pharmacy

Assisted living nearby

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

Lumia of Mequon Memory Care2.9 mi · Mequon, WI
Newcastle Place2.9 mi · Mequon, WI
River Oaks of Mequon2.9 mi · Mequon, WI
Senior Living Mequon II2.9 mi · Mequon, WI

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 Wisconsin Best hospitals in Wisconsin

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 86 common services exactly as Ascension Sacred Heart Rehabilitation Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

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

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

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$132.46 – $278.13
New patient office visit (about 30–44 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $278.13 HUMANA HMO POS — 1127_HUMANA 20221001: $255.52 HUMANA PPO — 1133_HUMANA PPO 20221001: $255.52 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $255.52 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $255.52
New patient office visit (about 30–44 minutes) CPT 99203 · Inpatient or outpatient In the file: OFFICE O/P NEW LOW 30 MIN	Not listed in the file	Not listed in the file	$132.46 – $278.13
New patient office visit (about 30–44 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $132.46
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$214.69 – $424.56
New patient office visit (about 45–59 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $424.56 HUMANA HMO POS — 1127_HUMANA 20221001: $390.43 HUMANA PPO — 1133_HUMANA PPO 20221001: $390.43 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $390.43 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $390.43
New patient office visit (about 45–59 minutes) CPT 99204 · Inpatient or outpatient In the file: OFFICE O/P NEW MOD 45 MIN	Not listed in the file	Not listed in the file	$214.69 – $424.56
New patient office visit (about 45–59 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $214.69
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: HC PBB OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES	$286	$151.58	$209.02
New patient office visit (about 60–74 minutes): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $209.02
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$291.52 – $532.53
New patient office visit (about 60–74 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $532.53 HUMANA HMO POS — 1127_HUMANA 20221001: $493.65 HUMANA PPO — 1133_HUMANA PPO 20221001: $493.65 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $493.65 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $493.65
New patient office visit (about 60–74 minutes) CPT 99205 · Inpatient or outpatient In the file: OFFICE O/P NEW HI 60 MIN	Not listed in the file	Not listed in the file	$291.52 – $532.53
New patient office visit (about 60–74 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $291.52
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: HC PBB OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MI	$110	$58.30	$86.74 – $106.79
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $86.74
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: HC PBB OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MI	$110	$58.30	$86.74 – $106.79
Established patient office visit (about 20–29 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $106.79
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OFFICE O/P EST LOW 20 MIN	Not listed in the file	Not listed in the file	$106.79 – $188.14
Established patient office visit (about 20–29 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $188.14 HUMANA HMO POS — 1127_HUMANA 20221001: $178.43 HUMANA PPO — 1133_HUMANA PPO 20221001: $178.43 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $178.43 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $178.43
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: HC PBB OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MI	$142	$75.26	$122.48
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $122.48
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OFFICE O/P EST MOD 30 MIN	Not listed in the file	Not listed in the file	$158.01 – $277.60
Established patient office visit (about 30–39 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $277.60 HUMANA HMO POS — 1127_HUMANA 20221001: $259.52 HUMANA PPO — 1133_HUMANA PPO 20221001: $259.52 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $259.52 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $259.52
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: OFFICE O/P EST MOD 30 MIN	Not listed in the file	Not listed in the file	$158.01 – $277.60
Established patient office visit (about 30–39 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $158.01
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	$144.53 – $317.98
Office consultation with a specialist (moderate): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $317.98 HUMANA HMO POS — 1127_HUMANA 20221001: $295.41 HUMANA PPO — 1133_HUMANA PPO 20221001: $295.41 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $295.41 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $295.41
Office consultation with a specialist (moderate) CPT 99243 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST LOW 30	Not listed in the file	Not listed in the file	$144.53 – $317.98
Office consultation with a specialist (moderate): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $144.53
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	$220.44 – $475.90
Office consultation with a specialist (moderate to high): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $475.90 HUMANA HMO POS — 1127_HUMANA 20221001: $442.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $442.18 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $442.18 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $442.18
Office consultation with a specialist (moderate to high) CPT 99244 · Inpatient or outpatient In the file: OFF/OP CNSLTJ NEW/EST MOD 40	Not listed in the file	Not listed in the file	$220.44 – $475.90
Office consultation with a specialist (moderate to high): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $220.44
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	$153.27 – $340.91
Preventive checkup, new patient, age 18–39: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $340.91 HUMANA HMO POS — 1127_HUMANA 20221001: $317.57 HUMANA PPO — 1133_HUMANA PPO 20221001: $317.57 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $317.57 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $317.57
Preventive checkup, new patient, age 18–39 CPT 99385 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 18-39	Not listed in the file	Not listed in the file	$153.27 – $340.91
Preventive checkup, new patient, age 18–39: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $153.27
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	$186.01 – $396.15
Preventive checkup, new patient, age 40–64: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $396.15 HUMANA HMO POS — 1127_HUMANA 20221001: $367.68 HUMANA PPO — 1133_HUMANA PPO 20221001: $367.68 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $367.68 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $367.68
Preventive checkup, new patient, age 40–64 CPT 99386 · Inpatient or outpatient In the file: PREV VISIT NEW AGE 40-64	Not listed in the file	Not listed in the file	$186.01 – $396.15
Preventive checkup, new patient, age 40–64: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $186.01
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: EMERGENCY DEPT VISIT LOW MDM	Not listed in the file	Not listed in the file	$114.58 – $160.58
Emergency room visit (moderate): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $160.58 HUMANA HMO POS — 1127_HUMANA 20221001: $154.84 HUMANA PPO — 1133_HUMANA PPO 20221001: $154.84 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $154.84 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $154.84
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: EMERGENCY DEPT VISIT LOW MDM	Not listed in the file	Not listed in the file	$114.58 – $160.58
Emergency room visit (moderate): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $114.58
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: EMERGENCY DEPT VISIT MOD MDM	Not listed in the file	Not listed in the file	$193.92 – $304.62
Emergency room visit (moderately high): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $304.62 HUMANA HMO POS — 1127_HUMANA 20221001: $282.67 HUMANA PPO — 1133_HUMANA PPO 20221001: $282.67 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $282.67 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $282.67
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: EMERGENCY DEPT VISIT MOD MDM	Not listed in the file	Not listed in the file	$193.92 – $304.62
Emergency room visit (moderately high): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $193.92
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: EMERGENCY DEPT VISIT HI MDM	Not listed in the file	Not listed in the file	$281.26 – $449.30
Emergency room visit (high): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $449.30 HUMANA HMO POS — 1127_HUMANA 20221001: $410.29 HUMANA PPO — 1133_HUMANA PPO 20221001: $410.29 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $410.29 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $410.29
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: EMERGENCY DEPT VISIT HI MDM	Not listed in the file	Not listed in the file	$281.26 – $449.30
Emergency room visit (high): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $281.26

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: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.88 – $38.59
Basic metabolic panel (blood test): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $38.59 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $8.88 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $32.67 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $32.67 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $32.67 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $11.75 HUMANA HMO POS — 1127_HUMANA 20221001: $17.41 HUMANA PPO — 1133_HUMANA PPO 20221001: $17.41 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $17.41 HUMANA WVN — 1135_HUMANA WVN 20221001: $11.33
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.88 – $38.59
Basic metabolic panel (blood test): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $14.38
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · modifier QW In the file: METABOLIC PANEL TOTAL CA	Not listed in the file	Not listed in the file	$8.88 – $38.59
Basic metabolic panel (blood test): rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $8.88 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $32.67 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $32.67 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $32.67
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	$11.09 – $48.21
Comprehensive metabolic panel (blood test): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $48.21 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $11.09 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $40.81 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $40.81 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $40.81 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $14.68 HUMANA HMO POS — 1127_HUMANA 20221001: $21.74 HUMANA PPO — 1133_HUMANA PPO 20221001: $21.74 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $21.74 HUMANA WVN — 1135_HUMANA WVN 20221001: $14.15
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$11.09 – $48.21
Comprehensive metabolic panel (blood test): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $17.95
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · modifier QW In the file: COMPREHEN METABOLIC PANEL	Not listed in the file	Not listed in the file	$11.09 – $48.21
Comprehensive metabolic panel (blood test): rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $11.09 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $40.81 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $40.81 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $40.81
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: HC PBB OBSTETRIC PANEL	$189	$100.17	$50.20 – $184.71
Obstetric blood test panel: 10 of 11 insurance plan rates ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $50.20 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $184.71 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $184.71 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $184.71 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $66.40 HUMANA HMO POS — 1127_HUMANA 20221001: $86.42 HUMANA PPO — 1133_HUMANA PPO 20221001: $86.42 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $86.42 HUMANA WVN — 1135_HUMANA WVN 20221001: $64.06 SEHN C89 — 1128_SEHN 20221001: $113.23
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: HC PBB OBSTETRIC PANEL	$189	$100.17	$50.20 – $184.71
Obstetric blood test panel: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $81.28
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	$50.20 – $218.15
Obstetric blood test panel: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $218.15 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $50.20 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $184.71 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $184.71 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $184.71 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $66.40 HUMANA HMO POS — 1127_HUMANA 20221001: $86.42 HUMANA PPO — 1133_HUMANA PPO 20221001: $86.42 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $86.42 HUMANA WVN — 1135_HUMANA WVN 20221001: $64.06
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$14.06 – $84.82
Cholesterol panel (lipid panel): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $84.82 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $14.06 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $51.73 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $51.73 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $51.73 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $18.60 HUMANA HMO POS — 1127_HUMANA 20221001: $27.55 HUMANA PPO — 1133_HUMANA PPO 20221001: $27.55 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $27.55 HUMANA WVN — 1135_HUMANA WVN 20221001: $17.95
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$14.06 – $84.82
Cholesterol panel (lipid panel): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $22.76
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · modifier QW In the file: LIPID PANEL	Not listed in the file	Not listed in the file	$14.06 – $84.82
Cholesterol panel (lipid panel): rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $14.06 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $51.73 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $51.73 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $51.73
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: HC RENAL FUNCTION PANEL	$136	$72.08	$9.11 – $39.63
Kidney function panel: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $39.63 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $9.11 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $33.55 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $33.55 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $33.55 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $12.06 HUMANA HMO POS — 1127_HUMANA 20221001: $17.85 HUMANA PPO — 1133_HUMANA PPO 20221001: $17.85 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $17.85 HUMANA WVN — 1135_HUMANA WVN 20221001: $11.63
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: HC RENAL FUNCTION PANEL	$136	$72.08	$9.11 – $39.63
Kidney function panel: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $14.76
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	$9.11 – $39.63
Kidney function panel: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $39.63 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $9.11 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $33.55 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $33.55 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $33.55 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $12.06 HUMANA HMO POS — 1127_HUMANA 20221001: $17.85 HUMANA PPO — 1133_HUMANA PPO 20221001: $17.85 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $17.85 HUMANA WVN — 1135_HUMANA WVN 20221001: $11.63
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	$8.58 – $37.29
Liver function panel: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $37.29 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $8.58 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $31.58 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $31.58 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $31.58 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $11.35 HUMANA HMO POS — 1127_HUMANA 20221001: $16.80 HUMANA PPO — 1133_HUMANA PPO 20221001: $16.80 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $16.80 HUMANA WVN — 1135_HUMANA WVN 20221001: $10.95
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.58 – $37.29
Liver function panel: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $13.89
Liver function panel CPT 80076 · Outpatient (no overnight stay) · modifier TC In the file: HEPATIC FUNCTION PANEL	Not listed in the file	Not listed in the file	$8.58 – $37.29
Liver function panel: rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $35.54
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	$3.33 – $14.47
Urine test (automated, with microscope): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $14.47 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $3.33 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $12.27 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $12.27 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $12.27 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $4.40 HUMANA HMO POS — 1127_HUMANA 20221001: $6.51 HUMANA PPO — 1133_HUMANA PPO 20221001: $6.51 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $6.51 HUMANA WVN — 1135_HUMANA WVN 20221001: $4.25
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.33 – $14.47
Urine test (automated, with microscope): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $5.39
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · modifier TC In the file: URINALYSIS AUTO W/SCOPE	Not listed in the file	Not listed in the file	$3.33 – $14.47
Urine test (automated, with microscope): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $13.77
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.65 – $11.66
Urine test (manual, without microscope): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $11.66 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $3.65 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $10.89 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10.89 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $10.89 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $4.35 HUMANA HMO POS — 1127_HUMANA 20221001: $5.26 HUMANA PPO — 1133_HUMANA PPO 20221001: $5.26 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $5.26 HUMANA WVN — 1135_HUMANA WVN 20221001: $4.66
Urine test (manual, without microscope) CPT 81002 · Inpatient or outpatient In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.65 – $11.66
Urine test (manual, without microscope): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $5.92
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · modifier TC In the file: URINALYSIS NONAUTO W/O SCOPE	Not listed in the file	Not listed in the file	$3.65 – $11.66
Urine test (manual, without microscope): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $11.46
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	$2.36 – $10.32
Urine test (automated, without microscope): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $10.25 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $2.36 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $8.67 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $8.67 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $8.67 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $3.11 HUMANA HMO POS — 1127_HUMANA 20221001: $4.62 HUMANA PPO — 1133_HUMANA PPO 20221001: $4.62 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $4.62 HUMANA WVN — 1135_HUMANA WVN 20221001: $3.02
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: URINALYSIS AUTO W/O SCOPE	Not listed in the file	Not listed in the file	$2.36 – $10.32
Urine test (automated, without microscope): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $3.83
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · modifier QW In the file: URINALYSIS AUTO W/O SCOPE	Not listed in the file	Not listed in the file	$2.36 – $10.32
Urine test (automated, without microscope): rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $2.36 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $8.67 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $8.67 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $8.67
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$19.31 – $83.95
PSA (prostate specific antigen) blood test: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $83.95 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $19.31 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $71.07 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $71.07 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $71.07 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $25.55 HUMANA HMO POS — 1127_HUMANA 20221001: $37.85 HUMANA PPO — 1133_HUMANA PPO 20221001: $37.85 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $37.85 HUMANA WVN — 1135_HUMANA WVN 20221001: $24.65
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$19.31 – $83.95
PSA (prostate specific antigen) blood test: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $31.26
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · modifier TC In the file: ASSAY OF PSA TOTAL	Not listed in the file	Not listed in the file	$19.31 – $83.95
PSA (prostate specific antigen) blood test: rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $80.23
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	$17.64 – $76.68
Thyroid stimulating hormone (TSH) test: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $76.68 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $17.64 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $64.94 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $64.94 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $64.94 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $23.34 HUMANA HMO POS — 1127_HUMANA 20221001: $34.56 HUMANA PPO — 1133_HUMANA PPO 20221001: $34.56 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $34.56 HUMANA WVN — 1135_HUMANA WVN 20221001: $22.51
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: ASSAY THYROID STIM HORMONE	Not listed in the file	Not listed in the file	$17.64 – $76.68
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $28.56
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · modifier QW In the file: ASSAY THYROID STIM HORMONE	Not listed in the file	Not listed in the file	$17.64 – $76.68
Thyroid stimulating hormone (TSH) test: rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $17.64 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $64.94 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $64.94 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $64.94
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	$8.16 – $35.48
Complete blood count (CBC) with differential: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $35.48 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $8.16 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $30.01 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $30.01 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $30.01 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $10.79 HUMANA HMO POS — 1127_HUMANA 20221001: $15.99 HUMANA PPO — 1133_HUMANA PPO 20221001: $15.99 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $15.99 HUMANA WVN — 1135_HUMANA WVN 20221001: $10.41
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$8.16 – $35.48
Complete blood count (CBC) with differential: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $13.21
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · modifier QW In the file: COMPLETE CBC W/AUTO DIFF WBC	Not listed in the file	Not listed in the file	$8.16 – $35.48
Complete blood count (CBC) with differential: rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $8.16 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $30.01 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $30.01 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $30.01
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	$6.79 – $29.51
Complete blood count (CBC), automated: 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $29.51 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $6.79 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $24.97 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $24.97 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $24.97 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $8.98 HUMANA HMO POS — 1127_HUMANA 20221001: $13.31 HUMANA PPO — 1133_HUMANA PPO 20221001: $13.31 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $13.31 HUMANA WVN — 1135_HUMANA WVN 20221001: $8.67
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.79 – $29.51
Complete blood count (CBC), automated: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $11
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · modifier TC In the file: COMPLETE CBC AUTOMATED	Not listed in the file	Not listed in the file	$6.79 – $29.51
Complete blood count (CBC), automated: rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $28.64
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME	Not listed in the file	Not listed in the file	$4.50 – $17.96
Blood clotting time test (prothrombin time, PT): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $17.96 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $4.50 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15.18 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $15.18 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $15.18 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $5.46 HUMANA HMO POS — 1127_HUMANA 20221001: $8.09 HUMANA PPO — 1133_HUMANA PPO 20221001: $8.09 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $8.09 HUMANA WVN — 1135_HUMANA WVN 20221001: $5.75
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: PROTHROMBIN TIME	Not listed in the file	Not listed in the file	$4.50 – $17.96
Blood clotting time test (prothrombin time, PT): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $7.29
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · modifier QW In the file: PROTHROMBIN TIME	Not listed in the file	Not listed in the file	$4.50 – $17.96
Blood clotting time test (prothrombin time, PT): rates for 4 insurance plans ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $4.50 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15.18 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $15.18 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $15.18
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	$6.31 – $27.40
Blood clotting test (partial thromboplastin time, PTT): 10 of 12 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $27.40 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $6.31 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $23.22 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $23.22 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $23.22 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $8.34 HUMANA HMO POS — 1127_HUMANA 20221001: $12.35 HUMANA PPO — 1133_HUMANA PPO 20221001: $12.35 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $12.35 HUMANA WVN — 1135_HUMANA WVN 20221001: $8.05
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.31 – $27.40
Blood clotting test (partial thromboplastin time, PTT): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $10.22
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · modifier TC In the file: THROMBOPLASTIN TIME PARTIAL	Not listed in the file	Not listed in the file	$6.31 – $27.40
Blood clotting test (partial thromboplastin time, PTT): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $26.36

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

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$66.66 – $374.33
CT scan of the head or brain, without contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $374.33 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $245.18 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $302.22 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $302.22 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$66.66 – $374.33
CT scan of the head or brain, without contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $180.68
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · modifier 26 In the file: CT HEAD/BRAIN W/O DYE	Not listed in the file	Not listed in the file	$66.66 – $374.33
CT scan of the head or brain, without contrast: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $140.93 HUMANA HMO POS — 1127_HUMANA 20221001: $113.47 HUMANA PPO — 1133_HUMANA PPO 20221001: $113.47 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $113.47 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $113.47
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$179.52 – $1,220.37
MRI of the brain, before and after contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,220.37 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $828.27 HUMANA HMO POS — 1127_HUMANA 20221001: $828.27 HUMANA PPO — 1133_HUMANA PPO 20221001: $956.66 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $956.66 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $828.27
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$179.52 – $1,220.37
MRI of the brain, before and after contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $545.82
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier 26 In the file: MRI BRAIN STEM W/O & W/DYE	Not listed in the file	Not listed in the file	$179.52 – $1,220.37
MRI of the brain, before and after contrast: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $381.13 HUMANA HMO POS — 1127_HUMANA 20221001: $306.34 HUMANA PPO — 1133_HUMANA PPO 20221001: $306.34 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $306.34 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $306.34
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$17.24 – $182.03
Chest X-ray, 2 views: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $98.83 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $182.03 HUMANA HMO POS — 1127_HUMANA 20221001: $182.03 HUMANA PPO — 1133_HUMANA PPO 20221001: $85.26 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $85.26 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $182.03
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$17.24 – $182.03
Chest X-ray, 2 views: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $55.18
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier TC In the file: X-RAY EXAM CHEST 2 VIEWS	Not listed in the file	Not listed in the file	$17.24 – $182.03
Chest X-ray, 2 views: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $62.58 HUMANA HMO POS — 1127_HUMANA 20221001: $55.99 HUMANA PPO — 1133_HUMANA PPO 20221001: $55.99 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $55.99 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $55.99
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$20.64 – $245.18
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $157.32 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $245.18 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $126.28 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $126.28 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$20.64 – $245.18
X-ray of the lower spine, at least 4 views: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $84.30
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier 26 In the file: X-RAY EXAM L-2 SPINE 4/>VWS	Not listed in the file	Not listed in the file	$20.64 – $245.18
X-ray of the lower spine, at least 4 views: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $52.33 HUMANA HMO POS — 1127_HUMANA 20221001: $35.01 HUMANA PPO — 1133_HUMANA PPO 20221001: $35.01 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $35.01 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $35.01
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: HC MRI LUMBAR SPINE WO CONTRAST	$4,072	$2,158.16	$116.26 – $719.71
MRI of the lower back (lumbar spine), without contrast: rates for 3 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $719.71 HUMANA HMO POS — 1127_HUMANA 20221001: $517.79 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $517.79
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: HC MRI LUMBAR SPINE WO CONTRAST	$4,072	$2,158.16	$116.26 – $719.71
MRI of the lower back (lumbar spine), without contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $326.77
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI LUMBAR SPINE W/O DYE	Not listed in the file	Not listed in the file	$116.26 – $719.71
MRI of the lower back (lumbar spine), without contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $719.71 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $517.79 HUMANA HMO POS — 1127_HUMANA 20221001: $517.79 HUMANA PPO — 1133_HUMANA PPO 20221001: $569.89 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $569.89 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $517.79
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: HC CT PELVIS W CONTRAST	$2,418	$1,281.54	$90.90 – $729.23
CT scan of the pelvis, with contrast: rates for 3 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $729.23 HUMANA HMO POS — 1127_HUMANA 20221001: $401.74 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $401.74
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$90.90 – $729.23
CT scan of the pelvis, with contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $729.23 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $401.74 HUMANA HMO POS — 1127_HUMANA 20221001: $401.74 HUMANA PPO — 1133_HUMANA PPO 20221001: $634.17 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $634.17 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $401.74
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT PELVIS W/DYE	Not listed in the file	Not listed in the file	$90.90 – $729.23
CT scan of the pelvis, with contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $393.91
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: HC MRI JOINT LOWER EXTREMITY WO CONTRAST	$6,753	$3,579.09	$106.40 – $763.70
MRI of a leg joint (such as the knee), without contrast: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $763.70 HUMANA HMO POS — 1127_HUMANA 20221001: $517.79 HUMANA PPO — 1133_HUMANA PPO 20221001: $599.56 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $599.56 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $517.79
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: HC MRI JOINT LOWER EXTREMITY WO CONTRAST	$6,753	$3,579.09	$106.40 – $763.70
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $345.92
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI JNT OF LWR EXTRE W/O DYE	Not listed in the file	Not listed in the file	$106.40 – $763.70
MRI of a leg joint (such as the knee), without contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $763.70 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $517.79 HUMANA HMO POS — 1127_HUMANA 20221001: $517.79 HUMANA PPO — 1133_HUMANA PPO 20221001: $599.56 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $599.56 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $517.79
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$142.78 – $1,006.51
CT scan of the abdomen and pelvis, with contrast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,006.51 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $828.27 HUMANA HMO POS — 1127_HUMANA 20221001: $828.27 HUMANA PPO — 1133_HUMANA PPO 20221001: $857.14 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $857.14 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $828.27
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$142.78 – $1,006.51
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $521.85
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · modifier TC In the file: CT ABD & PELVIS W/CONTRAST	Not listed in the file	Not listed in the file	$142.78 – $1,006.51
CT scan of the abdomen and pelvis, with contrast: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $703.30 HUMANA HMO POS — 1127_HUMANA 20221001: $613.19 HUMANA PPO — 1133_HUMANA PPO 20221001: $613.19 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $613.19 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $613.19
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: HC US ABDOMINAL COMPLETE	$1,107	$586.71	$63.26 – $399.79
Ultrasound of the abdomen, complete: rates for 3 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $399.79 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$63.26 – $399.79
Ultrasound of the abdomen, complete: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $399.79 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $245.18 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $322.43 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $322.43 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US EXAM ABDOM COMPLETE	Not listed in the file	Not listed in the file	$63.26 – $399.79
Ultrasound of the abdomen, complete: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $192.59
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: HC US OB 14 WKS / > SINGLE FETUS	$840	$445.20	$78.56 – $462.40
Pregnancy ultrasound (after the first trimester): rates for 3 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $462.40 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$78.56 – $462.40
Pregnancy ultrasound (after the first trimester): rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $462.40 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $245.18 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $367.89 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $367.89 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: OB US >= 14 WKS SNGL FETUS	Not listed in the file	Not listed in the file	$78.56 – $462.40
Pregnancy ultrasound (after the first trimester): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $223.94
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: HC US NON-OB TRANSVAGINAL	$733	$388.49	$54.71 – $396.84
Transvaginal ultrasound: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $396.84 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $323.06 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $323.06 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$54.71 – $396.84
Transvaginal ultrasound: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $396.84 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $245.18 HUMANA HMO POS — 1127_HUMANA 20221001: $245.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $323.06 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $323.06 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $245.18
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: TRANSVAGINAL US NON-OB	Not listed in the file	Not listed in the file	$54.71 – $396.84
Transvaginal ultrasound: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $197.73
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD UNI	$219	$116.07	$63.26 – $205.70
Diagnostic mammogram, one breast: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $119.90 HUMANA HMO POS — 1127_HUMANA 20221001: $205.70 HUMANA PPO — 1133_HUMANA PPO 20221001: $205.70 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $205.70 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $205.70
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$63.26 – $432.55
Diagnostic mammogram, one breast: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $432.55 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $205.70 HUMANA HMO POS — 1127_HUMANA 20221001: $205.70 HUMANA PPO — 1133_HUMANA PPO 20221001: $351.19 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $351.19 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $205.70
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: DX MAMMO INCL CAD UNI	Not listed in the file	Not listed in the file	$63.26 – $432.55
Diagnostic mammogram, one breast: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $206.28
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: HC DX MAMMO INCL CAD BI	$275	$145.75	$78.03 – $263
Diagnostic mammogram, both breasts: rates for 3 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $151.61 HUMANA HMO POS — 1127_HUMANA 20221001: $263 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $263
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$78.03 – $548.90
Diagnostic mammogram, both breasts: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $548.90 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $263 HUMANA HMO POS — 1127_HUMANA 20221001: $263 HUMANA PPO — 1133_HUMANA PPO 20221001: $443.11 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $443.11 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $263
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: DX MAMMO INCL CAD BI	Not listed in the file	Not listed in the file	$78.03 – $548.90
Diagnostic mammogram, both breasts: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $260.46
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: HC SCREEN MAMMO BI INCL CAD	$217	$115.01	$59.82 – $151.23
Screening mammogram, both breasts: rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $122.37
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$59.82 – $443.07
Screening mammogram, both breasts: rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $443.07 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $217.46 HUMANA HMO POS — 1127_HUMANA 20221001: $217.46 HUMANA PPO — 1133_HUMANA PPO 20221001: $358.37 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $358.37 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $217.46
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: SCR MAMMO BI INCL CAD	Not listed in the file	Not listed in the file	$59.82 – $443.07
Screening mammogram, both breasts: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $211.06

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	$23.29 – $60.31
Electrocardiogram (ECG/EKG) with reading: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $54.19 HUMANA HMO POS — 1127_HUMANA 20221001: $60.31 HUMANA PPO — 1133_HUMANA PPO 20221001: $60.31 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $60.31 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $60.31
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$23.29 – $60.31
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $23.29
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Inpatient or outpatient · modifier TC In the file: ELECTROCARDIOGRAM COMPLETE	Not listed in the file	Not listed in the file	$23.29 – $60.31
Electrocardiogram (ECG/EKG) with reading: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $23.29
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: HC PBB LEFT HRT CATH W/VENTRCLGRPHY	$2,813	$1,490.89	$359.09 – $2,806.62
Left heart catheterization (diagnostic): rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $2,806.62
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: HC PBB LEFT HRT CATH W/VENTRCLGRPHY	$2,813	$1,490.89	$359.09 – $2,806.62
Left heart catheterization (diagnostic): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $1,459.84
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	$359.09 – $22,129
Left heart catheterization (diagnostic): rates for 9 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $2,806.62 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $9,908 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $11,009 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $7,264 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $22,129 HUMANA HMO POS — 1127_HUMANA 20221001: $3,243.68 HUMANA PPO — 1133_HUMANA PPO 20221001: $3,243.68 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $3,243.68 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $3,243.68
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	$531.52 – $33,027
Heart rhythm study (electrophysiology evaluation): rates for 9 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $2,263.24 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $14,788 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $16,431 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,842 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $33,027 HUMANA HMO POS — 1127_HUMANA 20221001: $2,491.13 HUMANA PPO — 1133_HUMANA PPO 20221001: $18,652 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $18,652 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $16,122
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Inpatient or outpatient In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$531.52 – $33,027
Heart rhythm study (electrophysiology evaluation): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $1,122.83
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · modifier TC In the file: COMPREHENSIVE EP EVALUATION	Not listed in the file	Not listed in the file	$531.52 – $33,027
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $974.52 HUMANA HMO POS — 1127_HUMANA 20221001: $1,116.14 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,116.14 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,116.14 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,116.14
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	$1,443.40 – $33,027
Heart rhythm study with ablation for atrial fibrillation: rates for 10 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $3,597.23 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $14,788 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $16,431 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,842 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $33,027 HUMANA HMO POS — 1127_HUMANA 20221001: $4,323.37 HUMANA PPO — 1133_HUMANA PPO 20221001: $18,652 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $18,652 HUMANA WVN — 1135_HUMANA WVN 20221001: $18,026 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $16,122
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Inpatient or outpatient In the file: COMPRE EP EVAL ABLTJ ATR FIB	Not listed in the file	Not listed in the file	$1,443.40 – $33,027
Heart rhythm study with ablation for atrial fibrillation: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $1,443.40
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: HC PBB POLYSOMNOGRAPHY 4 OR MORE	$2,586	$1,370.58	$193.44 – $2,388
Sleep study (overnight, in a sleep lab): rates for 6 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,991.35 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $2,388 HUMANA HMO POS — 1127_HUMANA 20221001: $2,181.15 HUMANA PPO — 1133_HUMANA PPO 20221001: $2,181.15 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $2,181.15 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $2,181.15
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: HC PBB POLYSOMNOGRAPHY 4 OR MORE	$2,586	$1,370.58	$193.44 – $2,388
Sleep study (overnight, in a sleep lab): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $991.71
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	$193.44 – $5,429
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $1,991.35 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $3,257 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $3,619 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $2,388 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $5,429 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $1,829 HUMANA HMO POS — 1127_HUMANA 20221001: $2,181.15 HUMANA PPO — 1133_HUMANA PPO 20221001: $3,933 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $3,933 HUMANA WVN — 1135_HUMANA WVN 20221001: $995

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: HC 97110 THERAPEUTIC EXERCI	$126	$66.78	$37.41 – $104.21
Physical therapy: therapeutic exercise (each 15 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $104.21 HUMANA HMO POS — 1127_HUMANA 20221001: $37.41 HUMANA PPO — 1133_HUMANA PPO 20221001: $37.41 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $37.41 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $37.41
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: HC 97110 THERAPEUTIC EXERCI	$126	$66.78	$37.41 – $104.21
Physical therapy: therapeutic exercise (each 15 minutes): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $49.10
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: THERAPEUTIC EXERCISES	Not listed in the file	Not listed in the file	$37.41 – $104.21
Physical therapy: therapeutic exercise (each 15 minutes): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $104.21 HUMANA HMO POS — 1127_HUMANA 20221001: $37.41 HUMANA PPO — 1133_HUMANA PPO 20221001: $37.41 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $37.41 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $37.41
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	$104.53 – $259.22
Physical therapy evaluation (low complexity): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $259.22 HUMANA HMO POS — 1127_HUMANA 20221001: $104.53 HUMANA PPO — 1133_HUMANA PPO 20221001: $104.53 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $104.53 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $104.53
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: PT EVAL LOW COMPLEX 20 MIN	Not listed in the file	Not listed in the file	$104.53 – $259.22
Physical therapy evaluation (low complexity): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $167.16
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	$104.53 – $259.22
Physical therapy evaluation (moderate complexity): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $259.22 HUMANA HMO POS — 1127_HUMANA 20221001: $104.53 HUMANA PPO — 1133_HUMANA PPO 20221001: $104.53 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $104.53 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $104.53
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: PT EVAL MOD COMPLEX 30 MIN	Not listed in the file	Not listed in the file	$104.53 – $259.22
Physical therapy evaluation (moderate complexity): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $167.16
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	$104.53 – $259.22
Physical therapy evaluation (high complexity): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $259.22 HUMANA HMO POS — 1127_HUMANA 20221001: $104.53 HUMANA PPO — 1133_HUMANA PPO 20221001: $104.53 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $104.53 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $104.53
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: PT EVAL HIGH COMPLEX 45 MIN	Not listed in the file	Not listed in the file	$104.53 – $259.22
Physical therapy evaluation (high complexity): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $167.16
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	$110.70 – $254.82
Psychotherapy, 30 minutes: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $207.80 HUMANA HMO POS — 1127_HUMANA 20221001: $254.82 HUMANA PPO — 1133_HUMANA PPO 20221001: $254.82 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $254.82 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $254.82
Psychotherapy, 30 minutes CPT 90832 · Inpatient or outpatient In the file: PSYTX W PT 30 MINUTES	Not listed in the file	Not listed in the file	$110.70 – $254.82
Psychotherapy, 30 minutes: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $110.70
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	$146.54 – $338.92
Psychotherapy, 45 minutes: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $276.14 HUMANA HMO POS — 1127_HUMANA 20221001: $338.92 HUMANA PPO — 1133_HUMANA PPO 20221001: $338.92 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $338.92 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $338.92
Psychotherapy, 45 minutes CPT 90834 · Inpatient or outpatient In the file: PSYTX W PT 45 MINUTES	Not listed in the file	Not listed in the file	$146.54 – $338.92
Psychotherapy, 45 minutes: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $146.54
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	$215.66 – $507.97
Psychotherapy, 60 minutes: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $413.99 HUMANA HMO POS — 1127_HUMANA 20221001: $507.97 HUMANA PPO — 1133_HUMANA PPO 20221001: $507.97 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $507.97 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $507.97
Psychotherapy, 60 minutes CPT 90837 · Inpatient or outpatient In the file: PSYTX W PT 60 MINUTES	Not listed in the file	Not listed in the file	$215.66 – $507.97
Psychotherapy, 60 minutes: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $215.66
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	$158.13 – $372.52
Family psychotherapy, without the patient: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $334.95 HUMANA HMO POS — 1127_HUMANA 20221001: $372.52 HUMANA PPO — 1133_HUMANA PPO 20221001: $372.52 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $372.52 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $372.52
Family psychotherapy, without the patient CPT 90846 · Inpatient or outpatient In the file: FAMILY PSYTX W/O PT 50 MIN	Not listed in the file	Not listed in the file	$158.13 – $372.52
Family psychotherapy, without the patient: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $158.13
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	$164.99 – $385.84
Family psychotherapy, with the patient: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $346.76 HUMANA HMO POS — 1127_HUMANA 20221001: $385.84 HUMANA PPO — 1133_HUMANA PPO 20221001: $385.84 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $385.84 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $385.84
Family psychotherapy, with the patient CPT 90847 · Inpatient or outpatient In the file: FAMILY PSYTX W/PT 50 MIN	Not listed in the file	Not listed in the file	$164.99 – $385.84
Family psychotherapy, with the patient: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $164.99
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$38.73 – $101.20
Group psychotherapy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $83.52 HUMANA HMO POS — 1127_HUMANA 20221001: $101.20 HUMANA PPO — 1133_HUMANA PPO 20221001: $101.20 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $101.20 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $101.20
Group psychotherapy CPT 90853 · Inpatient or outpatient In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$38.73 – $101.20
Group psychotherapy: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $38.73

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	$650.57 – $1,954.63
Removal of breast growth (open surgery): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,714.29 HUMANA HMO POS — 1127_HUMANA 20221001: $1,954.63 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,954.63 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,954.63 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,954.63
Removal of breast growth (open surgery) CPT 19120 · Inpatient or outpatient In the file: REMOVAL OF BREAST LESION	Not listed in the file	Not listed in the file	$650.57 – $1,954.63
Removal of breast growth (open surgery): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $650.57
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	$4,772.25 – $28,491.48
Total hip replacement: rates for 7 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $4,772.25 HUMANA HMO POS — 1127_HUMANA 20221001: $5,280.96 HUMANA PPO — 1133_HUMANA PPO 20221001: $5,280.96 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $5,280.96 NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $19,879 TRILOGY — 1070_TRILOGY 20220101: $28,491.48 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $5,280.96
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	$4,771.23 – $28,491.48
Total knee replacement: rates for 7 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $4,771.23 HUMANA HMO POS — 1127_HUMANA 20221001: $5,275.80 HUMANA PPO — 1133_HUMANA PPO 20221001: $5,275.80 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $5,275.80 NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $19,879 TRILOGY — 1070_TRILOGY 20220101: $28,491.48 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $5,275.80
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	$267.05 – $678.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $614.78 HUMANA HMO POS — 1127_HUMANA 20221001: $678.88 HUMANA PPO — 1133_HUMANA PPO 20221001: $678.88 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $678.88 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $678.88
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Inpatient or outpatient In the file: SHO ARTHRS SRG DECOMPRESSION	Not listed in the file	Not listed in the file	$267.05 – $678.88
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $267.05
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	$864.13 – $2,117.45
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,910.78 HUMANA HMO POS — 1127_HUMANA 20221001: $2,117.45 HUMANA PPO — 1133_HUMANA PPO 20221001: $2,117.45 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $2,117.45 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $2,117.45
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Inpatient or outpatient In the file: KNEE ARTHROSCOPY/SURGERY	Not listed in the file	Not listed in the file	$864.13 – $2,117.45
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $864.13
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	$469.95 – $1,138.86
Removal of tonsils and adenoids (under age 12): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,040.46 HUMANA HMO POS — 1127_HUMANA 20221001: $1,138.86 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,138.86 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,138.86 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,138.86
Removal of tonsils and adenoids (under age 12) CPT 42820 · Inpatient or outpatient In the file: REMOVE TONSILS AND ADENOIDS	Not listed in the file	Not listed in the file	$469.95 – $1,138.86
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $469.95
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: HC PBB UPPR GI ENDOSCOPY DIAGNOSIS	$4,122	$2,184.66	$193.51 – $1,112.21
Upper GI endoscopy (diagnostic): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,093.82 HUMANA HMO POS — 1127_HUMANA 20221001: $1,112.21 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,112.21 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,112.21 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,112.21
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: HC PBB UPPR GI ENDOSCOPY DIAGNOSIS	$4,122	$2,184.66	$193.51 – $1,112.21
Upper GI endoscopy (diagnostic): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $193.51
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	$193.51 – $1,112.21
Upper GI endoscopy (diagnostic): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,093.82 HUMANA HMO POS — 1127_HUMANA 20221001: $1,112.21 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,112.21 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,112.21 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,112.21
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: HC PBB UPPER GI ENDOSCOPY BIOPSY	$4,375	$2,318.75	$218.45 – $1,484.73
Upper GI endoscopy with biopsy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,396.27 HUMANA HMO POS — 1127_HUMANA 20221001: $1,484.73 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,484.73 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,484.73 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,484.73
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: HC PBB UPPER GI ENDOSCOPY BIOPSY	$4,375	$2,318.75	$218.45 – $1,484.73
Upper GI endoscopy with biopsy: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $218.45
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	$218.45 – $1,484.73
Upper GI endoscopy with biopsy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,396.27 HUMANA HMO POS — 1127_HUMANA 20221001: $1,484.73 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,484.73 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,484.73 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,484.73
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: HC PBB DIAGNOSTIC COLONOSCOPY	$3,833	$2,031.49	$290.63 – $1,330.60
Colonoscopy (diagnostic): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,330.60 HUMANA HMO POS — 1127_HUMANA 20221001: $1,309.34 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,309.34 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,309.34 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,309.34
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: HC PBB DIAGNOSTIC COLONOSCOPY	$3,833	$2,031.49	$290.63 – $1,330.60
Colonoscopy (diagnostic): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $290.63
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$290.63 – $1,330.60
Colonoscopy (diagnostic): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,330.60 HUMANA HMO POS — 1127_HUMANA 20221001: $1,309.34 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,309.34 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,309.34 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,309.34
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: HC PBB COLONOSCOPY AND BIOPSY	$4,161	$2,205.33	$316.47 – $1,692.15
Colonoscopy with biopsy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,647.72 HUMANA HMO POS — 1127_HUMANA 20221001: $1,692.15 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,692.15 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,692.15 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,692.15
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: HC PBB COLONOSCOPY AND BIOPSY	$4,161	$2,205.33	$316.47 – $1,692.15
Colonoscopy with biopsy: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $316.47
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	$316.47 – $1,692.15
Colonoscopy with biopsy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,647.72 HUMANA HMO POS — 1127_HUMANA 20221001: $1,692.15 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,692.15 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,692.15 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,692.15
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: HC PBB LESION REMOVAL COLONOSCOPY	$4,161	$2,205.33	$400.74 – $1,765.38
Colonoscopy with removal of polyps (snare): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,727.03 HUMANA HMO POS — 1127_HUMANA 20221001: $1,765.38 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,765.38 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,765.38 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,765.38
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: HC PBB LESION REMOVAL COLONOSCOPY	$4,161	$2,205.33	$400.74 – $1,765.38
Colonoscopy with removal of polyps (snare): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $400.74
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	$400.74 – $1,765.38
Colonoscopy with removal of polyps (snare): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,727.03 HUMANA HMO POS — 1127_HUMANA 20221001: $1,765.38 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,765.38 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,765.38 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,765.38
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	$407.32 – $1,032.87
Ultrasound of the lower bowel by endoscope: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $954.34 HUMANA HMO POS — 1127_HUMANA 20221001: $1,032.87 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,032.87 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,032.87 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,032.87
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient In the file: COLONOSCOPY W/ENDOSCOPE US	Not listed in the file	Not listed in the file	$407.32 – $1,032.87
Ultrasound of the lower bowel by endoscope: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $407.32
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: HC PBB COLORECTAL SCREEN NOT HIH	$3,592	$1,903.76	$290.80 – $1,309.79
Screening colonoscopy (not high risk): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $558.71 HUMANA HMO POS — 1127_HUMANA 20221001: $1,309.79 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,309.79 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,309.79 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,309.79
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient In the file: HC PBB COLORECTAL SCREEN NOT HIH	$3,592	$1,903.76	$290.80 – $1,309.79
Screening colonoscopy (not high risk): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $290.80
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	$1,017.79 – $2,541.75
Gallbladder removal by laparoscope: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $2,296.78 HUMANA HMO POS — 1127_HUMANA 20221001: $2,541.75 HUMANA PPO — 1133_HUMANA PPO 20221001: $2,541.75 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $2,541.75 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $2,541.75
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$1,017.79 – $2,541.75
Gallbladder removal by laparoscope: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $1,017.79
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	$810.53 – $2,014.90
Groin (inguinal) hernia repair, age 5 or older: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,816.95 HUMANA HMO POS — 1127_HUMANA 20221001: $2,014.90 HUMANA PPO — 1133_HUMANA PPO 20221001: $2,014.90 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $2,014.90 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $2,014.90
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Inpatient or outpatient In the file: PRP I/HERN INIT REDUC >5 YR	Not listed in the file	Not listed in the file	$810.53 – $2,014.90
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $810.53
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: HC 55700 BIOPSY OF PROSTATE	$515	$272.95	$204.71
Prostate biopsy: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $204.71
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$204.71 – $988.47
Prostate biopsy: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $765.88 HUMANA HMO POS — 1127_HUMANA 20221001: $988.47 HUMANA PPO — 1133_HUMANA PPO 20221001: $988.47 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $988.47 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $988.47
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$204.71 – $988.47
Prostate biopsy: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $204.71
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,891.83 – $5,769.73
Prostate removal by laparoscope (radical prostatectomy): rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $4,993.68 HUMANA HMO POS — 1127_HUMANA 20221001: $5,769.73 HUMANA PPO — 1133_HUMANA PPO 20221001: $5,769.73 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $5,769.73 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $5,769.73
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Inpatient or outpatient In the file: LAPS SURG PRST8ECT RPBIC RAD	Not listed in the file	Not listed in the file	$1,891.83 – $5,769.73
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $1,891.83
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient In the file: HC PBB HYSTEROSCOPY BIOPSY	$395	$209.35	$363.80
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $363.80
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	$363.80 – $5,534.18
Hysteroscopy with biopsy of the uterus lining: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,417.34 HUMANA HMO POS — 1127_HUMANA 20221001: $5,534.18 HUMANA PPO — 1133_HUMANA PPO 20221001: $5,534.18 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $5,534.18 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $5,534.18
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Inpatient or outpatient In the file: HYSTEROSCOPY BIOPSY	Not listed in the file	Not listed in the file	$363.80 – $5,534.18
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $363.80
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: HC PBB NJX INTERLAMINAR LMBR/SAC	$564	$298.92	$158.39
Spinal injection, lower back (epidural), with imaging guidance: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $158.39
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	$158.39 – $1,020.57
Spinal injection, lower back (epidural), with imaging guidance: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $858.77 HUMANA HMO POS — 1127_HUMANA 20221001: $1,020.57 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,020.57 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,020.57 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,020.57
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: NJX INTERLAMINAR LMBR/SAC	Not listed in the file	Not listed in the file	$158.39 – $1,020.57
Spinal injection, lower back (epidural), with imaging guidance: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $158.39
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: HC PBB INJ FORAMEN EPIDURAL L/S	$850	$450.50	$177.84 – $782.10
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan ALLIANCE — 1066_ALLIANCE 20220101: $782.10
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: HC PBB INJ FORAMEN EPIDURAL L/S	$850	$450.50	$177.84 – $782.10
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $177.84
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$177.84 – $942.67
Nerve root injection, lower back, with imaging guidance: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $782.10 HUMANA HMO POS — 1127_HUMANA 20221001: $942.67 HUMANA PPO — 1133_HUMANA PPO 20221001: $942.67 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $942.67 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $942.67
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	$701.18 – $1,709.33
Carpal tunnel release: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,516.13 HUMANA HMO POS — 1127_HUMANA 20221001: $1,709.33 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,709.33 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,709.33 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,709.33
Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$701.18 – $1,709.33
Carpal tunnel release: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $701.18
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	$503.64 – $1,321.64
Laser treatment of clouding after cataract surgery: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $1,161.73 HUMANA HMO POS — 1127_HUMANA 20221001: $1,321.64 HUMANA PPO — 1133_HUMANA PPO 20221001: $1,321.64 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $1,321.64 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $1,321.64
Laser treatment of clouding after cataract surgery CPT 66821 · Inpatient or outpatient In the file: AFTER CATARACT LASER SURGERY	Not listed in the file	Not listed in the file	$503.64 – $1,321.64
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $503.64
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	$876.11 – $2,238.32
Cataract removal with lens implant: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $2,238.32 HUMANA HMO POS — 1127_HUMANA 20221001: $2,175.79 HUMANA PPO — 1133_HUMANA PPO 20221001: $2,175.79 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $2,175.79 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $2,175.79
Cataract removal with lens implant CPT 66984 · Inpatient or outpatient In the file: XCAPSL CTRC RMVL W/O ECP	Not listed in the file	Not listed in the file	$876.11 – $2,238.32
Cataract removal with lens implant: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $876.11

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	$3,679.41 – $7,260.16
Vaginal delivery, with care before and after: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $7,260.16 HUMANA HMO POS — 1127_HUMANA 20221001: $6,106.32 HUMANA PPO — 1133_HUMANA PPO 20221001: $6,106.32 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $6,106.32 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $6,106.32
Vaginal delivery, with care before and after CPT 59400 · Inpatient or outpatient In the file: OBSTETRICAL CARE	Not listed in the file	Not listed in the file	$3,679.41 – $7,260.16
Vaginal delivery, with care before and after: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $3,679.41
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	$4,030.28 – $8,036.76
Cesarean delivery (C-section), with care before and after: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $8,036.76 HUMANA HMO POS — 1127_HUMANA 20221001: $6,721.64 HUMANA PPO — 1133_HUMANA PPO 20221001: $6,721.64 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $6,721.64 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $6,721.64
Cesarean delivery (C-section), with care before and after CPT 59510 · Inpatient or outpatient In the file: CESAREAN DELIVERY	Not listed in the file	Not listed in the file	$4,030.28 – $8,036.76
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $4,030.28
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	$3,812.34 – $7,616.34
Vaginal delivery after a previous C-section, with care before and after: rates for 5 insurance plans ALLIANCE — 1066_ALLIANCE 20220101: $7,616.34 HUMANA HMO POS — 1127_HUMANA 20221001: $6,368.89 HUMANA PPO — 1133_HUMANA PPO 20221001: $6,368.89 HUMANA PREFERRED — 1134_HUMANA PREFERRED 20221001: $6,368.89 UHC NON OPTIONS PPO — 1130_UNITED HEALTH CARE NONOPTIONS 20221001: $6,368.89
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Inpatient or outpatient In the file: VBAC DELIVERY	Not listed in the file	Not listed in the file	$3,812.34 – $7,616.34
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan NETWORK HEALTH PLAN — 1136_NETWORK HEALTH PLAN 20221001: $3,812.34

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	$10,022 – $21,788
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 24 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $14,865 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $13,670 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15,189 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,022 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $21,788 ARISE — 1123_ARISE PREMIER MCWI OCWI 20221001: $17,737 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $14,524 CENTIVO — 1125_CENTIVO 20221001: $17,688 HEALTH PAYMENT SYSTEMS — 1126_HEALTH PAYMENT SYSTEMS 20221001: $15,215 HUMANA HMO POS — 1127_HUMANA 20221001: $18,957
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	$10,022 – $21,788
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $14,865 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $13,670 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15,189 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,022 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $21,788 ARISE — 1123_ARISE PREMIER MCWI OCWI 20221001: $17,737 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $14,524 CENTIVO — 1125_CENTIVO 20221001: $17,688 HEALTH PAYMENT SYSTEMS — 1126_HEALTH PAYMENT SYSTEMS 20221001: $15,215 HUMANA HMO POS — 1127_HUMANA 20221001: $18,957
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	$10,022 – $21,788
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $14,865 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $13,670 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15,189 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,022 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $21,788 ARISE — 1123_ARISE PREMIER MCWI OCWI 20221001: $17,737 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $14,524 CENTIVO — 1125_CENTIVO 20221001: $17,688 HEALTH PAYMENT SYSTEMS — 1126_HEALTH PAYMENT SYSTEMS 20221001: $15,215 HUMANA HMO POS — 1127_HUMANA 20221001: $18,957
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	$10,022 – $21,788
Uterus and ovary surgery (not for cancer), without complications: 10 of 24 insurance plan rates ALLIANCE — 1066_ALLIANCE 20220101: $14,865 ANTHEM BLUE CONNECTION — 1117_ANTHEM BLUE CONNECTION 20221001: $13,670 ANTHEM HMO POS — 1120_ANTHEM HMO POS 20221001: $15,189 ANTHEM PATHWAYS — 1121_ANTHEM PATHWAYS 20221001: $10,022 ANTHEM PPO — 1122_ANTHEM PPO 20221001: $21,788 ARISE — 1123_ARISE PREMIER MCWI OCWI 20221001: $17,737 CCHP MARKETPLACE — 1124_CCHP MARKETPLACE 20221001: $14,524 CENTIVO — 1125_CENTIVO 20221001: $17,688 HEALTH PAYMENT SYSTEMS — 1126_HEALTH PAYMENT SYSTEMS 20221001: $15,215 HUMANA HMO POS — 1127_HUMANA 20221001: $18,957

Source: Ascension Sacred Heart Rehabilitation Hospital’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 5, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Inpatient Rehabilitation Hospital
Address	13111 N Port Washington Rd Second Floor, Mequon, WI 53097
County	Ozaukee County
State	Wisconsin
Phone	(262) 292‑0400
Ownership	Non-profit
CMS Certification Number	523025
Name in Medicare records	ASCENSION SACRED HEART REHABILITATION HOSPITAL
Profile level	Medicare data + hospital website
Official website	healthcare.ascension.org
Corrections	Report an error or suggest an update →

Sources

Inpatient Rehabilitation Facility - General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-08-12, retrieved 2026-10-29
Medicare Care Compare — official Medicare tool to look up and compare this type of hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

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

Ascension Sacred Heart Rehabilitation Hospital | Ascension — healthcare.ascension.org

Ascension Sacred Heart Rehabilitation Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas^[4]

Conditions treated^[4]

Treatments^[4]

Programs and centers^[4]

Nearest emergency rooms

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Hospice providers

Home health agencies

Dialysis facilities

Outpatient surgery centers nearby

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital stays (whole stay, MS-DRG)

Hospital information

Sources

From the hospital’s website

Ascension Sacred Heart Rehabilitation Hospital

Summary

Profile from official sources

At a glance

Quick answers

Specialties and care areas[4]

Conditions treated[4]

Treatments[4]

Programs and centers[4]

Nearest emergency rooms

Other hospitals nearby

Nursing homes, hospice, home health and dialysis nearby

Nursing homes

Hospice providers

Home health agencies

Dialysis facilities

Outpatient surgery centers nearby

Community care nearby

Community health centers

Clinics and urgent care

Pharmacies

Assisted living nearby

ER wait times and Medicare ratings nearby

Prices

Office and emergency visits

Lab tests

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

Heart tests and sleep study

Physical therapy and mental health

Procedures and surgery

Pregnancy and childbirth

Hospital stays (whole stay, MS-DRG)

Hospital information

Sources

From the hospital’s website

Specialties and care areas^[4]

Conditions treated^[4]

Treatments^[4]

Programs and centers^[4]