Does Ascension Seton Smithville have an emergency room?

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

Where is Ascension Seton Smithville?

1201 Hill Rd, Smithville, TX 78957, in Bastrop County, Texas.

What is the phone number of Ascension Seton Smithville?

(512) 237-3214, as listed by Medicare (CMS).

What is the Medicare star rating of Ascension Seton Smithville?

CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Ascension Seton Smithville — Phone, Address & ER

Quick answers

Does Ascension Seton Smithville have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Ascension Seton Smithville. In a medical emergency, call 911.
Where is Ascension Seton Smithville?: 1201 Hill Rd, Smithville, TX 78957, in Bastrop County, Texas.
What is the phone number of Ascension Seton Smithville?: (512) 237-3214, as listed by Medicare (CMS).
What is the Medicare star rating of Ascension Seton Smithville?: CMS does not show an overall star rating for this hospital. This is common, for example when a hospital reports too few quality measures or is not part of the rating program.

Specialties and care areas^[4][5]

Conditions treated^[5]

Heart attack
Stroke
Concussion
Broken bones
Chest pain
Major trauma
Severe burns
Shortness of breath

Treatments^[4]

Injection and infusion therapy
Hydration therapy

Procedures^[4]

Minimally invasive general surgery

Programs and centers^[4]

Infusion suite (Tue and Thu, 9 a.m.-5 p.m.)

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

Emergency room	Yes
Open 24/7	Yes

Visiting and practical information

Interpreters and languages	Language assistance page with interpreter links for Spanish, Arabic, Polish, Haitian Creole, Vietnamese and more^[4]
Patient portal	Patient Portal

Doctors and clinicians (46)

46 doctors and other clinicians list Ascension Seton Smithville as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (46)

Adila Chaudhry, MDInternal Medicine
Akhil Vats, MDFamily Practice
Alison L. Smiley, CNACertified Registered Nurse Anesthetist (CRNA)
Amanda C. Westwood, PAPhysician Assistant
Amanda Rosenauer, NPNurse Practitioner
Amy J. Gutierrez, MDFamily Practice
Austin Al-Kazaz, MDFamily Practice
Bartlomiej Posnik, MDHematology/Oncology
Bradley M. Homza, PAPhysician Assistant
Brent Porter, MDInternal Medicine
Courtney P. Robinson, NPNurse Practitioner
David B. Tharp, MDDiagnostic Radiology
David C. Folkers, MDGeneral Surgery
Denise Culpepper, NPNurse Practitioner
Desmar Walkes, MDGeneral Practice
Elizabeth Pollock, MDFamily Practice
Elsa S. Varkey, NPNurse Practitioner
Hanna F. Pilat, PAPhysician Assistant
Hans J. Raj, MDFamily Practice
Hanzy Bustamante, MDInternal Medicine
Ivan R. Nepustil, MDInternal Medicine
Julie M. Sprunt, MDSurgical Oncology
Kareem A. Hinedi, MDInternal Medicine
Karsyn Stark, NPNurse Practitioner

And 22 more: the button below opens the full list.

Other emergency rooms nearby

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

Memorial Hospital38 mi · Gonzales, TX · Acute Care Hospital
Ascension Seton Edgar B Davis39 mi · Luling, TX · Critical Access Hospital
Lavaca Medical Center39 mi · Hallettsville, TX · Critical Access Hospital
Dell Children's Medical Center40 mi · Austin, TX · Children's Hospital
Dell Seton Medical Center at the University of TX40 mi · Austin, TX · Acute Care Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Smithville

Post Acute Medical at Luling LLC39 mi · Luling, TX · Long-Term Acute Care Hospital
Cross Creek Hospital40 mi · Austin, TX · Psychiatric Hospital

Hospitals in Bastrop County · Hospitals near me

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

Towers Nursing Home0.1 mi · Smithville, TX · 4 of 5 stars
Windsor Nursing and Rehabilitation Center of Bastr14 mi · Bastrop, TX · 2 of 5 stars
Bastrop Lost Pines Nursing and Rehabilitation Cent14 mi · Bastrop, TX · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Serenity Hospice15 mi · Bastrop, TX

All hospice providers in the state →

Home health agencies

Jol Healthcare15 mi · Bastrop, TX · 3 of 5 stars

All home health agencies in the state →

Dialysis facilities

Fresenius Medical Care East Bastrop15 mi · Bastrop, TX · 4 of 5 stars
NNA Bastrop15 mi · Bastrop, TX · 3 of 5 stars

All dialysis facilities 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

Bastrop Community Health Center12 mi · Bastrop, TX · Community health center
Bastrop ISD Health Center13 mi · Bastrop, TX · Community health center
CommUnityCare Bastrop14 mi · Bastrop, TX · Community health center

Clinics and urgent care

Ascension Seton Smithville Health Center2.9 mi · Smithville, TX · Rural health clinic
Ascension Seton Bastrop Health Center15 mi · Bastrop, TX · Rural health clinic
Fast Track Urgent Care15 mi · Bastrop, TX · Urgent care center

Pharmacies

Bayer Pharmacy Inc2.9 mi · Smithville, TX · Community/retail pharmacy
Brookshire Brothers Inc2.9 mi · Smithville, TX · Community/retail pharmacy
Hunterpharm Inc2.9 mi · Smithville, TX · Community/retail pharmacy

Assisted living nearby

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

Argent Bastrop Operations LLC15 mi · Bastrop, TX
New Haven Assisted Living of Bastrop15 mi · Bastrop, TX

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Ascension Seton Smithville reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Average (median) time patients spent in the emergency room before leaving (OP-18b)	117 minutesNational average: 162 minutes
Not reported to Medicare	Patients who left the emergency room before being seen (OP-22); Sepsis patients who got all the recommended early care (SEP-1)

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Not reported to Medicare: the patient survey, infections caught in the hospital, complications and deaths, readmissions. For these topics Medicare shows no result for this hospital (not reported, or too few cases).

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Texas Best hospitals in Texas

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 85 common services exactly as Ascension Seton Smithville 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 →

Show the prices of 85 common services

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	$75.13 – $321.54
New patient office visit (about 30–44 minutes): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $132.49 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $290.55 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $263.43 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $263.43 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $321.54 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $75.13 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $77.21
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	$127.40 – $544.40
New patient office visit (about 45–59 minutes): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $224.32 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $491.93 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $446.01 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $446.01 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $544.40 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $127.40 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $130.52
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	$166.28 – $710.44
New patient office visit (about 60–74 minutes): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $292.73 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $641.96 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $582.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $582.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $710.44 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $166.28 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $170.44
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	$50.49 – $215.39
Established patient office visit (about 20–29 minutes): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $88.75 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $194.63 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $176.46 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $176.46 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $215.39 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $50.49 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $51.87
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	$77.89 – $332.04
Established patient office visit (about 30–39 minutes): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $136.82 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $300.04 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $272.03 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $272.03 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $332.04 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $77.89 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $79.48
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	$94.91 – $403.84
Office consultation with a specialist (moderate): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $166.40 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $364.91 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $330.85 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $330.85 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $403.84 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $94.91 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $96.73
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	$152.54 – $649.10
Office consultation with a specialist (moderate to high): rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $267.46 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $586.54 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $531.79 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $531.79 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $649.10 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $152.54 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $155.46
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	$97.03 – $412.80
Preventive checkup, new patient, age 18–39: rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $170.09 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $373.01 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $338.20 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $338.20 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $412.80 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $97.03 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $99.28
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	$118.07 – $502.52
Preventive checkup, new patient, age 40–64: rates for 7 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $207.06 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $454.09 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $411.71 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $411.71 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $502.52 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $118.07 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $120.73
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: VISIT ER III W/25	$932	$335.52	$11.12 – $932
Emergency room visit (moderate): 10 of 59 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,009 AETNA HMO — 4486_AETNA HMO 20250801: $1,301 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $902 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,009 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,041 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $359.58 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $51.36
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: VISIT ER LVL III	$625	$225	$11.12 – $625
Emergency room visit (moderate): 10 of 42 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,009 AETNA HMO — 4486_AETNA HMO 20250801: $1,301 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,009 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,041 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $359.58 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $51.36 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,295
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: EXAM BY MD OR SANE	$257	$92.52	$11.12 – $257
Emergency room visit (moderate): 10 of 32 insurance plan rates BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.36 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $51.36 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $24 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.36 BCBS STAR KIDS — 5015_BLUE CROSS STAR KIDS (SMV) OUTPATIENT 20241201: $51.36 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $257 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $257 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $115.65
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: VISIT ER IV W/25	$2,453.50	$883.26	$200 – $2,453.50
Emergency room visit (moderately high): 10 of 59 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,325 AETNA HMO — 4486_AETNA HMO 20250801: $1,710 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $1,185 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,325 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,368 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $566.38 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $354.53 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $354.53 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $211.98 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $211.98
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: VISIT ER LVL IV	$3,048	$1,097.28	$200 – $3,048
Emergency room visit (moderately high): 10 of 51 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,325 AETNA HMO — 4486_AETNA HMO 20250801: $1,710 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,325 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,368 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $566.38 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $440.44 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $440.44 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $263.35 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $263.35 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,040
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: VISIT ER IV W/25	$2,453.50	$883.26	$200 – $2,453.50
Emergency room visit (moderately high): 10 of 25 insurance plan rates BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $354.53 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $264.98 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $354.53 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $264.98 DELL CHIP/CHIP PERINATE — 3605_DELL CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $354.53 DELL CHIP/CHIP PERINATE — 3611_DELL CHIP/STAR KIDS (SMV) INPATIENT 20240901: $264.98 DELL STAR — 3704_CHIRP DELL STAR (CHI,DCN) INPATIENT 20240901: $354.53 DELL STAR — 3710_CHIRP DELL STAR (SMV) INPATIENT 20240901: $264.98 SUPERIOR AMBETTER — 3879_SUPERIOR AMBETTER (CHI,DCN) INPATIENT 20240901: $347.57 SUPERIOR AMBETTER — 3880_SUPERIOR AMBETTER (CHI,DCN) OUTPATIENT 20240901: $347.57
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: VISIT ER V W/25	$4,589.50	$1,652.22	$200 – $4,589.50
Emergency room visit (high): 10 of 59 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $2,648 AETNA HMO — 4486_AETNA HMO 20250801: $3,416 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $2,368 AETNA POS 20140601 — 235_AETNA POS 20140601: $2,648 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $2,733 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $812.26 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $663.18 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $663.18 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $396.53 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $396.53
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: VISIT ER LVL V	$4,226.50	$1,521.54	$200 – $4,226.50
Emergency room visit (high): 10 of 50 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $2,648 AETNA HMO — 4486_AETNA HMO 20250801: $3,416 AETNA POS 20140601 — 235_AETNA POS 20140601: $2,648 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $2,733 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $812.26 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $610.73 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $610.73 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $365.17 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $365.17 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $5,200
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: VISIT ER V W/25	$4,589.50	$1,652.22	$200 – $4,589.50
Emergency room visit (high): 10 of 31 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $2,693 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $2,955 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $663.18 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $495.67 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $663.18 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $495.67 DELL CHIP/CHIP PERINATE — 3605_DELL CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $663.18 DELL CHIP/CHIP PERINATE — 3611_DELL CHIP/STAR KIDS (SMV) INPATIENT 20240901: $495.67 DELL STAR — 3704_CHIRP DELL STAR (CHI,DCN) INPATIENT 20240901: $663.18 DELL STAR — 3710_CHIRP DELL STAR (SMV) INPATIENT 20240901: $495.67

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC METABOLIC PANEL	$659.75	$237.51	$7.04 – $296.89
Basic metabolic panel (blood test): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $62.89 AETNA HMO — 4486_AETNA HMO 20250801: $46.11 AETNA POS 20140601 — 235_AETNA POS 20140601: $62.89 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $36.89 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $7.11 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $7.11 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $7.11 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $36.04 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $32.66 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $32.66
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BASIC MET PANEL CA TOTL	$429.75	$154.71	$7.04 – $193.39
Basic metabolic panel (blood test): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $62.89 AETNA HMO — 4486_AETNA HMO 20250801: $46.11 AETNA POS 20140601 — 235_AETNA POS 20140601: $62.89 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $36.89 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $7.11 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $7.11 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $7.11 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $36.04 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $32.66 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $32.66
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: BASIC METABOLIC PANEL	$659.75	$237.51	$7.04 – $296.89
Basic metabolic panel (blood test): 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $24.45 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $24.45 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $7.11 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $7.11 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $8.77 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $7.11 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $7.11 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $8.77 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $8.77 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $19.67
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMP METABOLIC PANEL	$264.25	$95.13	$8.87 – $118.91
Comprehensive metabolic panel (blood test): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $78.53 AETNA HMO — 4486_AETNA HMO 20250801: $57.55 AETNA POS 20140601 — 235_AETNA POS 20140601: $78.53 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $46.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $8.87 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $8.87 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $8.87 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $44.99 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $40.76 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $40.76
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMPREH METABOLIC PANEL	$210	$75.60	$8.87 – $94.50
Comprehensive metabolic panel (blood test): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $78.53 AETNA HMO — 4486_AETNA HMO 20250801: $57.55 AETNA POS 20140601 — 235_AETNA POS 20140601: $78.53 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $46.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $8.87 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $8.87 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $8.87 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $44.99 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $40.76 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $40.76
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: COMP METABOLIC PANEL	$264.25	$95.13	$8.87 – $118.91
Comprehensive metabolic panel (blood test): 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $30.53 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $30.53 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $8.87 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $8.87 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $10.95 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $8.87 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $8.87 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $10.95 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $10.95 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $24.57
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	$83.67
Obstetric blood test panel: 10 of 17 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $260.56 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $126.34 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $208.45 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $90.84 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $203.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $184.55 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $184.55 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $225.19 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $211.13 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $249.24
Obstetric blood test panel CPT 80055 · Inpatient or outpatient In the file: OBSTETRIC PANEL	Not listed in the file	Not listed in the file	$78.89 – $405.84
Obstetric blood test panel: rates for 3 insurance plans AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $138.08 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $138.08 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $111.19
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	$433.25	$155.97	$11.25 – $194.96
Cholesterol panel (lipid panel): 10 of 53 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $99.57 AETNA HMO — 4486_AETNA HMO 20250801: $72.98 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $35.38 AETNA POS 20140601 — 235_AETNA POS 20140601: $99.57 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $58.38 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $25.44 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $11.25 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $11.25 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $11.25 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $57.04
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: LIPID PANEL	$433.25	$155.97	$11.25 – $194.96
Cholesterol panel (lipid panel): 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $38.67 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $38.67 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $11.25 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $11.25 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $13.89 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $11.25 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $11.25 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $13.89 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $13.89 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $31.14
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	$409.25	$147.33	$7.29 – $184.16
Kidney function panel: 10 of 52 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $64.58 AETNA HMO — 4486_AETNA HMO 20250801: $47.31 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $22.94 AETNA POS 20140601 — 235_AETNA POS 20140601: $64.58 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $37.84 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $16.49 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $7.29 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $7.29 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $7.29 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $36.98
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: RENAL FUNCTION PANEL	$409.25	$147.33	$7.29 – $184.16
Kidney function panel: 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $25.08 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $25.08 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $7.29 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $7.29 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $9 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $7.29 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $7.29 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $9 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $9 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $20.19
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	$453.75	$163.35	$6.86 – $204.19
Liver function panel: 10 of 52 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $60.71 AETNA HMO — 4486_AETNA HMO 20250801: $44.53 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $21.60 AETNA POS 20140601 — 235_AETNA POS 20140601: $60.71 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $35.62 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $15.52 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $6.86 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $6.86 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $6.86 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $34.80
Liver function panel CPT 80076 · Inpatient or outpatient In the file: HEPATIC FUNCTION PANEL	$453.75	$163.35	$6.86 – $204.19
Liver function panel: 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $23.60 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $23.60 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $6.86 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $6.86 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $8.48 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $6.86 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $6.86 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $8.48 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $8.48 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $19
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: UA W/MICRO	$250.75	$90.27	$2.66 – $112.84
Urine test (automated, with microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $23.54 AETNA HMO — 4486_AETNA HMO 20250801: $17.28 AETNA POS 20140601 — 235_AETNA POS 20140601: $23.54 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $13.82 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $2.66 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $2.66 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $2.66 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $13.50 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $12.24 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $12.24
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: UA W/MICRO	$250.75	$90.27	$2.66 – $112.84
Urine test (automated, with microscope): 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $9.16 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $9.16 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $2.66 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $2.66 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $3.29 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $2.66 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $2.66 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $3.29 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $3.29 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $7.37
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	$5.55
Urine test (automated, with microscope): 10 of 52 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $23.54 AETNA HMO — 4486_AETNA HMO 20250801: $17.28 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $8.38 AETNA POS 20140601 — 235_AETNA POS 20140601: $23.54 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $13.82 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $2.66 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $2.66 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $2.66 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $13.50
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: URINE DIP/NON-AUTO	$57	$20.52	$2.92 – $25.65
Urine test (manual, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $19.02 AETNA HMO — 4486_AETNA HMO 20250801: $18.97 AETNA POS 20140601 — 235_AETNA POS 20140601: $19.02 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $15.17 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $2.92 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.82 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $13.43 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $13.43
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: CLINITEST	$41	$14.76	$2.92 – $19.02
Urine test (manual, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $19.02 AETNA HMO — 4486_AETNA HMO 20250801: $18.97 AETNA POS 20140601 — 235_AETNA POS 20140601: $19.02 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $15.17 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $2.92 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.82 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $13.43 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $13.43
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: KETONE GLUCOSE SCRN	$41	$14.76	$2.92 – $19.02
Urine test (manual, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $19.02 AETNA HMO — 4486_AETNA HMO 20250801: $18.97 AETNA POS 20140601 — 235_AETNA POS 20140601: $19.02 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $15.17 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $2.92 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $2.92 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $14.82 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $13.43 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $13.43
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: SPEC GRAV UR	$140.25	$50.49	$1.89 – $63.11
Urine test (automated, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $16.68 AETNA HMO — 4486_AETNA HMO 20250801: $12.26 AETNA POS 20140601 — 235_AETNA POS 20140601: $16.68 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $9.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1.89 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $9.59 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $8.69 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $8.69
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: UA CHEM ONLY	$140.25	$50.49	$1.89 – $63.11
Urine test (automated, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $16.68 AETNA HMO — 4486_AETNA HMO 20250801: $12.26 AETNA POS 20140601 — 235_AETNA POS 20140601: $16.68 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $9.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1.89 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $9.59 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $8.69 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $8.69
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: GTT3HR/GLU/U/1HR	$140.25	$50.49	$1.89 – $63.11
Urine test (automated, without microscope): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $16.68 AETNA HMO — 4486_AETNA HMO 20250801: $12.26 AETNA POS 20140601 — 235_AETNA POS 20140601: $16.68 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $9.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1.89 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1.89 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $9.59 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $8.69 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $8.69
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA TOTAL	$248.25	$89.37	$15.45 – $136.74
PSA (prostate specific antigen) blood test: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $136.74 AETNA HMO — 4486_AETNA HMO 20250801: $100.23 AETNA POS 20140601 — 235_AETNA POS 20140601: $136.74 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $80.18 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $15.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $78.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $70.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $70.99
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA,TOTAL	$248.25	$89.37	$15.45 – $136.74
PSA (prostate specific antigen) blood test: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $136.74 AETNA HMO — 4486_AETNA HMO 20250801: $100.23 AETNA POS 20140601 — 235_AETNA POS 20140601: $136.74 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $80.18 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $15.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $78.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $70.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $70.99
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PSA TOTAL AND FREE	$101.75	$36.63	$15.45 – $100.23
PSA (prostate specific antigen) blood test: 10 of 47 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $100.23 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $80.18 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $15.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $15.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $78.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $70.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $70.99 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $86.62 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $15.45
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH	$129.50	$46.62	$7.58 – $124.97
Thyroid stimulating hormone (TSH) test: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $124.97 AETNA HMO — 4486_AETNA HMO 20250801: $91.56 AETNA POS 20140601 — 235_AETNA POS 20140601: $124.97 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $73.25 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $14.11 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $14.11 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $14.11 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $71.57 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $64.85 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $64.85
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: TSH	$129.50	$46.62	$7.58 – $124.97
Thyroid stimulating hormone (TSH) test: 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $48.54 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $48.54 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $7.58 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $7.58 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $17.43 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $7.58 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $7.58 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $17.43 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $17.43 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $39.09
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	$29.40
Thyroid stimulating hormone (TSH) test: 10 of 52 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $124.97 AETNA HMO — 4486_AETNA HMO 20250801: $91.56 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $44.42 AETNA POS 20140601 — 235_AETNA POS 20140601: $124.97 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $73.25 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $31.92 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $14.11 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $14.11 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $14.11 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $71.57
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC (COMPLETE BLOOD COUNT)	$98	$35.28	$1.99 – $57.82
Complete blood count (CBC) with differential: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $57.82 AETNA HMO — 4486_AETNA HMO 20250801: $42.35 AETNA POS 20140601 — 235_AETNA POS 20140601: $57.82 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $33.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $6.53 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $33.10 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $29.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $29.99
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: EOSINOPHIL COUNT	$98	$35.28	$1.99 – $57.82
Complete blood count (CBC) with differential: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $57.82 AETNA HMO — 4486_AETNA HMO 20250801: $42.35 AETNA POS 20140601 — 235_AETNA POS 20140601: $57.82 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $33.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $6.53 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $33.10 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $29.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $29.99
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: CBC W/AUTO DIFF	$238.75	$85.95	$1.99 – $107.44
Complete blood count (CBC) with differential: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $57.82 AETNA HMO — 4486_AETNA HMO 20250801: $42.35 AETNA POS 20140601 — 235_AETNA POS 20140601: $57.82 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $33.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $6.53 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $6.53 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $33.10 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $29.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $29.99
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: FETAL HEMOGRAM	$113	$40.68	$1.99 – $50.85
Complete blood count (CBC), automated: 10 of 50 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $48.12 AETNA HMO — 4486_AETNA HMO 20250801: $35.26 AETNA POS 20140601 — 235_AETNA POS 20140601: $48.12 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $28.21 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $12.29 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $5.43 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $5.43 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $5.43 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $27.56 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $24.97
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: HEMOGRAM	$173	$62.28	$1.99 – $77.85
Complete blood count (CBC), automated: 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $48.12 AETNA HMO — 4486_AETNA HMO 20250801: $35.26 AETNA POS 20140601 — 235_AETNA POS 20140601: $48.12 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $28.21 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $5.43 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $5.43 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $5.43 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $27.56 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $24.97 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $24.97
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: HEMOGRAM	$173	$62.28	$1.99 – $77.85
Complete blood count (CBC), automated: 10 of 34 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $18.68 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $18.68 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $1.99 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $1.99 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $6.70 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $1.99 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $1.99 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $6.70 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $6.70 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $15.04
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME	$197	$70.92	$3.60 – $88.65
Blood clotting time test (prothrombin time, PT): 10 of 52 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $29.27 AETNA HMO — 4486_AETNA HMO 20250801: $23.38 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $10.39 AETNA POS 20140601 — 235_AETNA POS 20140601: $29.27 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $18.70 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $8.15 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $3.60 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $18.28
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTHROMBIN TIME (PT)	$197	$70.92	$3.60 – $88.65
Blood clotting time test (prothrombin time, PT): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $29.27 AETNA HMO — 4486_AETNA HMO 20250801: $23.38 AETNA POS 20140601 — 235_AETNA POS 20140601: $29.27 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $18.70 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $3.60 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $18.28 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $16.56 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $16.56
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PT 1:1 MIX STUDY	$197	$70.92	$3.60 – $88.65
Blood clotting time test (prothrombin time, PT): 10 of 49 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $29.27 AETNA HMO — 4486_AETNA HMO 20250801: $23.38 AETNA POS 20140601 — 235_AETNA POS 20140601: $29.27 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $18.70 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $3.60 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $3.60 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $18.28 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $16.56 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $16.56
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: FACTOR IX INHIBITOR PNL-85730	$114.50	$41.22	$5.05 – $51.52
Blood clotting test (partial thromboplastin time, PTT): 10 of 50 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $44.64 AETNA HMO — 4486_AETNA HMO 20250801: $32.75 AETNA POS 20140601 — 235_AETNA POS 20140601: $44.64 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $26.20 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $11.42 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $5.05 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $25.60 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $23.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: F-VIII INH COMPREHENSIVE-85730	$91.50	$32.94	$5.05 – $44.64
Blood clotting test (partial thromboplastin time, PTT): 10 of 50 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $44.64 AETNA HMO — 4486_AETNA HMO 20250801: $32.75 AETNA POS 20140601 — 235_AETNA POS 20140601: $44.64 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $26.20 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $11.42 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $5.05 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $25.60 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $23.20
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: FACTOR IX INHIBITOR-85730	$100	$36	$5.05 – $45
Blood clotting test (partial thromboplastin time, PTT): 10 of 50 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $44.64 AETNA HMO — 4486_AETNA HMO 20250801: $32.75 AETNA POS 20140601 — 235_AETNA POS 20140601: $44.64 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $26.20 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $11.42 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $5.05 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $5.05 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $25.60 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $23.20

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 WO CONT PEDI	$2,174.25	$782.73	$75.99 – $1,345
CT scan of the head or brain, without contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $706.77 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $118.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $452.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $411.33 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $411.33 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $501
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD WO CONT	$3,742.25	$1,347.21	$75.99 – $1,684.01
CT scan of the head or brain, without contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $706.77 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $118.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $452.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $411.33 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $411.33 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $501
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT HEAD WO CONT PEDI	$2,174.25	$782.73	$75.99 – $1,345
CT scan of the head or brain, without contrast: 10 of 40 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $507.38 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $747.81 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $507.38 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $109.60 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $109.60 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $109.60 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $109.60 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $109.60 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $109.60 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $109.60
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MR BRAIN WOW LTD PEDI	$5,725	$2,061	$274.01 – $3,084.62
MRI of the brain, before and after contrast: 10 of 48 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $2,558.97 AETNA HMO — 4486_AETNA HMO 20250801: $2,377.89 AETNA POS 20140601 — 235_AETNA POS 20140601: $2,558.97 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $404.76 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $332.80 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,542.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,401.39
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MR BRAIN WOW LTD	$4,498.75	$1,619.55	$274.01 – $3,084.62
MRI of the brain, before and after contrast: 10 of 48 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $2,558.97 AETNA HMO — 4486_AETNA HMO 20250801: $2,377.89 AETNA POS 20140601 — 235_AETNA POS 20140601: $2,558.97 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $404.76 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $332.80 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,542.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,401.39
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MR BRAIN WOW PEDI	$6,226.25	$2,241.45	$274.01 – $3,084.62
MRI of the brain, before and after contrast: 10 of 43 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $2,377.89 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $404.76 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $332.80 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $332.80 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,542.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,401.39 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,401.39 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,706.87
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: XR CXR PA/LAT PEDI	$372	$133.92	$20.12 – $323.23
Chest X-ray, 2 views: 10 of 45 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $181.40 AETNA HMO — 4486_AETNA HMO 20250801: $221.22 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $199.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $176.98 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $79.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $33.75 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $292.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $264.97
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: XR CXR DECUB BIL PEDI	$2,553.50	$919.26	$20.12 – $1,149.08
Chest X-ray, 2 views: 10 of 45 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $181.40 AETNA HMO — 4486_AETNA HMO 20250801: $221.22 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $199.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $176.98 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $79.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $33.75 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $292.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $264.97
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: XR CXR DECUB LT PEDI	$451.25	$162.45	$20.12 – $323.23
Chest X-ray, 2 views: 10 of 45 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $181.40 AETNA HMO — 4486_AETNA HMO 20250801: $221.22 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $199.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $176.98 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $79.81 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $33.75 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $33.75 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $292.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $264.97
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR SP COMP LUMB PEDI MIN 4 VWS	$618.50	$222.66	$34.08 – $453.92
X-ray of the lower spine, at least 4 views: 10 of 46 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $309.78 AETNA HMO — 4486_AETNA HMO 20250801: $367.56 AETNA POS 20140601 — 235_AETNA POS 20140601: $309.78 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $294.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $411.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $372.11 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $372.11
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR SP COMP LUMB 4+V	$782	$281.52	$34.08 – $453.92
X-ray of the lower spine, at least 4 views: 10 of 46 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $309.78 AETNA HMO — 4486_AETNA HMO 20250801: $367.56 AETNA POS 20140601 — 235_AETNA POS 20140601: $309.78 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $294.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $411.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $372.11 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $372.11
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR SP COMP LUMB MIN 4 VWS	$782	$281.52	$34.08 – $453.92
X-ray of the lower spine, at least 4 views: 10 of 46 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $309.78 AETNA HMO — 4486_AETNA HMO 20250801: $367.56 AETNA POS 20140601 — 235_AETNA POS 20140601: $309.78 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $294.05 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $51.45 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $51.45 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $411.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $372.11 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $372.11
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MR L SPN CANL WO PEDI	$3,452.75	$1,242.99	$156.11 – $1,969
MRI of the lower back (lumbar spine), without contrast: 10 of 43 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $1,365.21 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $247.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $199.14 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $199.14 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $199.14 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $941.48 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $855.26 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $855.26 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,041.69
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MR L SPN CANL WO	$3,178.75	$1,144.35	$156.11 – $1,969
MRI of the lower back (lumbar spine), without contrast: 10 of 43 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $1,365.21 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $247.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $199.14 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $199.14 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $199.14 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $941.48 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $855.26 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $855.26 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,041.69
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MR L SPN CANL WO PEDI	$3,452.75	$1,242.99	$156.11 – $1,969
MRI of the lower back (lumbar spine), without contrast: 10 of 40 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,741.75 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $1,548.81 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $1,741.75 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $212.84 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $212.84 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $211.18 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $211.18 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $212.84 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $211.18 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $211.18
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS LTD W PEDI	$2,654.75	$955.71	$173.75 – $1,701.09
CT scan of the pelvis, with contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $1,701.09 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $193.15 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $180.34 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $736.17 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $668.75 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $668.75 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $814.52
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W CONT PEDI	$2,654.75	$955.71	$173.75 – $1,701.09
CT scan of the pelvis, with contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $1,701.09 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $193.15 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $180.34 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $736.17 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $668.75 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $668.75 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $814.52
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS LTD W	$3,774	$1,358.64	$173.75 – $1,701.09
CT scan of the pelvis, with contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $1,701.09 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $193.15 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $180.34 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $180.34 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $736.17 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $668.75 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $668.75 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $814.52
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MR LW EXT WO J R LTD	$1,811.25	$652.05	$175.86 – $1,750
MRI of a leg joint (such as the knee), without contrast: 10 of 50 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,259.91 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,708.92 AETNA HMO — 4486_AETNA HMO 20250801: $1,536.48 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $1,382.83 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,708.92 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $247.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $210.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MR LW EXT WO J L LTD	$1,811.25	$652.05	$175.86 – $1,750
MRI of a leg joint (such as the knee), without contrast: 10 of 50 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,259.91 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,708.92 AETNA HMO — 4486_AETNA HMO 20250801: $1,536.48 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $1,382.83 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,708.92 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $247.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $210.84
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: LO EXTR,JNT,L,LTD PEDI	$3,349	$1,205.64	$175.86 – $1,975.92
MRI of a leg joint (such as the knee), without contrast: 10 of 48 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $1,708.92 AETNA HMO — 4486_AETNA HMO 20250801: $1,536.48 AETNA POS 20140601 — 235_AETNA POS 20140601: $1,708.92 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,969 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $247.02 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $210.84 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $210.84 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $941.48 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $855.26
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD/PEL W CONT	$7,293.75	$2,625.75	$228.53 – $3,282.19
CT scan of the abdomen and pelvis, with contrast: 10 of 41 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $2,374.56 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $404.76 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $318.09 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $318.09 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $318.09 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,542.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,401.39 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,401.39 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,706.87
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT ABD/PEL W CONT	$7,293.75	$2,625.75	$228.53 – $3,282.19
CT scan of the abdomen and pelvis, with contrast: 10 of 40 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,523.31 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $2,140.47 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $1,523.31 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $252.74 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $252.74 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $293.70 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $293.70 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $252.74 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $293.70 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $293.70
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	$605.66
CT scan of the abdomen and pelvis, with contrast: 10 of 47 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $2,140.47 AETNA HMO — 4486_AETNA HMO 20250801: $2,374.56 AETNA POS 20140601 — 235_AETNA POS 20140601: $2,140.47 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,345 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $404.76 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $318.09 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $318.09 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $318.09 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,542.67 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,401.39
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN CMPLT	$1,154.75	$415.71	$85.91 – $927.63
Ultrasound of the abdomen, complete: 10 of 47 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $927.63 AETNA HMO — 4486_AETNA HMO 20250801: $806.49 AETNA POS 20140601 — 235_AETNA POS 20140601: $927.63 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $645.19 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $112.08 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $411.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $372.11
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN CMPLT PEDI	$1,154.75	$415.71	$85.91 – $927.63
Ultrasound of the abdomen, complete: 10 of 47 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $927.63 AETNA HMO — 4486_AETNA HMO 20250801: $806.49 AETNA POS 20140601 — 235_AETNA POS 20140601: $927.63 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $645.19 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $112.08 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $411.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $372.11
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US ABDOMEN CMPLT	$1,154.75	$415.71	$85.91 – $927.63
Ultrasound of the abdomen, complete: 10 of 41 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $508.56 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $927.63 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $508.56 BCBS CHIP/CHIP PERINATE — 3594_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) INPATIENT 20240901: $114.46 BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $114.46 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $116.28 BCBS STAR — 3693_CHIRP BLUE CROSS STAR (CHI,DCN) INPATIENT 20240901: $116.28 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $114.46 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $116.28 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $116.28
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: OB US >/= 14 WKS SNGL FETUS	$793.50	$285.66	$91.54 – $717.05
Pregnancy ultrasound (after the first trimester): 10 of 47 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $891.63 AETNA HMO — 4486_AETNA HMO 20250801: $896.31 AETNA POS 20140601 — 235_AETNA POS 20140601: $891.63 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $717.05 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $91.54 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $335.95 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $303.91
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREG 2/3 TRIMST	$1,586.75	$571.23	$91.54 – $896.31
Pregnancy ultrasound (after the first trimester): 10 of 47 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $891.63 AETNA HMO — 4486_AETNA HMO 20250801: $896.31 AETNA POS 20140601 — 235_AETNA POS 20140601: $891.63 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $717.05 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $91.54 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $335.95 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $303.91
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREG 2/3 TRIMST PEDI	$793.50	$285.66	$91.54 – $717.05
Pregnancy ultrasound (after the first trimester): 10 of 43 insurance plan rates AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $717.05 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $91.54 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $335.95 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $303.91 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $303.91 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $370.74 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: EDUS NON-OB TRANSVAG	$738	$265.68	$88.30 – $706.39
Transvaginal ultrasound: 10 of 43 insurance plan rates AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $706.39 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $88.30 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.06 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $293.16 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $293.16 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $357.62 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US TRSVAG NONPREG	$738	$265.68	$88.30 – $706.39
Transvaginal ultrasound: 10 of 43 insurance plan rates AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $706.39 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $88.30 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.06 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $293.16 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $293.16 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $357.62 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: EDUS NON-OB TRNSVAG PEDI	$508.75	$183.15	$88.30 – $357.62
Transvaginal ultrasound: 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $88.30 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $106.88 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.06 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $293.16 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $293.16 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $357.62 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $106.88 BCBS STAR KIDS — 5015_BLUE CROSS STAR KIDS (SMV) OUTPATIENT 20241201: $106.88
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: DIAG MAM DIR DIGITAL - UNIL	$390.25	$140.49	$94.06 – $380.94
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $94.06 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $345.20 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $312.28 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $312.28 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $380.94 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $130.83 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $98.04 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $308.92 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $96.12 HUMANA HMO — 2668_HUMANA HMO 20230701: $159.44
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAG UNI LT	$408	$146.88	$94.06 – $380.94
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $94.06 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $345.20 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $312.28 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $312.28 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $380.94 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $130.83 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $98.04 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $308.92 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $96.12 HUMANA HMO — 2668_HUMANA HMO 20230701: $159.44
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: MAMMO DIAG UNI RT	$408	$146.88	$94.06 – $380.94
Diagnostic mammogram, one breast: 10 of 11 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $94.06 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $345.20 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $312.28 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $312.28 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $380.94 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $130.83 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $98.04 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $308.92 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $96.12 HUMANA HMO — 2668_HUMANA HMO 20230701: $159.44
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: DIAG MAM DIR DIGITAL - BILAT	$496.25	$178.65	$120.37 – $487.50
Diagnostic mammogram, both breasts: rates for 10 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $120.37 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $441.76 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $399.63 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $399.63 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $487.50 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $164.95 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $125.24 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $395.41 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $122.76 HUMANA HMO — 2668_HUMANA HMO 20230701: $203.94
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAG BILAT	$526.25	$189.45	$120.37 – $487.50
Diagnostic mammogram, both breasts: rates for 10 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $120.37 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $441.76 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $399.63 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $399.63 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $487.50 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $164.95 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $125.24 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $395.41 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $122.76 HUMANA HMO — 2668_HUMANA HMO 20230701: $203.94
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: DIAG MAM DIR DIGITAL - BILAT	$496.25	$178.65	$120.37 – $487.50
Diagnostic mammogram, both breasts: rates for 1 insurance plan CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $395.41
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCRN MAM DIR DIGITAL - BILAT	$677.50	$243.90	$44.79 – $615.93
Screening mammogram, both breasts: 10 of 11 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $99.47 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $365.05 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $330.24 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $330.24 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $402.85 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $133.14 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $103.55 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $326.69 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $101.52 HUMANA HMO — 2668_HUMANA HMO 20230701: $168.58
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: SCRN MAM DIR DIGITAL-UNILAT	$338.75	$121.95	$44.79 – $330.24
Screening mammogram, both breasts: rates for 10 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $99.47 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $365.05 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $330.24 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $330.24 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $133.14 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $103.55 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $326.69 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $101.52 HUMANA HMO — 2668_HUMANA HMO 20230701: $168.58 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $44.79
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCREENING BILAT	$375.50	$135.18	$44.79 – $365.05
Screening mammogram, both breasts: rates for 10 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $99.47 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $365.05 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $330.24 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $330.24 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $133.14 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $103.55 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $326.69 COMMUNITY HEALTH SERVICES — 2281_COMMUNITY HEALTH SERVICES Q32 20220901: $101.52 HUMANA HMO — 2668_HUMANA HMO 20230701: $168.58 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $44.79

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	$16.50 – $81.48
Electrocardiogram (ECG/EKG) with reading: 10 of 24 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $32.87 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $73.70 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $66.78 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $66.78 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $81.48 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $16.50 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $17.32 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $17.28 AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: 46% (a percentage in the contract, not a dollar amount) AETNA ACO HMO — 4495_AETNA ACO HMO (SMV) 20250801: 51% (a percentage in the contract, not a dollar amount)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: HRT-LHC (INC LV-NO CORS)	$10,282.75	$3,701.79	$610.21 – $9,289
Left heart catheterization (diagnostic): 10 of 20 insurance plan rates AETNA ACO PPO — 3438_AETNA ACO PPO 20240701: $4,832.89 AETNA ACO PPO/HMO - CHI — 4483_AETNA ACO PPO/HMO (CHI,DCN) 20250801: $7,197.93 AETNA HMO - CHI — 4481_AETNA HMO (CHI,DCN) 20250801: $8,740.34 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $9,289 AETNA MULTI-TIER WHOLE HEALTH SHA — 4484_AETNA MULTI-TIER WHOLE HEALTH SHA (CHI,DCN) 20250801: $7,917.72 AETNA PPO — 4460_AETNA PPO (EBD,SHL) 20250701: $8,431.85 AETNA PPO — 4488_AETNA PPO 20250801: $5,758.34 AETNA PPO - CHI — 4482_AETNA PPO (CHI,DCN) 20250801: $8,740.34 AETNA PPO EXCHANGE — 249_AETNA PPO EXCHANGE 20140101: $4,935.72 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $2,051.96
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	$610.21 – $14,841
Left heart catheterization (diagnostic): 10 of 35 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $12,169 AETNA ACO HMO — 4495_AETNA ACO HMO (SMV) 20250801: $5,244.20 AETNA ACO PPO — 3438_AETNA ACO PPO 20240701: $4,832.89 AETNA ACO PPO/HMO - CHI — 4483_AETNA ACO PPO/HMO (CHI,DCN) 20250801: $7,197.92 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $10,288 AETNA HMO — 4486_AETNA HMO 20250801: $14,841 AETNA HMO — 4492_AETNA HMO (SMV) 20250801: $6,375.31 AETNA HMO - CHI — 4481_AETNA HMO (CHI,DCN) 20250801: $8,740.34 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $9,289 AETNA MULTI-TIER WHOLE HEALTH SHA — 4484_AETNA MULTI-TIER WHOLE HEALTH SHA (CHI,DCN) 20250801: $7,917.72
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: LEFT HRT CATH W/VENTRCLGRPHY	Not listed in the file	Not listed in the file	$610.21 – $14,841
Left heart catheterization (diagnostic): rates for 1 insurance plan HUMANA EXCHANGE — 415_HUMANA EXCHANGE (CHI,DCN) 20160101: $3,531
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: EP EPS COMP W/O ATTEMPT IND	$15,678.75	$5,644.35	$4,538.98 – $14,559
Heart rhythm study (electrophysiology evaluation): rates for 8 insurance plans AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $14,456 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $12,432 AETNA POS 20140601 — 235_AETNA POS 20140601: $14,456 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $14,559 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $10,064.56 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $4,538.98 UHC — 4498_UNITED HEALTHCARE (AUS,NW,SW, BAS) 20250701: $11,719 UHC — 4500_UNITED HEALTHCARE (WIL,HAYS) 20250701: $11,718
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	$4,538.98 – $24,425.70
Heart rhythm study (electrophysiology evaluation): 10 of 18 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $15,968 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $14,456 AETNA HMO — 4486_AETNA HMO 20250801: $19,473 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $12,432 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $17,526 AETNA POS 20140601 — 235_AETNA POS 20140601: $14,456 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $14,559 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $10,064.56 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $22,071.41 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $20,011.41
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: HEART EPS-ABLATE AFIB	$27,530.50	$9,910.98	$1,126.05 – $23,909.27
Heart rhythm study with ablation for atrial fibrillation: 10 of 17 insurance plan rates AETNA HMO — 4486_AETNA HMO 20250801: $22,433 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $14,041 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $20,190 AETNA POS 20140601 — 235_AETNA POS 20140601: $16,328 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $16,770 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $14,713.39 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $21,048.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $19,617.86 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $19,617.86 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $23,909.27
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	$1,126.05 – $30,569
Heart rhythm study with ablation for atrial fibrillation: 10 of 24 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $18,394 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $16,328 AETNA HMO — 4486_AETNA HMO 20250801: $22,433 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $14,041 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $20,190 AETNA POS 20140601 — 235_AETNA POS 20140601: $16,328 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $16,770 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $14,713.39 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $21,048.33 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $19,617.86
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: POLYSOMNOGRAM PLUS 4	$4,245.25	$1,528.29	$524.25 – $2,504.70
Sleep study (overnight, in a sleep lab): 10 of 22 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,952.82 AETNA HMO — 4486_AETNA HMO 20250801: $2,377.34 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $2,165.08 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,952.82 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $856.61 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,878.53 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,703.20 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,703.20 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,078.90 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $602.98
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	$524.25 – $2,504.70
Sleep study (overnight, in a sleep lab): 10 of 24 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $1,952.82 AETNA HMO — 4486_AETNA HMO 20250801: $2,377.34 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $2,165.08 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $1,952.82 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $856.61 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,878.53 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,703.20 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,703.20 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,078.90 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $602.98

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: PT-EXERCISE/15MIN	$159	$57.24	$30.31 – $144.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $144.05 AETNA HMO — 4486_AETNA HMO 20250801: $137.33 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $66.13 AETNA POS 20140601 — 235_AETNA POS 20140601: $144.05 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $110.17 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $53.61 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $117.56 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $106.59 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $106.59 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $130.10
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: OT-THERAPEUTIC EX/15MIN	$175.75	$63.27	$30.31 – $144.05
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $144.05 AETNA HMO — 4486_AETNA HMO 20250801: $137.33 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $66.13 AETNA POS 20140601 — 235_AETNA POS 20140601: $144.05 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $110.17 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $53.61 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $117.56 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $106.59 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $106.59 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $130.10
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: EXERCISE PER 15	$82.50	$29.70	$30.31 – $72.27
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 14 insurance plan rates AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $144.05 AETNA HMO — 4486_AETNA HMO 20250801: $137.33 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $66.13 AETNA POS 20140601 — 235_AETNA POS 20140601: $144.05 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $110.17 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $53.61 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $117.56 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $106.59 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $106.59 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $130.10
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVALUATION LOW 2 30M	$286.25	$103.05	$83.55 – $180.42
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVALUATION LOW 3 45M	$286.25	$103.05	$83.55 – $180.42
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: PT EVALUATION LOW 1 15M	$286.25	$103.05	$83.55 – $180.42
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVALUATION MOD 4 60M	$334	$120.24	$83.55 – $324.34
Physical therapy evaluation (moderate complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVALUATION MOD 5 75M	$334	$120.24	$83.55 – $324.34
Physical therapy evaluation (moderate complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: PT EVALUATION MOD 1 15M	$334	$120.24	$83.55 – $324.34
Physical therapy evaluation (moderate complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVALUATION HIGH 5 75M	$381.50	$137.34	$83.55 – $370.64
Physical therapy evaluation (high complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVALUATION HIGH 6 90M	$381.50	$137.34	$83.55 – $370.64
Physical therapy evaluation (high complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: PT EVALUATION HIGH 1 15M	$381.50	$137.34	$83.55 – $370.64
Physical therapy evaluation (high complexity): rates for 9 insurance plans AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $165.10 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $370.64 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $147.90 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $324.34 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $294.07 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $294.07 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $358.93 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $86.08
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	$272.49
Psychotherapy, 30 minutes: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $62.59 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $63.43 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $272.49 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $67.29
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	$272.49
Psychotherapy, 45 minutes: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $83.55 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $84.54 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $272.49 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $120.81
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	$272.49
Psychotherapy, 60 minutes: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $125.47 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $127.13 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $272.49 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $120.81
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	$272.49
Family psychotherapy, without the patient: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $101.24 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $102.42 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $272.49 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $120.81
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	$272.49
Family psychotherapy, with the patient: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $105.19 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $106.76 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $272.49 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $120.81
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GRP PSYCHOTHERAPY PM IOP ADOL	$350.75	$126.27	$24.88 – $67.29
Group psychotherapy: rates for 3 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $24.88 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $25.09 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $67.29
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: GROUP PSYCHOTHERAPY	Not listed in the file	Not listed in the file	$156.87
Group psychotherapy: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $24.88 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $25.09 SENDERO IDEALCARE — 1571_SENDERO IDEALCARE OP 20200101: $156.87 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $67.29

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	$409.12 – $3,544.57
Removal of breast growth (open surgery): 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $2,181.28 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $963.66 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $963.66 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $963.66 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $963.66 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,120.44 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,908.37 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,908.37 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $3,544.57 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $963.66
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	$409.12 – $3,544.57
Removal of breast growth (open surgery): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$969.15 – $14,153
Total hip replacement: 10 of 12 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $8,568.51 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $12,257.73 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $11,424.68 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $11,424.68 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $13,923.83 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $1,347.10 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $1,384.22 HUMANA EXCHANGE — 387_HUMANA EXCHANGE 20160101: $6,640 HUMANA HMO — 2668_HUMANA HMO 20230701: $9,036 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
Total hip replacement CPT 27130 · Inpatient or outpatient In the file: TOTAL HIP ARTHROPLASTY	Not listed in the file	Not listed in the file	$969.15 – $14,153
Total hip replacement: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$969.15 – $14,153
Total knee replacement: 10 of 12 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $8,568.51 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $12,257.73 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $11,424.68 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $11,424.68 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $13,923.83 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $1,346.42 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $1,382.85 HUMANA EXCHANGE — 387_HUMANA EXCHANGE 20160101: $6,640 HUMANA HMO — 2668_HUMANA HMO 20230701: $9,036 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
Total knee replacement CPT 27447 · Inpatient or outpatient In the file: TOTAL KNEE ARTHROPLASTY	Not listed in the file	Not listed in the file	$969.15 – $14,153
Total knee replacement: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$175.13 – $1,549
Shoulder arthroscopy: shaving of shoulder bone: rates for 4 insurance plans CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $175.13 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $179.10 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $1,549
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	$175.13 – $1,549
Shoulder arthroscopy: shaving of shoulder bone: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$535.09 – $3,202.82
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,970.96 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1,088.27 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1,088.27 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1,088.27 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $1,088.27 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,819.57 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,627.95 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,627.95 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $3,202.82 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $1,088.27
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	$535.09 – $3,202.82
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$286.93 – $5,675.12
Removal of tonsils and adenoids (under age 12): 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $3,492.38 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1,954.22 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1,954.22 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1,954.22 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $1,954.22 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $4,996.05 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $4,656.51 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $4,656.51 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $5,675.12 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $1,954.22
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	$286.93 – $5,675.12
Removal of tonsils and adenoids (under age 12): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$1,590.03
Upper GI endoscopy (diagnostic): 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $565.86 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $334.95 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $809.50 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $754.48 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $754.48 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $919.53 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $334.95
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: EGD DIAGNOSTIC BRUSH WASH	Not listed in the file	Not listed in the file	$124.26 – $1,000
Upper GI endoscopy (diagnostic): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$1,590.03
Upper GI endoscopy with biopsy: 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $565.86 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $334.95 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $334.95 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $809.50 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $754.48 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $754.48 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $919.53 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $334.95
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: EGD BIOPSY SINGLE/MULTIPLE	Not listed in the file	Not listed in the file	$140.61 – $1,000
Upper GI endoscopy with biopsy: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$1,546.19
Colonoscopy (diagnostic): 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $549.99 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $328.50 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $328.50 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $328.50 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $328.50 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $786.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $733.32 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $733.32 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $893.74 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $328.50
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: DIAGNOSTIC COLONOSCOPY	Not listed in the file	Not listed in the file	$187.81 – $1,000
Colonoscopy (diagnostic): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$203.98 – $1,174.94
Colonoscopy with biopsy: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $723.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $429.26 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,034.35 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $964.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $964.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,174.94 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $429.26
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: COLONOSCOPY AND BIOPSY	Not listed in the file	Not listed in the file	$203.98 – $1,174.94
Colonoscopy with biopsy: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$258.93 – $1,174.94
Colonoscopy with removal of polyps (snare): 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $723.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $429.26 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,034.35 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $964.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $964.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,174.94 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $429.26
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: COLONOSCOPY W/LESION REMOVAL	Not listed in the file	Not listed in the file	$258.93 – $1,174.94
Colonoscopy with removal of polyps (snare): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$262.58 – $1,174.94
Ultrasound of the lower bowel by endoscope: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $723.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $429.26 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $429.26 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,034.35 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $964.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $964.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $1,174.94 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $429.26
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	$262.58 – $1,174.94
Ultrasound of the lower bowel by endoscope: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$655.46 – $19,004
Gallbladder removal by laparoscope: 10 of 57 insurance plan rates AETNA ACO HMO — 4489_AETNA ACO HMO 20250801: $5,421 AETNA CHOICE — 236_AETNA ELECT CHOICE 20140601: $4,582 AETNA HMO — 4486_AETNA HMO 20250801: $6,612 AETNA HMO EXCHANGE — 1377_AETNA HMO EXCHANGE 20200101: $4,138 AETNA MULTI-TIER WHOLE HEALTH SHA — 4490_AETNA MULTI-TIER WHOLE HEALTH SHA 20250801: $5,950 AETNA POS 20140601 — 235_AETNA POS 20140601: $7,708 AETNA SHA AISD — 4335_AETNA SHA AISD 20250101: $4,943 BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $3,480.27 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1,888.85 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1,888.85
Gallbladder removal by laparoscope CPT 47562 · Inpatient or outpatient In the file: LAPAROSCOPIC CHOLECYSTECTOMY	Not listed in the file	Not listed in the file	$655.46 – $19,004
Gallbladder removal by laparoscope: rates for 2 insurance plans HUMANA EXCHANGE — 415_HUMANA EXCHANGE (CHI,DCN) 20160101: $5,556 OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$517.65 – $3,637.93
Groin (inguinal) hernia repair, age 5 or older: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $2,238.72 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1,151.54 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1,151.54 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1,151.54 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $1,151.54 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $3,202.62 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,984.97 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,984.97 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $3,637.93 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $1,151.54
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	$517.65 – $3,637.93
Groin (inguinal) hernia repair, age 5 or older: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$131.65 – $2,072.71
Prostate biopsy: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,275.52 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $652.80 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $652.80 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $652.80 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $652.80 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,824.70 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,700.69 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,700.69 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,072.71 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $652.80
Prostate biopsy CPT 55700 · Inpatient or outpatient In the file: BIOPSY OF PROSTATE	Not listed in the file	Not listed in the file	$131.65 – $2,072.71
Prostate biopsy: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$969.15 – $9,843.34
Prostate removal by laparoscope (radical prostatectomy): rates for 8 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6,057.44 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $8,665.50 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $8,076.59 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $8,076.59 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $9,843.34 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $1,457.09 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $1,489.79 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
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	$969.15 – $9,843.34
Prostate removal by laparoscope (radical prostatectomy): rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$230.83 – $2,922.78
Hysteroscopy with biopsy of the uterus lining: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,798.63 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $1,063.52 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $1,063.52 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $1,063.52 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $1,063.52 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,573.04 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,398.18 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,398.18 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,922.78 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $1,063.52
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	$230.83 – $2,922.78
Hysteroscopy with biopsy of the uterus lining: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: PAIN EPIDRL INJ L/S W IMG	$1,767.50	$636.30	$99.21 – $969.15
Spinal injection, lower back (epidural), with imaging guidance: 10 of 33 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $450.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $262.86 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $643.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $600.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $600.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $731.31 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS STAR KIDS — 5015_BLUE CROSS STAR KIDS (SMV) OUTPATIENT 20241201: $262.86
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: PAIN EPIDRL INJ L/S W IMG	$1,767.50	$636.30	$99.21 – $969.15
Spinal injection, lower back (epidural), with imaging guidance: rates for 4 insurance plans BCBS CHIP/CHIP PERINATE — 3600_BLUE CROSS CHIP/STAR KIDS (SMV) INPATIENT 20240901: $193.54 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $193.54 BCBS STAR — 3699_CHIRP BLUE CROSS STAR (SMV) INPATIENT 20240901: $193.54 BCBS STAR — 4225_CHIRP BLUE CROSS STAR (SMV) OUTPATIENT 20241201: $193.54
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	$99.21 – $1,072.13
Spinal injection, lower back (epidural), with imaging guidance: 10 of 40 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $450.04 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $262.86 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $643.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $600.05 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $600.05 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $731.31 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $262.86 BCBS STAR KIDS — 5003_BLUE CROSS STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $262.86
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	$1,509.87
Nerve root injection, lower back, with imaging guidance: 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $584.68 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $340.77 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $340.77 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $340.77 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $340.77 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $836.41 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $779.57 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $779.57 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $950.10 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $340.77
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: NJX AA&/STRD TFRM EPI L/S 1	Not listed in the file	Not listed in the file	$111.31 – $1,000
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$422.46 – $2,011.64
Carpal tunnel release: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,237.93 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $659.94 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $659.94 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $659.94 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $659.94 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $1,770.93 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,650.58 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,650.58 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,011.64 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $659.94
Carpal tunnel release CPT 64721 · Inpatient or outpatient In the file: CARPAL TUNNEL SURGERY	Not listed in the file	Not listed in the file	$422.46 – $2,011.64
Carpal tunnel release: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$930.39
Laser treatment of clouding after cataract surgery: 10 of 42 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $364.99 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $208.33 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $208.33 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $208.33 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $208.33 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $522.14 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $486.65 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $486.65 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $593.11 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $208.33
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	$208.33 – $1,000
Laser treatment of clouding after cataract surgery: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$629.86 – $2,365.58
Cataract removal with lens implant: 10 of 41 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,455.74 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP (CHI,DCN) OUTPATIENT 20241201: $849.94 BCBS CHIP/CHIP PERINATE — 4168_BLUE CROSS CHIP/STAR KIDS (CHI,DCN) OUTPATIENT 20241201: $849.94 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP (SMV) OUTPATIENT 20241201: $849.94 BCBS CHIP/CHIP PERINATE — 4174_BLUE CROSS CHIP/STAR KIDS (SMV) OUTPATIENT 20241201: $849.94 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,082.52 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $1,940.99 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $1,940.99 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,365.58 BCBS STAR — 4219_CHIRP BLUE CROSS STAR (CHI,DCN) OUTPATIENT 20241201: $849.94
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	$629.86 – $2,365.58
Cataract removal with lens implant: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000

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	$969.15 – $2,548.07
Vaginal delivery, with care before and after: rates for 8 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,568.04 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,243.18 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,090.73 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,090.73 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,548.07 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $2,075.42 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $2,102.92 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
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	$969.15 – $2,548.07
Vaginal delivery, with care before and after: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$969.15 – $2,825.11
Cesarean delivery (C-section), with care before and after: rates for 8 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,738.53 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,487.06 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,318.04 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,318.04 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,825.11 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $2,297.98 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $2,327.15 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
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	$969.15 – $2,825.11
Cesarean delivery (C-section), with care before and after: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000
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	$969.15 – $2,673.73
Vaginal delivery after a previous C-section, with care before and after: rates for 8 insurance plans BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $1,645.37 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $2,353.80 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $2,193.83 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $2,193.83 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $2,673.73 CHAMPVA — 1135_CHAMPVA REST_TX 20180301: $2,175.99 CHAMPVA — 1136_CHAMPVA AUSTIN 20180301: $2,208 HUMANA HMO CUST — 206_HUMANA HMO CUSTOM 20140201: $969.15
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	$969.15 – $2,673.73
Vaginal delivery after a previous C-section, with care before and after: rates for 1 insurance plan OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $1,000

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	$4,937 – $112,179
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 24 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6,318 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $7,532 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $6,862 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $6,862 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $8,368 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $6,863 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $6,863 CSHCN CIDC — 4694_CSHCN CIDC IP (ADULT) 20251001: $6,150 HUMANA EXCHANGE — 387_HUMANA EXCHANGE 20160101: $61,511 HUMANA HMO — 2668_HUMANA HMO 20230701: $112,179
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient or outpatient 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	$4,937 – $112,179
Heart valve or major heart-chest surgery with heart catheterization, with major complications: rates for 6 insurance plans HUMANA EXCHANGE — 415_HUMANA EXCHANGE (CHI,DCN) 20160101: $57,489 MEDICARE OON — 4666_MEDICARE ADVANTAGE INPATIENT OON 20251001: $6,150 MEDICARE OON — 4667_MEDICARE ADVANTAGE OON (SMV) 20250811: $6,150 SUPERIOR CHIP/CHIP PERINATE — 3619_SUPERIOR CHIP INPATIENT 20240901: $37,800 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $56,632.91 TRICARE — 4696_TRICARE INPATIENT 20251001: $67,012.85
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	$4,701 – $13,993
Hip or knee replacement (major joint of the leg), without major complications: 10 of 24 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6,318 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $7,532 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $6,862 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $6,862 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $8,368 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $6,863 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $6,863 CSHCN CIDC — 4694_CSHCN CIDC IP (ADULT) 20251001: $6,150 HUMANA EXCHANGE — 387_HUMANA EXCHANGE 20160101: $5,030 HUMANA HMO — 2668_HUMANA HMO 20230701: $9,036
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient or outpatient 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	$4,701 – $13,993
Hip or knee replacement (major joint of the leg), without major complications: rates for 5 insurance plans HUMANA EXCHANGE — 415_HUMANA EXCHANGE (CHI,DCN) 20160101: $4,701 MEDICARE OON — 4666_MEDICARE ADVANTAGE INPATIENT OON 20251001: $6,150 MEDICARE OON — 4667_MEDICARE ADVANTAGE OON (SMV) 20250811: $6,150 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $12,180.64 TRICARE — 4696_TRICARE INPATIENT 20251001: $13,006.77
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	$4,701 – $15,398.85
Neck (cervical) spinal fusion, without complications: 10 of 24 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6,318 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $7,532 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $6,862 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $6,862 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $8,368 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $6,863 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $6,863 CSHCN CIDC — 4694_CSHCN CIDC IP (ADULT) 20251001: $6,150 HUMANA EXCHANGE — 387_HUMANA EXCHANGE 20160101: $5,030 HUMANA HMO — 2668_HUMANA HMO 20230701: $9,036
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient or outpatient In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$4,701 – $15,398.85
Neck (cervical) spinal fusion, without complications: rates for 5 insurance plans HUMANA EXCHANGE — 415_HUMANA EXCHANGE (CHI,DCN) 20160101: $4,701 MEDICARE OON — 4666_MEDICARE ADVANTAGE INPATIENT OON 20251001: $6,150 MEDICARE OON — 4667_MEDICARE ADVANTAGE OON (SMV) 20250811: $6,150 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $13,086.73 TRICARE — 4696_TRICARE INPATIENT 20251001: $15,398.85
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	$4,937 – $9,379
Uterus and ovary surgery (not for cancer), without complications: 10 of 13 insurance plan rates BCBS BAV EXCHANGE — 4127_BLUE CROSS BLUE SHIELD BAV EXCHANGE 20250101: $6,318 BCBS HMO ESSENTIALS — 4095_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101: $7,532 BCBS HPN — 4440_BLUE CROSS BLUE SHIELD HPN 20250501: $6,862 BCBS HPN — 4497_BLUE CROSS BLUE SHIELD HPN (DELL, WILLIAMSON,HAYS) 2025: $6,862 BCBS PPO — 4094_BLUE CROSS BLUE SHIELD PPO 20250101: $8,368 CIGNA HMO — 4475_CIGNA HMO (AUS,NW,SW,HAY) 20250701: $6,863 CIGNA HMO — 4476_CIGNA HMO (WIL,DEL) 20250701: $6,863 CSHCN CIDC — 4694_CSHCN CIDC IP (ADULT) 20251001: $6,150 OSCAR HEALTH EXCHANGE — 4511_OSCAR HEALTH PLAN 20251001: $9,379 SETON PERFORMANCE PLUS — 785_SETON PERFORMANCE EPO PPO (AUS,NW,SW,HAY) 20180101: $4,937
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient or outpatient In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$4,937 – $9,379
Uterus and ovary surgery (not for cancer), without complications: rates for 4 insurance plans MEDICARE OON — 4666_MEDICARE ADVANTAGE INPATIENT OON 20251001: $6,150 MEDICARE OON — 4667_MEDICARE ADVANTAGE OON (SMV) 20250811: $6,150 TRICARE — 1229_TRICARE CAH OUTPATIENT 20170101: $6,838.86 TRICARE — 4696_TRICARE INPATIENT 20251001: $7,992.45

Source: Ascension Seton Smithville’s standard charges file (healthcare.ascension.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on January 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

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

Hospital information

Hospital type	Critical Access Hospital
Address	1201 Hill Rd, Smithville, TX 78957
County	Bastrop County
State	Texas
Phone	(512) 237‑3214
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	Not rated by CMS
CMS Certification Number	671304
Name in Medicare records	ASCENSION SETON SMITHVILLE
Profile level	Medicare data + hospital website
Name on the hospital’s website	Ascension Seton Smithville Hospital
Official website	healthcare.ascension.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Ascension Seton Smithville Hospital — healthcare.ascension.org
Ascension Seton Smithville Emergency — healthcare.ascension.org